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An assessment of maturity from

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 Physical Fitness and Performance

An assessment of maturity from

anthropometric measurements
ROBERT L. MIRWALD, ADAM D. G. BAXTER-JONES, DONALD A. BAILEY, and GASTON P. BEUNEN
College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, CANADA; Department of Human
Movement Studies, University of Queensland, Brisbane, AUSTRALIA; and Department of Sport and Movement Sciences,
Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven, Leuven, BELGIUM

ABSTRACT
MIRWALD, R. L., A. D. G. BAXTER-JONES, D. A. BAILEY, and G. P. BEUNEN. An assessment of maturity from anthropometric
measurements. Med. Sci. Sports Exerc., Vol. 34, No. 4, pp. 689 – 694, 2002. Purpose: The range of variability between individuals of
the same chronological age (CA) in somatic and biological maturity is large and especially accentuated around the adolescent growth
spurt. Maturity assessment is an important consideration when dealing with adolescents, from both a research perspective and youth
sports stratification. A noninvasive, practical method predicting years from peak height velocity (a maturity offset value) by using
anthropometric variables is developed in one sample and cross-validated in two different samples. Methods: Gender specific multiple
regression equations were calculated on a sample of 152 Canadian children aged 8 –16 yr (79 boys; 73 girls) who were followed through
adolescence from 1991 to 1997. The equations included three somatic dimensions (height, sitting height, and leg length), CA, and their
interactions. The equations were cross-validated on a combined sample of Canadian (71 boys, 40 girls measured from 1964 through
1973) and Flemish children (50 boys, 48 girls measured from 1985 through 1999). Results: The coefficient of determination (R2) for
the boys’ model was 0.92 and for the girls’ model 0.91; the SEEs were 0.49 and 0.50, respectively. Mean difference between actual
and predicted maturity offset for the verification samples was 0.24 (SD 0.65) yr in boys and 0.001 (SD 0.68) yr in girls. Conclusion:
Although the cross-validation meets statistical standards for acceptance, caution is warranted with regard to implementation. It is
recommended that maturity offset be considered as a categorical rather than a continuous assessment. Nevertheless, the equations
presented are a reliable, noninvasive and a practical solution for the measure of biological maturity for matching adolescent athletes
Key Words: CHILDREN, ADOLESCENCE, GROWTH SPURT, PUBERTY, MATURITY, LONGITUDINAL STUDY

