Secular trend in stature in the Portuguese population (1904–2000)

transcript

C. Padez

Departamento de Antropologia, Universidade de Coimbra, 3000-056 Coimbra, Portugal

Received 22 February 2001; in revised form 16 October 2002; accepted 30 October 2002

Summary. The records of height of 995 101 18-year-old Portuguese males were analysed aswell as the relation between localities of the subject’s residence (districts) and final height.The sample includes all the Portuguese 18-year-old males born between 1966 and 1982 andexamined between 1985 and 2000, in the north, centre and south of Portugal, representingall the social strata. Statistically significant differences (p � 0:001) among the districts werefound: males from Lisboa (172.79 cm) and Braga (172.67 cm), the most developed districts,are the tallest, and those from Madeira (170.67 cm), Castelo Branco, Leiria and Coimbra(171.31 cm) are the shortest. Comparing to published data from 1904, a positive seculartrend in height was found. The average increase was 8.93 cm, which yields a rate of 0.99 cmper decade. This positive trend must be related to the general improvement in the popula-tion’s standard living conditions that took place in Portugal mainly after the 1960s and1970s, especially in terms of nutrition and the health system. However, taking into accountthe differences that still exist in mean height values between the districts, these results suggestthat there are still great social inequalities in Portugal and the secular trend in height willcontinue for the Portuguese population in future decades.

1. Introduction

Since the end of the 19th century a positive secular trend towards a taller adultstature can be found in almost every country in Europe, North America and Japan.Human adult height represents the end-product of a continuous and often non-additive interaction between genetic and environmental forces. The most importantenvironmental factors to influence secular trends are nutrition and health. Indirectfactors affecting nutrition (both qualitatively and quantitatively) and health arealterations in socio-economic living conditions, social and health care (preventiveand curative), minimum income, quality of food preparation, better sanitary con-ditions, mass vaccination, and level of education (van Wieringen 1986, Tanner 1992,Hauspie et al. 1996, Bodzsar and Susanne 1998). Growth of a population can there-fore be used as a ‘mirror of conditions in society’ (Tanner 1986). In recent years,economic historians, led by Robert Fogel (1982), have used data on the heights ofvarious populations over the last 150 years to trace their economic fortunes and evento predict their trends in mortality and morbidity. Adult height has been found to bea predictor of mortality from coronary heart disease, and to lesser extend otherdiseases (Waaler 1984, Barker et al. 1990). Some research has suggested that it isenvironmental influences during childhood that cause adult differences betweenpopulation subgroups (Nystrom Peck and Lundberg 1995).

Adult height reached a plateau during the mid-1980s in some developed Europeancountries, which suggests that they are possibly about to achieve their full geneticpotential or that their social conditions have ceased to improve. In the Europeancountries the secular trend is more marked amongst the lower social classes thanin the upper ones (Susanne and Heyne 1972, Low et al. 1981, 1982, Laska-Mierzejewska et al. 1982, Chinn et al. 1989, Vercauteren 1993). The aim of the

ANNALS OF HUMAN BIOLOGY

MAY–JUNE 2003, VOL. 30, NO. 3, 262–278

Annals of Human Biology ISSN 0301–4460 print/ISSN 1464–5033 online # 2003 Taylor & Francis Ltdhttp://www.tandf.co.uk/journals

DOI: 10.1080/0301446031000064530

present study is examine how social and economic changes that took place inPortugal during the 20th century relate to changes in adult height between 1904and 2000 in a sample of 18-year-old Portuguese males. Regional differences, from1904 to 2000, will also be analysed in this large sample of Portuguese males.

1.1. Social changes in PortugalIn contrast to many other European countries, that had important social and

economic changes after World War II, the general improvement in the living con-ditions of the Portuguese population took place late during the 1960s. At that time,from the demographic point of view, Portugal was, at the begin of 1960, a verydifferent country in Europe: it had the highest proportion of young people (lessthan 15 years), the lowest proportion of old people (more than 65 years), thelowest life expectancy at birth, the highest rate of natality and the highest rate ofinfant mortality. After 40 years, these values are very different. It is the country withthe lowest population growth rate, and the proportion of young and old people arenow similar to average European values that presented 18% and 15%, respectively.Life expectancy at birth is still one of the lowest (70.3 for men and 77.5 years forwomen) but close to the average European values (74 years), the birth rate is similarto the European mean, and the infant mortality rate (10.8) is also similar to otherEuropean countries (9) (Barreto 1996, 2000, PNUD 2001).

However, there are some specific factors in the social and economic evolution ofthe Portuguese population. The first is the rate of emigration to Europe, especially toFrance, and the second one is the internal migration from the countryside to thecities, especially to Lisboa and Porto. In 1990 almost 40% of the Portuguese popu-lation live in the Lisboa and Porto areas (Barreto 1996, 2000).

The industrial sector showed, also, an acceleration in the 1960s. But, in contrast toall the other European countries, services will be the more important economicsector and not industry.

An indirect consequence of these deep changes in social and economic structureswas a global improvement of living conditions during the past 40 years.

