Age and Ageing 1996.

25-300-306

Weight Height and Body Mass Index

Distributions in Geographically and Ethnically
Diverse Samples of Older Persons
LENORE J. LAUNER, TAMARA HARRIS on behalf of the Ad Hoc
Committee on the Statistics of Anthropometry and Aging*

Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019

Summary
We compared anthropometric data (height, weight and body mass index) from 19 geographically and ethnically
varied samples of community-dwelling elderly people. Participants were stratified into three age groups, 60—69,
70-79 and 80 years or older. We present age-group-specific means and standard deviations for height, weight
and body mass index (BMI, weight/height2) and the prevalence of underweight (BMI < 20) and overweight
(BMI Ss 30).
Across studies there are large differences in the prevalence of overweight and underweight, but in all studies
mean height and BMI decreased with age. In general, mean BMI among 70-79-year-old women is greater than
that for men of a similar age, and the Mediterranean samples are heavier for height than samples from Western
Europe, Asia, Africa and the United States.
The comparisons suggest that the sensitivity and specificity of a fixed cut-off for underweight and overweight
are likely to differ by sex, age, and geographic location in samples of older persons.

Keywords: Anthropometry, Elderly people, Screening, Epidemiology.

Introduction genetic background [4, 5]. Differences by age may

Height and weight are two of the most easily obtained
anthropometric measurements. In combination, they
have been used to demonstrate the health risks
associated with overweight as well as underweight and
are used extensively in screening and monitoring
programmes [1]. However, much of what is known
about these relationships relates to children, adoles-
cents, and middle-aged adults; little is known about
older people [2].
The WHO Expert Committee on Physical Status:
The Use and Interpretation of Anthropometry recently
formulated guidelines for data obtained from people
aged over 60 [3]. Data were obtained on height, weight
and body mass index (BMI; weight in kg/height in m )
in older persons from geographically and ethnically
diverse populations. In this report, we examine those
data with regard to differences in sex-specific distribu-
tions by geographic region/ethnic group, age, and
reported health status. These factors produce different
distributions of anthropometric data in studies of
younger populations. Geographic region/ethnic group
differences may reflect differences in early childhood
experiences and life-style during adulthood, as well as
•Contributing authors listed in Appendix 1.
emerge that are related to survival, or to physiological,
cohort and health status factors [6-9]. Health status
may be related to the distribution of weight and BMI
because of its association with the risk for, and the
consequences of, disease [2]. How these factors may
influence distributions of anthropometric data for older
populations is not clear.
Methods
On the basis of literature, personal contacts and suggestions
from colleagues, 13 groups were identified with candidate
data-sets based on surveys of randomly selected community-
dwelling elderly people. Twelve groups contributed data, 11
of whom had at least one sample that included individuals
aged 70—79 years. Some groups contributed data collected
from multiple sites and data from each site are presented
separately. The number of older persons in individual studies
ranged from 68 to over 4000. Complete details on the design
and results of individual studies are available from the
investigators (Appendix). As is reported in Table I, the
studies in general do not include institutionalized residents.
Some studies explicitly excluded this group, while others
included the institutionalized group in the larger study, but
did not collect anthropometric data from them. For all
studies, it is likely that the most disabled are underrepre-
sented owing to non-response.
From the eligible 24 studies, we compared 19 study sites
Table I. Sample characteristics of study sites included in the comparison of anthropometric data from geographically/ethnically diverse samples of older persons

