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

Pubertal, Auxological, and Adult Height Outcomes in Children Treated for Adrenocortical Tumors: Half a Century Experience

INTRODUCTION

Most children with adrenocortical tumors (ACTs) present with accelerated growth and skeletal maturation at diagnosis, which potentially compromises their adult heights (AHs). Knowledge about growth and pubertal patterns after ACT resection is scarce. This study presents the pubertal and auxological development of patients treated for ACT and followed up at a single pediatric endocrinology service in Brazil.

METHODS

Retrospective cohort study including 63 patients (47 girls) followed up between 1966 and 2021. Pubertal and auxological data from ACT diagnosis to AH were analyzed.

RESULTS

At diagnosis, the patients had median values of bone age (BA) more advanced than chronological age (CA), height standard deviation score greater than target height (TH-SDS), and predicted adult height (PAH-SDS) lower than TH-SDS. The difference between BA and CA decreased gradually during follow-up and the PAH-SDS moved closer to the TH-SDS 7 years after tumor resection. Puberty started at a median CA of 9.3 (8.3-11.3) years in girls and 9.9 (9.2-13.6) years in boys. Nine patients (6 girls) developed central precocious puberty (CPP), which was influenced by a CA >4 years at diagnosis. The difference between AH-SDS and TH-SDS was not significant (p = 0.3). The factors independently associated with AH below TH were CA >4 years at diagnosis, time between clinical manifestation and diagnosis >1 year, and development of CPP.

CONCLUSION

Most patients treated for ACT during childhood attained AH within the TH despite presenting with advanced skeletal maturation at diagnosis. Development of CPP was not infrequent.

Trends in age at menarche from 1943 through 1989 in Taiwan: A retrospective population-based analysis

BACKGROUND

Recent studies have demonstrated a global decline in the age at menarche. Our study aimed to determine the age at menarche of Taiwanese women born between 1943 and 1989.

METHODS

Data were obtained from the Taiwan Biobank. To view the trends in age at menarche, we analyzed data from 74,799 women. The mean, standard deviation, and annual percentage change in age at menarche were calculated for birth-year cohorts.

RESULTS

The mean age at menarche of Taiwanese women born in 1943 was 14.85 years. The age at menarche decreased to 12.20 years for those born in 1989. The mean age at menarche declined by 2.65 years across the 47-year study period; hence, the reduction rate was 0.56 years per decade. This study demonstrated a downward secular trend in the age at menarche of Taiwanese women born between 1943 and 1989. This trend occurred in three stages of decline: fast (1943-1953), slow (1953-1965), and moderate (1965-1989).

CONCLUSION

The age at menarche decreased by 2.65 years among Taiwanese women born in 1943 compared with those born in 1989. This decline occurred in three stages: fast (1943-1953), slow (1953-1965), and moderate (1965-1989). This significant downward secular trend in age at menarche reflects Taiwan's socioeconomic development.

New epidemiological profile of schistosomiasis from an area of low prevalence in Brazil

INTRODUCTION

Schistosomiasis, caused by infection from Schistosoma mansoni, is a disease that represents an important public health problem for Brazil, especially for states in the Northeast region. Thus, the aim of this study is to present a new epidemiological profile for the disease in a municipality with low prevalence in the state of Alagoas, Brazil.

METHODS

A cross-sectional study was conducted through a coproparasitological and malacological survey. A structured questionnaire was applied to the study participants to survey possible risk factors and a spatial analysis (kernel density) was used to measure the risk of infection.

RESULTS

Of the 347 participants, 106 (30.5%) were infected by Schistosoma mansoni, most of them from the urban area of the municipality (68.9%; 73/106). A 3-fold risk of infection was found for individuals living in the urban area and a risk of 2.15 times for self-declared farmers. Biomphalaria glabrata and B. straminea were the species found in the municipality, but no animals were diagnosed as infected by the parasite. Spatial analysis showed a random distribution of vectors and human cases of the disease, and the formation of two clusters of human cases in the urban area was seen.

CONCLUSIONS

A new epidemiological profile for schistosomiasis from S. mansoni infection was presented in a municipality of low endemicity: a high proportion of positive individuals in the urban area; presence of snails without positive diagnosis for S. mansoni infection; random distribution of vectors and human cases; and absence of association between classical risk factors and human infection.

Early Menarche is a Risk Factor for Short Stature in Young Korean Females: An Epidemiologic Study

OBJECTIVE

To assess the association between age at menarche and adult height [and body mass index (BMI)] in young Korean females and also to investigate whether early menarche (<12 years) is a risk factor for short stature and obesity in young Korean females.

