Emeritus Professor John Boulton

OBJECTIVE: To determine the degree of tracking of adiposity from childhood to early adulthood, and the risk of overweight in early adulthood associated with overweight in childhood and parental weight status in a cohort of children born in the mid-1970s. DESIGN: Longitudinal observational study. SUBJECTS: Approximately 155 healthy boys and girls born in Adelaide, South Australia, 1975-1976 and their parents. MEASUREMENTS: Height and weight of subjects at 2y, annually from 4 to 8y, biennially from 11 to 15y and at 20y, and of parents when subjects were aged 8y. Body mass index (BMI) of subjects converted to standard deviation scores and prevalence of overweight and obesity determined using worldwide definitions. Parents classified as overweight if BMI = 25 kg/m2. Tracking estimated as Pearson's correlation coefficient. Risk ratio used to describe the association between weight status at each age and parental weight status and weight status at 20y and weight status at each earlier age, both unadjusted and adjusted for parental weight status. RESULTS: The prevalence of overweight/obesity increased with age and was higher than that reported in international reference populations. Tracking of BMI was established from 6y onwards to 20y at r-values >0.6, suggesting that BMI from 6y is a good indicator of later BMI. Tracking was stronger for shorter intervals and for those subjects with both parents overweight compared with those with only one or neither parent overweight. Weight status at an earlier age was a more important predictor of weight status at 20y than parental weight status, and risk of overweight at 20y increased further with increasing weight status of parents. CONCLUSION: Strategies for prevention of overweight and targeted interventions for prevention of the progression of overweight to obesity are urgently required in school-aged children in order to stem the epidemic of overweight in the adult population.

Objective: To review the prevalence of overweight and obesity in Australian children and adolescents in two national samples, 10 years apart, using the new standard international definitions of the International Obesity Task Force Childhood Obesity Working Group. Design: Body mass index (BMI) cut-off points defining overweight and obesity were applied to the individual BMI values in the two cross-sectional samples. Setting: Australian community. Participants: 8492 schoolchildren aged 7-15 years (Australian Health and Fitness Survey, 1985) and 2962 children aged 2-18 years (National Nutrition Survey, 1995). Main outcome measure: Prevalence of overweight and obesity. Results: In the 1985 sample, 9.3% of boys and 10.6% of girls were overweight and a further 1.4% of boys and 1.2% of girls were obese. In the 1995 sample, overall 15.0% of boys (varied with age from 10.4% to 20.0%) and 15.8% of girls (varied with age from 14.5% to 17.2%) were overweight, and a further 4.5% of boys (2.4%-6.8%) and 5.3% of girls (4.2%-6.3%) were obese. The prevalence of overweight and obesity in the 1995 sample peaked at 12-15 years in boys and 7-11 years in girls. In schoolchildren aged 7-15 years, the rates represents a relative risk of overweight in 1995 compared with 1985 of 1.79 (95% CI, 1.59-2.00) and of obesity of 3.28 (95% CI, 2.51-4.29). Compared with previous estimates from these samples, the revised prevalence data are slightly higher for the 1985 data and considerably higher for the 1995 data. Conclusion: The secular trend of increasing overweight and obesity in the decade from 1985 and the high prevalence rates in Australian children and adolescents are a major public health concern.

BACKGROUND: Studies examining the foetal origins hypothesis suggest that small birth size may be a marker of foetal adaptations that programme future propensity to adult disease. We explore the hypothesis that birth size may relate to fat distribution in childhood and that fat distribution may be a link between birth size and adult disease. OBJECTIVE: To investigate the relationship between birth size and abdominal fat, blood pressure, lipids, insulin and insulin:glucose ratio in prepubertal children. DESIGN: Cross-sectional study, based on a birth cohort of consecutive full-term births. SUBJECTS: Two hundred and fifty-five (137 females) healthy, 7- and 8-y-old children. MEASUREMENTS: Body composition and abdominal fat was measured by dual energy X-ray absorptiometry. Lipid, glucose and insulin profiles were measured after an overnight fast and an automated BP monitor was used for blood pressure measurements. RESULTS: There was a negative association between abdominal fat and birth weight s.d. score across a range of normal birth weights (ß = -0.18; 95% Cl = -0.31 to -0.04, P = 0.009) and a positive association with weight s.d. score at 7/8y (ß = 0.35; 95% Cl = 0.24 to 0.46, P < 0.001). Children who were born with the lowest weight s.d. score and had the greatest weight s.d. score at 7/8y had significantly more (P < 0.001) abdominal fat, as a percentage of total fat (6.53 ± 1.3%) than those who had the highest birth weight s.d. score and the lowest weight s.d. score at 7/8y (4.14 ± 0.5%). Similar results were seen if head circumference, but not ponderal index, was used as an indicator of birth size. Increased abdominal fat was associated with higher total cholesterol:HDL cholesterol, higher triglyceride concentration and increased diastolic blood pressure. CONCLUSIONS: Birth weight independently predicted abdominal fat. Children with the highest amount of abdominal fat were those who tended to be born lighter and gained weight centiles. Increased abdominal fat was associated with precursor risk factors for ischaemic heart disease.