No. of sites Age range Sample

Name of study in analysis Location (years) size Sampling frame

Melbourne Chinese Health Study 1 Australia: Melbourne (Chinese) 60-80 68 Telephone lists
(Chinese, Australia)
Brazilian National Survey of 1 Brazil national survey 60-108 4419 Household sample
Health and Nutrition, 1989 O
X
Chinese Nationwide Nutrition 1 China national survey 60-94 1764 Household sample H
Survey 1982 X
Mini-Finland Health Survey 1 Finland national survey 60-90+ 2126 Population register; no m
anthropometric collection in O
institutionalized X
H
Nutritional Assessment of 1 Guatemala: one rural 60-103 202 >
Guatemalan Ambulatory Elderly location Z
Census; excludes institutionalized D
(Guatemala) a
Longitudinal Study of Health Hong Kong sample 70-100 977
and Social Support in the Hong
Kong Chinese Elderly Cohort Household and old-age housing
z
Nutrition in Old Age in Italy Italy: 17 locations 60-97 921 Electoral rolls; excludes en
(Italy/17) institutionalized and severely
Italian Nutrition Examination Italy: 5 locations 65-95 1248 Electoral rolls; excludes r
M
Survey of the Elderly (Padova, institutionalized en
Italy)" o
•n
Rotterdam Study Rotterdam, The Netherlands 60-103 3752 Population register O
National Health Examination United States national sample 60-86 3695 Household sample; excludes r
D
Follow-up Survey (U.S. institutionalized m
National White)
Food Habits in Later Life: Australia: Melbourne (Anglo Celtics) 60-79 111 Telephone, population or m
A Cross Cultural Study Australia: Melbourne (Greeks) 70-104 186 electoral registers; excludes v
China: Beijing 60-95 264 institutionalized in
China: Tianjin 70-96 441 O
Z
Greece: Spata 70-94 70 en
Sweden: Johanneberg 69-91 204
International Collaborative Barbados: 1 rural location 60-80+ 192 Population sample from census
Study on Hypertension in Nigeria: 2 rural locations 60-80+ 129 or government data; excludes
Blacks Cameroon: 2 rural locations 60-80+ 283 institutionalized

Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019

Table II. Anthropometric characteristics of 70-79-year-old men and women from geographically/ethnically diverse samples

Height (m) Weight (kg) BMI1

Number
Men Women Men Women Men Women
Name of study Men Women Mean (SD)2 Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Guatemala 31 30 1.56(0.06) 1.40(0.07) 49.3 (7.7) 41.6(9.0) 20.2 (2.2) 21.4(4.4) r
Beijing, China 44 54 1.61 (0.04) 1.54(0.04) 63.1 (9.2) 55.1 (9.0) 24.2 (3.5) 23.0(3.5)
China (National) 217 241 1.61 (0.08) 1.48(0.06) 54.1 (9.0) 45.5 (8.6) 21.0(3.3) 20.7 (3.6)
Hong Kong 246 479 1.62(0.06) 1.48(0.06) 55.7 (10.0) 49.4 (9.8) 21.2(3.4) 22.4 (4.0) C
187 206 2
Italy (17 sites) 1.62(0.07) 1.51 (0.07) 67.3(12.5) 64.7(13.2) 25.5 (4.3) 28.5 (5.4) M
Brazil (National) 634 698 1.63(0.10) 1.50(0.08) 61.3(15.1) 56.6(18.0) 22.9 (5.0) 25.0(7.4) 50
Anglos, Australia 24 26 1.64(0.10) 1.66(0.08) 71.6(12.0) 70.9 (8.7) 26.6(3.7) 25.6(3.0)
Padova, Italy 297 386 1.64(0.07) 1.51 (0.06) 71.6(11.3) 65.1 (13.0) 26.5 (3.8) 28.4(5.3)
X
Spata, Greece 26 20 1.66(0.06) 1.51 (0.06) 75.7(13.8) 64.8 (10.6) 27.5 (4.4) 28.3 (4.5)
Greek, Australia 64 59 1.65(0.06) 1.50(0.05) 76.4(10.9) 68.9(11.3) 28.0(3.6) 30.7(5.1) 50
3 3 3 50
Chinese, Australia 11 9 1.65 (0.08) 62.6 (8.9) 23.0(2.7)
Tianjin, China 180 181 1.66(0.06) 1.53 (0.06) 61.4(10.6) 52.2(10.9) 22.2(3.3) 22.2(4.1)
Barbados 31 30 1.66(0.06) 1.59(0.07) 69.9(15.4) 73.2(18.0) 25.3 (5.6) 29.2 (6.9)
Nigeria 21 13 1.67(0.08) 1.58(0.07) 57.2 (9.7) 58.1 (10.0) 20.6 (2.9) 21.5 (6.0)
9 3 3 3
Cameroon 16 1.67(0.06) 63.2(7.9) 22.6 (2.7)
Finland (National) 273 478 1.69(0.06) 1.55(0.06) 73.3 (12.4) 64.3 (11.7) 25.6(3.7) 26.8 (4.5)
US (National, White) 656 894 1.72(0.08) 1.59(0.05) 75.7(12.2) 64.9(12.7) 25.6(3.7) 25.7 (4.9)
Rotterdam, NL 560 900 1.73 (0.06) 1.59(0.07) 77.0(10.5) 68.7(11.0) 25.8(3.3) 27.1 (4.3)
Johanneberg, Sweden 51 75 1.74(0.06) 1.61 (0.05) 76.9(10.5) 62.5 (12.0) 25.4(3.2) 24.1 (4.5)

