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AMERICAN JOURNAL OF HUMAN BIOLOGY 4:757-766 (1992)
Physical Growth and Age at Eruption of Deciduous and Permanent Teeth in Well-Nourished Indian Girls From Birth to 20 Years
B-ALVINDER KAUR AND RAGHBIR SINGH Department of Anthropology, Uniuersity ofUelhi, Delhi-110007, India
ABSTRACT The results of a cross-sectional anthropometric survey of 1,643 well-nourished girls, from birth to 20 years, from the city of Delhi (India) are reported. The standardized measurements of body weight, heightkrown-heel length, sitting heightkrown-rump lenglh, biacromial and bicristal diameters, head circumference, chest girth, upper arm girth, calf girth and skinfolds a t biceps, triceps, and subscapular regions were taken for each subject. Medians fall between the 10th and 25th percentiles of National Center for Health Statistics (NCHS) reference data for height and the 10th and 50th percentiles for weight. The mean height and weight of the present girls are above the national reference values given by Indian Council of Medical Research (ICMR). Means and standard deviations of the weightiheight ratio and body mass index (BMI) are also pre- sented. The heightlweight ratio increases continuously with age to 18 years. The mean values of the BMI, however, decrease to 6 years, rising afterward to adult- hood. Median ages of eruption of deciduous and permanent teeth are presented. The first deciduous tooth to emerge in present girls is mandibular I, at 7.6 months. The sequence of emergence based on ascending median ages is I,, I,, MI, C, and M, for both maxillary as well as mandibular deciduous teeth. The perma- nent set of dentition starts with the emergence of mandibular M, a t 5.75 years. Despite the rapid physical growth of American and British girls, the present girls are ahead in dental emergence and show earlier emergence of maxillary and mandibular permanent premolars, suggesting a genetic basis for the emergence of deciduous and permanent teeth. Partial correlation coefficients with age constant between height and the number of erupted deciduous and permanent teeth are positive and significant, reflecting an association, to some degree, with height and weight. o 1992 Wiley-Liss, Inc.
Although there have been a considerable number of studies on the physical growth of Indian children in the last few decades, most of these are confined to preschool children (Ghai and Sandhu, 1968; Banik et al., 1970, Manwani and Aggarwal, 1973; Bhalla et al., 1985). Relatively few describe the growth pattern from early infancy to maturity [In- dian Council of Medical Research (ICMR), 1972; Sharma, 1970; Hauspie et al., 19801. Data from a national study of Indian infants and children from birth to 21 years, con- ducted from 1956 to 1965 by the ICMR (1972), are widely accepted as standards of growth of Indian children. Raghvan et al. (1971) reported data on school children 5-16
years from 14 private schools in 6 states, while Hauspie et al. (1980) reported on the growth of a sample of middle class Bengali families followed from 1952 to 1966. The sample reported by Sharma (1970) was drawn from lower middle class Maharash- trian children surveyed between 1958 and 1960. Information on weight-for-height indi- ces, especially the body mass index (HMI) of well-nourished Indian children from birth to 20 years is also limited.
Received June 10,1991; accepted July 6,1992.
0 1992 Wrley-Liss, Inc.
TAB
LE 1.
Mea
ns a
nd s
tand
ard
devi
atio
ns o
f an
thro
ponz
etri
c di
men
sion
s ar
id w
eigh
t-fiw
-hri
ght i
ndic
es o
f to
ell
nour
ishe
d In
dian
gir
ls f
rom
bir
th t
o 2
0 ve
ar.7
Bia
crom
ial
Bic
rist
al
Hea
d B
ody
wei
ght
Sta
ture
S
itti
ng
diam
eter
di
amet
er
circ
umfe
renc
e C
hest
gir
th
(cm
l (c
m)
(cm
i Cc
mi
~~
~_
__
he
ight
_
__
_
(cm
) -~
( k
g)
__
~
n M
ean
SD
Mea
n SD
M
ean
SD
Mea
n SD
M
ean
SD
Mea
n SD
M
ean
SD
New
born
s 75
2.
8 0.
3 49
.4
1.7
30.0
1.
