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Notes
The adult height of a child who grows up under the parents' heights ('midparent stature') is about
favourable environmental circumstances is to a large 0 * 75, allowing for a tendency for taller men to marry
extent dependent on heredity. It may thus be taller women (assortative mating) and presuming
predicted from the height of parents, though with a that parents and children grow up under simi-
considerable degree of uncertainty which arises from larly favourable circumstances. A child's adult
the various possible combinations of the many genes height can also be predicted from heights at
controlling stature, as well as from epigenetic and earlier ages, with correlations at favourable ages of
environmental effects and their interaction (Fisher, the order of 0-8 (Tanner et al., 1956). It takes
1918). Statistically speaking, each parent exerts an time, however, for the child to come to resemble his
equal effect on the child's stature. The correlation parents, or himself as an adult; as a newborn his
between stature of adult offspring and the average of length reflects chiefly the conditions he experienced
in his mother's uterus. Thus the full correlations
Received 29 May 1974. with his parents' height or his own adult height are
14
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TABLE I
Residual SDs and correlation coefficients in prediction of adult heightfrom present height, age, and RUS bone age
in boys
(Ay |Height
No. |Height+chronologIicl ae | Height + chronological
Age No. HihHegt+crnlgclae age + RUS bone age
(yr) - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TABLE II
Residual SDs and correlation coefficients in prediction of adult heightfrom present height, age, and R US bone age
in girls
ILE V
Coefficients for prediction of adult height of boys
Age Height Chronological age Bone age (RUS) Constant Residual SD
(yr) (cm) (yr) (yr) (cm) r
4,5,6,7+ 1-29 -7 3 0 82 4-0 0-84
850-
8-5-
1 22
1-23
-7-2
_7 -0
-0-4
0-7 821
82}
3-6
3-6
0-89
089
9-0- 1-22 -6-8 -0-8 824 3-6 0-89
95- 1-21 6-510-8 82
1020-
10-5-
1-20
1-19
-6-2
-1 9
-120
-142 831
8 3-6
3- 0-89
0-89
11-0- 1-16 5-5 -16 895 3
11-5- 1-13 -5-1 -2-0 9-4 089
12 - 1-08 4-2 -2-6 984 2*5 0*92
12-5- 1-03 -3 -4 -3-2 10343}5 0*88
13-0-
13-5-
0-98
0-94
-2-6
-1-9
-3-8 108
113i
3-1 0-89
-4-4
14-0-
14-5-
0-90
0-87
-1-4
-1-0
-4-5
-4-6
1141
114j
2 -9 0-90
15-0- 0-84 -0-8 -3-8 1041 509
15-5- 0-82 -0-6 -3-1 94!2509
16-0- 0 -88 -0-4 -2-4 711 2-0 0-96
16-5- 0-94 -0-3 -1-8 48j
17-0-
17-5-
0-96
0-98
-0-2
-0-1
-1-2
-0-7
341
19j
0-8 0-99
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Premenarcheal
110- 0 83 -2 -6 -3-6 114 29 082
11.5- 0 82 -2 5 -36 115~
12 0-
125-
0 83
083
-2 4
-23
-34
343
1111
108] 27
708
087
13-0-
130- ~ 0 8, -20
183 -3 1 981.
99901 *92
3 0
13-5-
4 0°
0 87
87
-- 30 222
14-0- 0.91 -16 -2 8 I 79 1-2 0-94
145- 0 95 -1-4 -2 5 67}
Postmenarcheal
11.0-
115-
0 87
0 89
-2 3
-129
-3 3 1001
91 } ~~~~2.
6* 0.87*
-3.3
12-0- 0.91 -1-4 -3 2 821 0-89
12 5- 0-93 -1 0 -2 7 67J 0
13 0-
135-
0 95
0 96
-09
0.9
-2 2
1 8
552
48 1-6 0-94
14-0- 0 96 -08 -1-4 41209
14 5- 0 97 08 -1 3 37
All girls
15 0-
15*5-
0 98
099 0m4
a07
_0-6 0-8 0199
*Value estimated.
