RESUMO
OBJECTIVE: The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces. DESIGN: ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. SETTING: Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina). PARTICIPANTS: 10 879 children of both sexes aged between 3 and 13·99. RESULTS: ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight. CONCLUSIONS: The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.
Assuntos
Estado Nutricional/fisiologia , Adolescente , Antropometria , Argentina/epidemiologia , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , MasculinoRESUMO
The aim of this study was to analyze growth in relation to menarche in girls from two Argentinean urban populations. We performed a comparative-descriptive cross sectional study in 2474 schoolchildren between 8.0 and 16.9 years old from Santa Rosa (SR) and La Plata (LP) cities. We registered the presence of menarche and anthropometrics variables of body weight, total and sitting heights, arm circumference, triceps and subscapular skinfolds. Body mass index, subscapular/triceps index and muscle and fat arm areas were calculated. The study group was divided into 4 groups according to the city and menarche. The socio-environmental structured survey indicated significant differences between cities with these variables: tenure status, building materials and services, health care coverage, cash assistance, educational level and parents' occupation, therefore establishing a higher welfare in youngsters of SR. Menarche at a mean age of 12.7 years old was more prevalent in SR (40.6%) than in LP (33.7%) (c2 = 12.9; p < 0.01). The ANOVA indicated significant differences between cities in total and sitting heights and muscle area (p < 0.01), body weight and arm circumference (p < 0.05) which were generally held in the post hoc comparison by age in pre-menarche and post-menarche groups. The presence of a small body size at the expense of lowering in: total height, muscle area and leg length in LP youngsters, associated with a lower prevalence of menarche in this city, it would represents the adaptive cost of a lower welfare environment.
Assuntos
Composição Corporal , Crescimento/fisiologia , Menarca/fisiologia , Maturidade Sexual/fisiologia , Adolescente , Argentina , Criança , Estudos Transversais , Feminino , Humanos , Fatores Socioeconômicos , População UrbanaRESUMO
BACKGROUND: Nutritional transition has been described in various countries, each showing inherent characteristics. Furthermore, different patterns also appear within the same country. AIM: To compare the nutritional status of schoolchildren, of both sexes, living in two Argentine cities with different urban and environment characteristics, from the perspective of nutritional transition. SUBJECTS AND METHODS: The sample comprised 5355 children (6-13 years) living in Puerto Madryn (Chubut) and General Alvear (Mendoza), Argentina. Weight and height were transformed into Z-scores according to NHANES I- II; underweight, stunting and wasting defined by - 2 SD and overweight and obesity calculated according the cut-off proposed by IOTF. Prevalences of nutritional status were estimated. RESULTS: Comparison of the two cities revealed significant χ² values for the indicators of nutritional status analysed. Puerto Madryn had higher prevalences of overweight and obesity. General Alvear exhibited higher stunting and underweight values. CONCLUSIONS: The cities studied are in different stages of nutritional transition. Puerto Madryn is undergoing growing industrialization and urbanization and thus exhibits characteristics typical of an 'obesogenic' environment. General Alvear, a less complex urban centre, where some cultural patterns related to an agrarian way of life appear to have been retained, is situated at a less advanced stage.