I
t is essential that all prospective studies in children, both mains the only accepted classification criterion. To date,
in context of youth sport classification and research maturity status has rarely been a factor used in participant
investigations, attempt to control for maturity. Matching classification into youth sports.
children to equalize competition, enhance chance for suc- Chronological age is of limited utility in the assessment of
cess, and reduce injury is an objective that many coaches growth and maturation (14). The need to assess maturation,
and health professionals have emphasized (3,15). Maturity the tempo and timing of the progress toward the mature
assessment has specific application in the classification of state, is imperative in the study of child growth. Although
children for sport during the adolescent period. The range of existing methodology provides the required mechanism to
variability between individuals of the same chronological assess maturation, there are limitations to the available
age in somatic and biological growth is large and especially methodologies (4). Skeletal age assessment, the single best
accentuated around the adolescent growth spurt maturational index, is costly, requires specialized equipment
(13,17,18,26). The formal methodologies to assess matura- and interpretation and incurs radiation safety issues. Al-
tion are beyond the resources of sport-governing bodies or though the methodology covers the entire period of growth
youth sport organizations and, therefore, the need to revert from birth to maturity, it does not lend itself to fieldwork.
to chronological age as the classification criteria. Despite Dental age and morphological age are broader measurement
the major maturity-related differences in height, weight, techniques with limited applicability. The assessment of
strength, speed, and endurance of children at identical chro- secondary sex characteristics is limited to the adolescent
nological age classifications (16,19), chronological age re- period and in a nonclinical situation is considered to be
personally intrusive by adolescent children and their par-
0195-9131/02/3404-0689/$3.00/0 ents. In addition to a limited application period, secondary
MEDICINE & SCIENCE IN SPORTS & EXERCISE® sex characteristics do not reflect the timing of growth.
Copyright © 2002 by the American College of Sports Medicine Somatic methods like age of peak height velocity (PHV) or
Submitted for publication June 2001. the differential growth associated with regional growth require
Accepted for publication August 2001. serial measurements for a number of years surrounding the
689
 The verification samples were children taken from the
Saskatchewan Growth and Development Study (SGDS) and
the Leuven Longitudinal Twin Study (LLTS). The SGDS
consisted of 207 7-yr-old boys who were randomly selected
on a stratified socioeconomic basis from the elementary
school system in Saskatoon, SK, and who were measured
annually from 1964 to 1973. The girls’ sample was drawn in
a similar fashion as the boys’ sample. However, the boys’
sample was a pure longitudinal design whereas the girls’
sample followed a mixed longitudinal design, with smaller
groups of subjects added each year and followed longitudi-
nally. A complete description of the study’s testing protocol,
sampling, analytical techniques, and ethical consent is avail-
FIGURE 1—Timing of peak velocities in (a) boys’ and (b) girls’ height, able elsewhere (20). The LLTS measured 95 twin pairs at
sitting height, and leg length. semiannual intervals between 10 and 16 yr and at 18 yr. This
study ran from 1985 through to 1999 with the intake spread
occurrence of peak velocity and thus are unusable in a one-off over several years; again, details of the study including
measurement in time. ethical consent can be found elsewhere (5). To be included
Age of PHV is the most commonly used indicator of in the present analysis, subjects required an age of peak
maturity in longitudinal studies of adolescence (16). It pro- height velocity. The number of subjects from each study
vides an accurate benchmark of the maximum growth dur- meeting this criterion are shown in Table 1.
ing adolescence and provides a common landmark to reflect Measurements. For both Canadian studies, identical
the occurrence of other body dimension velocities within anthropometric measurements were taken. Height and sit-
and between individuals. Using the known differential tim- ting height were measured to the nearest mm, body mass to
ings of growth of height, sitting height and leg length (Fig. the nearest 0.1 kg. Two measurements were taken for each
1) we hypothesized that the changing relationship between anthropometric variable. A third measurement was required
leg length and sitting height with growth may provide an if the first two differed by more than 4 mm for height and
indication of maturational status. sitting height and 0.4 g for weight (20,1). The two measure-
The purpose of the present study was to develop a simple, ments for each anthropometric measure were averaged. If
nonintrusive method to assess maturity status in children, three measures were taken, the median value was used (1).
years from peak height velocity, using anthropometric vari- The anthropometric techniques for LLTS are described else-
ables. The availability of data from three longitudinal stud- where (5).
ies provided a unique opportunity to develop predictive Both the BMAS and the SGDS used the age of PHV as
equations and verification samples to apply and test the the maturity measurement. Each subject’s distance data
equations. were used to calculate whole-year velocities. Peak height
velocity was determined for each individual with a cubic
spline fitted to the velocity data (21). The age of PHV was
METHODS individually determined and not derived from group data. In
Subjects. Data were selected on children who were the LLTS, age of PHV was determined by the application of
between 4 yr from PHV and 3 yr after PHV. The predictive the Preece-Baines model I to individual data (23). Table 2
equations were developed using data from the Saskatche- provides a comparison of the age of PHV between the three
wan Pediatric Bone Mineral Accrual Study (BMAS). The studies. By using the age of PHV as the maturational bench-
study was a mixed longitudinal study designed to assess the mark, each measurement occasion was described as years
factors associated with bone mineral accrual in growing from PHV by subtracting the age of PHV from the chrono-
children. The study was conducted from 1991 to 1997 and logical age at each measurement occasion. The difference in
consisted of 113 boys and 115 girls. A full complement of years was defined as a value of maturity offset.
anthropometric measurements was taken on a semiannual Leg length to sitting height ratio was used as a method to
basis; a complete description of the study including details predict maturational status. Table 3 illustrates the pattern of this
with regard to ethical consent can be found elsewhere (1,2). ratio variable and its sensitivity to the occurrence of PHV. The

TABLE 1. Subject numbers, number of observations, and test occasions.

Boys Girls
Study Subjects Observations Tests Subjects Observations Tests
BMAS 79 659 5–13 73 599 6–12
SGDS 71 433 4–7 40 225 4–7
LLTS 50 588 9–13 48 378 7–13
Total 200 1680 161 1202
BMAS, Saskatchewan Pediatric Bone Mineral Accrual Study; SGDS, Saskatchewan Growth and Development Study; LLTS, Leuven Longitudinal Twin Study.