4 11
.2
0.7
82
0.
4 33
5
1.1
32
.0
1.5
3 m
onth
s+
6 m
onth
s +
9 m
onth
s+
I+
2t
3r
4+
5t
6+
7-
8
+
9+
10+
11
+ 12
+
13+
14
+
15 t
16 t
17+
18
+
19+
20
+
7 7.
4 0.
4 4
8.0
0.6
14
8.7
0.6
35
9.8
1.3
35
12.1
1.
7 60
14
.3
29
90
15
.8
1.8
90
16.1
2.
7
65.1
0.
7 42
.2
2.2
13.9
1.
4 11
.2
0.8
42.7
67
.2
1.7
43.7
1.
6 14
.5
0.7
11.3
0.
4 42
.9
72.0
2.
3 45
.4
1.2
15.5
0.
8 11
.6
0.8
44.2
77
.4
3.3
46.8
1.
7 16
.8
1.4
13.0
1.
0 45
.6
85.9
4.
5 50
.0
2.3
18.8
1.
4 14
.6
1.1
47
.1
94.6
5
.1
52.5
3.
1 20
.3
1.7
15.8
1.
3 47
.7
01.2
4.
3 55
.4
2.4
20.9
1.
5 16
.4
0.9
46.0
08
.1
4.5
58.0
2.
6 22
.5
1.3
16.6
1.
0 49
.3
75
90
80
80
90
100
100
105
103 80
60
60
85
65
60
19.5
22
.4
24.8
27
.5
32.2
37
.6
41.4
46
.1
47.1
49
.1
49.5
48
.4
50.4
49
8
51.2
3.0
113.
2 5.
7 60
.0
4.1
118.
5 5.
4 62
.4
4.7
126.
0 5.
8 65
.3
4.6
1300
6.
4 67
.2
6.7
137.
2 6.
9 71
.0
7.9
143.
6 7.
5 73
.7
8.3
149.
0 6.
6 76
.7
9.2
152.
5 5.
9 79
.3
6.6
153.
2 5.
1 79
.6
6.4
156.
0 5.
3 81
.3
8.0
155.
2 4.
5 80
.3
5.8
157.
0 5.
4 81
.7
5.7
155.
7 3.
6 81
.3
5.8
155.
7 4.
2 81
.4
6.4
155.
6 4.
4 81
.5
3.0
2.9
3.1
3.6
3.6
4.0
3.9
3.4
2.8
2.9
2.5
2.8
2.5
2.6
2.6
23.0
1.
7 17
.0
1.3
23.8
1.
7 18
.1
1.3
24.9
1.
7 19
.3
1.4
26.1
1.
6 20
.4
1.3
28.1
1.
9 21
.7
1.6
29.8
1.
5 23
.2
1.8
30.7
1.
9 24
.4
1.8
31.3
1.
7 25
.2
1.7
31.4
1.
7 25
.6
1.5
32.6
1.
6 26
.0
1.3
33.0
1.
3 26
.3
1.4
33.0
1.
6 26
.1
1.3
33.2
1.
2 26
.5
1.3
33.1
1.
2 26
.3
1.4
33.2
0.
9 26
.4
1.5
49.4
50
.0
49.9
50
.2
51.3
52.2
52
.9
52.6
53
.2
52.8
53
.1
53.2
53
.4
53.2
52.0
1.8
39.5
1.
0 2.
I 41
.2
1.5
1.1
43.5
0.
9 1.
4 45
.5
1.8
2.0
47.1
2.
2 2.
2 48
.9
3.7
1.4
49.9
2.
1 1.
6 51
.8
2.8
1.6
52.2
2.
7 1
.5
55.3
3.
8 1.
2 56
.8
4.7
1.4
59.7
4.
7 1.
7 63
.8
6.3
1.6
69.0
7.
0 1.
6 72
.6
7.9
1.6
77.0
7.
2 1.
2 77
.4
5.7
1.2
77.5
6.
4 1.
4 78
.5
6.2
1.1
78
.5
5.0
1.1
80
.1
4.7
1.3
79.2
5.
4 1.