Assuntos
Estatura , Peso Corporal , Estado Nutricional , População Urbana , Adolescente , Argentina/epidemiologia , Índice de Massa Corporal , Criança , Feminino , Geografia , Humanos/crescimento & desenvolvimento , Masculino , Inquéritos Nutricionais , Obesidade/epidemiologia , Sobrepeso , Fatores Socioeconômicos , Magreza/epidemiologiaRESUMO
Indigenous communities in Argentina represent socially and economically neglected populations. They are living in extreme poverty and environmental degradation conditions. New information about health status and socio-environmental features is urgently needed to be applied in future sanitary policies. Present study describes the nutritional status, body composition, and intestinal parasitism among Mbyá-Guaraní children from three communities in the Misiones Province. Anthropometric parameters were analyzed for 178 individuals (aged 1-14). Data were transformed to z-scores using NHANES I and II. Stunting showed the greatest prevalence (44.9%). Children were found to have low arm circumference and low arm muscle area, although with tricipital skinfold value near to the reference. They also tend to have shorter than normal lower limbs. Fecal samples and anal brushes (for Enterobius vermicularis) were collected in 45 children (aged 1-13). Ritchie's sedimentation and Willis' flotation techniques were used to determine parasitoses. Ninety five percent of children were infected with at least one species and 81.4% were polyparasitized. The higher prevalences corresponded to Blastocystis hominis, hookworms (Ancylostoma duodenale/Necator americanus), and Entamoeba coli. Associations occurred between hookworms with B. hominis/E. coli and B. hominis with nonpathogenic amoebas. Thirty nine percent of the children with stunting presented B. hominis, Strongyloides, and hookworms. Our results indicate that this indigenous population is subjected to extreme poverty conditions and is one of the most marginalized in this country. Severe growth stunting and parasitic infection are still quite common among Mbyá children affecting about half of them along with significant changes in body composition and proportions.
Assuntos
Composição Corporal , Enteropatias Parasitárias/epidemiologia , Estado Nutricional/etnologia , Adolescente , Animais , Argentina/epidemiologia , Infecções por Blastocystis/epidemiologia , Infecções por Blastocystis/etnologia , Criança , Fenômenos Fisiológicos da Nutrição Infantil/etnologia , Pré-Escolar , Entamebíase/epidemiologia , Entamebíase/etnologia , Enterobíase/epidemiologia , Enterobíase/etnologia , Fezes/parasitologia , Feminino , Transtornos do Crescimento/etnologia , Infecções por Uncinaria/epidemiologia , Infecções por Uncinaria/etnologia , Humanos , Indígenas Sul-Americanos/estatística & dados numéricos , Lactente , Enteropatias Parasitárias/etnologia , Masculino , Músculo Esquelético , Contagem de Ovos de Parasitas , Áreas de PobrezaRESUMO
The objective of this study was to analyse the effects of intrauterine growth retardation (IUGR) and growth hormone (Gh) therapy on skeletal maturation in growth retarded rats. One-hundred and thirty-five rats constituted the groups: Control (C), Sham-operated (SH), IUGR and IUGR+Gh: injected with Genotropin 3.0 mg/kg/day) from 21 to 60 days of age. SH was injected only with saline solution. The thickness of tibial cartilage was assessed on X-ray at the ages 1, 21, 42, 63 and 84 days and categorised according to three levels. L1: maximal thickness, L2: reduction of 50% and L3: absence. The percentual differences between frequencies for each level were compared and clustered by simple ligation in Euclidean distance. The results lead to us to conclude that skeletal maturation does not appear to be modified by IUGR, while it is accelerated by growth hormone in growth-retarded rats.
Assuntos
Retardo do Crescimento Fetal , Hormônio do Crescimento Humano/farmacologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiologia , Animais , Modelos Animais de Doenças , Feminino , Masculino , Gravidez , Ratos , Ratos WistarRESUMO
The aim of this work was to analyze the action of growth hormone (GH) on postnatal body weight recovery in intrauterine growth-retarded (IUGR) rats. Wistar rats were assigned to three groups: 1) control; 2) IUGR and 3) sham-operated. Uterine vessels of dams in the IUGR group were partially bent on the 14th day of pregnancy. At weaning, some IUGR pups were randomly selected and injected with GH (3 mg/kg/day), up to the 60th day. A standard diet ad libitum was available to mothers and offspring. The animals were weighed and food intake was recorded weekly. The weight gained velocity and relative food intake (RFI) was calculated. IUGR animals showed significant lower body weights than the control group. GH treatment allowed body weight recovery in IUGR rats. In females, body weight increased 14 days before males, and the former had greater RFI values. In conclusion, our results indicated differences in sexual responses to GH treatment. There is a need for more research on the mechanisms involved in that sexual difference.
