Accuracy of short-term recall of age at menarche

Exploratory Study into the Classification Agreement between Self-Reported Age of Menarche and Calculated Maturity Offset in Adolescent Girls: A Two-Year Follow-Up Study

Menarche is a significant pubertal event influencing girls' participation in physical activity. As menarche is a sensitive matter, a non-invasive substitute is needed to help classify girls' maturity status and provide physical literacy to them in this regard. The objective of this exploratory study was to investigate the classification agreement between self-reported age of menarche and calculated maturity offset in adolescent girls from South Africa by making use of various statistical methods. Fifty-eight girls, n = 13 pre- and n = 45 post-menarche (Status Quo method) aged 13.51 ± 3.51 years at baseline, were analyzed (2010-2012). Independent t-testing, cross-tabulation, Roc Curve statistics and logistic regression were used to analyze the classification agreement between markers. All four statistical methods revealed the potential to categorize different maturity groups through the maturity offset equation, although the accuracy declined with increased age. A realized power of 0.92 was found for the group in the first year of the study, with a gradual and significant decline over time. Cross-tabs showed a significant moderate predictive effectiveness (Chi-square = 0.042) during T1, closer to PHV (13.51 years) although also declining significantly with increased age (T2, 14.51 years) beyond PHV (Chi-square = 0.459). Although positive results were found, caution must be used when using maturity offset equations in different homogenic populations due to their unique growth characteristics.

Do movement behaviours influence the association between early menarche and depression symptoms among Brazilian adolescents?

Early menarche has been associated with adverse health outcomes, such as depressive symptoms. Discovering effect modifiers across these conditions in the pediatric population is a constant challenge. We tested whether movement behaviours modified the effect of the association between early menarche and depression symptoms among adolescents. This cross-sectional study included 2031 females aged 15-19 years across all Brazilian geographic regions. Data were collected using a self-administered questionnaire; 30.5% (n = 620) reported having experienced menarche before age 12 years (i.e., early menarche). We used the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Accruing any moderate-vigorous physical activity during leisure time, limited recreational screen time, and having good sleep quality were the exposures investigated. Adolescents who experienced early menarche and met one (B: -4.45, 95% CI: (-5.38, -3.51)), two (B: -6.07 (-7.02, -5.12)), or three (B: -6.49 (-7.76, -5.21)), and adolescents who experienced not early menarche and met one (B: -5.33 (-6.20; -4.46)), two (B: -6.12 (-6.99; -5.24)), or three (B: -6.27 (-7.30; -5.24)) of the movement behaviour targets had lower PHQ-9 scores for depression symptoms than adolescents who experienced early menarche and did not meet any of the movement behaviours. The disparities in depressive symptoms among the adolescents (early menarche vs. not early menarche) who adhered to all three target behaviours were not statistically significant (B: 0.41 (-0.19; 1.01)). Adherence to movement behaviours modified the effect of the association between early menarche and depression symptoms.

Temporal relation between pubertal development and peer victimization in a prospective sample of US adolescents

Peer victimization typically peaks in early adolescence, leading researchers to hypothesize that pubertal timing is a meaningful predictor of peer victimization. However, previous methodological approaches have limited our ability to parse out which puberty cues are associated with peer victimization because gonadal and adrenal puberty, two independent processes, have either been conflated or adrenal puberty timing has been ignored. In addition, previous research has overlooked the possibility of reverse causality-that peer victimization might drive pubertal timing, as it has been shown to do in non-human primates. To fill these gaps, we followed 265 adolescents (47% female) prospectively across three-time points (Mage : T1 = 9.6, T2 = 12.0, T3 = 14.4) and measured self-report peer victimization and self- and maternal-report of gonadal and adrenal pubertal development on the Pubertal Development Scale. Multilevel modeling revealed that females who were further along in adrenal puberty at age 9 were more likely to report peer victimization at age 12 (Cohen's d = 0.25, p = .005). The relation between gonadal puberty status and peer victimization was not significant for either sex. In terms of the reverse direction, the relation between early peer victimization and later pubertal development was not significant in either sex. Overall, our findings suggest that adrenal puberty status, but not gonadal puberty status, predicted peer victimization in females, highlighting the need to separate gonadal and adrenal pubertal processes in future studies.

Exposure to Particulate Matter Air Pollution and Age of Menarche in a Nationwide Cohort of U.S. Girls

BACKGROUND

It remains unclear whether in utero and childhood exposure to air pollution affects pubertal development, particularly age of menarche in girls.

OBJECTIVE

The aim of this study was to determine whether residential ambient particulate matter (PM) exposure in utero and during childhood is associated with age of menarche.

METHODS

We studied 5,201 girls in the Growing Up Today Study 2 (2004-present) who were 10-17 y of age at enrollment (47.7% premenarchal; 52.3% postmenarchal). Exposure to three size fractions of PM [fine PM with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), PM with aerodynamic diameters between  2.5 μ m  and  10 μ m (PM 2.5 - 10 ), and PM with aerodynamic diameter 10 μ m (PM 10 )] was assigned based on maternal residential address, updated every 2 y, using nationwide spatiotemporal models. We estimated average PM exposure in utero, and time-varying windows: annual average exposure in the prior 1 and 2 y and cumulative average from birth. Age of menarche was self-reported on three surveys administered in 2004, 2006, and 2008. We calculated hazard ratios (HR) for menarche for an interquartile range (IQR) increase in PM exposure using Cox proportional hazard models adjusting for potential confounders.

RESULTS

Girls attained menarche at 12.3 y of age on average. In the adjusted model, higher residential exposure to ambient PM 2.5 during all time windows was associated with earlier age of menarche. The HRs of menarche for each IQR (4   μ g / m 3 ) increase in exposure to PM 2.5 during the in utero period, 1 y prior to menarche, and throughout childhood were 1.03 [95% confidence interval (CI): 1.00, 1.06], 1.06 (95% CI: 1.02, 1.10) and 1.06 (95% CI: 1.02, 1.10), respectively. Effect estimates for PM 10 exposure were similar, albeit attenuated, for all time windows. PM 2.5 - 10 exposure was not associated with age of menarche.

DISCUSSION

Among a large, nationwide, prospective cohort of U.S. girls, higher exposure to PM 2.5 and PM 10 in utero and throughout childhood was associated with an earlier age of menarche. Our results suggest that PM 2.5 and PM 10 may have endocrine-disrupting properties that could lead to altered timing of menarche. https://doi.org/10.1289/EHP12110.

Are pro-inflammatory markers associated with psychological distress in a cross-sectional study of healthy adolescents 15-17 years of age? The Fit Futures study

Background

Inflammatory markers have been associated with depression and anxiety disorder in adolescents. Less is known about the association between inflammation and subclinical symptoms in the form of psychological distress. We investigated prevalence of psychological distress and examined the associations between common pro-inflammatory markers and psychological distress in an adolescent population sample.

Methods

The study was based on data from 458 girls and 473 boys aged 15–17 years from the Fit Futures Study, a large-scale study on adolescent health, conducted in Northern Norway. Psychological distress was measured with the Hopkins Symptom Checklist (HSCL-10). Serum-levels of the following low-grade inflammatory markers were measured: C-reactive protein (CRP), interleukin 6 (IL-6), transforming growth factor-alpha (TGF-α), tumor necrosis factor alpha variant 1 (TRANCE) and tumor necrosis factor alpha variant 2 (TWEAK). Associations between quartiles of inflammatory markers and HSCL-10 were examined by logistic regression and adjusted for potential confounders in sex-stratified analyses.

Results

The proportion of psychological distress above cutoff were 26.9% and 10.8% among girls and boys, respectively. In both girls and boys, crude analysis showed positive associations between all inflammatory markers and HSCL-10, except for TWEAK and TRANCE in boys. However, none of these associations were statistically significant. Further, there were no significant findings in the adjusted analyses.

Conclusion

There was a higher prevalence of psychological distress in girls compared to boys. Pro-inflammatory markers were not significantly associated with psychological distress in data from healthy adolescents aged 15–17 years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00779-8.

C-Reactive Protein and TGF-α Predict Psychological Distress at Two Years of Follow-Up in Healthy Adolescent Boys: The Fit Futures Study

Objective

The scarcity of research on associations between inflammatory markers and symptoms of depression and anxiety during adolescence has yielded inconsistent results. Further, not all studies have controlled for potential confounders. We explored the associations between baseline inflammatory markers and psychological distress including moderators at follow-up in a Norwegian adolescent population sample.

Methods

Data was derived from 373 girls and 294 boys aged 15–18 years at baseline, in the Fit Futures Study, a large-scale 2-year follow-up study on adolescent health. Baseline data was gathered from 2010 to 2011 and follow-up data from 2012 to 2013. Psychological distress was measured with Hopkins Symptom Checklist (HSCL-10). Serum levels of the following inflammatory markers were measured: C-reactive protein (CRP), Interleukin 6 (IL-6), Transforming growth factor alpha (TGF-α), Tumor necrosis factor alpha variant 1 (TRANCE), and variant 2 (TWEAK). Independent associations between baseline inflammatory markers and HSCL-10 at follow-up were explored by linear regressions, in sex-stratified analyses.