2 80
.2
5.5
Age
(y
ears
)
New
born
s 3
mon
ths
t 6
mon
ths+
9
mon
ths+
I
t 21
3+
4+
5
+
ti+
7+
8
f 9
+
10+
11+
12+
13
+ 14
+
15 t
16 t
17+
18
+
19+
20
+
~~~
IJpp
er a
rm
girt
h (c
ml
Mea
n Sn
~~
Cal
f gi
rth
(cm
)
Bic
eps
skin
fold
(m
m 1
Mea
n SD
97
0.
8 12
.6
0.8
12.8
0.
6 13
.5
1.1
13.7
1.
2 14
.1
1.2
14.7
1.
8 14
.7
1.0
15.5
1.
5 15
.8
1.9
16.4
1.
8 17
.0
1.7
17.6
1.
8 18
.5
2.2
19.8
2.
5 20
.5
2.7
21.1
2.
5 21
.4
2.2
22.1
2.
5 21
.7
2.3
21.6
1.
7 22
.8
2.1
22.1
1.
7 22
.6
2.3
10.4
0.
8 15
.7
0.8
15.2
0.
8 15
.8
1.2
17.1
1.
4 18
.5
1.5
19.8
1.
9 20
.5
1.2
21.3
1.
7 21
.9
1.6
23.3
2.
1 24
.3
2.0
25.2
1.
9 26
.4
2.7
28.3
2.
7 29
.3
2.9
30.8
3.
1 31
.1
2.7
31.9
2.
3 31
.3
2.6
30.7
2.
4 31
.2
2.1
30.7
2.
5 31
.2
2.5
Mea
n SD
4.3
0.6
4.5
0.3
4.8
0.2
5.0
1.0
5.0
1.4
5.2
1.6
6.1
1.4
4.8
1 .o
4.
9 1.
4 4.
7 1.
2 5.
0 1.
4 5.
1 1.
4 5.
2 1.
7 5.
6 2.
2 6.
2 2.
3 6.
0 2.
4 5.
9 2.
1 6.
1 1.
8 6.
3 2.
2 6.
2 2.
4 6.
1 1.
7 7.
5 1.
9 6.
4 1.
7 6.
6 1.
6
~~
Tri
ceps
sk
info
ld
(mm
) M
ean
SD
52
0
6
70
1
7
-~
~ ~
-
7.7
1.3
7.3
1.8
7.7
1.5
8.1
1.6
8.6
2.4
8.6
2.1
8.9
2.1
9.5
1.9
10.5
2.
6 11
.8
2.6
11.9
3.
1 12
.7
3.9
13.2
3.
8 13
.3
3.6
12.5
3.
4 12
.8
3.0
13.1
3.
3 13
.9
3.6
14.1
2.
9 14
.5
3.2
14.6
3.
0 15
.2
3.5
Subs
capu
lar
skin
fold
(m
m)
Mea
n SD
4.7
0.5
6.6
0.9
6.0
0.4
6.4
1.2
5.7
1.4
5.6
1.5
5.9
2.1
5.7
1.7
5.7
1.7
5.4
1.2
6.2
2.6
6.7
2.7
7.0
2.8
8.1
3.7
9.7
4.0
10.2
4.
0 10
.9
4.6
11.6
3.
6 12
.0
4.0
11.6
4.
2 11
.2
3.0
13.2
4.
0 12
.7
3.2
12.7
4.
4
Wei
ghth
eigh
t ra
tio
(wei
ghth
eigh
t x 1
00)
Mea
n SD
5.7
0.5
11.4
0.
6 11
.9
0.4
12.1
0.
5 12
.7
1.4
14.1
1.
4 15
.1
2.5
15.6
1.
3 16
.7
2.0
17.2
2.
2 18
.8
2.9
19.6
3.
0 21
.1
2.7
23.4
4.
2 26
.1
4.5
27.7
4.
9 30
.2
5.6
30.7
4.
0 31
.5
4.2
31.9
4.
7 31
.8
3.2
32.6
3.
5 31
.9
3.3
32.9
4.
0
(kgk
m)
~
~~
~~~
__
Bod
v m
ass
inde
x
Mea
n SD
11.6
1.