690 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

TABLE 2. Age of peak height velocity (yr) in the three studies.
Boys Girls
Study Mean SD Minimum Maximum Mean SD Minimum Maximum
BMAS 13.4 0.7 11.1 15.6 11.9 0.7 10.3 13.6
SGDS 14.0 1.0 11.4 16.5 11.6 0.7 10.5 13.1
LLTS 14.2 0.8 12.6 15.8 12.5 0.8 10.9 14.6

ratio of leg length to sitting height increases steadily before The accuracy of the predictive equations developed from
PHV and then decreases at and after PHV. As a single mea- BMAS data was assessed by predicting maturity offset in
surement on two occasions, approximately 1 yr apart, it pro- data from SGDS and LLTS and then comparing the accu-
vides a broad categorization of maturity: if the ratio is increas- racy of the predicated maturity offset to actual maturity
ing, the individual is pre-PHV; if the ratio is decreasing, the offset according to the procedure described by Bland and
individual is post-PHV. Measurements less than 1 yr apart may Altman (8). All calculations were made using SPSS proce-
reflect seasonal variation in linear growth and result in some dures (SPSS for Windows release 10.0).
variability in the ratio (21). However, measurements minimally
1 yr apart do not demonstrate this variability and on an indi-
RESULTS
vidual basis consistently follow an increasing ratio to PHV and
declining ratio after PHV. In the BMAS, 72 of the 79 male In boys the predictive equation was as follows: (Eq. 1)
subjects and 67 of the 71 subjects followed this pattern. In fact, Maturity Offset ⫽ ⫺29.769 ⫹ 0.0003007·Leg Length and
in the 11 cases where the pattern was broken, a review of Sitting Height interaction ⫺0.01177·Age and Leg Length in-
the data indicated possible measurement variability. The teraction ⫹ 0.01639·Age and Sitting Height interaction ⫹
ratio requires serial measurements, 1 yr apart. A single 0.445·Leg by Height ratio, where R ⫽ 0.96, R2 ⫽ 0.915, and
measurement occasion is a major limitation in the appli- SEE ⫽ 0.490.
cation of this ratio. Therefore, the development of gen- In girls, the predictive equation was: (Eq. 2) Maturity Offset
der-specific multiple regression equation incorporating ⫽ ⫺16.364 ⫹ 0.0002309·Leg Length and Sitting Height in-
this ratio from a single measurement occasion provided a teraction ⫹ 0.006277·Age and Sitting Height interaction ⫹
viable alternative. 0.179·Leg by Height ratio ⫹ 0.0009428·Age and Weight in-
Statistical analysis. Maturity offset was used as the teraction, where R ⫽ 0.95, R2 ⫽ 0.910, and SEE ⫽ 0.499.
dependent variable in multiple regression analysis. Indepen- Figures 2a and 2b illustrate the Bland-Altman procedure for
dent variables included chronological age, height, sitting BMAS boys and girls. The mean difference between the pre-
height, subischial leg length, and weight. Interaction vari- dicted and actual maturity offset values are plotted against the
ables were included to reflect the interaction between spe- average of the two maturity offset values. The mean difference
cific anthropometric variables and age: age and height, age between the two measurements is ⫺0.010 yr with a standard
and sitting height, age and leg length, age and weight, and deviation of 0.489 yr in boys and ⫺0.021 yr with a standard
the interaction between leg length and sitting height. Five deviation of 0.497 yr in girls.
ratio variables were calculated: weight divided by height, To verify and cross-validate the predictive equations, boys
body mass index (weight divided by height squared), sitting and girls from SGDS and LLTS were utilized. Figures 3a and
height divided by height, leg length divided by height, and 3b illustrate the Bland-Altman procedure applied to the boys
leg length divided by sitting height. and girls of the combined verification samples. The mean
From these 15 independent variables, gender-specific difference between the two measurements is 0.243 yr with a
multiple regression equations were developed through a standard deviation of 0.650 yr in boys and 0.001 yr with a
hierarchical entry with consideration given to both biolog- standard deviation of 0.678 yr in girls.
ical and statistical significance of potential entry variables to When the three studies were combined, the following gen-
predict maturity offset. Based on significant changes in R der-specific predictive equations were developed. In boys, the
and the decrease in SEE, variables were accepted if they predictive equation was: (Eq. 3) Maturity Offset ⫽ ⫺9.236 ⫹
made a statistical significance contribution (alpha ⫽ 0.05) to 0.0002708·Leg Length and Sitting Height interaction
the predictive equation. ⫺0.001663·Age and Leg Length interaction ⫹ 0.007216·Age