Objective: To investigate the relationship between food energy and macronutrient intake and body fatness assessed up to seven times between 2 and 15 y of age. Design: Prospective, observational study. Generalised linear estimating equations were used to evaluate the longitudinal relationship between body fatness and macronutrient intake. Regression analysis was used to assess whether body fatness at a particular age was predicted by intake at any of the previos ages. Setting: Community-based project in Adelaide, South Australia. Subjects: In all 143-243 subjects from a representative birth cohort of healthy children recruited in 1975 and followed over 15 y. Main outcome measures: The dependent variables were body mass index (BMI), triceps (TC) and subscapular (SS) skinfolds, expressed as standard deviation (s.d.) scores at each age. The predictor variables were energy-adjusted macronutrient intake and total energy intake, estimated from a 3-4 day diet diary, the previous corresponding measure of body fatness, sex and parental BMI, TC or SS. Results: Across 2-15 y energy-adjusted fat and carbohydrate intakes were respectively directly and inversely related to SS skinfold measures but not to either BMI or TC skinfold. The best predictor of fatness was previous adiposity, with the effect strengthening as the age interval shortened. Parental BMI, maternal SS and paternal TC contributed to the variance of the corresponding measure in children at some but not all ages.

The influences on bone growth of familial factors, nutrition and physical activity are described in a cohort of 108 children (56M, 52F). Distal forearm bone width, mineral content and volumetric density, anthropometry, pubertal status, nutritional intake and physical activity were measured at ages 11, 13, 15 and 17 y. Parental forearm bone status was also determined. Both mothers' and fathers' bone variables were significant predictors of the respective children's bone variables, but heritability estimates were greater between mothers and their children than between fathers and their children. By age 17 y boys had attained 101%, 85% and 89% of their fathers' height, bone mineral content and volumetric density, respectively; girls had attained 103%, 95% and 98% of their mothers' height, bone mineral content and volumetric density, respectively. There were no consistent associations among nutrient variables and bone status or rate of change in bone status. However, there was a significantly greater increase in bone mineral content and density from 11-17 y in those girls with consistently high calcium intake. There were no significant correlations between physical activity and bone values or rate of change of bone values. Age, gender, pubertal status, height, weight and parental bone values accounted for 80%, 71% and 49% of the variance of bone mineral content, bone width and volumetric density, respectively and 52%, 55% and 58% respectively of the variance of change in these variables. After age, gender, sexual maturity and body size, heritability accounts for the greatest variance in bone values through adolescence.

The tempo and change in bone growth during puberty in relation to physical growth is described in a cohort of 56 boys and 52 girls. Distal forearm bone width, mineral content and volumetric density, anthropometry and pubertal status were measured at ages 11, 13, 15 and 17 y, and bone age at 17 y. Bone width and mineral content increased independently with age for each pubertal stage. Volumetric density fell during early puberty and then increased rapidly. Maximal increase of all bone variables occurred earlier in girls than in boys and earliest for bone width, then mineral content, then density. In girls most change occurred in the 12 mo before and after menarche. The degree of tracking was similar to that for height. Bone growth followed physical growth but at a slower tempo. By age 17 y boys had attained 86% of the reference adult bone mineral content and volumetric density; girls had attained 93% of the reference adult bone mineral content and 94% of volumetric density. Those skeletally mature at 17 y had greater mineral content and volumetric density. To maximize peak bone mass, modifiable environmental factors should be optimized before the onset of puberty and be maintained throughout this period of rapid growth and beyond attainment of sexual maturity.

Objective - To examine relationships between blood pressure during childhood and both placental weight and body size at birth, in an Australian population. Design - A follow up study of a birth cohort, undertaken when cohort members were aged 8 years. Setting - Adelaide, South Australia. Subjects - 830 children born in the Queen Victoria Hospital in Adelaide, South Australia, during 1975-6. Main outcome measures - Systolic and diastolic blood pressure measured when the children were aged g years. Results - Blood pressure at 8 years was positively related to placental weight and inversely related to birth weight, after adjusting for the child's current weight. For diastolic pressure there was a decrease of 1.0 mm Hg for each 1 kg increase in birth weight (95% confidence interval (CI) = -0.4 to 2.4) and an increase of 0.7 mm Hg for each 100 g increase in placental weight (95% CI = 0.1 to 1.3). Diastolic pressure was also inversely related to chest circumference at birth, independently of placental weight, with a decrease of 0.3 mm Hg for each 1 cm increase in chest circumference (95% CI = 0.2 to 0.5). Conclusions - These findings are further evidence that birth characteristics, indicative of fetal growth patterns, are related to blood pressure in later life.

We describe the pattern of change for serum lipids and apolipoproteins from 1 to 15 years of age in a cohort of 128 children, supplemented with 215 children from 11 years of age and 243 at 13 years of age. Total cholesterol (TC) decreased after infancy, increased in early puberty and then decreased to 15 years of age. Reciprocal changes in high (HDLC) and low (LDLC) density lipoprotein cholesterol occurred during each interval, with HDLC increasing from 13 to 15 years in both sexes. The correlation for TC between children of both sexes and mothers and fathers varied from 0.1 to 0.28 at 2-13 years. At 15 years of age the correlation between mothers: daughters increased to 0.31, decreased to 0.19 for fathers: daughters, but no asssociation was present between either parent and their sons. There were no differences in mean lipid values for the sample grouped according to the extent of family history of early ischaemic heart disease (before 60 years of age). There were few significant associations between serum lipids, energy and nutrients. At 15 years of age inverse associations were present between TC and energy, protein, sugar, starch and fibre intakes, and a positive association with total fat intake.Adolescence, apolipoproteins, cholesterol, diet, heredity, ischaemic heart disease, lipoprotein (a), lipoproteins, puberty Copyright © 1995, Wiley Blackwell. All rights reserved