Body Mass Index (weight in kg/height in m ); SD: Standard deviation; , < 10.

Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019

 WEIGHT, HEIGHT AND BMI IN SAMPLES OF OLDER PERSONS
(described more fully in Table I) that used standard methods
to measure weight (to the nearest 0.1 kg to 1.0 kg) and height
(to the nearest 0.1 cm). To assess geographic/ethnic differ-
ences, comparisons were limited to persons aged 70—79 years
old. To assess age trends within and between studies, three
age groups were defined (60-69 years old, 70-79 years old,
80+ years old). Comparisons between these age groups were
limited to eight studies with complete data for these age strata.
We also compared the BMI distributions of persons aged 70-
79 by three levels of reported global health status: poor/fair,
good, and very good/excellent. Since not all studies collected
data on health status, used the same question, or had adequate
numbers (^10 per health status category), comparisons by
health status were limited to five studies.
Data on height, weight and BMI are presented separately
for men and women. Distributions were compared using the
mean and standard deviation. The proportion in each sample
that fell within the BMI categories of <20 (underweight), 20-
24.99, 25-29.99, and >30 (overweight) was also calculated.
These categories were in general use at the time of data
collection [10].
Results
Variation by geographic/ethnic group in 70- 79-year-old
men and women
Height and weight: As expected, men were taller than
women. In general, the rank order of samples with
regard to height was similar in men and women; men
and women in Guatemala were the shortest and people
in Sweden the tallest. The mean (SD) height for men in
the Guatemalan sample was 1.56 (0.06) m and in the
Swedish sample 1.74 (0.06) m; the mean height for
women was 1.40 (0.07) m and 1.61 (0.05) m respectively
for Guatemala and Sweden (Table II). There was a
strong linear association between height and weight in
70 60 50
Nigeria
Cameroon
Guatemala
Chinese Australian
Hong Kong
Tianjin, China
Beijing, China
Brazil (National)
Johanneberg Sweden
Rotterdam, NL
US (National, White)
Italy (17 sites)
Finland (National)
Padova, Italy
Barbados
Anglo Australian
Greek Australian
Spata, Greece
0 10 20
Overweight (%)
* = prevalence is 0%
Figure 1. Comparison of anthropometric characteristics of older persons from geographically/ethnically diverse samples.
Percentage overweight (BMI ^30) and underweight (BMI < 20) among 70-79-year-old men.
3°3
men (weighted r = 0.79; p < 0.001) and women
(weighted r = 0.73; p = 0.01). However, the Mediter-
ranean samples [Italy (n = 2), Greece (n = 1), and
Greeks living in Australia (n = 1)] showed relatively
greater weight for height.
BMI: Women had a higher mean BMI and standard
deviation than men in most samples (Table II), which
may reflect greater variability in weight among women.
The highest mean BMI was generally found in the
samples of Mediterranean origin, as expected from the
data presented in Table II. Mean BMI was highest
among Australian women of Greek origin [30.7 (5.1)]
and women in Barbados [29.2 (6.9)].
Underweight and overweight: Geographic/ethnic dif-
Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019
ferences in the prevalence of underweight (BMI < 20)
and overweight (BMI ^30) were large (Figures 1 and
2). Among the 18 studies for which data were available,
the prevalence of overweight in 70-79-year-old men
ranged from 0% in the Asian and West African samples
to 35% in the Spata, Greece sample. The prevalence of
underweight went in the opposite direction (range:
1.0% in the Australian sample of Greek origin to 58% in
the Guatemalan sample). A similar pattern was
observed for women. The range of overweight among
women was 2.5% in the Hong Kong samples to 53.5% in
the Barbados sample, and of underweight from 0% in
the Greek sample to 53.8% in the Nigerian sample.
Variation by age
Height: Mean height decreased with age in each of the
eight studies which measured height in all three age
strata (Table III). Mean height in 60—69-year-old men
ranged from 1.9 cm to 6.7 cm more than that of the 80-1-
year-old men; similar differences were seen in women.
In other data with self-reported rather than measured
Underweight (%)
40 30 20 10 0
"B
30 40 50 60 70
 L. J. LAUNER, T. HARRIS ET AL.