2. Materials and methods

2.1. SampleData were obtained from the records of the medical examination at the District

Recruiting Centres of Portugal (north, centre and south). Military service is compul-sory in Portugal. The entire cohort of males born in a given year is examined bymilitary physicians during the registration visit lasting 3 days. The sample can thus beregarded as representing all regions of the country and all the social strata (figure 1).

The sample includes all the Portuguese 18-year-old males born between 1966 and1982 and examined between 1985 and 2000 (995 101 subjects). Mean height valueswill be presented in a table for those examined in 1985, 1990 and 2000 and the meansfor each year, from 1985 to 2000, will be presented in a figure. Data published byLacerda (1904) for all the districts of Portugal, also in 18-year-old conscripts anddata published by Sobral (1980) for the years 1930–1980 just for the south ofPortugal (districts of Lisboa, Setubal, Evora and Beja), also in conscripts, werealso considered.

In the medical examination, height was measured to the nearest centimetre.

Secular trend in stature in Portugal 263

2.2. Social dataLocalities of the subject’s residence by districts (i.e. administrative region) were

also obtained. In Portugal there are 20 districts. Two of them (Amores and Madeira)are islands located in the Atlantic Ocean (figure 1).

2.3. Vital statisticsData concerning demography, health, economy, nutrition and house conditions

for 1920–1990 were collected from the statistical yearbooks published by theNational Institute of Statistics (INE). For same variables, e.g. housing conditions,we only have data after 1960.

For demography and health the following indicators were collected: birth rate,age distribution, infant and post-neonatal mortality rate, life expectancy, adult lit-eracy, number of physicians per 1000 population, maternal mortality and born at thematernity (%).

For economy, the population (%) in the three economic sectors (agricultural,industry and services) were collected. For house conditions, the following were

264 C. Padez

Figure 1. Districts of Portugal where conscript data were sampled. 1, Viana do Castelo; 2, Braga; 3, VilaReal; 4, Braganca; 5, Porto; 6, Aveiro; 7, Viseu; 8, Guarda; 9, Coimbra; 10, Castelo Branco; 11, Leiria;12, Lisboa; 13, Santarem; 14, Portalegre; 15, Evora; 16, Setubal; 17, Beja; 18, Faro; 19, Acores; 20,Madeira.

collected: tap water, shower and bathing tub, sanitary equipment and seweragesystems.

Data concerning total daily energy intake (calories per day) of some products,between 1963 and 1997, and the programme of milk supply in elementary schoolswere also analysed.

For some variables only the total will be considered, for others such as populationsize, age distribution, post-neonatal mortality rate and the three economic sectorsthe distribution in each district will be presented.

2.4. Statistical analysisOne-way ANOVA for height and locality of subject residence, the 20 districts, was

carried out.

3. Results

3.1. Socio-demographic and health characteristicsTable 1 summarizes the evolution of some socio-demographic and health system

characteristics in Portugal during the 20th century. From 1920 to 1990, birth rate,

Table 1. Evolution of some socio-demographic and health system characteristics in Portugal between1920 and 1990.*

1920 1930 1940 1950 1960 1970 1980 1990

DemographyBirth rate1 33.6 29.7 24.3 24.3 24.1 20.9 16.13 11.8Age group < 15 years 32.6 31.9 31.8 29.2 29.2 28.5 25.5 20Age group � 65 years 5.9 6.2 6.4 6.9 8 9.7 11.5 13.6Fecundity index2 – 3.9 3.2 3.2 3.2 3 2.2 1.5Infant mortality rate3 177 144 126 94.1 77.5 55.5 21.8 10.8Post-neonatal mortality rate4 – 95.5 87.5 62.9 46.77 31.86 10.46 3.34Life expectancy—men (years) 35.8 44.8 48.6 55.5 60.7 64.2 69.3 70.3Life expectancy—women (years) 40 49.2 52.8 60.5 66.4 70.8 75.3 77.5Adult literacy (%) 34.6 39.6 46.4 58.3 66.9 74.4 81.4 89

HealthNumber of physicians per 1000population

352 508 1056 1256

Maternal mortality5 – 741 752 355 115.5 73.4 19 10.3Born at the maternity (%) – – – – 18.4 37.5 73.8 95.5

EconomyAgricultural sector – 48.2 51.4 49.4 43.3 39.7 19.4 10.6Industrial sector – 17.3 19.7 23.8 28.7 40 38.8 37.2Services – 34.5 28.9 26.8 28 20.3 41.8 50.4

Housing conditionsTap water (%) – – – – 28.9 47.4 72.4 86.8Shower and bathing tub (%) – – – – 18.6 28.7 58.2 81.8Sanitary equipment (%) – – – – 41.8 58.1 79.1 88.5Electricity (%) – – – – 40.5 63.8 90.7 97.7Sewerage systems (%) – – – – 38.3 58.1 68 90.7

*Adapted from Barreto (1996, 2000).1Number of births per 1000 of population.2Number of children, on average, for each women during their reproductive life (15–49 years).3Deaths, from birth to 1 year of life per 1000 live births.4Deaths, from 1 month to 1 year of life per 1000 live births.5Deaths per 100 000 women.

the percentage of young people (< 15 years), infant mortality rate as well as post-neonatal mortality rate all showed a strong decrease in their values. And, at the sametime, the percentage of old people, life expectancy in both sexes, and adult literacyincreased.