We report the results of food energy and nutrient intake, and somatic growth measured at intervals throughout infancy to 8 years of age in children from the Adelaide nutrition study cohort. At each age the sample was divided into three groups according to the percentage energy as fat: < 30%, 30¿34.9% and > 34.9%. There were no clinically significant differences in height, weight or skinfold thickness according to the proportions of fat in the diet, although the high fat intake group had a higher food energy intake at 2,4 and 8 years of age. The low fat group had a greater proportion of energy as sugar at 4,6 and 8 years of age, and as starch at 4 and 6 years. At some ages there were differences in calcium, iron, thiamine and vitamin C intakes. There were minor differences in nutrient intake in children at 8 and 15 years of age according to their fat intake at 1 and 2 years. Boys in the lower fat intake group at 2 years of age were slightly shorter and lighter at 15 years of age than those who had been in higher fat intake groups. We conclude that the contemporary shift to a lower fat diet in early childhood is unlikely to have deleterious effects on growth and nutrient intake if eaten in the context of a family eating pattern, which meets current guidelines. Copyright © 1995, Wiley Blackwell. All rights reserved

We describe the results of tracking serum lipids, and dietary intake of energy, fat and calcium in a cohort of 106 children in the Adelaide Nutrition Study who were followed to 15 years of age together with an additional 123 children recruited from 11 years of age. Measures of energy, fat and calcium intakes were obtained from analyses of 4-day weighed records. The pattern and level of tracking were similar for males and females. The tracking coefficient for total cholesterol was 0.28-0.49 between 1 and 15 years of age, 0.3-0.64 between 2-8 and 15 years of age, 0.48-0.64 between 8-11 and 15 years of age, 0.71-0.78 between 11-13 and 15 years of age and 0.71-0.78 between 13 and 15 years of age. The pattern was similar for low density lipoprotein cholesterol, but lower for high density lipoprotein cholesterol. For mean daily energy, fat and calcium intake, tracking coefficients were low below 4 years of age, but from then on were 0.46-0.64 for energy intake, 0.38-0.51 for fat (g) and 0.51-0.62 for calcium (mg).Adolescence, child, cholesterol, nutrition, tracking Copyright © 1995, Wiley Blackwell. All rights reserved

The food energy, macro-, and micronutrient intake of 78 boys and 63 girls aged 8 years who have been studied since birth is reported. Nutrient intake was calculated from 4 day weighed records using the CSIRONET data bank based on British tables of food composition. The mean values for daily intake for girls and boys, respectively, for energy (MJ), protein, fat, carbohydrate and fibre (g) were 7.4 and 6.5; 64 and 57; 71 and 62; 232 and 206; and 15 and 12 g. Half trie food energy came from carbohydrate, divided equally between starch and simple sugars, 15% from protein, and 35% from fat. This comprised 41 % saturated (S), 33% mono- and 16% polyunsaturated (P). The mean P: S ratio for girls was 0.46, and 0.41 for boys. Overall sweets and soft drinks contributed 4¿5% to energy intake, with large individual differences. Mineral and vitamin intakes were satisfactory in relation to theoretical optimal population needs. Vitamin and/or mineral supplements were taken by 8.5% of the sample. These results are discussed in relation to the Nutritional Guidelines. Copyright © 1987, Wiley Blackwell. All rights reserved

Abstract The values for macro- and micronutrients and food energy intake are reported from a sample of 154 healthy children aged 6 years who have been prospectively studied since birth. The daily food energy intake in absolute terms and adjusted for body mass was lower than reported previously, and lower than the current recommended daily intake (RDI) but consistent with values derived from predictive equations based on other studies of preschool children. The carbohydrate intake was similar, but the protein intake was slightly lower and the fat intake also less than that reported in previous studies of children of a similar age. Micronutrient intake was greater than the RDI for each. The intake of potassium was adequate, but that of sodium was high in relation to the recommended K:Na ratio of > 1, resulting in a value of 0.66. Stature was positively correlated with energy and fat intake, but there was an inverse correlation between fatness and energy intake, and intake of unrefined carbohydrate. These results are discussed in relation to the effect of different nutritional planes on growth rate. Copyright © 1987, Wiley Blackwell. All rights reserved

In a sample of 141 healthy 8 year old children, over 95% had three main meals on each of the 4 days of the food record. Two-thirds had an afternoon snack and nearly one-half a morning snack on each of the 4 days, but only one-quarter had supper on each day. Seventy-one per cent of all meals were eaten at home with the family, 20% at school with friends, and less than 1% of meals were eaten at a restaurant or fast food outlet. These data show that amongst children of primary school age, take away sources of food make a very small contribution to the diet, and that eating habits at home are of greatest importance to the child's diet. Copyright © 1987, Wiley Blackwell. All rights reserved

This report describes how nutrient intake was distributed throughout the day, and the nutrient density according to meal, in 78 boys and 63 girls who have been studied from birth. The food intake was calculated from 4 day weighed records using the CSIRONET data bank based on British tables of food composition. The percentages of total energy from breakfast, lunch, evening meal, and snacks were 20, 26, 31, 23%. There was a very wide range of individual nutrient intake for each meal. The evening meal made the largest contribution to fat and protein intake. Most starch came from lunch (30%) and least from snacks (16%). Snacks contained a large portion of the simple sugars (39%). Breakfast was an important source of calcium and B vitamins, but with wide ranges of micronutrients occurring for each meal. This analysis of nutrient density and distribution contributes towards the formulation of practical recommendations about beneficial dietary changes. Copyright © 1987, Wiley Blackwell. All rights reserved

A study of the usual nutrient intake of a sample of 183 healthy 4 year olds is reported. These children have been the subject of a longitudinal study from birth. Data include daily intakes of food energy, protein, fat, carbohydrate, fibre, minerals, and vitamins. Minor differences in nutrient intake were present between the sexes. Overall nutrient intakes were at a slightly lower level than those described previously. The methodological considerations of such a community nutrition study are discussed, including the intrinsic sources of error which may have contributed to the observed differences. Changes in recreational activity level and influences of climate may also be important factors affecting food energy and nutrient intake at this age.