Results

In girls, analyses showed positive associations between all inflammatory markers and HSCL-10, except for TRANCE. However, all associations were non-significant in crude as well as in adjusted analyses. In boys, CRP (p = 0.03) and TGF-α (p < 0.01) showed significant associations with HSCL-10, that remained significant after adjustment. Additionally, moderators were found. In boys, CRP was associated with HSCL-10 in those with high body fat and those being physical inactive, and the association between TWEAK and HSCL-10 was dependent upon sleep duration.

Conclusion

There were significant prospective associations between CRP, TFG-α, and HSCL-10 in boys aged 15–18 years at baseline.

Associations between reproductive history, hormone use, APOE ε4 genotype and cognition in middle- to older-aged women from the UK Biobank

Introduction

Relative to men, women are at a higher risk of developing age-related neurocognitive disorders including Alzheimer's disease. While women's health has historically been understudied, emerging evidence suggests that reproductive life events such as pregnancy and hormone use may influence women's cognition later in life.

Methods

We investigated the associations between reproductive history, exogenous hormone use, apolipoprotein (APOE) ε4 genotype and cognition in 221,124 middle- to older-aged (mean age 56.2 ± 8.0 years) women from the UK Biobank. Performance on six cognitive tasks was assessed, covering four cognitive domains: episodic visual memory, numeric working memory, processing speed, and executive function.

Results

A longer reproductive span, older age at menopause, older age at first and last birth, and use of hormonal contraceptives were positively associated with cognitive performance later in life. Number of live births, hysterectomy without oophorectomy and use of hormone therapy showed mixed findings, with task-specific positive and negative associations. Effect sizes were generally small (Cohen's d < 0.1). While APOE ε4 genotype was associated with reduced processing speed and executive functioning, in a dose-dependent manner, it did not influence the observed associations between female-specific factors and cognition.

Discussion

Our findings support previous evidence of associations between a broad range of female-specific factors and cognition. The positive association between a history of hormonal contraceptive use and cognition later in life showed the largest effect sizes (max. d = 0.1). More research targeting the long-term effects of female-specific factors on cognition and age-related neurocognitive disorders including Alzheimer's disease is crucial for a better understanding of women's brain health and to support women's health care.

Sexual Orientation and Age at Menarche in Three U.S. Longitudinal Cohorts

PURPOSE

The aim of this study is to examine age at menarche across sexual orientation groups.

METHODS

Data were obtained from 131,090 female participants, born 1947-2001, in 3 longitudinal studies-the Growing Up Today Study and Nurses' Health Study 2 and 3. We estimated the association between sexual orientation and age at menarche using regression models adjusted for age, race/ethnicity, birthweight, height, and body mass index.

RESULTS

Compared to heterosexual participants, sexual minorities were younger at menarche. Sexual minorities were more likely to have early menarche (≤11 years) and less likely to have late menarche (≥14 years) compared to heterosexual girls. As an example of this pattern, Nurses' Health Study 3 bisexual participants were >30% more likely than heterosexuals to have early versus average menarche (odds ratio 1.37, 95% confidence interval 1.09-1.72).

CONCLUSION

Sexual minority girls have a younger age at menarche than heterosexual girls and may benefit from screening for adverse outcomes associated with early menarche.

Pubertal development and risk of premenstrual disorders in young adulthood

STUDY QUESTION

Is pubertal timing associated with risk of premenstrual disorders (PMDs) in young adulthood?

SUMMARY ANSWER

Late pubertal development is associated with decreased premenstrual symptom burden and risk of PMDs in young adulthood.

WHAT IS KNOWN ALREADY

PMDs, including premenstrual syndrome and premenstrual dysphoric disorder, may begin during the teenage years. Few risk factors in early life have been identified for PMD development.

STUDY DESIGN, SIZE, DURATION

A prospective cohort study of 6495 female participants during 1996–2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We included participants from the Growing Up Today Study (GUTS). Pubertal development was indicated by the timing of menarche, breast and pubic hair growth. Self-reported age at menarche was longitudinally assessed at enrollment (in 1996/2004 for GUTS I/II) and onwards, and classified as early (age ≤ mean − SD, 11.64 years), normative and late menarche (age ≥ mean + SD, 13.95 years). Timing of pubic hair and breast growth were assessed multiple times during follow-up via Tanner scales, and classified into early, normative and late development according to mean ± SD. Using a validated questionnaire based on the Calendar of Premenstrual Experiences, we assessed premenstrual symptoms and identified probable cases of PMDs in 2013. We examined the associations of timing of pubertal development with premenstrual symptom score and disorders using multivariable linear and logistic regressions, respectively.

MAIN RESULTS AND THE ROLE OF CHANCE

In 2013 (mean age = 26), 1001 (15.4%) individuals met criteria for a PMD. An inverse association was found between age at menarche and premenstrual symptom z-score (β −0.05 per year, 95% CI −0.07 to −0.03) and risk of PMDs (odds ratio (OR) 0.93 per year, 95% CI 0.88 to 0.99). Compared to individuals with normative menarche, individuals with late menarche had a lower risk of PMDs (OR 0.73, 95% CI 0.59 to 0.91), while individuals with early menarche had comparable odds (OR 0.98, 95% CI 0.81 to 1.18). Moreover, early growth of pubic hair was associated with increased premenstrual symptoms (z-score β 0.09 per year, 95% CI 0.02 to 0.17) and PMD risk (OR 1.28, 95% CI 1.04 to 1.56), independent of age at menarche. No associations were noted for breast development.

LIMITATIONS, REASONS FOR CAUTION

One major limitation is some misclassification of menarche due to recall. We, however, showed robust association among participants who were premenarcheal at baseline.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings suggest that pubertal timing, particularly timing of menarche, is inversely associated with the risk of developing premenstrual symptoms in young adulthood, and that women with later menarche have significantly lower risk of PMDs. Information on PMDs should be provided to teenage girls and their parents. If these findings are confirmed in independent populations, prevention strategies and early detection programs may be considered for women with early pubertal development.

STUDY FUNDING/COMPETING INTEREST(S)

The work is supported by the National Institutes of Health and Swedish Research Council.

TRIAL REGISTRATION NUMBER

N/A

Characterization of Reproductive and Morphological Variables in Female Elite Futsal Players

We aimed to characterize the age of onset of training, age at menarche, menstrual periodicity, and performance perception during the menstrual cycle and examined the impact of these reproductive variables on body composition, morphology, and body weight satisfaction in Brazilian elite futsal players. The study consisted of 115 female Brazilian elite futsal players from the top national teams. Data were collected during the twentieth Women's Brazil Futsal Cup. Players were interviewed and self-reported their age of onset of training, age at menarche, menstrual periodicity, and the menstrual period, where they performed best. We also asked for what they considered to be their ideal body weight as well as information related to their training (i.e., volume and frequency). Subsequently, anthropometric measurements (i.e., body mass, height, circumferences, diameters, and skinfold thickness) were performed to estimate the body composition and determine morphological characteristics (e.g., somatotype). Fifty-nine (53.2%) players were postmenarche-trained and 52 (46.8%) were premenarche-trained. Eighteen (16.2%), 65 (58.6%), and 28 (25.2%) were classified as early, normal, and late menarche, respectively. Only 11 (9.6%) and 1 (0.9%) had irregular menstrual cycles and were amenorrheic, respectively. Seventy-three (69.5%), 23 (21.9%), and 9 (8.6%) reported that their game performance was the best at the follicular phase, menses, and luteal phase of the menstrual cycle, respectively. No associations between the four reproductive-related variables were found. Postmenarche-trained players had significant lower age at menarche and higher percentage body fat. The somatotype profile registered lower ectomorphy rate for the postmenarche-trained participants after controlling for covariates. Early menarche group presented higher sum of six skinfold thickness and endomorphy rate compared to normal and late menarche groups. No differences were found when menstrual periodicity groups and best performance groups were compared, except for higher femur width in the regular menstrual cycle group compared to the irregular one. The association between body weight satisfaction and the four reproductive-related variables were not observed. Premenarche-trained Brazilian elite futsal players had the menarche later than the postmenarche-trained athletes. Most of the participants had menarche age classified as "normal," presented "regular" menstrual cycles and perceived to perform better during the follicular phase of the menstrual cycle.