The health system of Portugal also showed large changes. Between 1960 and 1990,the number of physicians per 1000 population and the percentage of newborns thatwere delivered at a hospital increased. On the other hand, maternal mortalitydecreased.

In the economic sector, the agricultural system decreased from 48.2% in 1930 to10.6% in 1990. On the other hand, the industrial and services sectors both increasedin the same period, especially the industrial sector.

From 1960 to 1990, the percentage of houses with tap water increased from 28.9%to 86.8%. Those with shower and bathing tub increased from 18.6% to 81.8%.Homes with sanitary equipment (indoor toilets) increased from 41.8 to 88.5%.Homes with electricity increased from 40.5% to 97.7%. Finally, in 1960 a seweragesystem was present in just 38.35% of houses while in 1990 90.7% of the houses had asewerage system.

Taking into account the changes in nutrition in the Portuguese population, table 2presents the total daily energy intake of some products. From the 1960s to the 1990s,the consumption of some products increased very much, such as milk (76 to 237cal day–1), meat (78 to 328 cal day–1), fats (407 to 788 cal day–1), sugar (209 to 350cal day–1), eggs (14 to 30 cal day–1) and alcohol (172 to 196 cal day–1). The consump-tion of calories increased from 2671 to 3577 calories, between 1960 and 1990.

In 1972, a programme of milk supply started in Portugal in elementary schools.The number of students that took advantage of this programme increased from 1972(22 000 students) to 1986 (795 327 students), with the greatest increment in 1975/76(Henriques and Henriques 1990).

266 C. Padez

Table 2. Total daily energy intake (cal day–1).*

1963 1970 1980 1985 1990 1995 1997

Cereal and rice 1281 1185 1059 1117 1097 1127 1142Tuber 226 272 335 319 326 318 294Sugar 209 279 344 332 335 345 350Dry vegetables 64 68 34 30 48 41 38Fresh vegetables 84 112 48 49 61 62 65Fruits 156 160 84 96 142 164 172Meat 78 123 197 192 270 312 328Eggs 14 16 21 25 29 30 30Milk 76 117 140 172 213 227 237Fish 73 95 65 71 79 81 78Fats 407 518 617 687 734 784 788Alcohol 172 158 191 – 222 208 196Calories 2671 2940 2980 3127 3389 3544 3577Calories 2843 3098 3093 – 3601 3752 3773Proteins (g) – – 87.9 92.2 108.5 115.1 116.5Fats (g) – – 99.7 109.3 123.7 132.7 135.3HC (g) – – 432.9 443.7 463.5 476.6 477.9

*Adapted from Barreto (1996, 2000).Calories with alcohol.HC,

3.1.1. Population size. The evolution of population size in the Portuguese dis-

tricts can be grouped in three patterns. The first is districts located more inland,

such as Vila Real, Braganca, Guarda, Castelo Branco, Portalegre, Evora and

Beja. These inland districts increased their population size until the 1950s and

after that a large decrease occurred. With the exception of Evora, all the other dis-

tricts now have a smaller population size than in 1911 (figure 2a). The second pat-

tern is seen in the districts located in the centre—Coimbra, Leiria, Viseu and

Santarem. Despite the decrease that occurred in the 1970s, these areas show anoverall increase in their population size (figure 2b). The third pattern is for dis-

tricts located on the littoral—Viana do Castelo, Braga, Porto, Aveiro, Lisboa,

Figure 2. Evolution of population size in the districts located (a) more inland, (b) in the centre, and(c) on the littoral in Portugal.

Setubal and Faro. Viana do Castelo and Faro showed a small increase, but the

others had a strong increase in their population size mainly after the 1970s (figure

2c). Lisboa and Porto, the two biggest cities, increased three times their popula-

tion size during the 20th century. In 1990 the population of both cities represented

almost 40% of all the Portuguese population.

268 C. Padez

Figure 3. Post-neonatal mortality rate, from 1930 until 1990, in each district of Portugal.

Figure 4. Distribution of the percentage of (a) young people (<15 years) and (b) old people (>65years), in each district of Portugal.

3.1.2. Post-neonatal mortality rate and age distribution. Figure 3 shows the

changes in the post-neonatal mortality rate between 1930 and 1990. It is obvious

that a striking decreased occurred in all the districts in that period of time. The

greatest decreases occurred after the 1940s and the 1970s. In the last period (1990)

Braganca, Castelo Branco, Vila Real, Guarda, Viseu and Madeira show the high-

est rate, and Beja, Coimbra, Leiria, Santarem and Viana do Castelo show the

smallest value.

In figure 4 the percentage of young people (less than 15 years) and old people

(more than 65 years) are presented for each district. For all the districts the percen-

tage of young people decreased deeply and the percentage of old people increased.

These changes both took place mainly after 1980s, for the percentage of young

people and after the 1970s for old people.

Table 3. Distribution of the agricultural (A), industrial (I) and service (S) sectors (%) in each district,from 1950 to 1990.