The investigations to be described were performed on a sample of several hundred babies prospectively studied during their first two years, with supplementary cross-sectional studies on older children. The objective of the studies was to determine the extent to which the nutritional milieu influence measurable indices of health and growth. Dietary intake studies were complemented by measurements of adipose tissue (by skinfold thickness), blood pressure, and physical fitness (by ergometry), thereby providing standards for the sample population and data for subsequent analyses. The results comprise six sections. The first chapter describes the samples of children studied and the methodology used. The second chapter comprises data on nutrient intake through infancy to age two, and through school age. Additional analyses concern the effect of socioeconomic and ethnic factors on feeding practices during infancy, and breast milk intake patterns in the first four months. In the third chapter the influence of both qualitative (breast or bottle feeding), and quantitative (food energy intake) factors on early post natal somatic development was then investigated using the null hypotheses that: nutritional influences would not alter the time taken to attain the height and weight percentile track (channel); and, that body weight and growth velocity would not be related to daily food energy intake. The pattern of growth of adipose tissue, its correlates with other measurements of body build, and the relationship between its rate of growth and early dietary milieu, are described in the fourth chapter. The description of blood pressure changes through childhood and the analyses concerning the relationship of blood pressure to body build and nutritional factors comprise the fifth chapter. In the last section a dynamic aspect of health, that of physical fitness, is considered. Fitness can be measured by bicycle ergometry, in which oxygen uptake and pulse rate are linearly related to work output. During puberty the physical work capacity (PWC) rapidly accelerates with an increasing disparity between boys and girls. PWC was therefore studied in relationship to both age and measurements of somatic maturity and pubertal development, and the inter-relationship with nutritional factors was also investigated.

The familial clustering of clinical coronary heart disease (CHD) in certain families has been shown to be 'explained' in part by the familial aggregation of low plasma high density lipoprotein (HDL) cholesterol concentrations, independently of plasma total cholesterol and triglyceride. To explore this association further, measurements were made of HDL cholesterol and other lipoprotein lipids in cord blood from 1797 unselected births. Information on CHD prevalence in family members was obtained from the mothers of infants in the highest, modal and lowest deciles of HDL cholesterol (= 1.14, 0.62-0.70 and = 0.28 mmol/l respectively). Records were also made of the sex and birthweight of the infant, the age and health of the mother, and the nature of the pregnancy and delivery. In the entire cohort, HDL cholesterol was negatively correlated with cord blood low density lipoprotein (LDL) cholesterol, but was not significantly correlated with cord blood triglyceride. On Chi-squared analysis, CHD prevalence in greatgrand-parents increased (p < 0.05) with decreasing cord blood HDL cholesterol. A similar trend was observed for grandparents. On multivariate analysis (Duncan-Walker multiple logistic method) however, CHD prevalence in greatgrandparents and grandparents combined was not significantly correlated with HDL cholesterol, when other variables, including cord blood LDL cholesterol and total triglyceride, were held constant. Thus, the familial transmission of low HDL cholesterol levels in coronary-prone families appears to be absent at birth, and may therefore be a product of environmental rather than of genetic influences. © 1981.

Two indices of free serum androgenic activity, the normalized androgen ratio (NAR) and the free androgen index (FAI) were determined in 218 normal children aged 8¿17·9 years. Before the onset of puberty and between chronological age 8 and 11·9 years, NAR and FAI were similar in both sexes, the NAR being < 0·8 and FAI < 0·1. In boys mean NAR value increased from 0·87 to 1·39 between 12·5 and 17·5 years, and mean FAI from 0·14 to 1·85, between 12·5 and 17·5 years. In girls mean NAR increased from 0·79 to 0·85 between 12·5 and 15·5 years, and mean FAI from 0·11 to 0·23, between 12·5 and 15·5 years. Both indices did not change significantly between 15·5 and 17·5 years in girls. A rapid increase in NAR and FAI occurred in boys from a mean testicular volume of 4·1 to >20 ml and from genital stage G2+ to 5+. In girls a gradual increase in NAR and FAI occurred from breast stage B2 + to 5+. Although the androgen indices increased in both sexes between pubic hair stages PH2 + and 6 +, the values in girls were always less than in boys at corresponding stages suggesting an increased androgen sensitivity of the female pubic hair follicle during adolescence. The peak rise in NAR and FAI in boys between 13 and 15 years correlated closely with the timing of the pubertal growth spurt in this sex. A similar rise was not seen in girls at the time of their peak growth velocity between 11 and 13 years and suggested that androgens play only a minor or complementary part in the female growth spurt. Copyright © 1981, Wiley Blackwell. All rights reserved

Serum follicle stimulating hormone (FSH) luteinising hormone (LH) oestradiol (E2) concentrations in 117 girls aged 8 to 17.9 years were related to chronological age (CA), bone age (BA), breast development (B1-5+) and public hair development (PH1-5+). A progressive rise in serum LH and E2 was noted in relation to CA, BA and pubertal development. Serum FSH levels reached a peak in mid-puberty and fell thereafter. The FSH/LH ratio decreased with advancing CA and BA. LH In comparing the data in girls (Part II) with that in boys (Part I) serum FSH and LH levels began to rise earlier in girls and were generally higher than levels seen in boys throughout puberty. Similarly, an earlier rise in serum E2 in girls compared with T in boys supported the concept of an earlier activation of the female gonad.

