Physical Growth and Somatotype of Sasak Schoolchildren at Different Altitude in Lombok Island

PHYSICAL GROWTH AND SOMATOTYPE OF SASAK
SCHOOLCHILDREN AT DIFFERENT ALTITUDES IN
LOMBOK ISLAND

NOVITA TRI ARTININGRUM

GRADUATE SCHOOL
BOGOR AGRICULTURAL UNIVERSITY
BOGOR
2013

STATEMENT LETTER
I hereby declare that thesis entitled Physical Growth and Somatotype of
Sasak Schoolchildren at Different Altitude in Lombok Island is original result of
my own research supervised under advisory committee and has never been
submitted in any form at any institution before. All information from other
authors cited here are mentioned in the text and listed in the reference at the end
part of the thesis.
Bogor, August 2013
Novita Tri Artiningrum
Student ID G352110161

SUMMARY
NOVITA TRI ARTININGRUM. Physical Growth and Somatotype of Sasak
Schoolchildren at Different Altitude in Lombok Island. Supervised by
BAMBANG SURYOBROTO and TETRI WIDIYANI.
The human life cycle can be staged into neonatal, infancy, childhood,
juvenile, puberty, adolescence, adulthood, and senescence. During this cycle, the
body changes significantly in size, structure, proportions, and composition. The
physical growth and somatotype of schoolchildren are one of the important phases
in human life cycle. The puberty stage within this age range are indicated by the
growth spurt of stature (BH) and weight (BW) and followed by change in
somatotype.
The focus of this research is to evaluate the age-related body size and shape
variations at different altitude in Sasak children. A cross sectional growth study
was conducted during July to December 2012. The samples are students of
kindergarten to senior high schools aged 3 to 19 years. All of subjects are rural
children who lives in low (16 to 28 m asl), medium (525 to 628 m asl), and high
altitude (1130 to 1213 m asl). Ten anthropometric measurements are used to
determined the growth of body size and shape.
The result showed the children in low altitude were higher and heavier than

medium and high altitudes. Until puberty, the children in medium have same
stature and weight with those reside in high altitude but shorter and lighter
thereafter. The difference of height and weight are statistically different in girls
and indifferent in boys.
In growth of body shape, the Sasak children have a common pattern of
somatotype composition. It is an increased in endomorphy, a decreased in
mesomorphy, and an increased in ectomorphy during growth. The girl in medium
altitude show delayed and slowly increasing of endomorphy and slowly
decreasing of mesomorphy. Socioeconomic factors such as family income and
parental education gave more influence to the differentiation than the altitude
factor.
Key words : Altitude, Growth, Sasak, Somatotype

RINGKASAN
NOVITA TRI ARTININGRUM. Pertumbuhan Fisik dan Somatotype Anak
Sekolah Suku Sasak pada Ketinggian Berbeda di Pulau Lombok. Dibimbing oleh
BAMBANG SURYOBROTO dan TETRI WIDIYANI.
Kehidupan manusia dibagi dalam beberapa tahap yaitu bayi, batita, anakanak, prepubertas, pubertas, remaja, dewasa, dan tua. Setiap tahap mengalami
perubahan ukuran, struktur, proporsi dan komposisi tubuh yang signifikan.
Pertumbuhan fisik dan somatotipe anak-anak sekolah adalah salah satu fase yang

penting. Pada fase ini terjadi pubertas yang ditandai dengan percepatan
pertumbuhan tinggi dan berat badan yang diikuti dengan perubahan somatotipe.
Fokus dari penelitian ini untuk mengevaluasi variasi ukuran dan bentuk
tubuh yang berkorelasi dengan umur anak-anak Suku Sasak pada ketinggian
berbeda. Studi cross sectional telah dilakukan selama Juli sampai Desember 2012.
Sampel adalah anak-anak sekolah umur 3 – 19 tahun dari PAUD sampai SMA.
Semua subjek adalah anak-anak desa yang tinggal di dataran rendah (ketinggian
16-28 m dpl), menengah (525-628 m dpl) dan dataran tinggi (1130-1213 m dpl).
Sepuluh pengukuran tubuh digunakan untuk mendeterminasi pertumbuhan dan
bentuk tubuh anak-anak Suku Sasak.
Penelitian ini menunjukkan anak-anak dataran rendah, lebih tinggi dan lebih
gemuk dibandingakan anak-anak dataran menegah dan dataran tinggi. Sampai
fase pubertas, anak-anak dataran menengah memiliki tinggi dan berat badan yang
sama dengan anak-anak dataran tinggi tetapi lebih pendek dan lebih kurus setelah
pubertas. Perbedaan tinggi dan berat badan berbeda secara statistik pada anakanak perempuan dan tidak berbeda pada anak laki-laki.
Berdasarkan perubahan bentuk tubuh, anak-anak Suku Sasak memiliki pola
komposisi somatotipe yang umum selama pertumbuhan yaitu peningkatan
endomorphy, penurunan mesomorphy, dan peningkatan ectomorphy. Anak
perempuan di dataran menegah menunjukkan penundaan dan peningkatan
endomorphy yang rendah, dan penurunan mesomorphy yang rendah. Status

sosioekonomi seperti penghasilan keluarga dan pendidikan orangtua memberikan
pengaruh yang lebih besar terhadap pertumbuhan anak daripada perbedaan
ketinggian.
Kata Kunci : Ketinggian, Pertumbuhan, Sasak, Somatotype.