Characterization of pubertal development of girls in rural Bangladesh

This study aimed to describe the timing and patterns of pubertal maturation of girls living in rural Bangladesh. Starting in September 2015, a total of 15,320 girls from a birth cohort, aged 9 to 15 years at initial encounter, were visited twice at about a one year interval, typically in their birth month. Participants were asked to self-report extent of pubertal maturation, including breast development, pubic hair growth and age at menarche, if applicable. Pubertal stage (abbreviated as B2 and B3-4 for breast development and PH2 and PH3-4 for pubic hair growth) was assigned. Data from both visits were pooled, yielding a total of 29,377 age-related observations per pubertal characteristic. Probit regression models were used to estimate distributions of age at which each stage of pubertal development was attained. Before age 8, <3% of the study population initiated pubertal maturation as indicated by onset of breast development (B2). The median (95% confidence interval) age of B2 and B3-4 was 11.02 (11.00–11.04) and 12.82 (12.80–12.83) years, respectively; and 12.93 (12.91–12.94) and 14.29 (14.27–14.31) years for the onset (PH2) and advanced stage (PH3-4) of pubic hair growth, respectively. Median age at menarche was 13.17 (13.15–13.19) years, with 2.15 years of timespan from B2 to menarche. Girls in rural Bangladesh progressed through puberty following a well-documented sequence of sexual maturation stages. The age at which each pubertal milestone took place was somewhat later, but the tempo from breast development to menarche was comparable to that observed elsewhere. Our findings present a current norm of pubertal maturation in a typical, rural adolescent population in South Asia, which could help inform future studies and interventions to preserve or improve early adolescent health and development.

The relationship between pubertal timing and under-nutrition in rural Pakistan

INTRODUCTION

Sexual development in females and males are routinely measured according to the Tanner Stages. Sparse data exist on the timing of pubertal milestones in Pakistan. To fill this gap, the age of attainment of pubertal milestones and their relationship with nutritional status was explored among children and adolescents living in the rural district of Matiari, Pakistan.

METHODS

Anthropometry, nutrition biomarkers and Tanner Stage were assessed among girls aged 9.0-14.9 years (n = 723) and boys aged 10.0-15.9 years (n = 662) who were free from known disease in the rural District of Matiari, Pakistan. Median age was calculated for all Tanner Stages and menarche. Multivariable linear regressions were undertaken to determine covariates associated with the timing (age) of pubertal milestones.

RESULTS

Among participants living in this rural community, the median age of puberty onset for girls was 11.9 years (95%CI:10.9; 12.5) and boys was 12.3 years (95%CI:11.5; 12.9). Age at first menarche was 12.9 years (95%CI:12.1; 13.3). Undernutrition was widespread among adolescents in this community. Thirty-seven percent of females and 27.0% of males were stunted while 20.5% of females and 31.3% of males were thin. Only 8% (n = 58) of females and 12% (n = 78) of males were free from any nutrient deficiency with most adolescents having two or three nutrient deficiencies.

CONCLUSIONS

Undernutrition (stunting or thinness) was associated with relatively older ages for early puberty stages but not puberty completion. This may decrease the duration of the pubertal growth spurt and curtail potential catch-up growth that may occur during puberty. Efforts to decrease nutrient deficiencies, stunting and thinness beyond childhood should be made in rural Pakistan.

Estimating menarcheal age distribution from partially recalled data

In a cross-sectional study, adolescent and young adult females were asked to recall the time of menarche, if experienced. Some respondents recalled the date exactly, some recalled only the month or the year of the event, and some were unable to recall anything. We consider estimation of the menarcheal age distribution from this interval-censored data. A complicated interplay between age-at-event and calendar time, together with the evident fact of memory fading with time, makes the censoring informative. We propose a model where the probabilities of various types of recall would depend on the time since menarche. For parametric estimation, we model these probabilities using multinomial regression function. Establishing consistency and asymptotic normality of the parametric maximum likelihood estimator requires a bit of tweaking of the standard asymptotic theory, as the data format varies from case to case. We also provide a non-parametric maximum likelihood estimator, propose a computationally simpler approximation, and establish the consistency of both these estimators under mild conditions. We study the small sample performance of the parametric and non-parametric estimators through Monte Carlo simulations. Moreover, we provide a graphical check of the assumption of the multinomial model for the recall probabilities, which appears to hold for the menarcheal data set. Our analysis shows that the use of the partially recalled part of the data indeed leads to smaller confidence intervals of the survival function.

Timing of Pubertal Milestones in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Despite increasing global attention to adolescent health in low- and middle-income countries (LMICs), limited literature exists on the timing of pubertal development in these settings. This study aimed to determine the age at menarche (AAM) and age of puberty onset [female Tanner Stage Breast 2 (B2) and male Tanner Stage Genital 2 (G2)] among healthy adolescents living in LMICs. It also aimed to explore the impact of nutritional status on pubertal timing in this population. MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Scopus, and grey literature databases were searched. Observational studies and control arms of randomized controlled trials (RCTs) with healthy participants from LMICs born in or after 1998 were included. Pooled estimates with 95% CIs were calculated by random-effects meta-analyses using the DerSimonian and Laird inverse variance method for each pubertal milestone and by BMI category subgroups. Twenty-seven studies were included in the meta-analysis, representing 90,188 adolescents (78.3% female). Pooled mean estimates for AAM for normal, thin, and overweight BMI groupings were 12.3 y (95% CI: 12.1, 12.5), 12.4 y (95% CI: 12.2, 12.6), and 12.1 y (95% CI: 11.7, 12.5), respectively. For Tanner Stage B2, pooled mean age estimates for normal, thin, and overweight BMI groupings were 10.4 y (95% CI: 9.2, 11.6), 10.2 y (95% CI: 9.3, 11.4), and 8.4 y (95% CI: 6.8, 10.0), respectively. Finally, for Tanner Stage G2, pooled mean estimates for normal, thin, and overweight BMI groupings were 11.0 y (95% CI: 10.3, 11.7), 11.3 y (95% CI: 9.8, 12.9), and 10.3 y (95% CI: 10.0, 10.6), respectively. Data on the timing of pubertal milestones has traditionally come from high-income settings. In this systematic review of contemporary data from adolescents in LMICs, AAM, as well as age at pubertal onset, were similar to those reported from high-income settings.

Association of Early Menarche with Adolescent Health in the Setting of Rapidly Decreasing Age at Menarche

STUDY OBJECTIVE

This study aimed to investigate the association between age at menarche (AAM) and adverse health indicators in adolescent girls.

DESIGN

A retrospective cohort study.

SETTING

Population-based survey data.

PARTICIPANTS

A total of 319,437 female participants aged 12-18 years from the Korea Youth Risk Behaviour Web-based Survey.

INTERVENTIONS AND MAIN OUTCOME MEASURES

We assessed associations between AAM (categorized as ≤10, 11, and ≥12) and health indicators (poor self-rated health, high psychological stress, unhappiness, sexual initiation, and pregnancy). Covariates were individual-level (bodyweight, living with family, parent's education, household wealth, and presence of parents and siblings) and community-level factors (year of birth, single-sex education and level of school, urbanization level of school area, year of survey, and regional deprivation). Odds ratios (ORs) for each adverse health indicator were examined by each AAM group using multivariable regression analyses. For pregnancy, we calculated relative risks (RRs) using a log-binomial regression model.

RESULTS

Age at menarche was <12 in 42% of our study population. Nearly one-half of the girls born in the early 2000s went through menarche before the age of 12 years, whereas only one-third of girls born in the early 1990s went through menarche before the age of 12 years. Girls who experienced menarche at age ≤10 or age 11 years were more likely to show self-rated poor health (AAM ≤ 10: OR, 1.28; 95% confidence intervals [CI], 1.22-1.34; AAM = 11: OR, 1.16; 95% CI, 1.12-1.21), high stress (OR, 1.19; 95% CI, 1.14-1.23, and OR, 1.10; 95% CI, 1.06-1.14), and sexual initiation (OR, 2.21; 95% CI, 2.05-2.38, and OR, 1.32; 95% CI, 1.23-1.41) compared to those with AAM ≥12 years when data were adjusted for all covariates. AAM ≤10 years was associated with consistently higher odds for poor health than AAM ≥12 years. The ORs of sexual initiation increased with earlier AAM. Risk of pregnancy was similar across AAM groups when individual- and community-level covariates were controlled for.

CONCLUSION

Early menarche, defined as <12 years, can be still a useful indicator in adolescent health interventions to identify high-risk groups in the setting of declining AAM.

Stunting, recovery from stunting and puberty development in the MINIMat cohort, Bangladesh

AIM

This paper aimed to analyse the association between small for size at birth, stunting, recovery from stunting and pubertal development in a rural Bangladeshi cohort.

METHODS

The participants were 994 girls and 987 boys whose mothers participated in the Maternal and Infant Nutrition Interventions in Matlab trial. The birth cohort was followed from birth to puberty 2001-2017. Pubertal development according to Tanner was self-assessed. Age at menarche was determined and in boys, consecutive height measurements were used to ascertain whether pubertal growth spurt had started. The exposures and outcomes were modelled by Cox's proportional hazards analyses and logistic regression.

RESULTS

There was no difference in age at menarche between girls that were small or appropriate for gestational age at birth. Boys born small for gestational age entered their pubertal growth spurt later than those with appropriate weight. Children who were stunted had later pubertal development, age at menarche and onset of growth spurt than non-stunted children. Children who recovered from infant or early childhood stunting had similar pubertal development as non-stunted children.

CONCLUSION

Infant and childhood stunting was associated with a later pubertal development. Recovery from stunting was not associated with earlier puberty in comparison with non-stunted children.