Assuntos
Peso Corporal/efeitos dos fármacos , Retardo do Crescimento Fetal/tratamento farmacológico , Hormônio do Crescimento/farmacologia , Fatores Etários , Análise de Variância , Animais , Modelos Animais de Doenças , Ingestão de Alimentos , Feminino , Masculino , Análise Multivariada , Ratos , Ratos Wistar , Fatores SexuaisRESUMO
Growth and nutritional status of children and adults in two Mbyá-Guaraní communities from Argentina, was assessed. Height, weight, sitting height, upper arm circumference, triceps and subscapular skinfold were measured on 120 individuals aged from 2 to 60 between March and May, 2001. Data were transformed to z-scores using United States references (NHANES I and NHANES II). A z-score of less than -2 was used as the cut-off point to determine the prevalence of stunting and wasting respectively. Mean z-scores for weight, height, and upper arm circumference lie below the reference (0 > Z > -3), while in sitting height ratio and muscular area for females they were above the US standard (0 < Z < 2). Skinfold thicknesses and muscular area for males were similar to the reference (2 > Z > -1). Our findings are in agreement with others South American Indian research that the prevalence of stunting (36.7%) is significantly higher than wasting (1.8%). The presence of parasitic infections and nutritional environment previously described in this population could be related to the short stature.
Assuntos
Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Transtornos do Crescimento/epidemiologia , Distúrbios Nutricionais/epidemiologia , Adolescente , Adulto , Argentina/epidemiologia , Estatura , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estado Nutricional , PrevalênciaRESUMO
The aims of this work were to analyse body and brain growth as produced by deficiencies in the uteroplacental blood supply, and to evaluate sexual responses to intrauterine stress. Intrauterine growth retardation (IUGR) was experimentally induced in pregnant rats by partial obstruction in both uterine vessels at 1,7 and 14 gestational days. The dysfunctions in the placental circulation retarded both somatic and cerebral growth, depending on the period of gestational stress and the sex. Brain weight had a relatively greater resistance than body weight, which is called a "brain sparing" mechanism. The body and brain sexual dimorphism in control pups was inhibited in IUGR pups. This study shows that prenatal stress exposition might modify growth and sexual dimorphism at birth.
Assuntos
Encéfalo/embriologia , Retardo do Crescimento Fetal/fisiopatologia , Peso Fetal , Adaptação Fisiológica , Animais , Animais Recém-Nascidos , Feminino , Peso Fetal/fisiologia , Idade Gestacional , Masculino , Circulação Placentária , Gravidez , Ratos , Ratos Wistar , Fatores SexuaisRESUMO
The aim of the present study was to assess the catch-up growth in the postcranial skeleton of intrauterine growth retarded (IUGR) rats. Male and female Wistar rats were assigned to one of the following groups: controls, sham-operated, IUGR. The IUGR was produced by uterine vessels bending (day 14th of pregnancy). Trunk, pelvis, femur and humerus were measured on Rx of each animal, from I to 84 days of age. Data were processed by repeated analysis of variance and LSD post hoc test. The reduced placental blood flow disturbed the skeletal growth in pups, with the axial skeleton relatively more affected than the bones of the extremities. The catch up only took place in femur length of both sexes. The widths of long bones remained significantly retarded. We concluded that nutritional rehabilitation during the postnatal period might not be enough to allow a complete growth recovery.