Copyright © 2013 by Bogor Agricultural University
All Rights Reserved
It is prohibited to cite all or a part of this thesis without referring to and
mentioning the source. Citation is permitted for the purposes of education,
research, scientific paper, report, or critism writing only; and it does not defame
the name and honour of Bogor Agricultural University.
It is prohibited to republish and reproduce all or a part of this thesis without
permission from Bogor Agricultural University.

PHYSICAL GROWTH AND SOMATOTYPE OF SASAK
SCHOOLCHILDREN AT DIFFERENT ALTITUDES IN
LOMBOK ISLAND

NOVITA TRI ARTININGRUM

Thesis
As partial fulfillment of the requirements for Master Degree
in Animal Biosciences

GRADUATE SCHOOL
BOGOR AGRICULTURAL UNIVERSITY
BOGOR
2013

Extra-committee examiner: Dr dr Sri Budiarti

Title
Name
NRP

: Physical Growth and Somatotype of Sasak Schoolchildren at Different
Altitude in Lombok Island
: Novita Tri Artiningrum
: G352110161

Certified by
Advisory committee

r ambang Suryobroto
Chairman

Dr Tetri

'diyani, SSi, MSi
Member

Acknowledged by

Coordinator
Major of Animal Biosciences

ｄｲ ｾ

Dyab Perwitasari, MSc

Examination Date: August 20 th , 2013

Graduation Date:

J4

SfP lu13

Title
Name
NRP

: Physical Growth and Somatotype of Sasak Schoolchildren at
Different Altitude in Lombok Island
: Novita Tri Artiningrum
: G352110161
Certified by
Advisory committee

Dr Bambang Suryobroto

Chairman

Dr Tetri Widiyani, SSi, MSi
Member

Acknowledged by

Coordinator
Major of Animal Biosciences

Dean of Graduate School

Dr Ir RR Dyah Perwitasari, MSc

Dr Ir Dahrul Syah, MScAgr

Examination Date: August 20th, 2013

Graduation Date:

FOREWORD
On the blessing of God I am able to finish my thesis. This paper is made to
fulfill the requirement for master degree at Bogor Agricultural University. The
title of my paper is “Physical Growth and Somatotype of Sasak Schoolchildren at
Different Altitude in Lombok Island”.
I would like to thank my advisor committee Dr. Bambang Suryobroto and
Dr. Tetri Widiyani, SSi, MSi. I am indebted to Bakrie Center Foundation for the
Bakrie fellowship. I express my gratitude to the Governments of West Lombok,
Central Lombok, and East Lombok Regency for the permission of this study. We
would also like to express our gratitude to the school principals, teachers and all
the subjects for all their support throughout the study. My special thank to Yuliadi
Zamroni (my husband), Annisa Hishnul Izza (my daughter), and all of my friends
at Major of Animal Biosciences for their support.
Bogor, August 2013
Novita Tri Artiningrum

CONTENTS
LIST OF TABLE

vi

LIST OF FIGURE

vi

LIST OF APPENDIX

vi

LIST OF ABBREVIATIONS

vii

1 INTRODUCTION

1

2 MATERIALS AND METHODS
Subject
Body Size and Somatotype Measurements

Sosioeconomic Status
Data Analysis

2
2
3
4
4

3 RESULT AND DISCUSSION
Result
Sosioeconomic backgrounds
General body size
Body shape
Discussion

5
5
5
6
10
15

4 CONCLUSION

17

REFERENCES

18

APPENDIX

21

CURRICULUM VITAE

27

LIST OF TABLE
1 Site Sampling of Sasak Children

3

LIST OF FIGURE
1 Height-for-Age Percentiles of Sasak Boys and Girls Aged 3 to 19 Years
Live at Different Altitude
2 Growth Pattern of Body Height of Sasak Children
3 Annual Velocities of Body Height of Sasak Children
4 Weight-for-Age Percentiles of Sasak Boys and Girls Aged 3 to 19
Years Live at Different Altitude
5 Growth Pattern of Body Weight of Sasak Children
6 Annual Velocities of Body Weight of Sasak Children
7 The 50th Percentile Values of Somatotype Components Score in Sasak
Children
8 Somatoplot of The 50th Percentile Somatotype Score of Sasak Children
in Low Altitude
9 Somatoplot of The 50th Percentile Somatotype Score of Sasak Children
in Medium Altitude
10 Somatoplot of The 50th Percentile Somatotype Score of Sasak Children
in High Altitude
11 Comparison of Body Height and Body Weight of Several Populations
in Indonesia

6
7
8
9
9
10
12
13
14
14
16

LIST OF APPENDIX
1
2
3
4

Parents Occupation of Sasak Children Included The Study
Parents Education of Sasak Children Included The Study
Family Size of Sasak Children Included The Study
Somatotype Score and Somatotype Categories, by Age, Sex, and
Altitude
5 One-way ANOVA results of body height and body weight in Sasak
children
6 Tukey HSD test of body height and body weight of Sasak girls in each
altitude