Sex Hormone Phenotypes in Young Girls and the Age at Pubertal Milestones

CONTEXT

The age of pubertal onset is influenced by many variables in young girls. Previous studies have not examined sex hormones longitudinally around the time of breast development and their relationship to pubertal onset.

OBJECTIVE

We sought to use an unbiased statistical approach to identify phenotypes of sex hormones in young girls and examine their relationship with pubertal milestones.

DESIGN AND SETTING

Longitudinal observational study.

PARTICIPANTS AND MAIN OUTCOME MEASURES

In 269 girls, serum concentrations of steroid sex hormones [estradiol (E2), estrone, testosterone, and dehydroepiandrosterone sulfate] were measured by HPLC-mass spectrometry at time points before, at, and after thelarche. Girls were classified into four hormone phenotypes using objective principal components and cluster analyses of longitudinal hormone data. The association between the identified phenotypes and age of pubertal milestones was estimated using Cox proportional hazards modeling.

RESULTS

Mean ages at thelarche, pubarche, and menarche were 9.02, 9.85, and 12.30 years, respectively. Girls with low levels of all four hormones, phenotype 3b, were youngest at thelarche (8.67 years); those in phenotype 2, with the highest E2 levels and E2 surge 6 months after thelarche, were youngest at menarche (11.87 years) with shortest pubertal tempo. When controlling for race, maternal age of menarche, caregiver education, and body mass, different phenotypes were associated with the age of pubertal events.

CONCLUSIONS

Hormone phenotypic clustering can identify clinically relevant subgroups with differing ages of thelarche, pubarche, and menarche. These findings may enhance the understanding of timing of pubertal milestones and risk of adult disease.

Systematic review and meta-analysis of the association between childhood physical activity and age at menarche

AIM

To systematically appraise and summarise published evidence on the association between childhood physical activity (PA) and subsequent age at menarche (AAM).

METHODS

We searched PubMed (1990-2018) for studies that reported the relationship between childhood PA and AAM. We performed tabular synthesis of population-based studies and a random-effects meta-analysis of results of athlete/nonathlete studies.

RESULTS

One randomised controlled trial was identified, in which an intervention to prevent obesity reduced the likelihood of menarche during the two-year study period (relative risk: 0.75, 95% CI: 0.66-0.87; n = 422 girls). One of five prospective cohort studies (total n = 4492) reported a significant association between self-reported PA duration and subsequent menarche timing. Four of five historical cohort studies (total n = 89 470) reported significant associations between recalled premenarcheal PA and later AAM. Meta-analysis across 12 athlete/nonathlete studies showed that menarche occurred 1.13 years later (95% CI: 0.80-1.47) in athletes compared to nonathletes.

CONCLUSION

These findings suggest that AAM is a behaviourally modifiable trait. However, the quality of reported population-based study evidence is low and estimation of the true relationship between childhood PA and AAM is likely confounded by concomitant changes in diet and lifestyle behaviours.

Age of Menarche in a Longitudinal US Cohort

STUDY OBJECTIVE

Menarche is a critical milestone in a woman's life, and historically has been determined using several approaches. The goals of this study were to: (1) determine age at menarche from multiple reports of parents and adolescent participants in a prospective study; (2) examine factors affecting age at menarche; and (3) determine correlates of menarche and pubertal tempo.

DESIGN

Longitudinal observational study.

SETTING

Three sites of the Breast Cancer and the Environment Research Program.

PARTICIPANTS

Girls enrolled at 6-8 years of age.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Parental and participant reported age of menarche, and tempo of puberty.

RESULTS

There were 946 girls who were assigned an age of menarche. The correlation between parent and participant reports was high (Spearman R = 0.799, P < .001), and the difference was insignificant. Median age at menarche overall was 12.25 years. Compared with black participants, Hispanic girls were more likely to have menarche earlier, whereas white and Asian girls were more likely to have menarche later. Age of menarche was highly correlated with age of breast development (Spearman R = 0.547; P < .001), and inversely with body mass index (Spearman R = -0.403; P < .001). Tempo (interval of age of breast development to menarche) was slower in those with earlier breast development.

CONCLUSION

Parental and adolescent reports of menarche are highly correlated. Earlier breast maturation was associated with slower tempo through puberty. Body mass index had a greater effect on age at menarche than did race and ethnicity.

Prenatal lead exposure in relation to age at menarche: results from a longitudinal study in Mexico City

Animal and cross-sectional epidemiological studies suggest that prenatal lead exposure is related to delayed menarche, but this has not been confirmed in longitudinal studies. We analyzed this association among 200 girls from Mexico City who were followed since the first trimester of gestation. Maternal blood lead levels were analyzed once during each trimester of pregnancy, and daughters were asked about their first menstrual cycle at a visit between the ages of 9.8 and 18.1 years. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) for probability of menarche over the follow-up period using interval-censored Cox models, comparing those with prenatal blood lead level ⩾5 µg/dl to those with prenatal blood lead <5 µg/dl. We also estimated HRs and 95% CI with conventional Cox regression models, which utilized the self-reported age at menarche. In adjusted analyses, we accounted for maternal age, maternal parity, maternal education, and prenatal calcium treatment status. Across trimesters, 36-47% of mothers had blood lead levels ⩾5 µg/dl. Using interval-censored models, we found that during the second trimester only, girls with ⩾5 µg/dl prenatal blood lead had a later age at menarche compared with girls with prenatal blood lead levels <5 µg/dl (confounder-adjusted HR=0.59, 95% CI 0.28-0.90; P=0.05). Associations were in a similar direction, although not statistically significant, in the conventional Cox regression models, potentially indicating measurement error in the self-recalled age at menarche. In summary, higher prenatal lead exposure during the second trimester could be related to later onset of sexual maturation.

The impact of the Wenchuan earthquake on early puberty: a natural experiment

Background

The factors influencing pubertal timing have gained much attention due to a secular trend toward earlier pubertal onset in many countries. However, no studies have investigated the association between the Great earthquake and early puberty. We aimed to assess whether the Wenchuan earthquake is associated with early puberty, in both boys and girls.

Methods

We used data from two circles of a survey on reproductive health in China to explore the impact of the Wenchuan earthquake on early puberty , and a total of 9,785 adolescents (4,830 boys, 49.36%) aged 12-20 years from 29 schools in eight provinces were recruited. Wenchuan earthquake exposure was defined as those Sichuan students who had not experienced oigarche/menarche before May 12, 2008. Early puberty was identified as a reported onset of oigarche/menarche at 11 years or earlier. We tested the association between the Wenchuan earthquake and early puberty in boys and girls. Then, subgroup analysis stratified by the age at earthquake exposure also was performed.

Results

In total, 8,883 adolescents (4,543 boys, 51.14%) with a mean (SD) age of 15.13 (1.81) were included in the final sample. In general, children exposed to the earthquake had three times greater risk of early puberty (boys, RR [95% CI] = 3.18 [2.21-4.57]; girls: RR [95%CI] =3.16 [2.65-3.78]). Subgroup analysis showed that the adjusted RR was 1.90 [1.19-3.03] for boys and 2.22 [1.75-2.80] for girls. Earthquake exposure predicted almost a fourfold (RR [95%CI] = 3.91 [1.31-11.72]) increased risk of early puberty in preschool girls, whereas the increase was about twofold (RR [95%CI] = 2.09 [1.65-2.64]) in schoolgirls. Among boys, only older age at earthquake exposure was linked to early puberty (RR [95%CI] = 1.93 [1.18-3.16]).

Conclusions

Wenchuan earthquake exposure increased the risk of early puberty in boys and girls, and preschoolers were more at risk than schoolchildren. The implications are relevant to support policies for those survivors, especially children, to better rebuild after disasters.

Physical activity, but not sedentary time, influences bone strength in late adolescence

Physical activity is essential for optimal bone strength accrual, but we know little about interactions between physical activity, sedentary time, and bone outcomes in older adolescents. Physical activity (by accelerometer and self-report) positively predicted bone strength and the distal and midshaft tibia in 15-year-old boys and girls. Lean body mass mediated the relationship between physical activity and bone strength in adolescents.

PURPOSE

To examine the influence of physical activity (PA) and sedentary time on bone strength, structure, and density in older adolescents.

METHODS

We used peripheral quantitative computed tomography to estimate bone strength at the distal tibia (8% site; bone strength index, BSI) and tibial midshaft (50% site; polar strength strain index, SSI_p) in adolescent boys (n = 86; 15.3 ± 0.4 years) and girls (n = 106; 15.3 ± 0.4 years). Using accelerometers (GT1M, Actigraph), we measured moderate-to-vigorous PA (MVPA_Accel), vigorous PA (VPA_Accel), and sedentary time in addition to self-reported MVPA (MVPA_PAQ-A) and impact PA (ImpactPA_PAQ-A). We examined relations between PA and sedentary time and bone outcomes, adjusting for ethnicity, maturity, tibial length, and total body lean mass.