Assuntos
Desenvolvimento Ósseo , Retardo do Crescimento Fetal/fisiopatologia , Animais , Animais Recém-Nascidos , Desenvolvimento Ósseo/fisiologia , Feminino , Fêmur/crescimento & desenvolvimento , Masculino , Ratos , Ratos Wistar , Injeções de Esperma IntracitoplásmicasRESUMO
The aim of the present study was to investigate in monkeys the effects of undernutrition on neurocranial and facial components, correlated with a histometric and ultrastructural analysis of somatotroph (growth hormone, GH) and lactotroph (prolactin, PRL) pituitary populations. Twenty Saimiri sciureus boliviensis (Cebidae) of both sexes were employed. The monkeys were born in captivity and when they reached 1 year of age, they were separated into two groups: control and undernourished animals. They were fed ad libitum a 20% and 10% protein diet, respectively. The monkeys were radiographed when they were 3 years old in order to measure the length, width and height of the anterior, middle and posterior components of the neurocranium, as well as those of the masticatory, respiratory and optic components of the face. The volumetric and morphometric indices were then calculated. After the sacrifice, pituitary glands were processed for light and electron microscopy. The quantitative immunohistochemistry revealed a decrease in the volume density and cell density of both GH and PRL cells from malnourished animals when compared to control ones. The ultrastructural study showed changes suggestive of cellular hyperfunction for both types of cells in the former experimental group. Under nutrition also affected the size of the cranial components, with males being more affected than females; brain weight was, however, nonmodified by stress, with the brain/body ratio difference being the same for both sexes. We conclude that in monkeys, experimental undernutrition produces a decrease in the pituitary GH and PRL cell populations, in some way related to changes in the cranio-facial morphometric patterns.
Assuntos
Distúrbios Nutricionais/patologia , Hipófise/ultraestrutura , Crânio/patologia , Animais , Contagem de Células , Cefalometria , Citoplasma/ultraestrutura , Retículo Endoplasmático Rugoso/ultraestrutura , Feminino , Complexo de Golgi/ultraestrutura , Hormônio do Crescimento/metabolismo , Masculino , Distúrbios Nutricionais/fisiopatologia , Hipófise/metabolismo , Prolactina/metabolismo , Valores de Referência , Saimiri , Crânio/crescimento & desenvolvimentoRESUMO
Undernutrition elicited by a low-protein diet determines a marked reduction of hypophyseal activity and affects the function of the respective target organs. The objective of the present investigation was to study the ultrastructural and quantitative immunohistochemical changes of the different pituitary cell populations in undernourished monkeys that had been previously shown to have significant changes in craniofacial growth. Twenty Saimiri sciureus boliviensis monkeys of both sexes were used. The animals were born in captivity and were separated into two groups at one year of age, i.e., control and undernourished animals. The monkeys were fed ad libitum a 20% (control group) and a 10% (experimental group) protein diet for two years. Pituitaries were processed for light and electron microscopy. The former was immunolabeled with anti-GH, -PRL, -LH, -FSH, -ACTH, and -TSH sera. Volume density and cell density were measured using an image analyzer. Quantitative immunohistochemistry revealed a decrease in these parameters with regard to somatotrophs, lactotrophs, gonadotrophs and thyrotrophs from undernourished animals compared to control ones. In these populations, the ultrastructural study showed changes suggesting compensatory hyperfunction. On the contrary, no significant changes were found in the morphometric parameters or the ultrastructure of the corticotroph population. We conclude that in undernourished monkeys the somatotroph, lactotroph, gonadotroph, and thyrotroph cell populations showed quantitative immunohistochemical changes that can be correlated with ultrastructural findings.