Underweight (%)
70 60 50 40 30 20 10 0

Nigeria
Cameroon
Guatemala
Chinese Australian
Hong Kong
Tianjin, China
Beijing. China
Brazil (National)
Johanneberg, Sweden
Rotterdam, NL
US National. White
Italy (17 sites)
Finland (National)
Padova, Italy
Barbados

Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019

Anglo Australian
Greek Australian
Spata, Greece

10 20 30 40 50 60 70
Overweight (%)
+ = prevalence is 0%
* = <10 in the strata

Figure 2. Comparison of anthropometric characteristics of older persons from geographically/ethnically diverse samples.
Percentage overweight (BMI^30) and underweight (BMI < 20) among 70-79-year-old women.

Table III. Comparison of anthropometric characteristics of older persons from geographically/ethnically diverse samples: height
(m) by age strata

60-69 years 70-79 years 80-89 years

1
Men Women Men Women Men kVomen
Name of study Mean (SD) VIean (SD) Mean (SD) Mean (SD) Mean (SD) VIean (SD)

Guatemala 1.55 (0.05) 1.43 (0.06) 1.56(0.06) 1.40(0.07) 1.53(0.07) .40 (0.06)
China (National) 1.62 (0.07) 1.51 (0.06) 1.61 (0.08) 1.48(0.06) 1.55 (0.07) .46 (0.07)
Italy (17 sites) 1.64(0.07) 1.53 (0.07) 1.62(0.07) 1.51 (0.07) 1.60(0.07) .48 (0.07)
Brazil (National) 1.65 (0.11) 1.52(0.07) 1.63 (0.10) 1.50(0.08) 1.62(0.09) .49 (0.09)
Padova, Italy 1.66(0.06) 1.53 (0.06) 1.64(0.07) 1.51 (0.06) 1.62(0.07) .51 (0.07)
Finland (National) 1.70(0.12) 1.57(0.06) 1.69(0.06) 1.55(0.06) 1.67(0.06) .53 (0.06)
US (National, White) 1.74(0.05) 1.61 (0.05) 1.72(0.08) 1.59(0.05) 1.71 (0.05) .58 (0.05)
Rotterdam, NL 1.75 (0.06) 1.63 (0.06) 1.73 (0.06) 1.59(0.07) 1.71 (0.06) .57 (0.06)

Table IV. Comparison of anthropometric characteristics of older persons from geographically/ethnically diverse samples: body
mass index by age strata