District

1950 1960 1970 1980 1990

A I S A I S A I S A I S A I S

Aveiro 56 31 14 39 42 20 28 48 24 22 52 26 9.4 55 35Beja 75 10 15 75 10 15 68 11 21 41 20 33 27 23 50Braga 48 34 18 42 40 18 33 48 19 19 56 25 8.3 61 31Braganca 74 9.9 16 76 11 13 73 8.8 18 52 19 29 35 18 47C. Branco 61 21 17 60 24 17 51 28 22 33 35 32 18 39 44Coimbra 49 24 27 43 29 28 42 26 32 25 34 41 14 34 52Evora 66 14 20 64 15 22 52 19 29 38 24 38 22 28 50Faro 61 18 21 60 23 19 45 25 30 25 28 47 14 22 64Guarda 71 14 15 69 16 16 61 21 19 44 30 26 27 32 41Leiria 62 20 18 58 26 17 44 33 23 27 42 31 13 46 41Lisboa 19 27 54 14 32 54 5.8 30 64 4.3 33 63 2.5 27 70Portalegre 66 14 20 66 15 20 60 16 24 36 24 40 21 25 54Porto 26 42 33 19 48 33 9.8 48 42 8.1 51 41 3.8 51 46Santarem 64 18 19 56 23 21 44 28 28 27 36 37 16 36 48Setubal 43 30 27 35 38 28 21 41 38 9.6 44 46 5.7 34 61V. Castelo 66 17 18 63 21 17 65 19 16 47 29 24 29 33 38Vila Real 74 9.2 17 76 9.8 14 70 11 19 54 18 28 38 20 43Viseu 71 13 16 71 13 16 66 16 19 51 24 26 31 29 40Acores 64.2 15 20.8 60.6 16.8 22.6 50.3 17.4 28.2 31.4 15.8 52.8 19.4 23.1 58Madeira 59 19 23 54 22 24 36 35 32 21 32 47 16 27 57

Figure 5. Secular trend in height in the Portuguese population (1904–2000).

In 1990, the districts of Braga, Porto, Viana do Castelo, Vila Real, Viseu, Acoresand Madeira had the highest percentage of young people (less than 15 years). On theother hand, Beja, Castelo Branco, Evora, Guarda and Portalegre showed the highestproportion of old people (more than 65 years).

3.1.3. Agricultural, industrial and service sectors. Table 3 presents the distribu-tion, in percentages, of the agricultural (A), industrial (I) and service (S) sectors ofthe Portuguese economy.

Agricultural activity decreased in all the districts from 1950 to 1990. The greatestdecrease occurred after the 1970s and 1980s. In 1990, Beja, Braganca, Evora,Guarda, Viana do Castelo, Vila Real and Viseu showed the highest values, andLisboa, Porto and Setubal the smallest values.

The industrial and service sectors increased in all the districts between 1950 and1990. The greatest increase occurred between 1970 and 1980. In 1990, Aveiro, Braga,Leiria, Porto and Setubal showed the highest values for the industrial sector andBeja, Braganca, Faro and Vila Real showed the lowest values. In the service sector,in 1990, Faro, Lisboa and Setubal presented the highest values and Aveiro andBraga the lowest ones.

3.2. Secular trend in heightFigure 5 shows that a positive secular trend in height occurred in the Portuguese

male population between 1904 and 2000. In 1904, the mean height was 163.2 cm andin 2000 it was 172.13 cm (table 4). The average increase was 8.93 cm, which yields a

270 C. Padez

Table 4. Mean heights for Portuguese 18-year-old males in each district of Portugal in 1904, 1985, 1990and 2000. One-way ANOVA (F) between the 20 districts.

District

Examined in 1904{ Examined in 1985 Examined in 1990 Examined in 2000

n Mean n Mean�SD n Mean� SD n Mean�SD

Aveiro 3509 164.06 5404 168.09� 6.23 2208 170.08� 6.6 2882 171.93� 6.44Beja 1834 162.3 1597 169.76� 6.42 358 171.22� 6.6 767 171.42� 6.12Braga 555 163.95 7343 168.28� 6.16 3184 170.96� 6.24 5015 172.67� 6.3Braganca 210 160.3 1647 168.71� 6.06 719 170.87� 6.37 736 171.84� 6.3C. Branco 1671 160.4 1725 168.04� 6.1 740 170.98� 6.31 855 171.31� 6.4Coimbra 4983 162.58 3305 168.55� 6.39 1530 171.08� 6.58 1984 171.31� 6.4Evora 995 164.04 1405 170.15� 6.24 425 172.2� 6.33 840 171.72� 6.62Faro 2625 165 2000 170.37� 6.4 681 171.93� 6.41 1255 172.59� 6.43Guarda 378 160.5 1630 167.13� 6.36 603 169.69� 5.54 827 171.46� 6.15Leiria 410 162.1 3251 168.0� 6.15 1377 170.56� 6.35 1820 171.31� 6.46Lisboa 1319 164.2 12 860 171.58� 6.52 5529 172.75� 6.36 6395 172.79� 6.47Portalegre 410 162.3 1167 169.51� 6.28 370 171.52� 6.17 563 172.59� 6.54Porto 1213 163.8 14 346 168.97� 6.4 6069 171.56� 6.37 8092 172.25� 6.31Santarem 1050 164.7 3307 169.13� 6.16 1411 171.32� 6.28 1722 171.42� 6.09Setubal 450 164.48 2840 171.34� 6.23 1137 173.09� 6.01 1453 172.17� 6.4V. Castelo 1972 163.88 2127 168.71� 6.22 884 171.57� 6.48 1256 172.05� 6.25Vila Real 2095 163.3 2663 168.11� 6.24 1029 171.19� 6.27 1423 171.98� 6.4Viseu 2104 162.58 4138 167.52� 6.25 1537 169.77� 6.51 2281 171.84� 6.26Acores – – 1801 169.58� 6.41 1573 170.07� 6.69 1340 172.96� 6.43Madeira – – 2091 169.48� 6.53 1807 170.97� 6.35 1078 170.67� 6.3Total 27 783 163.2 76 647 169.24� 6.46 33 270 171.38� 6.45 42 584 172.13� 6.38F F ¼ 179:941* F ¼ 33:42* F ¼ 17:28*