Assuntos
Doenças dos Macacos/patologia , Hipófise/ultraestrutura , Desnutrição Proteico-Calórica/veterinária , Animais , Feminino , Masculino , SaimiriRESUMO
Undernutrition elicited by a low-protein diet determines a marked reduction of hypophyseal activity and affects the function of the respective target organs. The objective of the present investigation was to study the ultrastructural and quantitative immunohistochemical changes of the different pituitary cell populations in undernourished monkeys that had been previously shown to have significant changes in craniofacial growth. Twenty Saimiri sciureus boliviensis monkeys of both sexes were used. The animals were born in captivity and were separated into two groups at one year of age, i.e., control and undernourished animals. The monkeys were fed ad libitum a 20 percent (control group) and a 10 percent (experimental group) protein diet for two years. Pituitaries were processed for light and electron microscopy. The former was immunolabeled with anti-GH, -PRL, -LH, -FSH, -ACTH, and -TSH sera. Volume density and cell density were measured using an image analyzer. Quantitative immunohistochemistry revealed a decrease in these parameters with regard to somatotrophs, lactotrophs, gonadotrophs and thyrotrophs from undernourished animals compared to control ones. In these populations, the ultrastructural study showed changes suggesting compensatory hyperfunction. On the contrary, no significant changes were found in the morphometric parameters or the ultrastructure of the corticotroph population. We conclude that in undernourished monkeys the somatotroph, lactotroph, gonadotroph, and thyrotroph cell populations showed quantitative immunohistochemical changes that can be correlated with ultrastructural findings
Assuntos
Animais , Masculino , Feminino , Doenças dos Macacos/patologia , Hipófise/ultraestrutura , Desnutrição Proteico-Calórica/veterinária , SaimiriRESUMO
A functional skeletal criterion, as an extension of the van der Klaauw's cranial theory, was adopted in the present study. The null hypothesis tested was: "The major skeletal components of the platyrrhine body grow linearly, regardless of their functional dependence to different demands." The acceptance of the hypothesis will imply that all Saimiri skeletal growth may be satisfactorily explained by independent variables in a single equation. The rejection will suggest that such skeletal growth patterns have to be explained by variables in several different equations, and perhaps these equations may vary with the effect of sex and undernutrition. Control and undernourished squirrel monkeys were radiographed monthly for 2 years; they were also measured; and their volumetric and morphometric neurocranial, facial, and pelvic indices were calculated. The curves that best described each of the 24-point sequences were obtained. Three main growth patterns were observed: 1) Simple linear (femur length for all groups, and pelvic index for control and undernourished females), for which the simple regression equation explained more than 95% of the variation; 2) Complex linear (pelvic index for control and undernourished males, and neurocranial and facial indices for all of the groups), for which more than 95% of the variation was explained by one of the four four-function type equations; and 3) Noncorrelated with age (neurofacial index for undernourished males, and pelviofemoral index for control females and undernourished males and females), which showed nonsignificant correlations with respect to age. The food intake and the oscillations of the environmental temperature might help to explain the undulating growth trajectory observed in the complex linear components.
Assuntos
Desenvolvimento Ósseo , Distúrbios Nutricionais/veterinária , Saimiri/crescimento & desenvolvimento , Animais , Feminino , Fêmur/crescimento & desenvolvimento , Estudos Longitudinais , Masculino , Modelos Teóricos , Pelve/crescimento & desenvolvimento , Saimiri/anatomia & histologia , Fatores SexuaisRESUMO
Many experimental studies of the effects of placental blood flow on growth exist. Nevertheless, few of them deal with the relationship between impaired uterine blood supply, and cranial growth and sex differentiation. The object of the present study was to investigate the impact of intrauterine growth retardation (IUGR) on sexual cranial dimorphism in the newborn rat. Three experimental groups were employed: (a) control; (b) operated (IUGR), in which both uterine vessels were partially bent in the 15th day of gestation; and (c) sham-operated, identical to (b) but without vessel bending. At birth, pups were weighed, and their bodies and craniums, measured. In the cases of asymmetric distributions, data were logarithmically transformed. A multi-way analysis of variance (ANOVA) and LSD post-hoc tests were used to find out differences between experimental groups and sex. Controls had significant sex differences in body and cranial variables. The prenatal growth of IUGR pups was significantly inhibited. Body and facial variables were more affected than the neurocranial ones. Undernutrition produced body and cranial size changes. Since IUGR affected male more than female growth, sex dimorphism was clearly reduced in all variables which were dimorphic in controls.
Assuntos
Retardo do Crescimento Fetal/fisiopatologia , Caracteres Sexuais , Crânio/crescimento & desenvolvimento , Útero/irrigação sanguínea , Animais , Animais Recém-Nascidos , Feminino , Masculino , Ratos , Ratos WistarRESUMO
One hundred and sixty two Holtzman rats of both sexes were malnourished during suckling and post-weaning periods. Some of them received periodic injections of growth hormone. After sampling, at 56 days of age, skulls were cleaned and measured. Differences within and between sexes were estimated by Mahalanobis D2 distances. Normal cranial differentiation between sexes (SCD) was decreased by malnutrition and restored by growth hormone treatment. The effect of the growth hormone on skull size was larger in malnourished males than females. This differential increment between sexes explains how growth hormone acted on the restoration of SCD.