0 17
.5
1.1
17
.7
0.5
16.8
0.
7 16
.4
1.8
16.4
1.
4 15
.9
2.2
15.4
1.
1 15
.4
1.6
15.2
1.
7 15
.7
2.1
15.5
2.
0 16
.3
1.9
17.0
2.
7 18
.1
2.6
18.6
3.
0 19
.8
3.6
20.1
2.
6 20
2
29
20
.5
2.8
19.6
2.
0 20
.8
2.2
20.5
2.
0 21
.2
2.6
760 0. KAUR AND R. SINGH
TABLE 2. Median ages and standard errors at enzergence of deciduous and permanent teeth in well-nourished
Indian girls
Deciduous Permanent Median age Median age
Tooth (months) SE (vears) SE
Maxilla 11 9.92 12 11.67 C 20.65 PM' - PM2 -
M' 15.83 MZ 29.20
1, 7.60 1, 13.95 C 20.62
Mandible
- - PM,
PM2 M, 15.85 M 7 27.66
0.14 6.61 0.05 0.11 7.76 0.13 0.13 10.66 0.11 - 9.68 0.10 - 10.40 0.15
0.15 5.92 0.09 0.17 11.95 0.13
0.13 ti25 0.07 0.18 7.38 0.09 0.15 9.52 0.06 - 9.72 0.15 - 10.36 0.12
0.16 5.75 0.08 0.11 11.70 0.13
The time of emergence of teeth in a population appears to be one of the few de- velopmental indices which is relatively un- affected by factors which delay the develop- ment of other characteristics (Tanner, 1962). Thus, studies pertaining to the age of eruption of deciduous and permanent denti- tion are very important since tooth emer- gence may be a valuable indicator of matu- rity status at certain ages. Few reports are available on the eruption of deciduous teeth in Indian children (Banerjee and Mukherjee, 1967; Mukherjee, 1973; Prakash, 1974; Reddy, 1981). Data on the permanent denti- tion are also limited (Shourie, 1946; Nanda and Chawla, 1966; Kaul et al., 1975; Tewari and Chawla, 1979; Kaul and Prakash, 1982; Reddy, 1985,1986; Banerjee et al., 1985).
It is evident that previous surveys of In- dian children are limited in scope and sam- pling. In addition, most of the surveys were carried out in the 1950s and 1960s, and may not be appropriate for the current assess- ment of the growth status of Indian chil- dren. Growth standards need periodic revi- sion not only to monitor progress in a population, but also to ensure that stan- dards are appropriate and up-to-date (Preece, 1989). The present survey, there- fore, was carried out with the object of pro- viding more recent and comprehensive data on the physical growth and dental develop- ment of well-nourished Indian girls from birth to 20 years of age.
TABLE ?a. Correlations among the number of deciduous teeth erupted, weight, and height
Age (years) Heighkweight Weight:teeth Height:teeth
&12 0.88** 0.66*" 0.65''
I + 0.56"* 0.37 0.57** 2+ 0.78"* 0.35 0.43**
months
"P <: 0 01. '"P I: 0 001
TABLE 36. Correlations among the number of permanent teeth erupted, weight, and helght
nge (years)
5+ 6 7 8 9
10 11 12 13 14
Height:weight,
0.74"" 0.68"" 0.68'* 0.74'' 0.68** 0.64'" 0.75** 0.60"" 0.41"" 0.51*"
Weight ;teeth
0.16 0.22 0.18 0.29* 0.26k 0.28" 0.20 0.38"" - -
Heightteeth
0.18 0.30" 0.25 0.28" 0.37"" 0.28** 0.34"' 0.39** - -
"P i 0 01 "*P < 0 001
TABLE 3c Age constant partial correlations between the number of deciduous and permanent teeth erupted and
height and weight
Weight teeth Height teeth ~~ ~ ~~
Deciduous teeth 0 11 0 29* Permanent teeth 0 24* 0 2A*
*P 0.01
MATERIAL AND METHODS The sample
A cross-sectional study of 1,643 appar- ently healthy, well-nourished girls from families of high socioeconomic status (SES) in the city of Delhi was conducted in 1987. The sample ranged from birth to 20 years, and accurate birth dates were available for all subjects. Age classes I+, 2+ . . . 20+ years, centered at 1.5, 2.5 . . . 20.5 were es- tablished.