RESULTS

At the distal tibia, MVPA_Accel and VPA_Accel positively predicted BSI (explained 6-7% of the variance, p < 0.05). After adjusting for lean mass, only VPA_Accel explained residual variance in BSI. At the tibial midshaft, MVPA_Accel, but not VPA_Accel, positively predicted SSI_p (explained 3% of the variance, p = 0.01). Lean mass attenuated this association. MVPA_PAQ-A and ImpactPA_PAQ-A also positively predicted BSI and SSI_p (explained 2-4% of the variance, p < 0.05), but only ImpactPA_PAQ-A explained residual variance in BSI after accounting for lean mass. Sedentary time did not independently predict bone strength at either site.

CONCLUSION

Greater tibial bone strength in active adolescents is mediated, in part, by lean mass. Despite spending most of their day in sedentary pursuits, adolescents' bone strength was not negatively influenced by sedentary time.

Early maturation and substance use across adolescence and young adulthood: A longitudinal study of Finnish twins

Early maturation, indexed by pubertal development (PD), has been associated with earlier initiation and greater frequency of adolescent substance use, but this relationship may be biased by confounding factors and effects that change across development. Using a population-based Finnish twin sample (N = 3,632 individuals), we conducted twin modeling and multilevel structural equation modeling of the relationship between PD and substance use at ages 12-22. Shared environmental factors contributed to early PD and heavier substance use for females. Biological father absence was associated with early PD for boys but not girls, and did not account for the relationship between PD and substance use. The association between early PD and heavier substance use was partially due to between-family confounds, although early PD appeared to qualitatively alter long-term trajectories for some substances (nicotine), but not others (alcohol). Mediation by peer and parental factors did not explain this relationship within families. However, higher peer substance use and lower parental monitoring were themselves associated with heavier substance use, strengthening the existing evidence for these factors as targets for prevention/intervention efforts. Early maturation was not supported as a robust determinant of alcohol use trajectories in adolescence and young adulthood, but may require longer term follow-up. Subtle effects of early PD on nicotine and illicit drug use trajectories throughout adolescence and adulthood merit further investigation.

Validity of self-reported age at menarche in computer-assisted interview among Chinese schoolgirls: a cross-sectional study

OBJECTIVE

The attitudes of girls regarding menarche vary according to their cultural backgrounds. Asian girls may hesitate to discuss menarche. Computer-assisted self-administered interviewing (CASI) is considered a valid and effective tool for investigating the timing of menarche; however, the validity of self-reported menarche data from CASI in Chinese culture is currently unknown. We aimed to validate the status and age of menarche attainment by comparing CASI with face-to-face interviewing (FFI).

METHODS

Based on a cross-sectional study, we collected information regarding the status and age of menarche attainment using CASI and FFI among Chinese schoolgirls. We explored the tools of standard epidemiological indices, including sensitivity, specificity, predictive values and accuracy to examine the capacity of CASI for correctly classifying the status of menarche. Both Pearson and Spearman correlations were calculated for the correlation of age at menarche using CASI with FFI. A Bland-Altman plot was drawn to measure the agreement between the two interview techniques.

RESULTS

In this study, CASI and FFI were conducted in 3478 schoolgirls with an average age (SD) of 14.3 years (2.46). Menarche attainment was reported in 2496 (71.2%) and 2538 (73.0%) girls using CASI and FFI, respectively. Compared with FFI, the sensitivity, specificity, positive predictive value (PPV), negative predictive value and the accuracy of CASI were 0.97, 0.80, 0.96 and 0.92, respectively. The correlation of age at menarche between CASI and FFI was 0.728. Approximately >95% and 76.3% of the difference in the age at menarche was within 12 months and 3 months, respectively, between the two interview methods. Among primary schoolgirls in grade 5, the sensitivity, specificity, PPV, accuracy and the correlation (0.335) of CASI was lower than those in other subgroups.

CONCLUSIONS

Overall, the timing of menarche investigated using CASI was valid among all Chinese schoolgirls, except for those in grade 5 or lower.

AGE AT MENARCHE AND SEXUAL DEBUT AMONG YOUNG FILIPINO WOMEN

There has been a secular decline in age at menarche since the 19th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973-1977, to 12.9 years and 12.3 years, respectively, among those born in 1993-1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968-1972 birth cohort to 53.4% for the 1988-1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women's education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth.

Differential Impact of Genetic Loci on Age at Thelarche and Menarche in Healthy Girls

CONTEXT

Recent genetic studies have identified genetic variants associated with age at pubertal onset. Whereas genome-wide association studies reported associations of several hundred genetic variants with timing of self-reported age at menarche, a recent clinical study focused on genetic variation affecting follicle-stimulating hormone action and clinically determined age at thelarche. The observations appear to be incongruent, as effect sizes varied substantially among the studies. Alternatively, this may point to a differential impact of specific genetic loci on distinct pubertal events.

OBJECTIVE

To investigate whether top-candidate genetic variants exhibit a different impact on timing of thelarche vs menarche, respectively.

DESIGN

Cross-sectional and longitudinal study of healthy girls.

SETTING

Population-based study in the Copenhagen area.

PATIENTS OR OTHER PARTICIPANTS

Girls (1478) were followed through puberty and genotyped for FSHB c.-211G>T (rs10835638), FSHR c.-29G>A (rs1394205), FSHR c.2039A>G (rs6116), LIN28B (rs7759938), INHA (rs4141153), MKRN3 (rs12148769), TMEM38B (rs10453225), and ZNF483 (rs10980921).

MAIN OUTCOME MEASURES

Clinical pubertal staging and anthropometric data.

RESULTS

We observed an association of LIN28B (rs7759938) with age at thelarche (P < 0.001, effect size: 0.27 year, 95% confidence interval: 0.12 to 0.42) and age at menarche (P = 0.005, 0.17 year, 0.05 to 0.29). FSHB c.-211G>T (rs10835638) and FSHR c.-29G>A (rs1394205) minor allele count was associated with age at thelarche (P = 0.004, 0.19 year, 0.06 to 0.31) but not with age at menarche (P = 0.97; all adjusted for body mass index z scores).

CONCLUSION

Our results indicate a differential impact of specific genetic loci on age at thelarche and menarche in healthy girls.

Birth weight, early life weight gain and age at menarche: a systematic review of longitudinal studies

BACKGROUND AND OBJECTIVE

Adiposity in pre- and postnatal life may influence menarcheal age. Existing evidence is primarily cross-sectional, failing to address temporality, for which the role of adiposity in early life remains unclear. The current study sought to systematically review longitudinal studies evaluating the associations between birth weight and infant/childhood weight status/weight gain in relation to menarcheal age.

METHODS

PubMed, EMBASE, Web of Science, Global Health (Ovid) and CINAHL were systematically searched. Selected studies were limited to English-language articles presenting multi-variable analyses. Seventeen studies reporting risk estimates for birth weight (n = 3), infant/childhood weight gain/weight status (n = 4) or both (n = 10), in relation to menarcheal age were included.

RESULTS

Lower vs. higher birth weight was associated with earlier menarche in nine studies and later menarche in one study, while three studies reported a null association. Greater BMI or weight gain over time and greater childhood weight were significantly associated with earlier menarche in nine of nine and six of seven studies, respectively.

CONCLUSIONS

Studies suggested that lower birth weight and higher body weight and weight gain in infancy and childhood may increase the risk of early menarche. The pre- and postnatal period may thus be an opportune time for weight control interventions to prevent early menarche, and its subsequent consequences.

Birth weight and prepubertal body size predict menarcheal age in India, Peru, and Vietnam

Evidence on the associations of birth weight and prepubertal nutritional status with menarcheal age for low- and middle-income countries is limited. We investigated these relationships using the Young Lives younger cohort for 2001 Indian, Peruvian, and Vietnamese girls born in 2001-2002. Girls were followed at approximately ages 1, 5, 8, and 12 years. Weibull survival models estimated hazards of earlier menarche on the basis of birth weight Z-scores (BWZ), and age-8 BMI-for-age Z-scores (BMIZ) and height-for-age Z-scores (HAZ). Estimates controlled for potential individual-, mother-, and household-level confounders and for changes in anthropometry between 1 and 8 years. In adjusted models, BWZ predicted later age at menarche (hazard ratio (HR) = 0.90, 95% CI: 0.83-0.97). Conversely, HAZ (HR = 1.66, 95% CI 1.5-1.83) and BMIZ at 8 years (HR = 1.28, 95% CI: 1.18-1.38) predicted earlier menarche. Changes in HAZ and BMIZ between 1 and 8 years were not associated with earlier menarche. Associations were consistent across countries, though with variation in estimated magnitudes. Maternal height and age were associated with later menarche. This evidence points to consistently robust and opposite associations of birth weight versus prepubertal attained height and body mass index with menarcheal age in three diverse settings with regard to nutrition, ethnicity, and socioeconomic status.