{ In Lacerda (1904).*p � 0:001.

rate of secular increase of 0.99 cm per decade. Those mean increments that occurred

during this period of time range from 6.72 cm (Santarem) to 11.54 cm (Braganca). It

is clear from figure 6 that the greatest increments took place in those districts withthe smallest mean height in 1904, namely Castelo Branco, Guarda, Braganca, Beja

and Portalegre. On the other hand, Santarem, Evora and Faro showed the lowestincrements and the highest mean heights in 1904.

3.3. Regional differencesTable 4 and figure 6 show the mean values of heights for Portuguese 18-year-old

males in each district of Portugal. The mean values for heights in 1904, collectedfrom previously published data, were also represented. These data were also

obtained from the records of the medical examination at the District Recruiting

Centres of Portugal, which means that it could be compared with present data.The one-way ANOVA for the mean height shows statistically significant differ-

ences among the localities of subject’s residence in 1985 (F ¼ 179:941, p � 0:001), in1990 (F ¼ 33:42, p � 0:001) and still in 2000 (F ¼ 17:28, p � 0:001). In 2000, the 18-

year-old males from Lisboa and Braga are the tallest and those from Madeira andCoimbra the shortest. However we should stress that, despite the significant differ-

ences that occurred in 2000 among the districts, the range between the tallest andshortest males is now much smaller (2.29 cm) than it was in 1904 (4.7 cm). Even in

1985 the difference between the tallest and the shortest males was very high

(4.45 cm). We used the present place of residence, which is not an indicator ofhow long subjects have lived in the same residence. However, for each district the

difference between mean height for residence and for place of birth are not statisti-cally significant (data not shown).

Figure 6. Mean height of Portuguese 18-year-old males, in each district of Portugal, in 1904 and2000, and the increments between 1904 and 2000.

4. Discussion

This study of secular trend in Portugal has shown that a positive increment in

height occurred in Portuguese 18-year-old males between 1904 and 2000. The overall

increase in this period was 8.93 cm, which yields a rate of 0.99 cm per decade. This

increment is similar to the average rates of secular increase that took place during

this century in most Western and industrialized countries. The secular increase in

adult height varied between 0.3 and 3.0 cm per decade (Eveleth and Tanner 1990,

Hauspie et al. 1996). At present, the average final height is 172.13 cm. Despite this

increase, the Portuguese are the shortest in Europe. The most recent published data

indicate mean males heights of: Spain—173.8 cm (Rebato 1998); France—174.9 cm

(Pineau 1993); Belgium—176.8 cm (Vercauteren 1993); Bulgaria—173.6 cm (Stoev

and Yordanov 1998); Czech Republic—178.84 cm (Vignerova and Blaha 1998);

Austria—177.5 (Weber et al. 1995); England—175.7 cm (Rosenbaum et al. 1985);

Poland—176.86 cm (Bielicki and Waliszk 1991); Greece—177.6 cm (Manolis et al.

1995); Hungary—178.5 cm (Gyenis 1997); Sweden—179.5 cm (Tuvemo et al. 1999);

and Netherlands—184 cm (Fredriks et al. 2000).

As in almost all the other countries, the rate of secular increase was not constant

during the overall period. Taking into account our results, for 2000, and those

published by Sobral (1990) just for the same districts that both of us analysed

(Lisboa, Setubal, Evora and Beja for 1930–1980), we obtain the following rates:

1.21 cm for 1930–1940, 0.74 cm for 1940–1950, 0.7 cm for 1950–1960, 1.11 cm for

1960–1970, 2.7 cm for 1970–1980, 1.68 cm for 1980–1990 and 0.75 cm for 1990–2000.