The data were collected a t various public schools, colleges, day-care centers, and hos- pitals in Delhi. In selecting the sample, the institutions were divided into four geo- graphical areas (north, south, east, west) and two schools, two day-care centers and one college were chosen from each area.
PHYSICAL GROWTH OF INDIAN GIRLS 761
190, 190
'05
160
155
l E C
145
1 4 0
'f 135
$. l?il
: 120
2 130
115
1 1 0
in? 1zc
95
Y O
85
8 0
2 3 4 5 6 7 8 9 '0 11 12 ' 3 li 15 16 '7 18 age ryr :
Flg. 1 . Median heights and weights of well-nour- ished Indian girls plotted on NCHS smoothed centiles.
Children were selected using a systematic random sampling technique.
None of the subjects had any obvious med- ical problem or physical deformity, or had suffered from any illness during the 3 months prior to examination. Only residents of Delhi were included in the survey. Only full-term, apparently healthy newborns who were free from any birth defects and who weighed 2.5 kg or more were included in the study. All newborns were measured within 48 hr of birth. A replacement sample was selected in institutions t o substitute for chil- dren not meeting the requirements of the study.
Measurements Twelve standardized anthropometric di-
mensions were taken: body weight, heighti crown-heel length, sitting heightlcrown rump length, biacromial and bicristal diam- eters, head, chest, upper arm. and calf cir- cumferences, and skinfolds at the biceps, triceps, and subscapular sites. All measure- ments were made and recorded by one indi-
vidual (B.K.) throughout the study. Mea- surement reliability was established for measurements by test-retest method. The observer's range of error was tested by tak- ing the measurements twice on each subject and the difference between the two recorded values of a measurement was almost negli- gible. Technical error of measurements (S,,,,) for all body measurements were within permissible limits given for NCHS data (Johnston et al., 1972; Malina et al., 1973).
Standard techniques (Tanner et al., 19691 were used for the anthropometry. Body weight was measured to the nearest 0.05 kg using a lever actuated balance. Checking of the unloaded weighing scale at zero was done every day prior to measurement. For infants and children up to 3 years, crown- heel and crown-rump lengths were mea- sured using a locally prepared infantometer (Singh and Kaur, 1986). The techniques em- ployed for taking these measurements are described by Singh and Venkatachalam (1962). Height was measured with an an- thropometer on barefooted subjects. The an- thropometer was held perpendicular to the ground, and the measurement was recorded to the nearest 0.1 cm. Biacromial and bicris- tal diameters were measured to the nearest 0.1 cm, using the first segment of the an- thropometer. All body circumferences were taken with a flexible steel tape. Skinfolds were measured to the nearest 0.2 mm using a Holtain caliper.
Each subject was also examined for gingi- val eruption of the teeth. A tooth was consid- ered emerged if any part of the crown had pierced the gum. Only the right side of the dentition was used, since no significant dif- ference was found between left and right dentition. The median ages a t eruption of various teeth were computed by probit anal- ysis (Finney, 1951). All the statistical analy- ses were done at Delhi University Computer Centre using SPSSPC Package.
RESULTS Sample sizes, means, and standard devia-
tion for the anthropometric dimensions and indices are presented in Table 1. Body weight increases with age, with the maxi- mum increase occurring during the first year of life. A steady increase is observed to 8 years, becoming faster to 13 years, after which it slows. Mean height and sitting height also increase with age. A regular in-
762 B. KAUR AND R. SINGH
Fig. 2. Mean heights (cm) of the present sample of Indian girls compared with the ICMR high socioeconomic girls and all India pooled sample of girls (ICMR, 1972).