Childhood body mass index at 5.5 years mediates the effect of prenatal maternal stress on daughters’ age at menarche: Project Ice Storm

Early pubertal timing is known to put women at greater risk for adverse physiological and psychological health outcomes. Of the factors that influence girls’ pubertal timing, stress experienced during childhood has been found to advance age at menarche (AAM). However, it is not known if stress experienced by mothers during or in the months before conception can be similarly associated with earlier pubertal timing. Prenatal maternal stress (PNMS) is associated with metabolic changes, such as increased childhood adiposity and risk of obesity, that have been associated with earlier menarchal age. Using a prospective longitudinal design, the present study tested whether PNMS induced by a natural disaster is either directly associated with earlier AAM, or whether there is an indirect association mediated through increased girls’ body mass index (BMI) during childhood. A total of 31 girls, whose mothers were exposed to the Quebec’s January 1998 ice storm during pregnancy were followed from 6 months to 5 1/2 to 5.5 years of age. Mother’s stress was measured within 6 months of the storm. BMI was measured at 5.5 years, and AAM was assessed through teen’s self-report at 13.5 and 15.5 years of age. Results revealed that greater BMI at 5.5 years mediated the effect of PNMS on decreasing AAM [B=−0.059, 95% confidence intervals (−0.18, −0.0035)]. The present study is the first to demonstrate that maternal experience of stressful conditions during pregnancy reduces AAM in the offspring through its effects on childhood BMI. Future research should consider the impact of AAM on other measures of reproductive ability.

Early pubertal timing is common among adolescent girl-to-boy sex reassignment applicants

OBJECTIVES

The aim of our study was to explore whether gender dysphoria in adolescent girls is associated with early pubertal timing.

METHODS

We compared menarcheal timing among 52 adolescent girl-to-boy sex reassignment (SR) applicants with that of 644 adolescent girls who participated in an adolescent population mental health survey.

RESULTS

Of the population girls, 21% presented with early (≤11 years), 61% with normative (12-13 years) and 19% with late (≥14 years) menarcheal timing; among the SR applicants, 42% presented with early, 46% with normative and 12% with late menarcheal timing (p = 0.003). The odds ratio for SR applicant girls to have early menarcheal timing was 2.7 (95% confidence interval (CI) 1.3, 5.7), controlling for age and family structure.

CONCLUSION

Like emotional and behavioural disorders, gender dysphoria in adolescence is associated in girls with early pubertal timing. The finding is discussed in the light of literature related to pubertal maturation and mental health.

What does the mean menarcheal age mean?-An analysis of temporal pattern in variability in a historical swiss population from the 19th and 20th centuries

OBJECTIVES

Age at menarche is one of the most important factors when observing growth and development. The aim of this study was to assess the temporal pattern in variability of menarcheal age for a historic Swiss population from the 19th and 20th centuries.

METHODS

Medical health records from the Bernese women's hospital (Switzerland) were analyzed. From 10,081 women of a historical Swiss population (born from 1815 to 1954), menarcheal age was calculated. A possible decline in average menarcheal age and variance and skewness were analyzed with the use of descriptive statistics, generalized additive models, and correlation.

RESULTS

Mean menarcheal age declined from 17.34 years (n = 358) around 1830 to 13.80 years (n = 141) around 1950. Within-cohort variance decreased from 7.5 to 2.1 year(2) . Skewness was negatively correlated with birth year (r = -0.58).

CONCLUSION

This study provided evidence for a secular trend in various statistical parameters for age at menarche since the 19th century. Furthermore, the results of the analysis of temporal pattern in variability revealed that the secular trend in menarcheal age happened in two phases. Am. J. Hum. Biol. 28:705-713, 2016. © 2016 Wiley Periodicals, Inc.

Detecting menarcheal status through dental mineralization stages?

Menarche is an indicator frequently used to study variation in growth, development, and related health conditions among members of living populations. As a life event, menarche is often associated with changes in an individual's social identity. The reproductive lifespan, which for females starts with menarche, is a paramount feature of palaeodemographic studies. Determination of menarche status from the skeletal remains of individuals of past populations can be obtained by assessing the developmental status of the iliac crest, as well as the hand and wrist bones, which are, unlike teeth, often poorly recovered in bioarchaeological contexts. The present study seeks to evaluate the link between dental mineralization and menarche in a population of known menarche status. The relationship between permanent teeth mineralization and menarche status was investigated by using data of developing permanent teeth (167 radiographs) rated in accordance with the well-known standards of Demirjian et al. and Moorrees et al. collected among 73 living French females of known menarcheal status. Using correlation ratios, GLMM and CART algorithm, menarcheal status is correlated with mineralization of the premolars. Menarcheal status is predicted correctly for 92 and 77% of radiographs of the learning and validation samples, respectively. Although promising, the results require caution prior to generalization to other populations. The age of menarche in this particular sample may simply coincide with the development of the premolars in this particular sample. Therefore, further investigation applied to populations with various mean ages of menarche is required in order to provide new evidence of variation in human growth and development from the correspondence between the mineralization of the permanent teeth and menarche.

Age related changes in pelvis size among adolescent and adult females with reference to parturition from Naraingarh, Haryana (India)

This research examines the ontogenic patterns of changes in growth during adolescence, pelvis variations and growth during twenties and thirties of age, structural remodeling of pelvis related to childbirth and relationship of pelvis area with physique based on the cross-sectional data on 391 females from the state of Haryana. Peak growth velocity for body height and breadths of skeletal traits occurred between 11 and 12 years, much before mean age of menarche at 13.5 years; while for body weight and body mass index (BMI) occurred between 14 and 15 years, after the mean age of menarche. Untill the age 11 years, 11.87% of growth in stature was remaining, 19.37% for bi-cristal breadth, 25.96% for bi-ischial breadth and 35.82% for pelvic area. The hypothesis of critical value of pelvic width of 240mm at iliocristale for menarche to occur has been only a statistical association. Higher prevalence of malnutrition during pubertal phase than pre- and post-pubertal phases was due to greater nutritional needs during puberty. Among adult females, BMI was very poorly correlated with stature but very strongly correlated with body breadths, body breadth-stature indices and body weight. The body mass and pelvis size continued to change during 20s and first half of 30s. The continued increase of BMI was due to increase in body fat and muscle mass in females 18 years and older. To tease apart age and parturition effects on pelvis variations, the analysis showed that pelvic bones remodeling took place after the first child was born and not after the subsequent births, and it was a sign of childbirth phenotypic plasticity rather than age. Pelvis area was strongly associated with stature, BMI and age. Mean pelvic area of tall females was greater than those of medium and short stature. Females with broad shoulders had significantly greater mean pelvis area than those with narrow shoulders and medium shoulders. Females having thin/lean physique had the smallest mean pelvis area compared to those having medium and obese types of physiques. The stepwise multiple regression analysis revealed that BMI was the major determinant factor (multiple r=0.37) of pelvis area; addition of stature component increased the value of multiple r to 0.50, while addition of age marginally increased multiple r to 0.53.

Early Childhood Father Absence and Depressive Symptoms in Adolescent Girls from a UK Cohort: The Mediating Role of Early Menarche

Absence of the biological father in early childhood has been linked to depressive symptoms in mid-adolescent girls. Earlier studies have linked father absence to early timing of menarche, and early menarche is a risk factor for increased depressive symptoms in adolescence. No studies, however, have examined whether the association between father absence and depressive symptoms may be explained by the early onset of menarche. This study investigated whether age at menarche mediates the association between father absence in early childhood (birth to 5 years) and depressive symptoms in adolescent girls aged 14 years. The study sample comprised 7056 girls from a large UK birth cohort (Avon Longitudinal Study of Parents and Children) who provided data on age at onset of menarche and depressive symptoms assessed using the Short Mood and Feelings Questionnaire at 14 years. Mothers provided data on father absence from the birth of the study child up to 10 years. Using structural equation modelling, we found that 15 % of the total estimated association between father absence in early childhood and depressive symptoms at 14 years was explained by early age at menarche. In addition to the mediated effect, father absence was linked to an 11 % increase in depressive symptoms in adolescence. The findings suggest that early age at menarche is one of the pathways linking early childhood father absence and depressive symptoms in mid-adolescent girls. Preventive strategies could be targeting young girls at risk for depressive symptoms as a function of stressful family factors (e.g., biological father absence) and earlier menarche.

Trends and correlates of age at menarche in Colombia: Results from a nationally representative survey

Surveillance of age at menarche could provide useful information on the impact of changing environmental conditions on child health. Nevertheless, nationally representative data are exceedingly rare. The aim of this study was to examine trends and sociodemographic correlates of age at menarche of Colombian girls. The study sample included 15,441 girls born between 1992 and 2000 who participated in the Colombian National Nutrition Survey of 2010. We estimated median menarcheal age using Kaplan-Meier time-to-event analyses. Hazard ratios with 95% confidence intervals were estimated with Cox regression models. The median age at menarche was 12.6 years. There was an estimated decline of 0.54 years/decade (P<0.001) over the birth years; this decline was only observed among girls from urban areas, and was more pronounced among girls from wealthier versus poorer families. Child height and BMI, maternal BMI and education, and family wealth were each inversely associated with menarcheal age whereas food insecurity and number of children in the household were positively associated with age at menarche. In conclusion, a negative trend in age at menarche is ongoing in Colombia, especially in groups most likely to benefit from socioeconomic development.