From these values, it is clear that the greatest rates occurred between the 1960s and

the 1970s. This variability of rates was also found in other countries, such as

Poland—2.4 cm in 1965–1976, 2.1 cm in 1976–1986 and 1.8 between 1986 and

1995 (Bielick and Szklarska 1999); in Zagreb—3 cm in 1951–1964, 0.6 cm in 1964–

1973, 2.5 cm in 1973–1982 and 0.6 cm in 1982–1991 (Prebeg et al. 1995); in Austria—

0.8 cm for birth years 1962–1966 and 1.3 cm for 1972–1975 (Weber et al. 1995); in

Italy—6.4 cm in 1874–1951 and 2.6 cm in 1951–1960 (Ullizi and Terrenato 1982); in

the Netherlands—2.7 cm in 1955–1965, 2.0 cm in 1965–1980 and 1.3 cm in 1980–1997

(Fredriks et al. 2000); in the Czech Republic—0.9 cm in 1951–1961, 2.08 cm in 1961–

1971, 1.77 cm in 1971–1981 and 0.69 cm in 1981–1991 (Vignerova and Blaha 1998);

in Spain—1.4 cm in 1960–1970, 3.2 cm in 1970–1980 and 2.5 cm in 1980–1990

(Rebato 1998); and in Hungarian university students—1.49 cm in 1976–1985 and

0.89 cm in 1986–1990 (Gyenis 1997), just to compare some of the published data.

The overall positive secular trend in height in the Portuguese population, and the

greatest increase in adult height in those districts that were the shortest in 1904,

represents a general improvement in living conditions that occurred in Portugal after

the 1970s. Castelo Branco, Guarda, Braganca and Portalegre, some of the more

inland districts, were the shortest in 1904 but had the highest increments between

1904 and 2000, reaching values of 10.91 cm, 10.96 cm, 11.54 cm and 10.29 cm, re-

spectively. On the other hand, Santarem, Faro and Evora were the tallest in 1904 and

had the lowest increments between that period of time with values of 6.72, 7.59 and

7.68 cm, respectively. The first ones also had the highest post-neonatal mortality

rates in 1930, respectively 81.75, 116.05 and 96.11. The last ones had lower post-

neonatal mortality rates with 72.13, 81 and 90.23, respectively. This probably means

that the short heights of the first group were related to the worse living conditions of

their districts, according to post-neonatal mortality values.

272 C. Padez

This similarity was found in almost all the studied countries. In the Belgianpopulation, Vercauteren (1993) found that university students, from families of anabove-average socio-economic status, had a smallest increment on height (0.5 cm perdecade) than the sample of conscripts that represented the whole population (1.6 cmper decade). In France, Demoulin (1998) noted that the greatest increase was foundexactly in the departments where mean stature had initially been short. The 10departments with the smallest (<3 cm) increment in 1880–1960 showed the highestincrease of mean stature between 1960 and 1989 (on average 5.8 cm). By contrast, the10 departments with the highest increment (>6 cm) in 1880–1960 displayed thesmallest further increase of height (3.8 cm) between 1960 and 1989. Similar findingswere reported by Rebato (1998) in Spain. The regions that started with a small meansizes, namely Galicia, Andalusia, Extremadura and both Castilles, had the highestabsolute increase (5–6 cm from 1965 to 1985), in contrast with the increase recordedin the regions of traditionally taller stature as, for instance, the Basque country (lessthan 4 cm), or the 4 and 5 cm reported for Cantabria and Catalonia. Similar resultswere reported for the Austrian population (Weber et al. 1995). Between 1962 and1975, 18-year-old Austrian males from urban areas increased their height by only0.1 cm per decade, while their peers from rural areas showed a secular increase instature of 0.8 cm per decade during the same period. A different pattern was found inthe Polish population. In two large samples of conscripts (n=12711 and 31 155),aged 19 years, and examined in 1965 and 1995, a secular increase in height occurredin all the socio-economic groups, but was greatest for the upper social group (Bielickiet al. 1981, Bielicki and Waliszko 1991).

Socio-economic factors cannot influence growth directly, but have to act throughbiological factors such as nutrition and infection, both of which may influence con-script height (Sandberg and Steckel 1987, Floud et al. 1990, Floud 1994). Importantchanges took place in Portugal, mainly after the 1970s, in the nutrition pattern, thehealth care system, the economy and even in housing conditions.

The Portuguese nutrition pattern changed a great deal between 1960 and 1997.Consumption of some products, such as milk, meat, eggs, sugar, proteins and fats,increased considerably. In other populations like Italy, Ullizi and Terrenato (1982)stressed the importance of these dietary components on the secular trend on Italianconscripts born from 1874 and 1960. Another example is the Japanese population.Takahashi (1984) has linked the secular trend in height in Japan to the consumptionof milk, which has risen steeply since World War II and concluded that milk con-sumption among the younger generation was one of the most important causes ofthe acceleration of growth in height. In Portugal, besides the increase in milk con-sumption in the general population, a programme of milk supply in elementaryschools started in 1972/73 and increased especially after 1975/76. Some authorssuch as Bogin (1998, 1999) considered that milk is an important component thatinfluences positively the growth of children. Another important element is sugarconsumption, which increased from 209 to 350 cal day–1 between 1963 and 1997 inthe Portuguese population. Ziegler (1967) and Froment (1986) agree that theincrease in sugar consumption has implications for the secular trend too becauserefined sugars provide more rapidly accessible energy.