21
22
23
24
25
26

LIST OF ABBREVIATIONS
ANOVA
Asl
BH
BPS
BW
HSD
HWR
IDR
NHANES
NTB
MA
PAUD
SD
SES
SMA
SMK
SMP
TKI
TK
WHO

analysis of variance
above sea level
body height
Badan Pusat Statistik (Statistics Indonesia)
body weight
honest significant difference
height weight ratio
Indonesian Rupiah
National Health and Nutrition Examination
Nusa Tenggara Barat
Madrasah Aliyah (Senior High School level)
Pendidikan Anak Usia Dini (Kindergarten School level)
Sekolah Dasar (Elementary School level)
socioeconomic statuses
Sekolah Menengah Atas (Senior High School level)
Sekolah Menengah Kejuruan (Senior High School level)
Sekolah Menengah Pertama (Junior High School level)
Tenaga Kerja Indonesia (migrant worker)
Taman Kanak-Kanak (Kindergarten School level)
World Health Organization

1 INTRODUCTION
The human life cycle can be staged into neonatal (birth to 28 days),
infancy (2 to 36 months), childhood (3 to 7 years), juvenile (7 to 12 y), puberty
(transition between juvenile to adolescence/ days or few weeks), adolescence (5 to
8 years after the onset of puberty), adulthood (20 years to end of child-bearing
years), and senescence (end of child-bearing years to death). During this cycle, the
body changes significantly in size, structure, proportions, and composition (Bogin
1999). The age of schooling is one of the important phases in human life cycle.
The puberty stage within this age range is indicated by the growth spurt of stature
and weight.
Both of genetic and environmental factors contribute to body shape and
size variations during development. For instance, children who live in high
altitude face numerous environmental stresses. The stresses are hypoxia, cold
climate, ultraviolet radiation, and rough and difficult terrain. This condition needs
more physical and physiological activities than the children who live in low
altitude (Hastuti 2005; Malhotra et al. 2006; Singh et al. 2007). Several studies
showed reduced birth weight and reduced childhood growth in the high altitude
(Yip et al. 1988; Jensen and Moore 1997; Lestari 2006). The other studies found
little or no difference in growth between children living at low and high altitude
(Freyre and Ortiz 1988; Hastuti 2005).
Independent of body size, a somatotype is a convenient shorthand
descriptor of overall physique in terms of body shape and composition (Carter
1996). It measurements expressed in a three-number somatotype reflecting body
composition; they are endomorphy, mesomorphy, and ectomorphy. Endomorphy
is the relative fatness, mesomorphy is the relative musculoskeletal robustness, and
ectomorphy is the relative linearity or slenderness of a physique (Carter and Heath
1990). Somatotype is useful for description and comparison of population for
monitoring growth change. A large variety somatotype studies have yielded much
information about human physique (Bhasin and Jain 2007).
Physical activity is one of factor influenced somatotype variation.
Rahmawati et al. (2007) studied the differences of somatotype between athlete
and non athlete. Fett et al. (2006) evaluated the somatotype of overweight and
obese women in pre and post circuit training or jogging, while Ozener and Duyar
(2008) studied the labour effect during adolescent period in somatotype. The other
factors are sex, age and socioeconomic statuses (SES). Sex influences personal
somatotype because male and female have different trajectory of growth and
development (Bhasin and Jain 2007). The children exhibit different somatotype
pattern form adults (Rahmawati et al. 2004). SES such as parent education, parent
occupation and monthly income were widely influence the growth of children
(Eiben and Mascie-Taylor 2004; Bener and Kamal 2005; Bala et al. 2010; Lazzeri
et al. 2011; Widiyani et al. 2011).
Growth and somatotype of children has been intensively studied at several
populations in Indonesia such as Bogor (Puspita 2004), Bantul and Yogyakarta
(Rahmawati et al. 2004), Karawang (Hermawan 2007), Purwakarta (Miharja
2008), Bandung (Aryo 2011), Magelang (Widiyani et al. 2011), and Arfak tribe in
Papua (Kawulur et al. 2012). Most of the study was carried out in low or medium

2
altitude Java and Sunda ethnics in Java island. However, the study of other ethnics
is lacking.
The focus of this research is to evaluate the age-related body size and shape
variations at different altitude in Sasak tribe. Sasak is one of dominant ethnics in
Lombok island. The Statistics Indonesia (BPS) estimated 3.168.693 people live in
Lombok with 40.63 % of them having age cohort of 0 to 19 years old. Based on
BPS data, a half of populations (47.12%) work as farmer and 17.47% as merchant.
One fifth (21.55%) of West Nusa Tenggara population live in under poverty
where 36.15% of them not attended formal education (BPS 2011).
The subjects of this research are Sasak schoolchildren who live in three
altitudes; low, medium, and high altitudes. The children in low altitude population
were found to be higher and heavier than medium and high altitude populations.
Until puberty, the children in medium population have similar stature and weight
with those reside in high altitude population but shorter and lighter thereafter.
There were significant differences in three altitudes for girl height and weight but
no difference for boys.
Based on body shape differentiation, the Sasak children have an increased in
endomorphy, a decreased in mesomorphy, and an increased in ectomorphy during
growth. The children in low altitude more endomorphic in 7 to 16 y than the two
others. Boys were more ectomorph and less endomorph than the girl. We also find
different pattern of growth in medium altitude compare to the others. The children
in medium altitude show delayed and slowly increasing of endomorphy and
slowly decreasing of mesomorphy. This condition made the children have long
central period of somatotype category before puberty. Family income and parental
education exerted more influence to the differentiation than the altitude factor.