Assuntos
Hormônio do Crescimento/farmacologia , Distúrbios Nutricionais , Caracteres Sexuais , Crânio/anatomia & histologia , Animais , Feminino , Crescimento/fisiologia , Hormônio do Crescimento/administração & dosagem , Injeções , Masculino , Ratos , Ratos Sprague-Dawley , Crânio/efeitos dos fármacos , Crânio/crescimento & desenvolvimento , DesmameRESUMO
One hundred and twenty five Holtzman rats of both sexes were submitted to malnutrition during suckling with or without periodic injections of testosterone enantate in males and estradiol valerianate in females. Ten cranial measurements were made, and morphological differences within and between sexes were calculated by multivariate Mahalanobis D2-distances. Malnutrition delayed the cranial difference between sexes, which was restored by hormonal treatment. Testosterone arrested the skull size difference between sham and malnourished males. Estradiol stimulated the skull size difference between sham and malnourished females. This counteracting effect indicates that at early ages, both hormones stimulate sexual cranial dimorphism when a protein-calorie malnutrition acts on both sexes.
Assuntos
Estradiol/análogos & derivados , Desnutrição Proteico-Calórica/fisiopatologia , Caracteres Sexuais , Crânio/anatomia & histologia , Testosterona/análogos & derivados , Animais , Estradiol/farmacologia , Feminino , Masculino , Análise Multivariada , Ratos , Ratos Endogâmicos , Crânio/crescimento & desenvolvimento , Testosterona/farmacologiaRESUMO
One hundred and twenty five Holtzman rats of both sexes were submitted to malnutrition during suckling with or without periodic injections of testosterone enantate in males and estradiol valerianate in females. Ten cranial measurements were made, and morphological differences within and between sexes were calculated by multivariate Mahalanobis D2-distances. Malnutrition delayed the cranial difference between sexes, which was restored by hormonal treatment. Testosterone arrested the skull size difference between sham and malnourished males. Estradiol stimulated the skull size difference between sham and malnourished females. This counteracting effect indicates that at early ages, both hormones stimulate sexual cranial dimorphism when a protein-calorie malnutrition acts on both sexes.
RESUMO
One hundred and twenty five Holtzman rats of both sexes were submitted to malnutrition during suckling with or without periodic injections of testosterone enantate in males and estradiol valerianate in females. Ten cranial measurements were made, and morphological differences within and between sexes were calculated by multivariate Mahalanobis D2-distances. Malnutrition delayed the cranial difference between sexes, which was restored by hormonal treatment. Testosterone arrested the skull size difference between sham and malnourished males. Estradiol stimulated the skull size difference between sham and malnourished females. This counteracting effect indicates that at early ages, both hormones stimulate sexual cranial dimorphism when a protein-calorie malnutrition acts on both sexes.
RESUMO
Holtzman rats were subjected to food restriction during gestation or lactation, or both periods (overall stress). At weaning, male pup skulls were measured and female brains and cranial masticatory muscles were weighed and a neuromuscular index was calculated. It was found that gestational protein-calorie malnutrition (PCM) without suckling restoration accounted for about 30% of the growth delay observed under overall stress. That effect disappeared after a normal suckling restoration. Under the same conditions of maternal food restriction in both periods, growth delay in the offspring was greater during lactation than gestation. As in lactation, craniofacial changes during gestational restriction were due to an adjustive response of bone growth to PCM. This response seemed to accrue from an altered relationship between the growth of the brain-less sensitive and highly restorable-and the growth of the masticatory muscles-more sensitive and less restorable. Some degree of delay in orthocephalization would be the skeletal outcome of such adjustive neuromuscular response.