The Portuguese health system has made great improvements, mainly after the1940s and 1970s, as confirmed by the decrease in post-neonatal mortality values inall the districts, the increase in life expectancy and the specific increase in otherhealth care characteristics such the number of physicians per 1000 population, or

the percentage of newborn that were born at the maternity. The post-neonatal

mortality rate is regarded as a sensitive indicator of infant health for a population

(Kessel 1990). Infant nutritional status and the prevalence of infections are regarded

as the most important determinants of post-neonatal mortality (Stembera 1990).

These results are in a good agreement with those obtained by Schmidt et al.

(1995) who found that, among several European countries, the general trend is

that height increases toward a maximum when post-neonatal mortality approaches

zero. They speculate that adult height in the middle and southern European coun-

tries will continue to increase for approximately two decades after post-neonatal

mortality has reached a low and stable level at about 3–5 per 1000 deliveries.

Viewed in this perspective, and taking into account the post-neonatal mortality

values that still exist in 1990 in the districts analysed, we could still expect an increase

in the mean height of the adult Portuguese population in the future decades because

some of the districts still present a high rate, such as Braganca (8.03), Guarda (5.89),

Madeira (5.92), Viana do Castelo (5.93), Castelo Branco (4.73), Vila Real (5.93) and

Viseu (4.68). Those districts were also in the group of those with the shortest mean

heights in 2000.

The heights of recruits reflect the nutritional status of a population some 15–20

years before. Many studies suggested that adverse environmental factors have their

strongest effects during childhood (Brundtland et al. 1980, Nystrom Peck and

Vagero 1987, Tanner 1992, Nystrom Peck and Lundberg 1995, Schmidt et al.

1995, Wadsworth 1997, Cole 2000). The subjects of the analysed data were born

between 1966 and 1982. If their birth decade is paired with the socio-economic

changes described, namely those concerning nutrition, health system and economic

development, they were in their childhood or adolescence. This means that they were

the first ones to take advantage of those improvements in the living conditions,

especially to be able to afford better nutrition, a better health care system, a better

economy, in general a more comfortable way of life.

Even in a small country such as Portugal considerable regional differences

occurred in the course of secular changes. The differences are most prominent

between the inland and the littoral districts. In fact, those districts located more

inland like Guarda and Castelo Branco are still in the group of the shortest mean

heights. These were also the districts where the population size decreased during this

century, they continued to have the highest values in post-neonatal mortality and

they have the highest percentage of old people (age group > 65 years). However we

should stress that, despite the statistically significant differences that occurred in

2000 among the districts, the range between the tallest and shortest males is now

much smaller (2.29 cm) than it was in 1904 (4.7 cm). In 1985 the difference between

the tallest and the shortest males was very high (4.45 cm) and decreased to 3.4 cm in

1990. This means that in 15 years, from 1985 to 2000, the difference decreased for

almost half, from 4.45 cm to 2.29 cm and between 1904 and 1985, in 81 years, the

changes were very small. This shows that it was the social, economic and health

changes that took place after the 1960s and 1970s that were responsible for this

positive trend. The explanation for their shortest height must be related to their

lowest height in 1904, and this was probably because at that time those districts

had also poor living conditions according to their values of post-neonatal mortality

rate. In 1930, the highest values of post-neonatal mortality rate were in Lisbon,

Porto and Setubal, the biggest cities, and then in the inland districts such as

274 C. Padez

Guarda (116.05), Braganca (96.11) and Castelo Branco (81.75). At the economiclevel, they were also districts with a high percentage of agricultural activity.

It is difficult to define which indicator would be the most representative of envir-onmental improvement because they are always intricate and they are the result of allthe social and economic changes of the Portuguese society in the last decades but, inthis country, we can make the hypothesis that the health system had the strongesteffect and must be the best ‘mirror’ of Portuguese living conditions.

Data on secular change in the maturity of males are not available, but age atmenarche decreased from 15 years in 1880–1890 to 12.4 years in 1980 (Rocha et al.1998). Corresponding changes can be assumed in the male population. This impliesthat recruits in 1904 probably did not achieve their final height at 18 years. It shouldbe noted, however, that Lacerda (1904) added 1 cm to the height values to avoid thisproblem.

In summary, these results demonstrated that a positive secular increase in adultheight is occurring, like that which took place over all the European countries, and isstill continuing in several countries. Great socio-economic changes took place inPortugal, especially in terms of nutrition and the health system. We could concludethat these improvements are reflected in the increase of mean adult heights.Nevertheless, and despite these positive changes, some regional differences(2.76 cm) still exist between the districts located more inland and those in the littoral.And, as we found in another work (Padez and Johnston 1999), social differences arestill present in the Portuguese population. We found a difference of almost 4 cm inheight between the two extremes of parents’ educational level. This suggests that onecould expect that height will continue to increase in the Portuguese population in thefuture decades because the pattern of living conditions will continue to improve.

Acknowledgement

We thank the Portuguese Army High Command (Estado Maior do Exercito) fortheir kindness in providing all the raw data.

