Correlation of Stature with Cephalofacial Measurements

Abstract

Tinggi badan merupakan parameter antropometri yang dapat digunakan dalam penentuan status gizi dan identifikasi jenazah. Pada individu dengan kondisi yang tidak memungkinkan dilakukan pengukuran tinggi badan secara konvensional dibutuhkan suatu metode pengukuran tinggi badan alternatif. Salah satu metode pengukuran tinggi badan alternatif yaitu surrogate height measurement. Surrogate height measurement dapatdiukurmenggunakan formula khusus berdasarkan ukuran tulang, misalnya ukuran antropometri cephalofacial. Jenis penelitian ini adalah deskriptifobservasionaldengandesainpotong-lintang. Pengambilan data dilakukan melalui pengukuran lebar maksimal kepala, lingkar kepala horizontal, lebar minimal dahi, dan tinggi badan pada 110 subjek perempuan dan 57 subjek laki-laki. Data dianalisis dengan uji normalitas Kolmogorov-Smirnov, uji korelasi Pearson antara tinggi badan dan parameter antropometri cephalofacial, dan uji regresi linier untuk mendapatkan model prediksi tinggi badan.Hasil uji korelasi Pearson antara lingkar kepala horizontal dan tinggi badan, baik dengan atau tanpa stratifikasi jenis kelamin bermakna signifikan (p<0,05). Hasil uji korelasi Pearson antara lebar maksimal kepala dan tinggi badan pada populasi total dan kelompok perempuan bermakna signifikan (p<0,05), sementara pada kelompok laki-laki korelasi tidak bermakna signifikan (p>0,05). Hasil uji korelasi Pearson antara lebar dahi minimal dan tinggi badan, baik dengan atau tanpa stratifikasi jenis kelamin tidak bermakna signifikan (p>0,05).Tidak terdapat korelasi yang signifikan antara lebar minimal dahi dan tinggi badan.Terdapat korelasi yang signifikan antara lingkar kepala horizontal danlebarmaksimalkepalaterhadaptinggi badan.

Full text

Majalah Kedokteran Sriwijaya, Th. 51
Nomor 2, April 2019
80
Correlation of Stature with Cephalofacial Measurements
Michael Chandra1, Tri Suciati 2*, Msy. Rulan Adnindya2
1Undergraduate Student, Faculty of Medicine, University of Sriwijaya, Palembang
2Department of Anatomy, Faculty of Medicine, University of Sriwijaya, Palembang
*three_plg@yahoo.com
Abstrak
Tinggi badan merupakan parameter antropometri yang dapat digunakan dalam penentuan status gizi dan identifikasi
jenazah. Pada individu dengan kondisi yang tidak memungkinkan dilakukan pengukuran tinggi badan secara
konvensional dibutuhkan suatu metode pengukuran tinggi badan alternatif. Salah satu metode pengukuran tinggi badan
alternatif yaitu surrogate height measurement. Surrogate height measurement dapatdiukurmenggunakan formula
khusus berdasarkan ukuran tulang, misalnya ukuran antropometri cephalofacial. Jenis penelitian ini adalah
deskriptifobservasionaldengandesainpotong-lintang. Pengambilan data dilakukan melalui pengukuran lebar maksimal
kepala, lingkar kepala horizontal, lebar minimal dahi, dan tinggi badan pada 110 subjek perempuan dan 57 subjek laki-
laki. Data dianalisis dengan uji normalitas Kolmogorov-Smirnov, uji korelasi Pearson antara tinggi badan dan parameter
antropometri cephalofacial, dan uji regresi linier untuk mendapatkan model prediksi tinggi badan.Hasil uji korelasi
Pearson antara lingkar kepala horizontal dan tinggi badan, baik dengan atau tanpa stratifikasi jenis kelamin bermakna
signifikan (p<0,05). Hasil uji korelasi Pearson antara lebar maksimal kepala dan tinggi badan pada populasi total dan
kelompok perempuan bermakna signifikan (p<0,05), sementara pada kelompok laki-laki korelasi tidak bermakna
signifikan (p>0,05). Hasil uji korelasi Pearson antara lebar dahi minimal dan tinggi badan, baik dengan atau tanpa
stratifikasi jenis kelamin tidak bermakna signifikan (p>0,05).Tidak terdapat korelasi yang signifikan antara lebar
minimal dahi dan tinggi badan.Terdapat korelasi yang signifikan antara lingkar kepala horizontal
danlebarmaksimalkepalaterhadaptinggi badan.
Kata kunci:surrogate height measurement, tinggi badan, ukurancephalofacial
Abstract
Stature, as one of the anthropometry measurements, can be used for determination of nutritional status and corpse
identification. Surrogate height measurement as one of the alternative measurement for height is required in a person
whose conventional height measurement cannot be performed. This alternative measurement consists of specific
formula using bone measurements, one of which is cephalofacial measurement. This is a descriptive observational study
with a cross-sectional approach. Data were taken by measuring maximum head breadth, horizontal circumference of
head, minimum frontal diameter, and stature from 110 females and 57 males. Normality test was carried out using
Kolmogorov-Smirnov test, continued with Pearson correlation test on cephalofacial measurements and stature followed
by linear regression to estimate stature. Pearson correlation tests between horizontal circumference of head and stature
on all subjects with or without sexual stratification showed significant results (p<0.05). Pearson correlation tests
between maximum head breadth and stature on all subjects and female group are significant (p<0.05), meanwhile the
correlation is insignificant (P>0,05) in the male group. Pearson correlation tests between minimum frontal diameter and
stature on all subjects with or without sexual stratification are insignificant (p>0.05). There is no significant correlation
between minimum frontal diameter and stature. There are significant correlations between horizontal circumference of
head and maximum head breadth toward stature.
Keywords: surrogate height measurement, stature, cephalofacial measurement