2 MATERIALS AND METHODS
Subject
The subjects in this research are the children of Sasak tribe who lived at
different altitude in Lombok Island, West Nusa Tenggara province. After
Sumbawa, Lombok with 4738.6 km2 is the second widest island in the province.
The northern and south eastern part of Lombok is mountainous and hilly with
lowland and plateau in between. Rinjani is the highest mountain (3726 m above
sea level, asl) in Lombok (BPS 2011).
A cross sectional growth study was conducted during July to December
2012. The samples are students of kindergarten to senior high schools aged 3 to
19 years (Table 1). All of subjects are rural children who lives in low (16 to 28 m
above sea level), medium (525 to 628 m asl), and high altitude (1130 to 1213 m
asl). Global Positioning System (Garmin Etrex 10 GPS) used to determine the
altitude.
Before enrolling, a letter with detailed information about this research was
send to the parents or guardians of children in kindergarten and elementary school
samples; as for junior and senior high school subjects, the informed consents were
asked directly. If they approve to participate, they will be ask to sign the informed

3
consent and completing a questionnaire on birth dates, ethnicity and other
socioeconomic data. Data analysis was conducted at Section of Biosystematic and
Ecology of Animals, Department of Biology, Faculty of Mathematics and Natural
Sciences, Bogor Agricultural University.
Table 1 Site sampling of Sasak children
Name of the School
Low Altitude
TK Satu Atap SD 1 Labuan Tereng , West Lombok
SD 1 Labuan Tereng, West Lombok
SD 4 Batulayar, West Lombok
SMP 1 Batulayar, West Lombok
SMK Pariwisata Batulayar, West Lombok
SMK Perikanan Lembar, West Lombok

Number of Samples
408
19
31
46
144
126
42

Medium Altitude
PAUD Mawar Rindang Tetebatu, East Lombok
SD Sekedek, Central Lombok
SMP 3 Batu Kliang Utara, Central Lombok
MA Nurussalam Tetebatu, East Lombok

271
19
96
82
74

High Altitude
PAUD Sembalun Bumbung, East Lombok
SD 2 Sembalun Bumbung, East Lombok
SMP 2 Sembalun Bumbung, East Lombok
SMA 1 Sembalun, East Lombok
Total

273
17
113
86
57
952

TK and PAUD are Kindergarten School Level; SD is Elementary School Level; SMP is Junior High School
Level; SMA, SMK and MA are Senior High School Level

Body Size and Somatotype Measurements
Ten antrophometric measurements were used to determine growth of size
and somatotype of subjects. They are stature (BH), weight (BW), four skinfolds
(triceps, subscapular, supraspinale, and medial calf), two bone breadths
(biepicondylar humerus and femur), and two limb girths (upper-arm and calf). I
followed the anthropometric measurement manual of NHANES III (1988).
BH and BW are the main dimensions of body size. BH is a linear
measurement of the distance from the standing surface to the top (vertex) of the
skull; it is a composite of linear dimensions contributed by the lower extremities,
the trunk, the neck, and the head. It was measured to the nearest 1 mm using
anthropometer. BW is a measure of body mass; it is a composite of independently
varying tissues. BW was measured using digital weight scale with resolution 100
gram.
The skinfolds, bone breadths, and limb girths were obtained to determine
the somatotype (Carter and Heath 1990). Skinfolds were estimated by skinfold
caliper, whereas, bone breadths were measured by sliding caliper. The three

4
somatotype components, i.e., endomorphy, mesomorphy, and ectomorphy of each
participants were calculated following Heath-Carter method (Carter 2002). These
three calculated number described the somatotype. The equation of Endomorphy
= − 0.7182 + 0.1451(X) − 0.00068 (X2) + 0.0000014 (X3) where X is sum of
triceps, subscapular and supraspinale skinfolds. Mesomorphy were calculated
with the formula: Mesomorphy = [(0.858 × humerus breadth) + (0.601 × femur
breadth) + (0.188 corrected arm girth) + (0.161 × corrected calf girth)] − (height
× 0.131) + 4.5. Ectomorphy had three equations. If Height Weight Ratio (HWR)
was greater than or equal to 40.75, Ectomorphy = HWR × 0.732 − 28.58, if HWR
was less than 40.75 but more than 38.25, then Ectomorphy = HWR × 0.463 −
17.63 and if HWR was equal to or less than 38.25 given a rating of 0.1. HWR was
body height divided by cube root of body weight. Each component have score
range between one to seven. The number one represented the lowest observed
amount of the component and seven for the highest. All of the measurements were
obtained on the right side of each subjects in the morning as far as possible.
Sosioeconomic Status
The sosioeconomic statuses (SES) of children are factor that affect growth
of size and somatotype. It is ascribed to them based on the SES of their parents.
SES is a concept to measure some aspect of education, occupation and social
prestige of a person or a social group (Bogin 1999). It was measured by formal
education (schooling), occupation, monthly income of child’s parents, birth order
of child, and number of children in the family. Six educational levels, ten
occupational categories, five monthly incomes of parents, five birth order level,
and five number of children category were used to identify socioeconomic status.
Data Analysis
BW and BH were presented as charts of age changes growth which were
fitted by applying generalized additive models for location, scale and shape
(GAMLSS) (Rigby and Stasinopoulos 2005). We predicted nine levels (3%, 5%,
10%, 25%, 50%, 75%, 90%, 95%, and 97%) of percentiles to describe the pattern
of growth of the whole populations from small to big sizes. In order to evaluate
the variation of body size in different altitudes, we computed the Z value of each
individu. Z score is based on the statistical population mean and measured in unit
of the standard deviation. By using Z score of BH and BW we effectively
removed the effect of age changes on body sizes. One-way ANOVA were used to
evaluate altitudinal effect on body size in each sex groups. The Tukey HSD
(honest significant difference) post hoc test was used to evaluate the differences
between each pair of altitudes.
For body shape evaluation, the percentile 50 of somatotype scores of each
age group were plotted on a somatochart (Carter 2002), using the following axis :
X coordinate = ectomorphy - endomorphy and Y coordinate = 2 * mesomorphy (ectomorphy + endomorphy). The somatotypes were classified into thirteen
categories following Carter’s Classification (Carter 1990). All statistical
procedures were performed using the R software version 2.9.1 (R Development
Core Team 2010).