Milk Consumption after Age 9 Years Does Not Predict Age at Menarche

BACKGROUND

Regular milk consumption during childhood and adolescence is recommended for bone health. However, milk consumption increases circulating insulin-like growth factor I concentrations, and may also accelerate puberty.

OBJECTIVE

We prospectively investigated the association between milk consumption and age at menarche in the Growing Up Today Study.

METHODS

Study participants were 5583 US girls who were premenarcheal and ages 9-14 y in 1996. Girls were followed through 2001, at which time 97% of noncensored participants had reported menarche. Frequency of milk and meat consumption was calculated with the use of annual youth/adolescent food frequency questionnaires from 1996-1998. Intake of related nutrients was also measured. Age at menarche was self-reported annually through 2001.

RESULTS

During follow-up, 5227 girls attained menarche over 10,555 accrued person-years. In models adjusted for dietary and sociodemographic predictors of menarche, frequency of milk consumption did not predict age at onset of menarche (for >3 glasses of milk/d vs. 1.1-4 glasses/wk, HR: 0.93; 95% CI: 0.83, 1.04). After additional adjustment for body size, premenarcheal girls consuming >3 glasses of milk daily were 13% less likely (95% CI: -3%, -23%; P-trend: <0.01) to attain menarche in the next month relative to those consuming 1.1-4 glasses/wk. Neither total meat nor red meat consumption was associated with age at menarche.

CONCLUSIONS

Our findings suggest that regular consumption of milk in girls aged ≥9 y is unlikely to substantially affect age at onset of menarche. Studies assessing associations between diet in early childhood and pubertal timing may be more illuminating.

Early stress predicts age at menarche and first birth, adult attachment, and expected lifespan

Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximize the probability of leaving any descendants at all. The fact that early menarche facilitates early reproduction provides an adaptationist rationale for our first two hypotheses: that women who experience more risky and uncertain environments early in life would have (1) earlier menarche and (2) earlier first births than women who experience less stress at an early age. Attachment theory and research provide the rationale for our second two hypotheses: that the subjective early experience of risky and uncertain environments (insecurity) is (3) part of an evolved mechanism for entraining alternative reproductive strategies contingent on environmental risk and uncertainty and (4) reflected in expected lifespan. Evidence from our pilot study of 100 women attending antenatal clinics at a large metropolitan hospital is consistent with all four hypotheses: Women reporting more troubled family relations early in life had earlier menarche, earlier first birth, were more likely to identify with insecure adult attachment styles, and expected shorter lifespans. Multivariate analyses show that early stress directly affected age at menarche and first birth, affected adult attachment in interaction with expected lifespan, but had no effect on expected lifespan, where its original effect was taken over by interactions between age at menarche and adult attachment as well as age at first birth and adult attachment. We discuss our results in terms of the need to combine evolutionary and developmental perspectives and the relation between early stress in general and father absence in particular.

Grow first, gain fat in the meantime. Longitudinal study of anthropometric changes around menarche

There is a long dispute among anthropologist over which factor is more important – skeletal maturation or energy accumulation – for menarche occurrence. Here we report results of longitudinal study conducted on the sample of 178 girls followed for the period from 2 years before to 2 years after the age of menarche. Each year during this period anthropometric measures of waist and hip circumference, pelvis breadth, subscapular, triceps and abdominal skinfold thickness were taken to document girls’ physical development. We found that changes in hip circumference and pelvis breadth were the most closely associated with menarche appearance. We also found that changes in anthropometric measures of lower body part preceded changes in anthropometric measures of upper body part and tended to peak one year before menarche occurrence while changes in upper body part tended to peak one year after menarche occurrence. These results suggest that both skeletal maturation and energy accumulation in the form of fat are equally important for menarche to occur. Furthermore, we are proposing a new indicator describing allometric changes of pelvis around menarche: hip circumference to pelvis breadth ratio (HCPBR).

[The importance of memory bias in obtaining age of menarche by recall method in Brazilian adolescents]

OBJECTIVE

To compare the age at menarche obtained by recall method according to the time elapsed since the event, in order to verify the importance of the recall bias.

SUBJECTS AND METHODS

Were evaluated 1,671 girls (7-18 years) at schools in Campinas-SP regarding the occurrence of menarche by the status quo method (menarche: yes or no) and the recall method (date of menarche, for those who mentioned it). The age at menarche obtained by the status quo method was calculated by logit, which considers the whole group, and the age obtained by the recall method was calculated as the average of the mentioned age at menarche. In this group, the age at menarche was obtained by the difference between the date of the event and the date of birth. Girls who reported menarche (883, 52.8%) were divided into four groups according to the time elapsed since the event. To analyze the results, we used ANOVA and logistic regression for the analysis, with a significance level of 0.05.

RESULTS

The age at menarche calculated by logit was 12.14 y/o (95% CI 12.08 to 12.20). Mean ages obtained by recall were: for those who experienced menarche within the previous year 12.26 y/o (±1.14), between > 1-2 years before, 12.29 y (±1.22); between > 2-3 years before, 12.23 y/o (±1.27); and more than 3 years before, 11.55y/o (±1.24), p < 0.001.

CONCLUSION

The age at menarche obtained by the recall method was similar for girls who menstruated within the previous 3 years (and approaches the age calculated by logit); when more than 3 years have passed, the recall bias was significant.

Prenatal smoking and age at menarche: influence of the prenatal environment on the timing of puberty

STUDY QUESTION

Do prenatal exposure to cigarette smoking and birthweight influence age at menarche (AAM) in a cohort of Australian girls?

SUMMARY ANSWER

We find that prenatal smoke exposure and lower birthweight increase the chance of earlier menarche in accordance with theoretical predictions as do confounding factors of maternal AAM and higher BMI of the girls.

WHAT IS KNOWN ALREADY

Much prior research focuses on the role of the early childhood environment in determining AAM but fewer studies consider the role of the prenatal environment. Those studies that examine the prenatal period find an acceleration of maturation associated with maternal smoking and low birthweight. Life history theory predicts that early life exposure to stressful environments should promote more rapid maturation and that this timing can be established before birth, making the prenatal environment particularly important.

STUDY DESIGN, SIZE, DURATION

Statistical analysis of longitudinal survey data collected from a large cohort (n = 2446) of Australian children using data from birth to 12-13 years of age.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Owing to missing data, 1493 girls were included in the final analysis. Using cox regression, we examine how (i) maternal cigarette smoking during gestation and (ii) birthweight influence girls' AAM. Cox regression was used because not all girls had reached menarche.

MAIN RESULTS AND THE ROLE OF CHANCE

We find that older maternal AAM (hazards ratio (HR): 0.75, confidence interval (CI) (95%): 0.71-0.79) and higher birthweight (HR: 0.86, CI (95%): 0.75-0.97) lower the chance of earlier menarche; while higher girls' BMI at 8-9 years (HR: 1.12, CI (95%): 1.10-1.15), and maternal cigarette smoking on 'most days' during gestation (HR: 1.40, CI (95%): 1.10-1.79 with 'no smoking' as the reference level) increased the chance of earlier menarche. All factors were statistically significant at P = 0.05.

LIMITATIONS, REASONS FOR CAUTION

Not all girls had reached menarche, necessitating the use of cox regression. As with other longitudinal studies, there was study sample attrition and some missing data, particularly in reports of maternal smoking. In addition, as the degree of bias in the missing data is unknown, possible inaccurate reporting of maternal smoking may influence the results of birthweight on AAM.

WIDER IMPLICATIONS OF THE FINDINGS

Because of the association between younger AAM and higher risk of uterine, endometrial and breast cancer development, our finding adds to the need to consider the stress caused by prenatal smoke exposure as an important health risk. In addition, this study needs to be extended, when the same girls are 14-15 years of age, and on a larger dataset from a younger cohort within the same Australian Government project.

STUDY FUNDING/COMPETING INTERESTS

No funding was received for this study and there are no competing interests to declare.

Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls

STUDY QUESTION

Is sugar-sweetened beverage (SSB) consumption associated with age at menarche?

SUMMARY ANSWER

More frequent SSB consumption was associated with earlier menarche in a population of US girls.

WHAT IS KNOWN ALREADY

SSB consumption is associated with metabolic changes that could potentially impact menarcheal timing, but direct associations with age at menarche have yet to be investigated.

STUDY DESIGN, SIZE, DURATION

The Growing up Today Study, a prospective cohort study of 16 875 children of Nurses' Health Study II participants residing in all 50 US states. This analysis followed 5583 girls, aged 9-14 years and premenarcheal at baseline, between 1996 and 2001. During 10 555 person-years of follow-up, 94% (n = 5227) of girls reported their age at menarche, and 3% (n = 159) remained premenarcheal in 2001; 4% (n = 197) of eligible girls were censored, primarily for missing age at menarche.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Cumulative updated SSB consumption (composed of non-carbonated fruit drinks, sugar-sweetened soda and iced tea) was calculated using annual Youth/Adolescent Food Frequency Questionnaires from 1996 to 1998. Age at menarche was self-reported annually. The association between SSB consumption and age at menarche was assessed using Cox proportional hazards regression.