Majalah Kedokteran Sriwijaya, Th. 51
Nomor 2, April 2019
81
1. Introduction
Anthropometry is the study of
measurements of the human body in terms of
the dimensions of bones, muscles and fat
tissue. The body size that can be described by
anthropometry includes body weight, head
circumference, body width, and stature.1
Stature can be used in various medical fields
such as corpse identification and assessment of
nutritional status through calculation of body
mass index (BMI).2
Stature measurement is generally done
bymeasuring the head’s peak to the lowest
point of the foot.2In individuals with certain
conditions such as being unable to stand
upright or mutilated corpse, stature
measurement cannot be done directly.
Measurement of stature in individuals who
experience abnormal posture will also provide
inappropriate interpretations on the assessment
of nutritional status through BMI
calculation.3,4 These findings trigger the
development of an alternative method of
stature measurement to get an easier
measurement with better accuracy.
Surrogate height measurement is one
alternative to the measurement of stature. The
stature measurement procedure is carried out
through a stature prediction model that is
calculated based on various sizes of body parts
such as hands, body, legs, upper and lower
limbs, and cephalofacialmeasurement.5
Several previous studies attempting to
associate cephalofacialmeasurement and
stature. Research by Krishan and Kumar
concluded that cephalofacialmeasurement has
a strong correlation to predict stature.5,6 The
studyby Jervas et al produced a stature
prediction model based on
cephalofacialmeasurement.7Datta and Vishnu
research showed a difference correlation
between cephalofacial measurement and
stature with a target population of different
races.8
Research on the correlation
betweencephalofacialmeasurement and stature
in Indonesia is still very little. The prediction
model for stature is also very dependent on the
target population. These finding trigger the
researchers to conduct this research.
2. Method
This research is an observational
descriptive cross-sectional design. The study
was conducted at the Faculty of Medicine
University of Sriwijaya (FK Unsri) in October
2018 − January 2019. Based on total sampling,
110 female subjects and 57 male subjects met
the inclusion criteria: over 20 years old and
were undergraduate students at FK
Unsri.Exclusion criteria are having a history of
Table 1. Distribution of Cephalofacial Measurement, Statureand Data Normality
Measurement
Gender
Mean
SD
Total
P value*
Stature
Male
169,4579
5,57443
57
0,491
Female
156,3945
6,37457
110
0,560
Total
160,8533
8,70413
167
0,259
Minimum frontal diameter
Male
12,2912
0,79450
57
0,319
Female
12,3985
0,74492
110
0,688
Total
12,3619
0,76152
167
0,414
Horizontal circumference of head
Male
56,5300
2,01380
57
0,606
Female
54,9609
1,74473
110
0,093
Total
55,4965
1,98085
167
0,190
Maximum head breadth
Male
14,6549
0,69676
57
0,378
Female
14,6827
0,62502
110
0,065
Total
14,6732
0,64855
167
0,493
* Normality testKolmogorov-Smirnov, p>0,05