-Preseit Study - l iMR (Ai l India Fccled! 1972 -lCMR Wel l -3 f f Gir Is
1 ~ 1 0 5 s I j 1972
LO ~
Cr 1 - - : 3 0 -
m m
3 x 2 0 - D 0 m
p , # I , , , 1 1 - p , 0 0-12 1 2 3 L 5 6 7 8 9 10 1' 12 13 14 15 16 17 18 i9 20
A g e ( yr ) mo
Fig. 3. Mean weights (kg) of the present sample of Indian girls compared with the ICMR high socioeco- nomic girls and all India pooled sample of girls (ICMR, 1972).
crease in height is observed to 12 years, then becomes slow and does not increase after 18 years. Variation in height and weight also increases with age.
Biacromial and bicristal diameters in- crease regularly through 13 years. Head and chest circumferences also increase with age, with the maximum increase occurring in the first year. Head and chest circumferences are almost equal at about 1.5 years, after which chest overtakes head circumference. A regular increase in upper arm and calf girths continues through 15 years, after which there is a slight decrease in measure- ments.
The triceps skinfold shows yearly in- creases to 12 years with a slight decline at 13 and 14 years, and then a regular increase thereafter. The subscapular skinfold exhib- its a similar pattern although values are lower than at the triceps site.
The weightheight ratio increases through 13 years and thereafter increases more slowly. The BMI decreases from 1 until ap- proximately 6 years, and increases there- after.
Median ages of eruption of the deciduous and permanent dentition are presented in Table 2. Eruption of the deciduous teeth starts with mandibular I, a t 7.6 months, fol-
PHYSICAL GROWTH OF INDIAN GIRLS 763
TABLE 4. Emergence ages (months) of deciduous teeth in females of different ethnic orzgin
Indian Indian London Japanese Australian Indonesian (present (Fkddy, US. White (Isighton, (OGwara, Korean (Roche et al., New Guinean tHolman and
Teeth stndy) 1981) (Nanda, 1960) 1968) 1968) (Yun, 1957) 1964) (Malcolm, 1970) Jones, 1991)
Maxillary I' 9.9 10.5 9.1 9.2 10.9 10.0 10.1 11.5 11.3 I' 11.7 123 12.0 10.6 12.6 11.9 12.0 13.0 13.0 c 20.7 16.0 21.7 18.2 17.9 16.7 19.9 18.8 20.6 M' 15.8 13.5 17.0 14.7 17.3 16.1 15.6 15.1 17.7 M2 29.2 26.5 31.3 26.3 28.6 23.2 29.0 22.4 28.6
Mandibular 11 7.6 10.5 7.5 7.3 9.4 8.3 6.7 8.6 10.3 12 13.9 13.3 14.0 11 5 13.8 12.3 13.6 14.0 16.4 C 20.6 18.0 20.8 18.3 19.7 17.0 20.4 19.1 22.2 Mi 15.9 16.3 16.6 I4 8 17.9 16.3 16.3 15.7 18.9 M2 27.7 26.5 29.8 25.7 27.2 23.1 27.7 23.5 28.3
TABLE 5. Emergence ages (years) ofpermanent teeth in females of different ethnic origgsn
Kenyan India American Bntish Asian Gambian Japanese New Guinea
India (Kaul (Knott and (Clements (Hassanali (Billewicz (Eveleth and Chinese (Malcolm (present et. al., Meredith, et al., and Odhimho, and McGreyor, Freitas, h e et al.. and Bue,
Teeth sludy) 1975) 1966) 1953h) 1981) 19751 1969) 1965h) 1970) ~~ ~~ -~ ~~ -~ ~
iMaxillary I' 72 c PM' PM2 MI MJ
11 12 C
Mandihullar
6.8 6.9 6.9 6.6 7.8 8.1 7.9 7.8
10.7 10 5 10.8 10.7 9.9 10.2 10.3 9.8
10.4 11.2 11.1 11.1 5.9 6 0 6.2 5.9
11.9 11.2 11.9 11.5
6.3 6.5 6.0 5.8 7.4 7.6 7.1 7.0 9 5 9 8 9 8 9 4
6.9 8.0
10.6 9.7
10.7 6.3
11 5
6.3 7.2 9.7
7.1 6.7 7.2 8.1 8.1 8.3
10.5 10.3 10.4 9.8 9.1 9.5
10.6 10.3 10.4 5.8 6.1 6.2
11.2 11.8 12.0
6.1 ti. 1 6.1 7.1 6.Y 7.2 9.7 9 1 Y.6
6.6 7.5 9.4 9.7
10.3 5.7
10.7
6.3 6.9 9 1
PMi 9.7 10.5 10.1 10.5 9.8 9.9 9.9 9 8 9.8 PMz 10.4 11.2 11.0 11.6 10.7 10.7 10.9 10.7 10.4 MI 5.7 5.6 6.0 5.8 6.1 5.5 5.9 5 0 5.6 Mi 11.7 10.7 11.2 11.2 11.1 10.9 11.3 11.3 10.6
lowed by maxillary I1 at 9.9 months. The sequence of emergence is I,, I,, M,, C, and Mz for both maxillary and mandibular teeth. The emergence of the deciduous teeth is complete by the age of about 2.5 years.