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Address for correspondence: Cristina Padez, Departamento de Antropologia, Universidade de Coim-bra, 3000-056 Coimbra, Portugal. Email: cpadez@ci.uc.pt

Zusammenfassung. Die Untersuchungsprotokolle fur die Korperhohe von 995101 18jahrigen Portugiesenwurden analysiert und u.a. auch die Relationen zwischen der Wohngegend (Distrikte) und derFinalkorperhohe betrachtet. Die Stichprobe umfasste alle Portugiesen im Alter von 18 Jahren, diezwischen 1966 und 1982 geboren wurden. Die Untersuchungen fanden im Zeitraum zwischen 1985 und2000 in Nord-, Zentral- und Sudportugal statt und erfassten alle sozialen Schichten. Statistisch signifikanteDifferenzen (p < 0:001) wurden zwischen folgenden Distrikten gefunden:Manner von Lissabon (172.79 cm) und Braga (172.76 cm), als den am weitesten entwickelten Regionen,weisen die großten Korperhohen auf. Diejenigen vonMadeira (170.67 cm), C. Branco, Leiria und Coimbra(171.3 cm) haben die durchschnittlich kleinsten Korperhohen. Im Vergleich zu den 1904 publiziertenDaten wurde ein positiver sakularer Trend gefunden. Der durchschnittliche Anstieg der Korperhohebetrug in diesem Zeitraum 8.93 cm, was einer Zunahme von 0.99 cm pro Dekade entspricht. Dieser positiveTrend ist in Beziehung zu sehen mit der generellen Verbesserung des Lebensstandards der Bevolkerung,welche in Portugal hauptsachlich in den 60er und 70er Jahren vor allem im Hinblick auf die Ernahrungund das Gseundheitssystem stattgefunden hat. Berucksichtigend, dass die Differzen, welche hinsichtlichder Korperhohe noch zwischen den Distrikten existieren, leigt es nahe festzustellen, dass sie Folge dergroßen sozialen Unterschiede in Portugal sind, und dass der sakulare Trend der Korperhohe in derportugiesischen Population auch in den kommenden Dekaden weiterbestehen wird.

Resume. Les enregistrements de la stature de 995101 jeunes hommes portugais de 18 ans ont ete analyses,ainsi que la relation entre les localites de residence des sujets (districts) et stature finale. L’eechantilloncomprend tous les jeunes hommes portugais de 18 ans nes entre 1966 et 1982 et examines entre 1985 et2000, dans le nord, le centre et le sud du Portugal et representant toutes les strates sociales. Des differencesstatistiquement significatives (p # 0.001) ont ete trouvees entre les districts. Les hommes de Lisbonne(172,79 cm) et de Braga (172,67 cm) qui sont les districts les plus developpes, sont les plus grands et ceux deMadere (170,67 cm), C. Branco, Leiria et Coımbra (171,31 cm) sont les plus petits. La comparaison avecdes donnees publiees depuis 1904 montre l’existence d’une tendance seculaire d’accroissement de la stature.L’augmentation moyenne est de 8,93 cm, ce qui correspond a un rythme de 0,99 cm par decennie. Cettetendance positive doit etre associee a l’amelioration generale des conditions de vie de la population quis’est essentiellement affirmee au Portugal apres les annees soixante et soixante-dix, notamment en termesde nutrition et de systeme de sante. Cependant, si l’on tient compte des differences qui existent encore dansles valeurs moyennes de la stature entre districts, ces resultats suggerent qui’il y a encore de grandesinegalites sociales au Portugal et que la tendance seculaire se poursuivra pendant les prochaines decennies.

Resumen. Se analizaron los registros de la estatura de 995.101 varones portugueses de 18 anos de edad,ası como la relacion entre las localidades de residencia (distritos) de los sujetos y la estatura final. Lamuestra incluıa a todos los varones portugueses de 18 anos de edad nacidos entre 1966 y 198 y examinadosentre 1985 y 2000, en el norte, centro y sur de Portugal, representando a todos los estratos sociales. Seencontraron diferencias estadısticamente significativas (p � 0; 001) entre los distritos: los varones de Lis-boa (172,79 cm) y de Braga (172,67 cm), los distritos mas desarrollados, son los mas altos, y los de Madeira(170,67 cm), Castelo Branco, Leiria y Coimbra (171,31 cm) los mas bajos. Comparados con los datospublicados desde 1904, se encontro una tendencia secular positiva para la estatura. El incrementomedio fue de 8,93 cm, lo que arroja una tasa de 0,99 cm por decada. Esta tendencia positiva debe rela-cionarse con la mejora general en los estandares de las condiciones que vida de la poblacion, que tuvolugar en Portugal sobre todo a partir de los anos 1960 y 1970, especialmente en terminos de nutricion y enel sistema sanitario. Sin embargo, teniendo en cuenta las diferencias que aun existen en los valores mediosde estatura entre los distritos, estos resultados sugieren que hay todavıa grandes desigualdades sociales enPortugal, y que la tendencia secular en estatura continuara para la poblacion portuguesa en las futurasdecadas.

278 C. Padez

Secular trend in stature in the Portuguese population (1904–2000)

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