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Table 2. Correlation of Stature withCephalofacial Measurement
Measurement
Gender
Pearson coefficient correlation (r)
Pvalue
Minimum frontal diameter
Male
0,211
0,115
Female
0,058
0,549
Total
0,027
0,730
Horizontal circumference of head
Male
0,426
0,001*
Female
0,407
0,000*
Total
0,535
0,000*
Maximum head breadth
Male
0,179
0,184
Female
0,345
0,000*
Total
0,187
0,016*
*significant correlation (p<0,05)
skull, face, spine, pelvis, or lower limb
fractures, having spinal arch abnormalities
(lordosis, kyphosis, scoliosis), having a
history of hormonal disorders during the
development period, or did not agree to be
the subject of the study.
Data collection was performed by
measuring minimum frontal diameter,
horizontal circumference of head, maximum
head breadth, and stature on all subject.
Minimum frontal diameter is the most
medial distance from the frontotemporal
point. Horizontal circumference of head is
the maximum head circumference measured
from glabella to opisthocranion. Maximum
head breadth is the distance of the two most
lateral points of the parietal bone (biparietal
diameter). Stature is measured from the
highest point of the head (vertex) to the
lowest point in the calcaneus bone (calcanei
tuberosity). Cephalofacial measurement was
measured using a measuring tape and
calipers, while stature was measured using
stature meter.2,9
Data distribution is presented
descriptively with mean and standard
deviation for normal or median data
distribution and minimum − maximal value
for abnormal data distribution. Data analysis
was performed usingPearson correlation test
to determine the correlation between
cephalofacialmeasurement and stature.
Linear regression test was carried out to
determine the stature prediction model
based on cephalofacialmeasurement.
3. Results
Table 1 presents the distribution of
cephalofacialmeasurement and stature as
well as the normality test with gender-based
groupings. Table 2 presents the Pearson
correlation test between minimum frontal
diameter and stature, where no significant
correlation was found between the two with
or without grouping according to gender (p>
0.05).The Pearson correlation test in table 2
shows a significant correlation between
horizontal circumference of head and
stature, with or without grouping by gender
(p <0.05). Based on the Pearson correlation
test between the maximum head breadth and
stature in table 2, there is asignificant
correlation between the two in groups of
Table 3. Stature Prediction ModelBased on Cephalofacial Measurement
Variabel
Total
Laki-laki
Perempuan
Maximum Head Breadth
124,086+
(2,506 x MHB*)
-
104,787+
(3,515 x MHB*)
Horizontal Circumference of Head
30,424+
(2,350 x HCoH**)
102,750+
(1,180 x HCoH**)
74,694+
(1,487 x HCoH**)
*Maximum Head Breadth
**Horizontal Circumference of Head