Serum follicle stimulating hormone (FSH), luteinising hormone (LH) and testosterone (T) concentrations in 118 boys aged 8 to 17.9 years were related to chronological age (CA), bone age (BA), genital development (G1-5+), pubic hair development (PH1-5+) and mean testicular colume (MTV). A progressive rise in serum FSH, LH and T was noted in relation to CA, BA and all pubertal parameters studied. FSH showed an approximate twofold increase, LH an eight to tenfold increase and T a fourfold increase from pre-puberty through to full adult maturity. The FSH ratio decreased with advancing CA, BA and pubertal development.

Normal values for serum levels of total cholesterol, and of low-density and high-density lipoprotein cholesterol from a longitudinal study of children from birth to two years of age, and from cross-sectional studies of four-year-old children, schoolchildren aged from eight to 18 years, and the young adult parents of the two-year-old children are reported. These data will provide a reference range for the normal Australian youth population, and cut-off points in the identification of hypercholesterolaemia.

In this issue of the Journal, Dr Dwyer and his colleagues (page 331) have looked further into the effects of social status, ethnic origin and gender on blood pressure, fatness, serum cholesterol level and fitness in a sample of ten-year-olds in Adelaide. Despite the inherent difficulties in the interpretation of this type of data, the study is of use in helping to raise the level of awareness of these potential risk factors amongst primary care practitioners. There is accumulating evidence that tracking of both blood pressure and cholesterol levels begins in early childhood, which means that children in the top percentiles for these are likely to remain there.

Abstract. Boulton, T. J. C. (Department of Paediatrics, University of Adelaide, The Adelaide Children's Hospital, South Australia). Serum cholesterol in early childhood: Familial and nutritional influences, and the emergence of tracking. Acta Paediatr Scand, 69: 441, 1980.¿The influence of familial and nutritional factors on serum total cholesterol (TC), and the age at which evidence of tracking appeared, was investigated in the first 2 years. The level of association between the parents' and children's TC levels increased to age two (r 0.25, p < 0.001), being slightly greater for the boys than for the girls. This was paralleled in the results for low density lipoprotein cholesterol (LDL), but weak association only occurred for high density lipoprotein cholesterol (HDL). Comparing the relative influence on the children's TC of nutritional and familial factors, the parents' TC levels and a family history of early coronary heart disease were found to be important correlates of the children's TC. Low correlations occurred for nutritional factors. The degree of tracking of cholesterol (the extent to which the level maintains its relative position in the distribution curve through time) as measured by the correlation coefficient of the level at time one on the level at time two, increased through infancy to r 0.40 from one to two years. The association between the TC level in cord blood and later levels increased to two years (r 0.32). The results are interpreted as showing either familial influences on a child's TC level become increasingly important from the end of the first year, or that the effect of these influences is obscured during infancy by other, presumably nutritional, factors which themselves are elusive because of the inherently inadequate methodological techniques of dietary studies. Copyright © 1980, Wiley Blackwell. All rights reserved

Serum follicle stimulating hormone (FSH), luteinising hormone (LH) and oestradiol (E2) concentrations in 117 girls aged 8 to 17.9 years were related to chronological age (CA), bone age (BA), breast development (B1¿5+) and pubic hair development (PH1¿5+). A progressive rise in serum LH and E2 was noted in relation to CA, BA and pubertal development. Serum FSH levels reached a peak in mid-puberty and fell thereafter. The FSH/LH ratio decreased with advancing CA and BA. In comparing the data in girls (Part II) with that in boys (Part I) serum FSH and LH levels began to rise earlier in girls and were generally higher than levels seen in boys throughout puberty. Similarly, an earlier rise in serum E2 in girls compared with T in boys supported the concept of an earlier activation of the female gonad. Copyright © 1980, Wiley Blackwell. All rights reserved

Serum follicle stimulating hormone (FSH), luteinising hormone (LH) and testosterone (T) concentrations in 118 boys aged 8 to 17.9 years were related to chronological age (CA), bone age (BA), genital development (G1¿5+), pubic hair development (PH1¿5 +) and mean testicular volume (MTV). A progressive rise in serum FSH, LH and T was noted in relation to CA, BA and all pubertal parameters studied. FSH showed an approximate twofold increase, LH an eight to tenfold increase and T a fourfold increase from pre-puberty through to full adult maturity. The FSH/LH ratio decreased with advancing CA, BA and pubertal development. Copyright © 1980, Wiley Blackwell. All rights reserved

The regulation of the serum cholesterol level in infancy is not understood but it has been suggested that it is less precise than in adulthood. Ten infants, ages 3 to 16 months, were studied during two periods of 1 month each, first consuming a low-cholesterol, polyunsaturated fatty acid-rich diet and later a cholesterol containing, polyunsaturated fatty acid-poor diet. Changes in serum cholesterol, bile acid excretion, and net sterol balance (sterol excretion minus cholesterol intake) were measured at the end of each period. The serum cholesterol level rose with the second diet in all infants by from 30 to 111 mg/100 ml. The theoretical response that might be expected in adults to a similar change in cholesterol and fat intake either resembled that, or was not less than that, shown by seven of the infants, while three infants showed a larger than predicted difference in serum cholesterol between the diets. The mean observed and predicted differences in the serum cholesterol level were, respectively, 56 and 58 mg/100 ml suggesting that the magnitude of the response becomes established in early life. Bile acid excretion was significantly higher with dietary polyunsaturated fatty acids, probably explaining some of the effect on the serum cholesterol. The sterol balance data showed that the net sterol balance fell substantially during the consumption of cholesterol in seven of the 10 infants. Although a steady state for cholesterol metabolism is not being claimed for growing infants, the fall in the net sterol balance is strongly suggestive of lessened endogenous cholesterol synthesis as reported in adults.