5

3 RESULT AND DISCUSSION
Result
Socioeconomic Backgrounds
The subjects from low altitude consisted of 203 boys and 205 girls from
two villages, Batu Layar and Labuan Tering, located at coastal areas. A third of
father in this group were labor (majority work in brick production, porter in
traditional market and construction), one fifth as fisherman, and 17% of them
work as merchant. However, a half of their mothers were housewives or jobless,
20% merchant and 15% labor in brick production and home servant. Over half of
their parents (50% of fathers and 56% of mothers) had received primary school,
28 and 18% attended secondary education (junior and senior high school) and
only 0.5 to 4% of parents graduated in the college (diploma and bachelor).
Whereas, one fifth of parents were not attended formal education.
The children from medium altitude live at agricultural villages near
Rinjani National Park. The subjects comprised of 123 boys and 148 girls from
three villages (Sekedek, Seteleng, and Tete Batu). A half of their fathers work as
farmer and the others (30%) work as labor (majority in brick production,
construction, and migrant worker/TKI). A third of their mother (34%) were not
working or housewives, 30% worked as farmer, and the other as labour and
harvesting natural products. This group has a high percentage of parents not
attended formal education (50%), only 36% of parents had received primary
school, and the other had secondary education.
In high altitude, the children live at agricultural villages at Rinjani
Mountain. The subjects of the third group consisted 133 boys and 140 girls from
four villages (Sembalun Lawang, Sembalun Bumbung, Jorong and Telaga).
Majority of the fathers in high altitude are farmers (86%). Over half of mothers
(52%) also worked as farmer and a quarter of it as housewives. A third of father
(37%) and over half of mother (58%) were not attended formal education, a third
other had formal education until elementary school, and only one fifth of father
and 10% of mother had secondary education.
Majority of family in all altitudes are small size with one to three children
where total monthly income of parents categorized as low and very low
(Appendix 1 to 3, respectively). The regional minimum wage of West Nusa
Tenggara (NTB) in 2013 is IDR 1 100 000. Regional minimum wage is regulated
every year by local government based on the rates of several goods in an area. It is
a standard used by industry in paying their labor or their employees. But, majority
of people who lives in rural had work as self financed (farmer, fisherman, and
construction) with unstable monthly income. In average, their monthly income
was lower than the regional minimum wage of West Nusa Tenggara.

6
General Body Size (Stature and Weight)
Growth rate can be evaluated from body height (BH) and body weight
(BW) measurements. It provides general information of body size. The
relationships between their age-related changes in BH and BW are shown in
Figures 1 to 6.
A. Stature
The relationships between age-related changes in BH are shown in Figures
1 and 2. According to the 50th percentile, the 3 years old girls of Sasak have 89 to
91 cm BH. When they reached 19y the body height both of low and high altitude
girls increased to 160 cm, while the girls in the medium 146 cm. The trends of age
related changes in boys were the same as with girls. The 3y boys in low altitude
have 93 cm height and increased to 165 cm at 19y, whereas the boys in high
altitude started from 93 cm and increased to 170 cm at 19y. The boys in medium
altitude have the smallest body height (86 cm in 3y and increased to 161 cm in
19y).

Figure 1 Height-for-age percentiles of Sasak boys and girls aged 3 to 19 years live
at different altitudes.

7

Figure 2 Growth pattern of body height of Sasak children. The patterns are taken
from 50th percentile (see Figure 1). Boys, open; girls, closed.
In the early development, the BH growth of girls in low and medium
altitudes were relatively stable (Figure 3). The velocity started to declined at 6.5y
in lowland. In the age 15.5y, the velocity turned flat at 2.3 cm year-1. The girls in
the medium altitude were practically stopped to grow in the age 15.5y and tend to
grow negatively between 16.5 to 18.5y. The growth rate in highland started to
increase at 3.5y with velocity 4.4 cm year-1, reached maximum at 10.5y with
acceleration of 6 cm year-1 and decreased after that. Reaching the age 18.5 years,
the velocity in highland was relatively stable at 2.6 cm year-1.