60-69 years 70-79 years 80-89 years

Men Women Men Women Men Women

Name of study Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)

Guatemala 21.3 (2.6) 22.4(3.3) 20.2 (2.2) 21.4(4.4) 19.6(2.3) 20.7(4.1)

China (National) 20.8 (3.0) 21.7(3.9) 21.0(3.3) 20.7 (3.6) 21.0(2.6) 19.6(3.1)
Italy (17 sites) 26.6 (4.6) 28.6 (4.5) 25.5 (4.3) 28.5 (5.4) 25.1 (3.7) 27.0 (5.0)
Brazil (National) 23.7 (5.4) 25.8 (6.7) 22.9 (5.0) 25.0 (7.4) 22.4(4.1) 23.9 (4.9)
Padova, Italy 26.9 (3.7) 29.0 (5.0) 26.5 (3.8) 28.4(5.3) 25.1 (3.6) 26.6 (4.7)
Finland (National) 26.0(3.7) 27.8 (4.5) 25.6 (3.7) 26.8 (4.5) 24.3 (3.9) 25.6 (4.0)
US (National, White) 26.4 (4.0) 26.5 (5.3) 25.6 (3.7) 25.7 (4.9) 24.6(3.1) 24.4 (5.0)
Rotterdam, NL 25.8 (2.9) 26.8 (2.9) 25.8(3.3) 27.1 (4.3) 24.9 (3.4) 26.9 (3.4)
 WEIGHT, HEIGHT AND BMI IN SAMPLES OF OLDER PERSONS 3°5

Table V. Comparison of anthropometric characteristics of older persons from geographically/ethnically diverse samples: body
mass index by strata of self-reported health status

Self-reported health

Excellent/very good Fairly good Poor

Name of study n Mean (SD) n Mean (SD) n Mean (SD)

Hong Kong
Men 13 21.8(3.8) 112 21.7(3.2) 117 20.7 (3.5)
Women 17 22.3 (4.2) 221 22.8 (4.0) 239 22.2 (4.0)
Padova, Italy
Men 31 26.1 (3.4) 305 26.5 (3.7) 165 26.2 (4.0)

Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019

Women 27 25.9(3.6) 411 28.3 (5.0) 236 27.9(5.6)
Tianjin, China
Men 78 22.0 (3.0) 82 22.3 (3.4) 16 22.9(3.6)
Women 68 22.0 (4.0) 88 21.6(3.7) 20 23.9 (4.6)
Finland (National)
Men 19 24.4 (2.3) 168 26.2 (3.8) 85 25.2 (4.0)
Women 27 27.5 (4.5) 332 26.8 (4.5) 117 26.4 (4.9)
US (National, White)
Men 181 26.0 (3.8) 224 25.5 (3.4) 219 25.4 (4.2)
Women 284 25.5 (4.3) 272 25.7 (4.2) 295 25.8 (6.0)

SD: Standard deviation.