The sequence of emer ence of the perma-
M2, in the maxilla. In the mandible, canines precede PM, and the sequence becomes M,, I,? I,, C, PM,, PM,, and M2. The permanent mandibular first molars erupt earlier than maxillary first permanent molars.
The emergence of the permanent teeth is divisible into two active periods separated by an interval of relative inactivity. The first period pertains to the emergence of first mo- lars and the central and lateral incisors; the second period pertains to the emergence of the canines, first and second premolars, and second molars. The interval between the two active periods is approximately 1.8 years.
Age-specific correlations ( r ) between the number of teeth emerged (deciduous as well
nent dentition is MI, I,, I % , PM', C, PM2, and
as permanent) and height and weight are summarized in Tables 3a and 3b. Correla- tions between the number of emerged decid- uous teeth at a given age and height, range from 0.43 to 0.65 (P < 0.001). Correlations between the number of permanent teeth emerged at a given age and height are also positive and significant for most age groups except at 5 and 7 years (Table 3b).
Partial correlations with age constant are positive and significant between height and number of deciduous as well as permanent teeth emerged (Table 3c). However, the body weight shows no significant correlation with dentition.
DISCUSSION Compared to the 50th percentiles of
height and weight of US. reference data (Hamill et al., 1979), girls from India are shorter and lighter at all ages. The median values of height of Indian girls nearly ap- proximate the 25th percentiles to 12 years
764 €3. KAUR AND R. SINGH
and then fluctuate between the loth and 25th percentiles of the reference data (Fig. 1). Growth in height appears to slow down in Indian girls after 12 years and gains are smaller than American girls. As a result, American girls are taller by approximately 7-8 cm than their Indian peers at 17-18 years.
Median weights of Indian girls fluctuate between 25th and 50th percentiles of the ref- erence data to 13 years; subsequently, val- ues approach the 25th percentiles and fall below this percentile a t 16 years (Fig. 1). Thus, the average Indian girl at 17-18 years are lighter by 6-7 kg than American girls.
Differences between populations in body size may be due to differences in gene pools or environments. It has been suggested that prior to adolescence, differences result largely from the operation of environmental factors but during adolescence, population genetic differences become more important (Johnston et al., 1976). However, the genetic potential €or growth in a population can be realized only in the most favorable living conditions. The present sample came from high SES conditions, received better than average care, and enjoyed favorable circum- stances; yet, they are shorter and lighter than American girls. The smaller body size of well-nourished Indian girls thus seems attributable to genetic variation.
Compared to Indian national standards (All India pooled sample as well as Class-I sample from high SES) given by the Indian Council of Medical Research (19721, which were based on a nationwide survey between 1956 and 1965, the present sample shows significantly higher mean values for height and weight in all age groups (Figs. 2 and 3). These observations suggest a secular trend, and this positive trend may be attributed to the better diet and living conditions enjoyed by the girls in the present study. However, mean heights in the present study are some- what lower than those reported for well-off girls from Hyderabad from 14, high fee resi- dential public schools throughout India (Raghvan et al., 1971). The children in Raghvan's study apparently represent a highly select and more affluent group.