Figure 3 Annual velocities of body height of Sasak children. The patterns are
taken from 50th percentile. Boys, open; girls, closed.
The growth of BH in boy in low altitude was relatively stable into 5.5y,
decreased after that, increased again in 9.5y, reached maximum in 12.5y and than
declined after that. The boys in medium altitude have a decreased BH velocity 6.3
cm year-1 at 3.5y to 0.78 cm year-1 at 18.5y, without growth spurt. On the other
hand, the boys in high altitude increased their velocity, reached maximum spurt at
13.5y and declined after that.
Based on Z score value, both girls and boys in lowland have above average
stature indicated by positive mean Z score value (0.2346 for girls and 0.1089 for
boys). On the other side, both of children in medium and high altitudes have

8
average stature below population mean with negative BH Z score values.
According to the ANOVA results (appendix 5), the elevation influenced the body
height in girls with P < 0.05 and not significant differed in boys (P > 0.05).
Tukey’s Honest Significant Difference test was used to determine which
groups differ from each other. Based on this test, body height of girls in low
altitude differed with girls in medium and high altitudes with P < 0.05, whereas
the girls in medium did not differ with high altitude (appendix 6).
B. Weight
According to the 50th percentile of body weight (Figure 4 & 5), the 3 years
old girls of Sasak tribe live in different altitudes have 8 to 11 kg of BW. When
they reached 19y the body weight of low and high altitude girls increased to 52 kg,
while in medium altitude only 43 kg. The 3y boys in low altitude weighed 10 kg
and increased to 53 kg in 19y. The boys in medium altitude have a weight of 9 kg
in 3y and increased to 51 kg in 19y, whereas the boys in high altitude 12 kg and
increased to 57 kg at the same ages.
In Figure 6, girls BW in all altitudes started to ascend between 6.5 to 7.5y
at 2.6, 1.4, and 1.7 kg year-1 (low, medium, and high altitudes, respectively). The
peaks achieved between ages 11.5 to 12.5y with velocity 3.1, 4.1, and 4.1 kg year1
, and then decreased after that. BW grew relatively stable in age 17.5 to 18.5 with
velocity 2.5 kg year-1 for girls in low and highland, while the girls in medium
altitude was stopped to grow in the same age. The boys BW in all altitudes grew
relatively stable into 7.5y, increased after that and reached maximum in age 13.5y.
The boys BW velocity in medium altitude decreased in age 14.5y, while the
velocity in the others still stable.

9

Figure 4 Weight-for-age percentiles of Sasak boys and girls aged 3 to 19 years at
different altitudes.

Figure 5 Growth pattern of body weight of Sasak children. The patterns are taken
from 50th percentile (see figure 4). Boys, open; girls, closed.

10

Figure 6 Annual velocities of body weight of Sasak children. The patterns are
taken from 50th percentile. Boys, open; girls, closed.
The children in lowland have above average weight (mean Z score are
0.2458 for girls and 0.0577 for boys). Both of children in medium and high
altitudes have average weight below population mean with negative Z score.
Analysis of variance showed a significant influnce of elevation to body weight in
Sasak girls but not in the boys (appendix 5).
According Tukey’s Honest Significant Difference test, body weight of
girls in low altitude significant differed to medium and high altitudes with P <
0.05. In the other hand, the girls in medium did not significant differ to high
altitude with P > 0.05 (appendix 6).
Body Shape
Body shape can be evaluated using somatotypic measurements.
Somatotype is a description of the morphological state of individual at a given
moment. This method had yielded much information about human physique and
compositions.
A. Somatotype Compositions
Somatotype comprises of three components, they are relative adiposity
(endomorphy), musculo-skeletal robustness (mesomorphy), and linearity
(ectomorphy) (Carter and Heath 1990). Figure 7 shows the three components of
somatotype compositions in age group comparison.
a. Endomorphy
In low altitude, the first somatotypic component of girls slowly increased
from 3 to 9y, quickly grew in 10 to 15y and came to flat afterward. In medium
altitude, the scores grew relatively stable in 3 to 11y old period and quickly
increased until 19y. On the other hand in high altitude, the score decreased from 3
to 11y before increasing.
The endomorphy scores of boys are relatively stable into adulthood in low
altitude. The boys in medium and high altitudes showed decreased of scores in 3
to 8y and relatively stable after that.

11
The older girls (16 to 19y) in low and high altitudes were more
endomorphic than in the medium altitude; on the contrary, the boys are either
equal or differ with no more than 0.5 units for all altitudes. We found sex
differences (the score difference of more than 1 unit) in endomorphic score along
childhood into adulthood (the ages between 13 to 19y). The girls were more
endomorphic than the boys.
b. Mesomorphy
Mesomorphy, the second component of physique is an indicator of relative
musculo-skeletal development per unit of length. The scores are decline quickly at
both younger (3 to 9y) boys and girls in lowland, relatively stable in medium
altitude, and drop slowly in high altitude. Both of younger boys and girls in low
altitude are mostly mesomorphic than the other two altitudes. In older age groups
(10 to 19y), the scores were relatively stable for both of boys and girls in all
altitudes. This result does not mean that younger ones are more muscular than the
older ones, partly because of the fact that mesomorphy is adjusted for height.
The mesomorphy did not display any sex difference along age groups in
each altitudes. However, although the differences were less than 1 unit, boys had
higher mesomorphy. As this component is adjusted for height and boys being
taller especially after 14y of age, they were stronger and muscular than the girls.
c. Ectomorphy
Ectomorphy or the relative linearity of individual physique demonstrates a
steady increase with age until 11y both in boys and girls at all altitudes. The
scores then decreased slowly in older girls (12 to 19 years). In other hand, in older
boys, the scores are relatively stable. We found sex differences in ectomorphic
score after 11y where the boys more ectomorphic than the girls.