In the boys studied the predictions fell within School between the ages of 9 + and 12 + and whose
approximately ±7 cm of actual adult height in those final height was also measured. 7 of them were
of ages up to 12 +, ±6cmatages 13 and 14, 5 cm predicted from height at age 9, 22 each from 10 and
at age 15, and +4 cm at age 16. The 95 % range of 11, and 11 from age 12. Fig. 2 shows the
adult male height is ±12 5 cm, so the use of the distribution of errors (see also Table X below).
prediction equation considerably narrowed the The results accord well with expectation.
target area. In girls the corresponding limits of
error were about ±6 cm up to age 11; 5 cm at age Allowance for parental heights. Unfortunately
12 if premenarcheal and ±4 cm if postmenarcheal; measured parental heights were only available for a
±4 cm at age 13 if premenarcheal and +3 cm if minority of our children and so we have been unable
postmenarcheal; and +2 cm at age 14. The 95% to include midparent height, as we would wish, in
range of adult female height is ± 11*5 cm. Con- our prediction equation. However, we have
sidered as coefficients of variation the error of computed the regressions at each year of age
estimate was about ±2 0% of the mean for boys up between the errors of estimate (actual less predicted
to age 12 reducing to ±1 -7 % at ages 13 and 14; and adult height) and midparent height. The results
±1 -8% for the girls up to age 11, reducing to are shown in Table VII.
±1 @4% at ages 12 and 13 for premenarcheal and The number of cases is so small that generaliza-
tions are hazardous. It does appear, however, that
1 1% if postmenarcheal.
there was a just significant relation (P = 0 05) with
Prediction of height of ballet dancers. The a regression coefficient of about 0 -3 to 0 4 over the
equations of Table VI have been used to predict the ages 9 to 14 in the boys and 7 to 13 in the girls. We
height of 62 girls who entered the Royal Ballet thus propose to allow for parents' heights by adding
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4
4+ 21 0-52 0 -60 4+ 20 0 -42 0o45
5+ 19 0 -40 0-52 5+ 18 0 -20 0-22
E 6+ 31 0 -60 0-63 6+ 23 0 -21 0 -33
7+ 22 0 -60 0 -62 7+ 16 0 -38 0-39
3- 8+ 25 0 -19 0-28 8+ 24 0 -14 0 -19
9+ 21 0 -26 0 -32 9+ 23 0 -40 0 51
10 + 23 0 -27 0-36 10 + 20 0o11 0 -16
11+ 22 0-32 0-46 11+ 15 0-45 053
2- 12+ 30 0-44 0-49 12+ 25 0-44 0-53
Boy s 13+ 19 0-36 0-47 13+ 16 0-23 0-49
Girls 14+ 14 0-32 0-52
A.:
C-
.I Premenarcheal
Postmenarcheal
being added or subtracted. Use of the adjustment
0 I I .
might be expected to reduce the residual SDs by the
5 6 7 8 9 10 11 12 13 14 IS 16 17 18 order of 0 2 cm.
-
TABLE IX
Coefficients for prediction of adult height of girls, based on R US bone age classification
RUS bone age Height Chronological age Constant Residual SD r
(yr) (cm) (yr) (cm)
4+ 0-98 -5*7 87 3 8 0-76
5 0- 0 98
~0 97
-5 5
-5 3
86}
86.?3 3*0 0*87
8
5-5-
6 0- 0 96 -5 1 86 3-2 0-86
6-5- 0.95 -49 85)
7 -0- 0 94 -4 6 84 3-5 0-83
7 5- 0 93 -4 4 83J
8 0- 0 92 _431 82 2*8 0-89
8 5- 0.90 -3 8 81)
9.0-
9 5°-
0 88
0 87
-3 5
-332 79.?
