This cross-sectional study was performed in the Anatomy Department of Sir Salimullah Medical College, Dhaka, from January 2009 to June 2011. One hundred right-handed adult Muslim Bangladeshi males 25 to 45 years of age participated in the study.
Selection of subject
The present study was confined to a small group of people with similar nutritional status, religion, and ethnicity. Bangladesh is the country with the fourth-highest Muslim population in the world. Among them, approximately half of the population is male (Mubashar 2017). Muslims have generalised food habits. They are not classified as vegetarian or nonvegetarian. Food habits and climate affect the stature and growth of long bones.
The nutritional status of people affects the stature and upper limb dimensions. Expenditure on food items is reflected in overall growth. According to the household income and expenditure survey 2016 conducted by the Bangladesh Bureau of Statistics (2019), all the subjects belonged to the lower-income group. (Income groups were determined based on monthly household income reported in taka; lower-income group: up to 5188 takas). Each subject was asked about average monthly income and expenditures. This information was noted in the checklist.
Ossification is an essential factor in the growth of long bones. Generally, all long bones are completely ossified by the twenty-fifth year of life, and bone loss begins after the forty-fifth year of life (Berendsen and Olsen 2015). Therefore, subjects between 25 and 45 years of age were selected for the study.
Persons who were tribal or mixed in origin and had a history of genetic disorders (e.g., achondroplasia, Marfan’s syndrome), endocrine disorders (e.g., acromegaly, dwarfism, DM), any acquired trauma that can affect stature or other (e.g., RTA), neurological findings that can affect the extremities (e.g., CVD) and limb defects (e.g., meromelia, polydactyly, or syndactyly) were excluded from the study.
Number and sampling of the subject
The minimum sample size was calculated to be 61 using G*power 3.1, (Faul et al. 2009) where the effect size (f2) was 0.35, α was 0.05, power (1-β) was 0.80, and the number of predictors was 12. To achieve 61 respondents on an anticipated 50% dropout rate, a total of 122 persons were selected through simple random sampling. Later, due to incomplete data and subject unavailability, the sample number was 100.
The subject was cordially received, and the procedure of taking measurements was explained. The subject was assured that the procedure would not harm him. The subject's questions regarding the procedure were clarified. The subject was asked to answer according to the checklist. Written informed consent to measure the different physical measurements were obtained from each subject. All the subjects of the present study were right-handed, which was confirmed as noted on the checklist.
The stature or standing height was measured using a stadiometer. After removing the footwear and socks, the participants stood on the wooden platform, and the heels were kept together. The participant's heels, buttocks, shoulders, and head touched the upright portion of the instrument. The arms were allowed to hang freely by the sides with the palms facing the thighs. The head was maintained in Frankfurt's horizontal plane, and the participant looked forward. The head plate of the stadiometer was brought into firm contact with the vertex along the midsagittal plane. After asking the subject to take a deep breath and holding it, readings were taken to the nearest 0.1 centimetres (Mohanty et al. 2001).
The arm’s length was measured using a spreading calliper from the most lateral point on the end of the acromial process of the shoulder girdle to the most distal point on the capitulum of the humerus while flexing the forearm at right angles to the arm. The measurement was recorded in centimetres to the nearest 0.5 cm (Hossain 2009).
Callipers were used to measure the length of the radius. First, the subject extended the elbow, revealing a well-marked depression to the posterolateral side of the elbow. Then, the subject was asked to pronate and supinate the forearm to locate the radial head in that depression (Frank et al. 2010). Finally, from the back of the subject, the researcher placed one end of the calliper at the radial head and another end at the most distal end on the styloid process of the radius. The measurement was recorded in centimetres to the nearest 0.5 cm (Hossain 2009).
The ulna length was measured using a spreading calliper from the olecranon process tip to the styloid process tip while the subject was sitting with the forearm resting comfortably on a table, bending the elbow at 90°. The measurement was recorded in centimetres to the nearest 0.5 cm (Mondol et al., 2009).
The researcher measured the hand's length as the distance between the distal-most point of the middle finger and distal wrist crease using a sliding calliper. The value was recorded in centimetres to the nearest 0.1 cm (Sanli et al. 2005).
The hand’s breadth was measured as the distance between the lateral surfaces of the second metacarpal to the medial surface of the fifth metacarpal at the level of the knuckles with a sliding calliper. At the same time, the participant held his four fingers together abducted the thumb to the side. The measurement value was recorded in centimetres to the nearest 0.1 cm (Agnihotri et al. 2006).
The wrist circumference was measured using a tension-gated flexible measuring tape positioned over the Lister tubercle of the distal radius and the distal ulna (Capizzi et al. 2011).
The principal researcher recorded all the measurements twice and later calculated the average measure. Hence for the reliability and validity of the measurements, only intra-observer reliability and validity tests were carried out (Pederson and Gore 2004).
The relationship between stature and each variable was calculated using a regression equation (stature = constant + regression coefficient × variable).
The measurements’ reliability was assessed by the intra-class correlation coefficient (ICC). The instruments’ precision, accuracy, and validity were evaluated by absolute and relative technical error of measurement (TEM and rTEM) and coefficient of reliability. The relationship between the dependent variable (measured stature) and independent variables (right and left arm length, radius length, ulna length, hand length, handbreadth, and wrist circumference) was analyzed using simple linear regression. The constant and beta coefficients for each variable were also calculated. An unpaired t-test was used to investigate the differences in the mean between the measured stature and estimated stature. R2 values and standard errors of the estimates were used to compare different models. Statistical analyses were performed using IBM SPSS Statistics 16.