83
Table 4. Comparison of Research on Correlation of CephalofacialMeasurement and Stature
Study
Population
Total
Gender
MFD**
HCoH***
MHB****
Agnihotri (2011)
Indo-Mauritian
75
Male
0,103
0,494*
0,015
75
Female
0,255*
0,375*
0,193
Krishan (2007)
India Utara
252
Male
0,515*
0,773*
Kumar (2013)
Haryanvi
400
Male
0,181*
0,321
400
Female
0,122*
0,008
Sahni (2010)
Barat Laut India
173
Male
0,124
127
Female
0,253
Ezekie (2015)
Igbo
88
Male
0,285*
123
Female
0,023
211
Total
0,058
Penelitian ini
South Sumatran
57
Male
0,211
0,426*
0,179
110
Female
0,058
0,407*
0,345*
167
Total
0,027
0,535*
0,187*
*significant correlation (p<0,05)
** Minimum Frontal Diameter
*** Horizontal Circumference of Head
**** Maximum Head Breadth
female and the entire population (p <0.05),
but did not correlate significantly in the
male group. Linear regression tests were
performed on cephalofacialmeasurement
and stature, and height prediction models
were obtained based on table 3.
4. Discussion
Based on table 1, the mean of stature and
horizontal circumference of head in maleare
greater than female. These results are
similar to those of Agnihotri et al which
found that male stature and horizontal
circumference of head were greater than
female.10This difference was due to sexual
dimorphism that arises when a person
experiences growth spurt. Acceleration of
growth in female occurs earlier and ends
faster than male. The growth period in male
also lasts longer so that men will tend to be
larger in size than female.11
The results of the study also showed that
the average minimum frontal diameter and
maximum head breadth in femaleare greater
than male. Several previous studies have
resulted in a comparison of different mean
values for the two cephalofacial
anthropometric parameters. Based on
researches by Ekezie et al. and Sahni et al.,
it was concluded that the average minimum
frontal diameter and maximum head breadth
in femalewere greater than that of
male.12,13In the Agnihotri et alstudy, the two
mean cephalofacial anthropometric
parameters were greater in male.10 This
difference may be due to dimorphism which
also affects the size of a person's head. The
fact that there are differences in results from
other studies shows the possibility of
maximum head breadth and minimum
frontal diameter varying more than the size
of stature and horizontal circumference of
head.
Based on table 2, it can be concluded that
there is no significant correlation between
minimum head breadth and stature, either
with or without grouping by gender. This
result is similar to the study by Sahni et al
which states that there is no significant
correlation between the minimum width of
the forehead and height with gender-based
stratification.13 However, some previous
studies also showed that a significant
correlation was found between minimum
head breadth and stature. Research by
Krishan and Kumar showed a significant
correlation between minimum frontal

84
diameter and stature.6Agnihotri et al in their
study found differences in correlation with
grouping by gender, wherein female there
was a significant correlation, while in male
no significant correlation was found.10
A significant correlation between
horizontal circumference of head and stature
both with and without gender grouping is
presented in table 2. These results are
similar to previous studies conducted by
Krishan and Kumar, Agnihotri, and Kumar
and Gopichand which state that there is a
significant correlation between horizontal
circumference of head and stature.6,10,14
Pearson correlation analysis test results in
Table 2 show a significant correlation
between the maximum head breadth and
stature on female’s groups and the whole
subject. This is similar to findings in
previous studies where there were
differences in the significance of the
correlation analysis with gender
stratification.The study by Ekezie et al
showed a significant correlation between
maximum head breadth and stature in male,
while in the same population, no significant
correlation was found in female and in
overall subjects of the study.12 Research by
Kumar and Gopichand, and Agnihotri et al
showed no significant correlation between
maximum head breadth and stature in both
gender.10,14
The significant result of correlation
analysis on horizontal circumference of
head and stature indicates that the greater
the horizontal circumference of head, the
higher the stature. This is in accordance with
the theory that the head will represent
approximately 6% of adult height.15,16 Head
and body have different growth speeds so
that the proportion of the body will continue
to change with growth. Head growth takes
place more quickly, especially at the age of
gestation until the early age of
toddler.17Head growth will be followed by
height growth in childhood and puberty
where the child will experience growth spurt
that cause the growth rate takes place faster.
At the end of the growth period, where there
is no growth in height and head size, the
body will reach a peak height and the size of
the head can represent part of the height.
Head growth is also determined primarily by
genetic factors through local epigenetic
factors, such as brain growth. Due to the
determination of the genetic height of an
individual, it can be ascertained that there is
a correlation between
cephalofacialmeasurement and stature.10
The result of correlation analysis of
height and two other cephalofacial
anthropometric parameters (maximum head
breadth and minimum frontal diameter) that
did not significantly correlated indicate the
existence of uncertainty in the study of
correlation between stature and the two
cephalofacial anthropometric parameters.
This can be due to the large variation in the
measurement of the two cephalofacial
anthropometric parameters. This variation
may not be bound to a person's growth rate
so that they do not significantly correlate
with stature.
Based on table 3, a person's height can be
predicted if the size of the head
circumference is horizontal or the maximum
width of the head is known. For example, if
someone named A has a horizontal head
circumference of 60 cm, then based on the
height prediction model without gender
stratification, the prediction of A’s height is
30.424+ (2,350 x 60) = 171,424 cm.
5. Conclusion
Based on the results of this study, the
conclusions are as follows:
1. There is no significant correlation
between minimum frontal diameter and
stature.
2. There are significant correlations
between horizontal circumference of
head and maximum head breadth toward
stature.

85
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