Summary: This study was designed to test the proposition that an optimal age for screening for hypercholesterolaemia (HC) might be defined. The samples of children studied included 200 two-year-olds, 385 four-year-olds, and 230 primary and secondary children aged from eight to 17 years. The 95th percentile value for total serum cholesterol (TC) was used to define HC in children and to select children for family studies. Four of the 15HC two-year-olds had an HC parent with three having a history of early coronary heart disease (CHD). Twenty-three of the 310 parents sampled had HC, 15 having a family history of early CHD, but only four having an HC child. Family studies were done on 20 HC four-year-olds of whom half had a positive family history of premature coronary heart disease (CHD). Half of each group of parents were HC, but probable familial hypercholesterolaemia (FH) was detected only in three parents, environmental causes accounting for the HC of the others. Four primary and five secondary school students were HC, and selected for family studies. A positive family history of CHD was present in two of the primary and all of the secondary students, with five of the seven families having one or more HC parent, one having probable FH. It is proposed that programmes for detecting HC in childhood become valid only from four years of age, and that the presence of a positive family history of early CHD would reduce the proportion of children to be tested to a practical level without significantly impairing the accuracy of the case finding procedure. School entry might provide a suitable time to identify children with HC. Copyright © 1979, Wiley Blackwell. All rights reserved

Summary: The effects of adverse maternal, fetal, and intrapartum factors on cord serum total cholesterol (TC) and triglyceride (TG) were studied retrospectively on a sample of 428 neonates comprising four subgroups: (1) 54 with isolated cord serum hypercholesterolaemia (HC); (2) eight with cord serum HC and hypertriglyceridaemia (HTg); (3) 70 with isolated cord HTg; and (4) 296 with normal cord serum TC and TG levels. Low birth weight babies (< 2500 g) had higher levels of cord TG (P < 0·001) and TC (P < 0·1) than normal weight babies, as did pre-term (less than 37 weeks gestation) babies, P < 0·05 for TG, P < 0·001 for TC, and postmature (over 41 weeks gestation) babies, P < 0·01 for TG. The regression coefficient between gestational age and TC was-0·20 (P < 0·001), and for TG-0·13 (P < 0·02). Babies with low one and five-minute apgar scores had higher means for TG (P< 0·001) with the coefficients of regression being 0·34 and 0·30, but no differences were present for TC. Those who had had signs of intrapartum distress, such as tachycardia and bradycardia, also had higher means for TG (P < 0·01), but their TC was lower than in the control group (P < 0 05). Copyright © 1979, Wiley Blackwell. All rights reserved

Boulton, T. J. C. and Coote, L. M. (1979). Aust. Paediatr. J., 15, 81¿86. Nutritional studies during early childhood. II. Feeding practices during infancy, and their relationship to socio-economic and cultural factors. The results are presented of an analysis of socio-economic and ethnic factors which are related to the practices of infant-feeding. The results include the prevalence figures for breast-feeding and an analysis of the different types of milk formulation used through the first year of life. The type of milk formula used related to the level of the mother's education, her country of origin, and the language spoken at home. Breast-feeding was continued longer by mothers with tertiary education (p<0.001), and for less time by mothers born in southern Europe (p<0.05). The age of such mothers on arrival in Australia was significantly related to the duration of breast feeding (p<0.05). It is proposed that the influence of these observed relationships may lead to the establishment early in life of certain patterns of nutrient intake with possible long term effects. These may contribute to the differences in incidence of nutritionally based disorders with socio-economic and ethnic status. Copyright © 1979, Wiley Blackwell. All rights reserved

Abstract. A prospective follow-up study of infants selected by cord blood total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL-C) levels from 2000 consecutive live births was undertaken to reassess the role of cord blood screening in the diagnosis of familial hypercholesterolaemia (FH). Mean values for serum cholesterol were (mmol/l ± S.D.): TC, 1.83 ± 0.56; LDL-C, 0.90 ± 0.49; HDL-C, 0.70 ± 0.33; TG, 0.38 ± 0.16. Seventy-three of 117 infants who had had a cord TC and/or LDL-C >95th percentile, and 373 control group children (cord TC and/or LDL-C >95th percentile) were followed up at age 3¿12 months. Six of the 117 were hypercholesterolaemic (HC), and one child had an HC parent: positive detection rate =0.05%; false positive rate =3.7%. Four control-group children were HC and had an HC parent; false negative rate =1.1%. With the possible exception of detecting FH in a child with a known affected parent, cord blood screening appears to be unreliable for the diagnosis of FH. Copyright © 1979, Wiley Blackwell. All rights reserved