12

13
B. Somatotype: Category
Somatotypic categories are classification of body shape based on
combination of the three components of somatotype. The results of age changes in
somatotypic categories and their comparison between sex and altitude
differentiations are showed in Figure 8, 9, 10, and appendix 4, respectively.
The girls in low altitude have endomorphic-mesomorph category in age 3
to 5y, changed to mesomorph-endomorph in 6y, go to central in age 7 to 9y, and
balanced endomorph after that until 19y. The boys have endo-mesomorph
category at 3 to 5y, move to balanced mesomorph at 6y, changed to central at 7 to
9y, move to balanced ectomorph at 10 to 12y and back to central until 19y (Figure
8).

Figure 8 Somatoplot of the 50th percentile somatotype score of Sasak children in
low altitude; boy (black square) and girl (grey triangle).
The girls from medium altitude have mesomorph-endomorph category in
age 3 to 6y, move to central in 7 to 13y, and changed to balanced endomorph until
19y. Whereas the boys have mesomorph-endomorph category in 3 to 6y, go to
central into 9y. Balanced ectomorph have found in the boys age 10 to 16y and
back to central after that until 19y (Figure 9).

14

Figure 9 Somatoplot of the 50th percentile somatotype score of Sasak children in
medium altitude; boy (black square) and girl (grey triangle).
The girls from high altitude have mesomorph-endomorph category in age
3 to 6y, move to central in 7 to 12y, and changed to balanced endomorph until 19y.
Whereas the boys have mesomorph-endomorph category in 3 to 5y, move to
balanced mesomorph at 6y, changed to central at 7 to 12y, move to balanced
ectomorph until 18y and back to central at 19y (Figure 10).

Figure 10 Somatoplot of the 50th percentile somatotype score of Sasak children in
high altitude; boy (black square) and girl (grey triangle).

15
Discussion
Genetic and enviromental factors affect the physical growth and
development of children. Sex differentiaton, age, and tribe are the genetic factors.
Human activities, sosioeconomic statuses, and location where human live are
several factors of environment. Hypoxic stress in high altitude is one of factors
causing delay and modifying the growth spurt in children (Malhotra et al. 2006).
The altitude had inverse correlation with oxygen content in the air; the higher
altitude, the lower oxygen content in the air. The reduction in the partial pressure
of oxygen is more significant above 3000 m (Virués-Ortega et al. 2006). As
expected Hastuti (2005) reported no significant differences in BH and BW of girl
or boy between Samigaluh district (high altitude, less than 1000 m asl) and Galur
district (low altitude, coastal area) at Kulon Progo regency. Those indicated that
altitude below 3000 m has relatively little effect on body size. However, the Sasak
girls in low altitude (16 to 28 m asl) were heigher in age 3 to 12y and heavier in
age 6 to 14y than medium (525 to 628 m asl) and high altitude (1130 to 1213 m
asl) populations. These differences were statistically significant. The trends in
boys were the same as girls but the altitudinal differences were not statistically
significant. Both sexes of children in medium altitude have similar stature and
weight to the population age 5 to 15y who reside in high altitude, but shorter and
lighter thereafter. According to their body size, biggest to smallest population are
from low, highland and medium altitudes respectively. There is an evidence that
the high altitude children have lower stature. It is partly caused by smaller size at
birth. Infants born at high altitude were often experience intrauterine growth
restriction in contrast to preterm birth (Jensen and Moore 1997, Lestari 2006). For
medium altitude population of Sasak, we should not expect 500 m asl altitude has
adverse effect on intrauterine growth to make their size smaller. Therefore the
different body sizes in girls of Sasak children might be better explained by
differences in SES.
Family income and parental education would be better indicators of SES
(Julia et al. 2004; Moestue and Huttly 2008). In low altitude, 88.7% of parents
have monthly income less than 1 100 000 IDR or lower than regional minimum
wage, whereas high and medium populations are 91.3% and 92.4%, respectively.
Majority of parents in low altitude were fishermen, while in medium and high
altitudes were farmers. This presented an advantage to the children in lowland in
having higher intake of protein from animal food (especially fishes and sea food).
Furthermore the children in medium and high altitudes have more parents without
formal education. These differences in family income and parental education gave
more influence to the body size differentiation than the altitude factor.
The effect of SES to growth of children can also be seen in the comparison
between Sasak and other populations in Indonesia. Growth of children has been
intensively studied at several populations in Indonesia such as Bantul and
Yogyakarta (Rahmawati et al. 2004), Karawang (Hermawan 2007), Purwakarta
(Miharja 2008), Magelang (Widiyani et al. 2011), and Arfak tribe in Papua
(Kawulur et al. 2012). All populations except Arfak tribe above are the same
Mongoloid race, so enviromental factor such SES and human activities gave more
influence to the differentiaton then genetic factor. It is a well known fact that the
well-off population has higher physical growth then the poor ones (Delemarre-van

16
de Waal 1993; Shen et al. 1996; Mueller and Smith 1999; Rahmawati et al. 2004;
Artaria and Henneberg 2007). Yogyakarta, Karawang and Magelang samples
came from urban populations with higher SES level than Sasak Children; hence
they had better nutrition and optimum living conditions. On the other hand,
Purwakarta and Bantul samples came from rural population with SES relatively
similar with Sasak Children. In all study populations of Sasak children, the
monthly income of parents was unstable and lower than the regional minimum
wage of NTB. In general, they were shorter and lighter than urban populations and
relatively in similar proportion with rural population in Java (Figure 11). The
growth constraints of body size is strongly associated with poverty (Julia et al.
2004; Water et al. 2004).