Muscle mass is an indirect indicator of protein reserve, and measurements of limb circumferences are often used to assess the nutritional status of children (Jelliffe and Jelliffe, 1969). Further, increased subcuta- neous fat, resulting from either high calorie intake or less energy expenditure, reflects a
greater calories reserve (Frisancho, 1974; Malina et al.. 1974). Reference values for these measurements for nutritional status have not previously been available for In- dian children.
The BMI is an important index of obesity (CronkandRoche, 1982; Florey, 1970; Gould- bourt and Medialie, 1974). It is widely used in epidemiological studies and is applicable to children as well as adults (Rolland-Cach- era et al., 1982; Singh, 1992). Since there are no reported values of this index for Indian children, the values from the present study may serve as provisional reference data.
Although there are differences in body size between American (Hamill et al., 1979) and British girls (Tanner et al., 1966) and Indian girls, the well-off Delhi girls of the present study compare favorably to Ameri- can and British girls in dental emergence. Variation in emergence times of deciduous teeth is determined almost entirely by ge- netic factors (Hatton, 1955; Garn et al., 1965; Doering and Allen, 1942) and is rela- tively unaffected by environmental determi- nants of slow growth (Malcolm, 1973).
Most studies show no differences between populations in the emergence time of decid- uous (Bailey, 1964; Friedlander and Bailit, 1969) compared t o permanent teeth. The timing of emergence of deciduous teeth for Indian females is more or less similar to val- ues reported for Australian females (Roche et al., 1964), but somewhat earlier than those of American (Nanda, 1960) and later than British children (Leighton, 1968) (Ta- ble 4). The emergence times of the perma- nent teeth, however, vary among popula- tions (Table 5). There is considerable variation in the order in which the teeth emerge and the sequence of emergence. Based on ascending median ages, the order of emergence in the present sample is M1, I', I,, PM', C, PM', and M2 for maxillary teeth and M,, I,, I,, C, PM,, PM,, and M, for man- dibular teeth. The most frequent order for British females (Clements et al., 1953) is maxillary M1, I,, I', PM', C, PM', M' and mandibular I,, I,, M,. C, PM,, M,, PM,. For U.S. females (Knott and Meredith, 1966), the order of emergence is maxillary M' , I' , 12, PM1, C, PM2, M2 and mandibular I,, M,, I,, C, PM,, PM,, M,.
Compared with other populations (Table 5), ages of emergence for the permanent teeth of Indian girls are more or less similar to ages reported for Kenyan Asian females (Hassanali and Odhiambo, 1981), American
PHYSICAL GROWTH OF INDIAN GIRLS 765
females (Knott and Meredith, 1966) and British females (Clements et al, 1953). How- ever, the sample shows earlier emergence of maxillary and mandibular permanent pre- molars compared t o American and British girls.
The population differences in emergence times and sequence are reportedly associ- ated with various factors, including socio- economic differences (Lee et al., 1965; Kaul et al., 1975), nutritional and prenatal condi- tions (Friedlander and Bailit, 1969) and other environmental factors (Eveleth, 1966). Hassanali and Odhiambo (1981), however, noted that environmental factors have a rel- atively unimportant influence on emergence of teeth. In the present study, the effects of socioeconomic and nutritional factors are minimal since the sample belongs to chil- dren drawn from higher SES and presum- ably enjoyed optimum environmental condi- tions. The differences in timing and sequence may be attributed to genetic fac- tors, and the results of the present study thus agree with the consensus that genetics is the main determinant in tooth emergence (Garn, 1962; Friedlander and Bailit, 1969).
The association of dental development and physical maturation has also been re- ported (Billewicz et al., 1973; Lewis and Garn, 1960; Garn et al., 1965; Malcolm, 1970; Malcolm and Bue, 1970; McGregor et al., 1968; Valsik, 1972; Rao et al., 1973). These studies show a positive but low corre- lation between growth status and dental de- velopment, which is consistent with the findings of this study. This suggests that the timing of dental emergence and physical growth are under different, but somewhat related, control.
ACKNOWLEDGMENTS Financial support by the Indian Council of
Medical Research is greatly acknowledged. The authors also express their sincere thanks to the principals and heads of all the institutions from which the data were col- lected and to all the subjects who partici- pated in the study for their cooperation.
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