Boulton, T. J. C., and Coote, L. M. (1979). Aust. Paediatr. J., 15, 72¿80. Nutritional studies during early childhood. I. Energy and nutrient intake. The results are reported of a prospective, longitudinal, nutritional study of 391 infants, who were representative of the Adelaide population. The results include a description of the change in pattern of milk and solid food in-take, the percentage contribution from carbohydrate, fat, and protein, and its relationship to the type of diet the child was having through infancy. The energy intake of these food classes is described, and the relationship to both the contribution from each nutrient group, and the type of milk formula used is described for each age studied. It is proposed that these studies on normal Australian children provide evidence of the inter-related nature of the qualitative and quantitative aspects of diet during infancy, and may form a basis for further studies on the relationships between nutrition and the growth of fatness, variation in blood pressure, and nutritional influence on lipoprotein metabolism. Copyright © 1979, Wiley Blackwell. All rights reserved

Boulton, T. J. C. and Rowley. M. P. (1979). Aust. Paediatr. J., 15, 87¿90. Nutritional studies during early childhood. III. Incidental observations of temperament, habits, and experiences of ill-health. The mothers of 391 normal 3-month-old and 266 one-year-old babies were asked standard questions about their child's motor activity, sleeping, and thumb-sucking habits, and whether the child had had colic, regurgitant vomiting, or an episode of ill-health during infancy. By one year 36.5% of the mothers considered their babies to be very active, compared to only 4% considering them placid. At 3 months of age 20% of babies were waking at least once a night, and significant ethnic differences were present, with babies of Itaiian-born parents waking more frequently. Colic was reported in 40% of babies, occurring frequently in 24.5%. It occurred slightly more frequently in babies of mothers with higher educational attainment, and in first-born. Fifty-nine percent of the babies had no episode of ill-health, or only one or more episodes of upper respiratory infection. Prevalence figures are reported for wheezing episodes, bronchitis and vomiting with diarrhoea. Copyright © 1979, Wiley Blackwell. All rights reserved

Boulton, T. J. C. and Coote, L. M. (1979). Aust. Paediatr. J., 15, 81¿86. Nutritional studies during early childhood. II. Feeding practices during infancy, and their relationship to socio-economic and cultural factors. The results are presented of an analysis of socio-economic and ethnic factors which are related to the practices of infant-feeding. The results include the prevalence figures for breast-feeding and an analysis of the different types of milk formulation used through the first year of life. The type of milk formula used related to the level of the mother's education, her country of origin, and the language spoken at home. Breast-feeding was continued longer by mothers with tertiary education (p<0.001), and for less time by mothers born in southern Europe (p<0.05). The age of such mothers on arrival in Australia was significantly related to the duration of breast feeding (p<0.05). It is proposed that the influence of these observed relationships may lead to the establishment early in life of certain patterns of nutrient intake with possible long term effects. These may contribute to the differences in incidence of nutritionally based disorders with socio-economic and ethnic status. Copyright © 1979, Wiley Blackwell. All rights reserved

A study has been made of 10,149 mothers whose babies were born at a major maternity hospital. The incidence of breast feeding was related to both maternal and child factors. Mothers' and babies' health in pregnancy and the perinatal period, and existing family size, affected the likelihood of a mother breast feeding her baby. Mothers of high socio-economic status were more likely to breast feed their babies.

A coronary risk-factor profile of 4 year olds. II. Inter-relationships, clustering, and tracking of blood pressure, serum lipoproteins, and skinfold thickness. A study of coronary risk factor detection on 486 preschool children is reported. Risk-factors at this age are described as deviations from the observed normal range for blood pressure, serum cholesterol, and fatness, to a degree that would be unequivocally associated with an increased coronary risk in an adult. Children were identified with an increased risk from either hypercholesterolaemia (n = 22), or an elevated diastolic blood pressure (n = 9). Clustering of risk factors was detected in 2.1% of girls, and 0.8% of boys. Tracking was recorded for both diastolic blood pressure and fatness. The blood pressure was positively correlated with weight, height, and obesity, but not with serum lipoproteins. Copyright © 1978, Wiley Blackwell. All rights reserved

Studies on the development of adipose tissue in infancy would seem essential to test the hypothesis that adult fat stores relate to the numbers of fat cells developed during early childhood. Thirty infants aged from 1-28 months and 13 fetuses of approximately 11-16 weeks of gestation obtained at therapeutic abortion and two preterm infants of 28 weeks of gestation were studied. The cells of both fetal and infant adipose tissue were separated from connective tissue and fixed by treatment with osmium tetroxide in buffered collidine using a method modified from Hirsch and Gallian (J. Lipid Res., 9:100 (1968)) for estimation of cell size and number. In fetal and early infancy there are two populations of cells in adipose tissue. Small cells found in tissue before birth and the first months of postnatal life do not contain fat. The larger cells, which are fat containing, represent maturing fat cells. They are cells which include fat cells recognized by previous workers but up to 24.6% were found to be less than 25 µm in diameter. Small cells in the early stages of fat accumulation may make an important contribution to the cell population of fat mass. It is apparent that increasing fat accumulation in the first 6-12 months of life, as demonstrated by increased skinfold thickness measurements, is associated with increasing fat cell size and that this association bears a linear relationship. © 1978 International Pediatric Research Foundation, Inc.