Figure 11 Comparison of body height and body weight at several populations in
Indonesia
The somatotype compositions showed the Sasak children have a common
pattern where we observed an increased in endomorphy, a decreased in
mesomorphy, and an increased in ectomorphy during growth. The children in low
altitude more endomorphic in 7 to 16 y than the two others. If compared with
Javanese population who life at low altitude (~ 360 asl) in Bantul, Magelang and

17
Yogyakarta (Rahmawati et al. 2004, Widiyani et al. 2011), the Sasak boys in low
altitude appear more endomorphic than the others populations expect the boys in
Yogyakarta and more ectomorphic than Yogyakarta but relatively balanced with
the others. The girls in low altitude are more endomorphic than the other and less
ectomorphic than Bantul.
The Sasak children in medium altitude (525 to 628 asl) exhibit generally
higher values of endomorphy and mesomorphy than Sundanese population in
Bandung who life at medium altitude (~791 asl) (Aryo 2011). Whereas, the last
group of Sasak children are more endomorph than Spitian population who life at
high altitude (3500 – 4200 asl) in India (Singh et al. 2007).
Based on Somatotype categories, before puberty, the children in low
altitude, were distributed in endomorphic-mesomorph to central in both sex. The
children in high altitude were distributed in mesomorph-endomorph to central
before puberty. After puberty, the boys were distributed at balanced ectomorph to
central whereas the girls were distributed to balanced endomorph. This pattern is
relatively similar with common somatotype categories in Bandung, Magelang,
and Yogyakarta. The difference pattern can be find in Bantul population where the
boys and girls have ectomorphic category before puberty.
Rahmawati et al. (2004) suggest two phenomena in somatotype variation
related to age changes. First, the somatotype of well-off children shifts in puberty
from endo-mesomorphy to ectomorphy in the boys, and to endomorphy in the
girls. Second, the somatotype of lower-income children remains ectomorphic both
before and after puberty, but the girl after puberty seem to shift to endomorphy
while the boys become more and more ectomorpic according to age.
The girls in medium altitude show delayed and slowly increasing of
endomorphy and slowly decreasing of mesomorphy. The low ratings of the
endomorphy component signify physiques with a small amount of body fat, while
high value of mesomorphy implies marked musculoskeletal development (Jürimäe
and Jürimäe 2000). Moreover, the girls in this altitude have a long period of
central somatotype (7 to 13 y), that indicated all three of somatotype are equal or
differ no more than one unit. The pattern is uncommon for the girls development.
For puberty preparation, the girls need to deposit the fat with increasing
endomorphy value and decreasing mesomorphy (Jürimäe and Jürimäe 2000).

4 CONCLUSION
The children in low altitude population were higher and heavier than
medium and high altitude populations. Until puberty, the children in medium
population have same stature and weight with those reside in high altitude
populations but shorter and lighter thereafter. The difference of height and weight
are statistically significant in girls and not in boys.
Based on somatotype compositions, the Sasak children have a common
pattern where we observed an increased in endomorphy, a decreased in
mesomorphy, and an increased in ectomorphy during growth. The girl in medium
altitude show delayed and slowly increasing of endomorphy and slowly
decreasing of mesomorphy. Family income and parental education exerted more
influence to the differentiation than the altitude factor.

18

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Appendix 1 Parents occupation of Sasak Children included the study
Elevation
Middle

Low

Parents Status

Male

Height

Female
n
%

Male

Female

Male

n

%

n

%

n

%

n

Female

n

%

%

Father occupation
Civil Servant (Teacher, Soldier, and others)
Farmer
Fisherman
Entrepreneur (Merchant, Tailor, Mechanic)
Labor (Porter, Construction, Gardener)
Driver (Traditional Transportation/Cidomo)
Jobless
Harvesting Natural Product (Wood, Vegetable)
Security
Other (Pass away)

13
36
35
38
60
13
1
0
2
1

6.53
18.09
17.59
19.01
30.15
6.53
0.50
0.00
0.93
0.50

7
16
34
27
61
16
1
0
5
1

4.17
9.52
20.24
16.07
36.31
9.52
0.60
0.00
2.98
0.60

6
50
0
8
36
0
1
7
0
2

5.45
43.45
0.00
7.27
32.73
0.00
0.91
6.36
0.00
1.82

3
73
0
5
40
2
0
8
0
2

2.26
54.89
0.00
3.76
30.08
1.50
0.00
6.01
0.00
1.50

6
105
0
7
2
0
0
1
0
0

4.96
86.78
0.00
5.78
1.63
0.00
0.00
0.83
0.00
0.00

6
104
0
6
3
1
0
0
0
3

4.87
84.55
0.00
4.87
2.44
0.72
0.00
0.00
0.00
2.43

Mother occupation
Civil Servant (Teacher and others)
Farmer
Fisherman
Entrepreneur (Merchant, Tailor)
Labor (Porter, Servant)
Driver (Traditional Transportation/Cidomo)
Housewives/Jobless
Harvesting Natural Product (Wood, Vegetable)
Security
Other (Pass away)

1
20
1
47
27
0
82
0
0
21

0.50
10.05
0.50
23.63
13.57
0.00
41.21
0.00
0.00
10.55