Table 3. Ratio of leg length to sitting height (%) in BMAS male and female subjects.
Years from PHV N Boys N Girls
⫺4 24 87.9 ⫾ 3.1 9 87.1 ⫾ 3.0
⫺3 68 89.6 ⫾ 3.4 46 89.1 ⫾ 3.9
⫺2 98 91.1 ⫾ 3.4 73 90.3 ⫾ 3.8
⫺1 125 92.5 ⫾ 3.9 96 91.2 ⫾ 3.7
0 141 93.2 ⫾ 4.0 124 91.4 ⫾ 3.9
1 110 92.3 ⫾ 4.2 121 90.3 ⫾ 3.5
2 68 90.4 ⫾ 3.9 97 89.3 ⫾ 4.2
3 25 89.6 ⫾ 3.0 33 88.5 ⫾ 3.9
Mean ⫾ SD; PHV, peak height velocity.

ASSESSING MATURITY BY ANTHROPOMETRY Medicine & Science in Sports & Exercise姞 691
 FIGURE 3—Bland Altman procedure for SGDS and LLTS in (a) boys
and (b) girls.
FIGURE 2—Bland Altman procedure for BMAS in (a) boys and (b) girls.

in youth sport remains an important but unresolved issue. The

and Sitting Height interaction ⫹ 0.02292·Weight by Height purpose of this investigation was to establish a noninvasive and
ratio, where R ⫽ 0.94, R2 ⫽ 0.891, and SEE ⫽ 0.592. practical method to assess maturity status during adolescence.
In girls, the predictive equation was: (Eq. 4) Maturity Offset ⫽ We have shown that age from peak height velocity, a matura-
⫺9.376 ⫹ 0.0001882·Leg Length and Sitting Height interaction tional benchmark, can be predicted with a reasonable degree of
⫹ 0.0022·Age and Leg Length interaction ⫹ 0.005841·Age and accuracy by measuring height, sitting height, body mass, and
Sitting Height interaction ⫺ 0.002658·Age and Weight interaction chronological age.
⫹ 0.07693·Weight by Height ratio, where R ⫽ 0.94, R2 ⫽ 0.890, Although the Bland-Altman procedure (8) provides the
and SEE ⫽ 0.569. appropriate methodology to assess the prediction equations,
Figures 4a and 4b illustrate the Bland-Altman procedure the acceptance of the prediction equations requires the re-
applied to the three study prediction model for male and searcher to establish reasonable and practical limits for the
female subjects, respectively. prediction. For the purposes of the present investigation, the
authors suggest acceptable limits to approximate the mean
plus or minus 1 yr (assuming a mean of zero and an SD of
DISCUSSION
0.5 yr).
During adolescence, it is essential that the effects of matu- Within the limitations stated above, the cross-validation
ration be controlled for both in context of youth sport classi- of the prediction equations meets statistical standards for
fication and research investigations. All prospective studies acceptance. Ideally, further verification on different samples
that evaluate the physiological process in children must attempt would provide additional support. The cross-validation al-
to control for maturity. Equitable classification of participants lows the prediction equations to be tested for generalizabil-
692 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org
 sample. Note that measurements were taken once a year in
SGDS and twice a year in the BMAS and LLTS. It is
recommended that the three study prediction equations be
used to predict maturity offset. With more extensive obser-
vations on either side of PHV and the increase in observa-
tions, these latter prediction equations are more robust and
possibly afford greater generalizability given the combina-
tion of three different samples.
Both the age range and variability of the predicted value
should be considered in the application of the predictive
equations. Although it is possible to predict a continuous
maturity measure, years from PHV, an alternative may be
the application of categorical maturity offset values (6). For
example, any negative maturity offset prediction should
classify the individual as pre-PHV and any positive predic-
tion as post-PHV. Used in this manner, a common bench-
mark maturity classification can be constructed for both
boys and girls. This would be similar to a pre- and post-
menarcheal categorization, which is only available in girls.
To assure the best estimate of maturity from these prediction
equations, care and attention must be paid to standardized
measurement procedures, especially in the measurement of
sitting height. The magnification of measurement error by
prediction equations is a major limitation to any method but
especially where one measurement, sitting height, has a direct
relationship with a number of independent variables.
The quest to develop a noninvasive measurement of ma-
turity is not a new issue (7,24). For nearly 100 years, there
have been advocates for various classification indexes to
account for size and maturity in elementary, junior, and
senior high school and college men and women
(9 –12,19,22,25,28). The purpose of these classifications
was to improve instruction and to place students into equi-
table groups according to “their capacities and their achieve-
ments on which they are likely to succeed” (19). The earlier
approaches predict adult stature and calculate maturity as a