In developing adipose tissue, cells of size less than 25 µm may make a major contribution to adipose tissue cell populations. This study reports the separation, identification, and sizing of infant and foetal adipose tissue small cells. Subcutaneous adipose tissue was taken from the anterior abdominal wall of children aged 2 months and 22 months. Subcutaneous tissue was also obtained from a paraumbilical site in 4 fetuses of gestational age 16 weeks. Tissue samples were fixed in buffered osmium tetroxide solution containing collidine. Aliquots of cell preparations suspended in saline on microscope slides were viewed and separated using a dissecting microscope. A diameter distribution of particle size was obtained using at least 200 cells for each preparation. There was a substantial number of cells that were smaller than 20 µm. Their modal cell size was remarkably constant in fetuses and in 2-month- old and 22-month-old infants. Ultrastructural studies show that the tissue is composed of a relatively uniform population of cells within sparsely collagenous connective tissue. Although some of the cells show no intracytoplasmic aggregates of lipid material, others show variable amounts of lipid material which can occupy a very large part of the cell volume. © 1978 International Pediatric Research Foundation, Inc.

A coronary risk-factor profile of 4 year olds. II. Inter-relationships, clustering, and tracking of blood pressure, serum lipoproteins, and skinfold thickness. A study of coronary risk factor detection on 486 preschool children is reported. Risk-factors at this age are described as deviations from the observed normal range for blood pressure, serum cholesterol, and fatness, to a degree that would be unequivocally associated with an increased coronary risk in an adult. Children were identified with an increased risk from either hypercholesterolaemia (n = 22), or an elevated diastolic blood pressure (n = 9). Clustering of risk factors was detected in 2.1% of girls, and 0.8% of boys. Tracking was recorded for both diastolic blood pressure and fatness. The blood pressure was positively correlated with weight, height, and obesity, but not with serum lipoproteins. Copyright © 1978, Wiley Blackwell. All rights reserved

Anthropometric and biochemical data from a pilot-study of 65 four-year-old children is presented. The children in the study fell into the normal range for height, weight, fatness, blood pressure, and serum lipids. Within this normal sample, positive correlations were found between height and fatness (P < 0.02, r 0.27), height and bone age (P < 0.01, r 0.33), fatness and blood pressure (P < 0.001, r 0.46), and systolic blood pressure and height (P < 0.05, r 0.3). There was no correlation between body fatness and serum cholesterol, nor triglyceride levels. A positive association between high-normal values for serum lipids, systolic blood pressure, and fatness were found in 10% of the sample. Copyright © 1977, Wiley Blackwell. All rights reserved

Anthropometric and biochemical data from a pilot-study of 65 four-year-old children is presented. The children in the study fell into the normal range for height, weight, fatness, blood pressure, and serum lipids. Within this normal sample, positive correlations were found between height and fatness (P < 0.02, r 0.27), height and bone age (P < 0.01, r 0.33), fatness and blood pressure (P < 0.001, r 0.46), and systolic blood pressure and height (P < 0.05, r 0.3). There was no correlation between body fatness and serum cholesterol, nor triglyceride levels. A positive association between high-normal values for serum lipids, systolic blood pressure, and fatness were found in 10% of the sample. Copyright © 1977, Wiley Blackwell. All rights reserved

Blood pressure has been measured in 209 children on first consultation when referred to the Obesity Research Clinic. Blood pressure correlated with estimates of obesity made by subscapular-skinfold thickness, and calculations of per cent body weight as fat. Neither age nor duration of the obesity showed significant correlation with the blood pressure. Copyright © 1974, Wiley Blackwell. All rights reserved

Blood pressure was measured in 209 children on first consultation when referred to an Obesity Research Clinic. Blood pressure correlated with estimates of obesity made by subscapular skinfold thickness, and calculations of per cent body weight as fat. Neither age nor duration of the obesity showed significant correlation with the blood pressure. 114 children had either a diastolic blood pressure of 90 mm Hg or more, or a systolic blood pressure of 135 mm or more; 21 children appeared to have significant hypertension with a diastolic pressure of 95 mm or more. It is concluded that hypertension has a significant association with severe childhood obesity.

Four patterns of fat cell size and population distribution have been described in subcutaneous adipose samples from normally nourished children up to 2 yr of age. A population of foetal adipocytes with a modal value for cell diameter of 11 µm has been described which represents a fat cell with a lipid content of 5 x 10-4 µg. Fat cells containing less than 0.01 µg of lipid have not previously been counted. It is proposed that these cells become progressively larger during the first 2 yr of life. A trend with age for the pattern of cell distribution was noted.

Four patterns of fat cell size and population distribution have been described in subcutaneous adipose samples from normally nourished children up to 2 years of age. A population of foetal adipocytes with a modal value for cell diameter of 11 µ has been described which represents a fat cell with a lipid content of 5 µ 10-4µ. Fat cells containing less than 0.01 µ of lipid have not previously been counted. Copyright © 1974, Wiley Blackwell. All rights reserved

This paper addresses the questions of whether early nutritional experience affects later somatic growth, the growth of the adipose tissue, or the levels of serum lipids among well-nourished children. The analyses are based on data from three prospective studies. Postnatal nutrition and growth: there were differences in growth between breast-fed and formula-fed children. There was no association between linear growth and differences in food energy or macronutrient intake. Birth size and postnatal growth: there was no association between ponderal index (PI) at birth and body mass index (BMI) in the second year. For boys, the PI at 3 and 6 months of age was significantly positively correlated with BMI at the ages of 8 and 15 years, but not for girls. Childhood growth and lipids: there was no association between lipids at the age of 8 years and either birth weight or length, but children who had had a low PI at birth had higher lipid levels at the age 8 years. A positive association was found between serum lipids and abdominal fat and BMI. We conclude that, although early diet may influence growth rate beyond infancy, the evidence for fat patterning resulting from differences in fetal or early postnatal nutrition is still open to question.