8013008
30 082
100-
10.5-
0 86
0 85
-2 9
-2 6
761
731
2*8 0-86
110- 0 84 -2 3 70} 3 0 0-86
11 5- 0 82 -2 0 68)~
12-0- 0 80 -1 8 687 3-2 0-77
12-5- 0 78 -1 7 671f
Premenarcheal
13 0- 0 76 -1 6 66} 27 0*79
13 5- 0-75 -1.6 66.?2107
Postmenarcheal
130O- 0-96 -4.3 67 1- 9
13 5- 0 97 -4 8 65. 18 0*93
All girls
140- °09 -07 1 1.1 0 98
145- 0998 -0 95 12
15 0- 0.99 -04 90709
15 -5- 0.99 -0-3 0709
Downloaded from adc.bmj.com on March 12, 2010 - Published by group.bmj.com
Retardation of bone age is little weighted, so that a 97th centile. Her RUS bone age is 14- 0, however,
considerable discrepancy of prediction arises in though she is premenarcheal. Her height prediction
comparison with the CA-based scales in the case of a fromTableVI,is 1652 x0 83-12 0 x2 4-14 0 x3 4+
delayed child (amounting typically to 3-4 cm for a 111-0 = 171 7 cm (5' 71"). This is just beyond the
2-year delay). Advancement is weighted some- 90th centile, and well within normal limits. If the
what more, so that in advanced children agreement parents were both at the 97th centile (as is not uncommon
in such subjects) then the midparent height would be 180
with the CA-based scale is better (discrepancies cm or 12 cm above the mean of 168 cm. Thus
being typically 2 cm for a 2-year advance). The approximately 4 cm (one-third of 12) should be added to
distribution of errors of prediction from the allow for this, giving 176 cm (5' IOj"), which is a little
BA-based scale for the ballet entrants shown in Fig. over the 97th centile. The limits associated with this
2 is given in Table X. estimate are twice 2-7 cm, thus 166 cm to 177 cm
without allowing for parents, or approximately 171 to 181
Worked examples. (1) Suppose a boy is referred who cm allowing for parents. These predictions should be
is worried about his short stature. He is aged 12- 5 years used in making the decision as to whether to give
and has a height of 136-0 cm, a little below the 3rd oestrogen. If the girl had been post- instead of
centile. His RUS bone age turns out to be 11 - 0 'years'. premenarcheal her predicted height would have been
His parents heights are 170-0 cm (5' 6") and 160-0 cm only slightly smaller, 170- 7 cm, but the confidence limits
(5' 3"). He is thus a typical case of the small/delay would have been considerably narrower, the residual SD
diagnosis (Tanner, 1973). being 2 - 1 cm instead of 2 - 7 cm. Then the 95 % limits
From Table V, his predicted height is given as would have been 166 5 to 174 9 cm allowing a further
136-0 x 1 -03-12-5 x 3-4-11 -0 x3 2+ 103-0 = 165-3 reassurance as to the maximal height likely to be reached.
cm. This is at about the 10th centile of adult height; the
parents however are at the 25th centile and 30th centile; Discussion
thus midparent height is 165 - 0 cm which is 3 0 cm below
the local average of 168 - 0. Thus i of 3 0 cm = 1 - 0cm The chief points that need discussion concern the
should be subtracted to allow for parents' heights. The accuracy and applicability of the predictions.
Downloaded from adc.bmj.com on March 12, 2010 - Published by group.bmj.com
160
150
140
130
120
/
110
100
901
701 II Repeated-Visit s
Standard 9
(longitudinal) I
'A
Age, years
50
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Chart prepared by J. M. T.... ad
. R. H. Whit.h... U.i-,sity of
Lond.o lwI.t.t f Child Health for the Hospit.1 for Sdk Children Great 0rmond St,-, London W.C.1
Made in, England by Cesyof H.rtf.rd
FIG. 3.--Growth curve of normal but unusual subject with deviations of predictedfrom actual adult height. The lines with
points at the end represent the prediction allowing for midparent height. This represents the worst prediction in our series.
Downloaded from adc.bmj.com on March 12, 2010 - Published by group.bmj.com
190
BOYS
180 P Cr. Height
170 -M
160
150
140
H
I
I1
G 1 2-3-4-5
PH 1 2-3-4 5
1(
Repeated-Visit _ i1
Standard
(longitudinal) _ -i
Age, years
5 6 ChF pGp.74
- r Thnner
10 11
8 9 Wha.eh 12 13 Ho14ta15
ight-redi.
16 Cho1drt17Gst reat18
Hoy pithl
19 20 21 22
d by and R. H. 1s,tu f Child th. for armond ott
, r h
for Sik S L ddela
W yC
Made i. England by Cr.-y, of H,,,ttord
FIG. 4.-Growth curve and height predictions of a boy with short stature and growth delay.
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