percentage of adult stature. The current investigation at-
tempts to assess maturation by predicting the tempo of
FIGURE 4 —Bland Altman procedure for BMAS, SGDS, and LLTS in
growth or where the individual is in relation to a matura-
(a) boys and (b) girls. tional benchmark, PHV. The test of any approach is the
generalizability to other populations and other maturity as-
ity. When population specific equations are applied to other sessment methods. Skeletal age is another common and
samples, there may be a loss in the accuracy of the predic- important method of assessing maturity. Is there a relation-
tion or shrinkage reflected in the reduction of the R2 value ship between skeletal age assessment and maturity offset?
(27). The R2 values for the boys and girls in the BMAS were The male subjects in the SGDS had skeletal hand-wrist
0.92 and 0.91. When the prediction equations were applied x-rays assessed at age 11 yr. The correlation coefficient
to the verification samples, the R2 values were 0.89 and 0.88 between skeletal age offset from chronological age and
for male and female subjects, respectively. This difference PHV maturity offset from chronological age was 0.83. Al-
would indicate a small amount of shrinkage from the de- though the methods are different, the direction and strength
velopment sample to the prediction sample. However, the of the relationship indicate a maturational commonality
increase in the standard deviation of the difference between between the two methodologies.
predicted and actual maturity offset values 0.49 in boys and Although it is feasible and possible to seek a biologically
0.50 in girls from the development sample (BMAS) to 0.65 based classification system, the practical application of this
in boys and 0.68 in girls in the verification samples (SGDS outcome rests with the acceptance by sport-governing body
and LLTS) is a more critical evaluation of the prediction authorities and youth sport organizers. An application of
equations. these predictive equations is illustrated in the following
When the three studies are combined, the predictive example: two male individuals, A and B, were first tested at
Equations 3 and 4 provided a more complete and balanced chronological ages 11.4 and 11.3. The difference in their
ASSESSING MATURITY BY ANTHROPOMETRY Medicine & Science in Sports & Exercise姞 693
height and weight was 4.7 cm and 6.2 kg. The application of height velocity (a measure of maturity offset) by using four
the maturity offset prediction equation categorized each anthropometric variables (chronological age, stature, sitting
individual as pre-peak height velocity. When both individ- height, and body mass). The use of stature and sitting height in
uals were 14 yr of age, the difference in their height was the prediction takes into consideration the differential timing of
25.8 cm and in their weight was 13.7 kg. The maturity offset the adolescent spurt in body dimensions and also their inter-
prediction categorized the taller and heavier individual as actions with chronological age. The present results indicate that
post-peak height velocity and the other individual as pre- maturity offset can be estimated within an error of ⫾ 1 yr 95%
peak height velocity. At 17 yr of age, there was less than a of the time. We believe this level of accuracy is sufficient for
1-cm difference in height and a 2-kg difference in weight, adolescence to be assigned a maturational classification. A
and both individuals were predicted as post-peak height classification that can be applied to various research designs. In
velocity. The age of PHV for the two individuals was 13.09 a sporting context, matching adolescence sports groups biolog-
and 15.09 yr. This example illustrates the effect of tempo of ically rather than chronologically may equalize competition,
growth in two individuals of the same chronological age enhance chances for success, and possibly reduce incidence of
who were relatively the same size before and after adoles- injury.
cence. However, the path to maturity is variable and an
Partial funding for this project was provided by a grant from the
individual one. National Health Research Development Program, Government of
All studies of adolescent children need to control for the Canada (NHRDP Grant No. 6608 –1261). Our sincere thanks go to
confounding effects of maturation. Current assessment meth- Dr. Martine Thomis for assistance in the use of the LLTS data.
Address for correspondence: R. L. Mirwald, Ph.D., College of
odologies are invasive, intrusive, and/or gender specific. Gen- Kinesiology, University of Saskatchewan, 105 Gymnasium Place,
der-specific equations are presented that predict age from peak Saskatoon SK S7N 5C2, Canada; E-mail: [email protected].

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