height, differences by age were smaller, suggesting the
potential for bias in self-reported data on height from
older persons (data not shown).
BMI: The mean BMI tended to decrease with age
more for women than for men (Table IV). We have
shown that height declined with age; for BMI to decline
with age, weight must also decline and to a greater
extent than height. In general, this decline resulted in a
shift in the distribution for the entire sample rather
than a skewed tail of lower weight.
Underweight and overweight: Consistent with the
shift in BMI distributions by age, in most studies the
proportion of the sample with a BMI < 20 increased
with age. For example the prevalence of underweight in
women was 1.5 times higher in the Brazil sample and
6.0 times higher in the Italy/17 sample in the 80+ year-
old group than in the 60-69-year-old groups. Patterns
were similar for the men (data not shown).
Variation by reported health status in 70— 79-year-old
men and women
Across studies, no one range of BMI was consistently
associated with either excellent/very good health or fair/
poor health (Table V). Rather, the distribution by
health status overlapped considerably within studies
and related to the underlying distribution of BMI in the
sample.
Discussion
Anthropometry is often used as an indicator of
nutritional and health status, in particular for infants,
children and adults; little is known about its value for
predicting the health status of older people. As a first
step towards evaluating the use of anthropometric
indicators in persons older than 60 years, we undertook
a comparison of distributions of weight, height and
BMI from geographically diverse populations. There
are some common findings relating to patterns of
weight and height by age and sex. However, these
distributions differed widely by geographic region/
ethnic groups and by health status.
Some caution is needed when interpreting these
comparisons. Although most studies randomly
recruited their participants and included more than
1000 respondents, several studies were based on small
samples of <15 per age-sex stratum. These small
samples may not be representative of the older persons
living in their community. In addition, the distribu-
tions based on these smaller samples may not be stable.
Therefore, the size of the sample should be taken into
account when evaluating the comparison. For instance,
the regression association of height and weight from
data in Table II were weighted by sample size.
Given the limitations of sample size and representa-
tiveness, these comparisons highlight the differences in
height and BMI distributions by geographic region/
ethnic group and by age, as well as in the prevalence of
underweight and overweight. Sources of these differ-
ences reflect multiple factors including the effects of
genetic potential, early growth and nutritional status,
differences in socio-economic status and health beha-
viours, biological changes in body composition that
accompany ageing, the high prevalence of chronic
3 o6 L. J. LAUNER, T. HARRIS ET AL.
diseases in old age, and differential loss in older samples
due to mortality. The exploration of the contribution of
each of these factors as explanatory variables is beyond
the scope of this descriptive paper but has begun in
some of the studies.
These sources of differences in distribution will affect
the extent to which an anthropometric variable is
predictive of, or associated with, a given outcome. More
data on older people describing the relations of
anthropometry to health outcomes and body composi-
tion are needed before the utility of anthropometry in
screening and monitoring programmes for older people
can be assessed. If anthropometric data prove to be
useful indicators of health in older people, then the
systematic differences in the distributions across
populations will have to be accounted for if standard
cut-off points for screening, monitoring and evaluation
purposes are being considered. Similarly, the differ-
ences across populations will need to be considered
when selecting a set of standard curves to facilitate
comparisons within and across samples.
A cknowledgemen t
This study was undertaken as a part of the preparatory
activities for the WHO Expert Committee on Physical Status:
The Use and Interpretation of Anthropometry, Chair: Prof.
J-P. Habicht; Secretary: Dr M. de Onis; Chair of the Sub-