MAIN RESULTS AND THE ROLE OF CHANCE

More frequent SSB consumption predicted earlier menarche. At any given age between 9 and 18.5 years, premenarcheal girls who reported consuming >1.5 servings of SSBs per day were, on average, 24% more likely [95% confidence interval (CI): 13, 36%; P-trend: <0.001] to attain menarche in the next month relative to girls consuming ≤2 servings of SSBs weekly, adjusting for potential confounders including height, but not BMI (considered an intermediate). Correspondingly, girls consuming >1.5 SSBs daily had an estimated 2.7-month earlier menarche (95% CI: -4.1, -1.3 months) relative to those consuming ≤2 SSBs weekly. The frequency of non-carbonated fruit drink (P-trend: 0.03) and sugar-sweetened soda (P-trend: 0.001), but not iced tea (P-trend: 0.49), consumption also predicted earlier menarche. The effect of SSB consumption on age at menarche was observed in every tertile of baseline BMI. Diet soda and fruit juice consumption were not associated with age at menarche.

LIMITATIONS, REASONS FOR CAUTION

Although we adjusted for a variety of suspected confounders, residual confounding is possible. We did not measure SSB consumption during early childhood, which may be an important window of exposure.

WIDER IMPLICATIONS OF THE FINDINGS

More frequent SSB consumption may predict earlier menarche through mechanisms other than increased BMI. Our findings provide further support for public health efforts to reduce SSB consumption.

STUDY FUNDING/COMPETING INTERESTS

The Growing up Today Study is supported by grant R03 CA 106238. J.L.C. was supported by the Breast Cancer Research Foundation; Training Grant T32ES007069 in Environmental Epidemiology from the National Institute of Environmental Health Sciences, National Institutes of Health; and Training Grant T32HD060454 in Reproductive, Perinatal and Pediatric Epidemiology from the National Institute of Child Health and Human Development, National Institutes of Health. A.L.F. is supported by the American Cancer Society, Research Scholar Grant in Cancer Control. K.B.M. was supported in part by the National Cancer Institute at the National Institutes of Health (Public Health Service grants R01CA158313 and R03CA170952). There are no conflicts of interest to declare.

Chronological age vs. biological maturation: implications for exercise programming in youth

Biological maturation is associated with significant change to a number of physiological and structural processes throughout childhood and, in particular, adolescence. Mismatched rapid growth in the long bones relative to muscular lengthening may disrupt structure, neuromuscular function, and physical performance. Practitioners who work with school-age youth should be aware of the age-related changes that typically take place during a child's development to ensure that their strength and conditioning programming is as safe and effective as possible for enhancing performance and reducing injury risk. Although there are several methods available to assess biological maturation, practitioners who work with youth can benefit from assessment methods that are available and feasible, and that provide utility in the quantification of the degree and stages of biological maturation that affect motor performance in children and adolescents. This article synthesizes the relevant assessment methods and provides a rationale for understanding usable biological maturation assessment tools that can aid in the development of training program design for youth.

Urinary bisphenol A and age at menarche among adolescent girls: evidence from NHANES 2003-2010

BACKGROUND

Bisphenol A (BPA) is an environmental estrogen used in the manufacture of polycarbonate plastics and epoxy resins used to make food and beverage packaging. Increasing evidence suggests that BPA mimics estrogens in the body and may be associated with putative markers of breast cancer risk.

OBJECTIVES

We analyzed the National Health and Nutrition Examination Survey (NHANES) 2003-2010 data to investigate the association of BPA with age at menarche in adolescent girls. We hypothesized that urinary BPA, as a surrogate biomarker for BPA exposure, is associated with earlier age at menarche, and that body mass index (BMI) may modulate this association.

METHODS

We conducted cross-sectional analyses of urinary BPA, BMI and age of menarche in a subsample of 987 adolescent girls aged 12-19, using pooled data from the 2003-2010 NHANES. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the association between urinary BPA and early onset of menarche, with adjustment for sampling design. We additionally assessed interaction of BPA with BMI.

RESULTS

Adolescent girls with moderate BPA levels appeared to be less likely to have early onset of menarche than those with the lowest levels (OR=0.57; 95% CI=0.30, 1.08) after adjusting for age, race/ethnicity, parental education, country of birth, NHANES cycle, BMI and creatinine. BMI appeared to modify the BPA-menarche association.

CONCLUSIONS

Although a non-significant trend suggests increasing urinary BPA may be associated with delayed menarche in adolescent girls, these results are based on cross-sectional data. Results should be clarified in carefully designed longitudinal cohort studies.

Early and late menarche and risk of depressive symptoms in young adulthood

We investigated whether girls experiencing early menarche have an increased risk of depression during young adulthood. This study used data collected in the Growing Up Today Study (N = 9,039), an ongoing prospective cohort of the daughters of women enrolled in the Nurses' Health Study II. After excluding girls who were postmenarcheal at baseline in 1996, <20 or ≥26 years old in 2007, or missing data on key covariates, the final sample size was 3,711. Self-reported age at menarche was collected annually. Depressive symptomatology was measured in 2007 using the 10-item Center for Epidemiologic Studies Depression (CES-D-10) score. Sixteen percent of girls (N = 596) reported high levels of depressive symptoms (CES-D-10 ≥ 14) in 2007. Neither early nor late menarche was associated with high depressive symptoms (for early vs. normative menarche, odds ratio (OR) = 1.08, 95 % confidence interval (CI) = 0.85-1.38; for late vs. normative menarche, OR = 0.91, 95 % CI = 0.70-1.18) or with differences in continuous CES-D-10 score in young adulthood. Although previous studies suggest that girls with early menarche suffer from an increased risk of adolescent depression, this does not appear to persist into young adulthood.

The Tromsø Study: Fit Futures: a study of Norwegian adolescents' lifestyle and bone health

Bone mass achievement predicts later fracture risk. This population-based study describes bone mineral density (BMD) levels and associated factors in Norwegian adolescents. Compared with international reference ranges, BMD levels appear higher and physical activity levels are positively associated with BMD.

PURPOSE

Norway has one of the highest reported incidences of osteoporotic fractures. Maximisation of peak bone mass may prevent later fractures. This population-based study compared BMD levels of Norwegian adolescents with international reference ranges and explored associated factors.

METHODS

All first-year upper-secondary school students, aged 15-19 years in the Tromsø region were invited to the Fit Futures study in 2010-2011. Over 90 % of the invited participants attended, 508 girls and 530 boys. BMD was measured at total hip, femoral neck and total body by dual X-ray absorptiometry. Lifestyle variables were collected by self-administered questionnaires and interviews. All analyses were performed sex stratified, using linear regression models.

RESULTS

In girls, mean BMD (SD) was 1.060 g/cm(2) (0.124), 1.066 g/cm(2) (0.123) and 1.142 g/cm(2) (0.077) at the total hip, femoral neck and total body, respectively. In boys, corresponding values were 1.116 (0.147), 1.103 (0.150) and 1.182 (0.097), with significant higher values than the Lunar pediatric reference at 16 years of age. In girls, height and self-reported intensive physical activity of more than 4 h a week and early sexual maturation were positively associated with BMD at both femoral sites (p < 0.047). Among boys age, height, body mass index, physical activity and alcohol intake were positively (p < 0.038), whereas early stages of sexual maturation and smoking was negatively (p < 0.047) related to BMD.

CONCLUSIONS

Despite the heavy fracture burden, Norwegian adolescents' BMD levels are higher than age-matched Caucasians. Physical activity is associated with 1 SD increased BMD levels in those involved in competition or hard training.

Relationships between biomarkers of inflammation, ovarian steroids, and age at menarche in a rural Polish sample

OBJECTIVES

To test the hypothesis that life history trade-offs between maintenance and reproductive effort would be evident through inverse associations between levels of a biomarker of inflammation [C-reactive protein (CRP)], and ovarian hormones. Associations between CRP and age at menarche were also explored.

METHODS

Urinary CRP, salivary progesterone, and estradiol were measured over one menstrual cycle from rural Polish women (n = 25), representing a natural fertility sample. Age of menarche was assessed through interview recall methods. We used minimum second-order Akaike Information Criteria as a means of multiple regression model selection, and repeated measures ANOVA to test cycle-dependent hypotheses.

RESULTS

Comparisons of individuals in high and low CRP tertiles revealed that those with high CRP had significantly lower progesterone (luteal P = 0.03, mid luteal P = 0.007) but not estradiol (follicular P = 0.21, luteal P = 0.15) concentrations through the menstrual cycle. However, when the age at menarche was included in the analysis, both age at menarche and urinary CRP were negatively associated with estradiol (R(2) = 0.44, P = 0.0007). Age at menarche and estradiol were the strongest negative predictors of CRP (R(2) = 0.52, P = 0.0001).

CONCLUSIONS

Inflammation itself may suppress ovarian function, or indicate immune challenges that lead to ovarian suppression. The timing of menarche may also influence adult inflammatory sensitivity and ovarian hormone concentrations. This lends support to existing models of trade-offs between maintenance and reproduction in women.