committee on Adults over 60 years of age: Dr P. B. Eveleth.
References
1. Mason JB, Habicht JP, Tabatabai H, Valverde V.
Nutritional surveillence. Geneva: WHO, 1984.
2. Van Itallie TB. Health implications of overweight and
underweight. Ann Intern Med 1985;103:(suppl;part
2):977-1077.
3. Physical status: the use and interpretation of anthro-
pometry (Report of a WHO Expert Committee). WHO
Tech Rep Ser 1995.
4. Eveleth PB, Tanner JM. World-wide variation in human
growth. 2nd edn. Cambridge: Cambridge University
Press, 1990.
5. Ravussin E, Swinburn BA. Pathophysiology of obesity.
Lancet 1992;340:404-8.
6. Borkan GA, Hults DE, Glynn RJ. Role of longitudinal
change and secular trend in age differences in male body
dimensions. Hum Biol 1983;55:629-41.
7. Shimokata H, Tobin JD, Muller DC, Elahi D, Coon PJ,
Andres R. Studies in the distribution of body fat: I.
Effects of age, sex, obesity. J Gerontol 1989;44:66-73.
8. Shimokata H, Andres R, Coon PJ, Elahi D, Muller DC,
Tobin JD. Studies in the distribution of body fat: II.
Longitudinal effects of change in weight. Int J Obes
1989;13:455-64.
9. Fischer J, Johnson MA. Low body weight and weight loss
in the aged. Perspect Pract 1990;90:1697-706.
10. Garrow JS. Treat obesity seriously—a clinical manual.
Edinburgh: Churchill Livingstone, 1981.
Authors' addresses
L. J. Launer
National Institute of Public Health and Environmental
Protection,
RIVM/CCM, PO Box 1, 3720 BA,
Bilthoven, The Netherlands
T. Harris
Epidemiology, Demography and Biostatistics Program,
National Institute on Aging,
National Institutes of Health, USA
Received in revised form 11 December 1995
Appendix. Contributors to the Ad Hoc Committee on the
Statistics of Anthropometry and Aging
B. H.-H. Hsu-Hage, M. L. Wahlqvist. Department of
Medicine, Monash Medical Centre, Monash University,
Melbourne, Australia (Melbourne Chinese Health Study).
R. Sichieri, D. C. Coltinho, M. M. Leao. Centro Nacional de
Epidemiologia e Informacao, Hospital do Apareiho Loco-
motor, Brasilia-DF Brazil (Brazilian National Survey of
Health and Nutrition, 1989).
Downloaded from https://academic.oup.com/ageing/article-abstract/25/4/300/30890 by guest on 04 April 2019
Kayou Ge. Institute of Nutrition and Food Hygiene, Beijing,
China (Chinese Nationwide Nutrition Survey).
A. Rissanen, M. Heliovaara. The Social Insurance Institution
of Finland, Helsinki, Finland (The Mini-Finland Health
Survey).
N. W. Solomons, M. Mazariegos, I. Mendoza. Cessiam,
Hospital de Ojos y Oidos, Guatemala City, Guatemala
(Nutritional Assessment of Guatemalan Ambulatory
Elderly).
S. C. Ho. Department of Community and Family Medicine,
The Chinese University of Hong Kong, Hong Kong (Longi-
tudinal Study of Health and Social Support in the Hong
Kong Chinese Elderly Cohort).
A. Ferro-Luzzi, G. Maiani, C. Scaccini. National Institute of
Nutrition and WHO Coordinating Centre in Nutrition,
Rome, Italy (Nutrition in Old Age in Italy).
G. Enzi, M. R. A. Gatto, E. M. Inelmen. Department of
Internal Medicine, Institute of Geriatrics, University of
Padova, Padova and Institute of Hygiene, University of
Bologna, Bologna, Italy (Italian Nutrition Examination
Survey of the Elderly).
D. E. Grobbee. Department of Epidemiology and Biostatis-
tics, Erasmus University Medical School, Rotterdam, the
Netherlands (Rotterdam Study).
J. H. Madans, J. J. Feldman, T. Harris. National Center for
Health Statisics, Hyattsville, MD, USA (NHANES I
Epidemiologic Follow-up Study).
Coordinating Centre, M. L. Wahlqvist (chairman). Depart-
ment of Medicine, Monash Medical Centre, Monash Uni-
versity, Melbourne, Australia (IUNS Study of Food Habits
in Later Life).
R. S. Cooper for the ICSHIB Investigators, Department of
Preventive Medicine, Loyola University Medical School,
Maywood, IL, USA (The International Collaborative Study
on Hypertension in Blacks).
M-C. Chang, A. Hermalin, J. Liang. Institute of Gerontol-
ogy, University of Michigan, Ann Arbor, MI, USA (1989
Survey of Health and Living Status of the Elderly in Taiwan).
Epidemiology, Demography and Biostatistics Program.
National Institute on Aging, National Institutes of Health,
Bethesda MD, USA (Established Populations for Epidemio-
logic Studies of the Elderly).
W. A. van Staveren, C. P. G. M. de Groot, J. G. A. G.
Hautvast. Department of Human Nutrition, Wageningen
Agricultural University, Wageningen, the Netherlands
(Euronut Seneca Study on Nutrition and the Elderly).