METHODS

Data on 1148 females aged 18-30 years and 612 mother (612 pairs of mothers and daughters) from the 6^th Korea National Health and Nutrition Examination Survey (2013-2015) were analyzed.

RESULTS

Among 1148 females, 256 (22.3%) had early menarche. Their stature was approximately 0.445 cm shorter when menarche had occurred one year earlier. The prevalence of short stature (≤153 cm) and obesity (BMI ≥25) was higher in females with early menarche compared to those with later menarche (short stature: 10.5% vs 6.4%, obesity; 20.7% vs 13.1%, all p<0.001). In multivariate regression, the odds ratio (OR) for short stature was 2.62 [95% confidence interval (CI): 1.26-5.44] after adjusting for current age and mother’s height. OR for obesity was 1.74 (95% CI: 0.98-3.07) after adjusting for age and maternal BMI.

CONCLUSION

Final height in girls is influenced by age of menarche. Early menarche increased the risk for adult short stature in young Korean females.

Menarche, pregnancies, and breastfeeding do not modify long-term prognosis in multiple sclerosis

OBJECTIVE

To investigate the effect of menarche, pregnancies, and breastfeeding on the risk of developing multiple sclerosis (MS) and disability accrual using a multivariate approach based on a large prospective cohort of patients with clinically isolated syndrome (CIS).

METHODS

A cross-sectional survey of the reproductive information of female participants in a CIS cohort was performed. We examined the relationship of age at menarche with the risk of clinically definite MS (CDMS), McDonald 2010 MS, and Expanded Disability Status Scale (EDSS) 3.0 and 6.0. The effect of pregnancy (before and after CIS) and breastfeeding in the risk of CDMS, McDonald 2010 MS, and EDSS 3.0 was also examined. Univariate and multivariate analyses were performed and findings were confirmed using sensitivity analyses and a propensity score model.

RESULTS

The data of 501 female participants were collected. Age at menarche did not correlate with age at CIS and was not associated with the risk of CDMS or EDSS 3.0 or 6.0. Pregnancy before CIS was protective for CDMS in the univariate analysis, but the effect was lost in the multivariate model and did not modify the risk of EDSS 3.0. Pregnancy after CIS was protective for both outcomes in univariate and multivariate analyses when pregnancy was considered a baseline variable, but the protective effect disappeared when analyzed as a time-dependent event. Breastfeeding did not modify the risk for the 3 outcomes.

CONCLUSIONS

These results demonstrate that menarche, pregnancies, and breastfeeding did not substantially modify the risk of CDMS or disability accrual using a multivariable and time-dependent approach.

ERICA: age at menarche and its association with nutritional status

OBJECTIVE

To estimate the mean age at menarche and its association with nutritional status in Brazilian adolescents.

METHODS

The study sample included female adolescents aged 12-17 who participated in a multicenter, school-based, country-wide, cross-sectional study entitled The Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes [ERICA]). Mean and median ages at menarche in Brazil were estimated. The association of age at menarche with sociodemographic data and nutritional status were described as means and their respective 95% confidence intervals. Survival analysis was used to assess the age at menarche according to nutritional status categories and the log-rank test was used to compare the medians. Bivariate and multivariate analyses were performed using Cox regression to verify the association between menarche and other variables.

RESULTS

A total of 73,624 students were evaluated, comprising 40,803 girls, of whom 37,390 reported menarche at a mean age of 11.71 years and a median of 12.41 years. Median age at menarche was lower in overweight and obese girls (p<0.001). The multivariate analysis showed that excess weight (HR=1.28; 95% CI 1.21-1.36; p<0.001) and studying in a private school (HR=1.06; 95% CI 1.02-1.10; p=0.003) were associated with menarche.

CONCLUSIONS

This is a pioneering study in Brazil with national and regional representativeness to estimate the mean and the median age of occurrence of menarche. Adolescents with excess weight had an earlier menarche than their peers, even after adjustment for confounding factors.

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.

Rural-urban variations in age at menarche, adult height, leg-length and abdominal adiposity in black South African women in transitioning South Africa

Background: The pre-pubertal socioeconomic environment may be an important determinant of age at menarche, adult height, body proportions and adiposity: traits closely linked to adolescent and adult health.

Aims: This study explored differences in age at menarche, adult height, relative leg-length and waist circumference between rural and urban black South African young adult women, who are at different stages of the nutrition and epidemiologic transitions.

Subjects and methods: We compared 18–23 year-old black South African women, 482 urban-dwelling from Soweto and 509 from the rural Mpumalanga province. Age at menarche, obstetric history and household socio-demographic and economic information were recorded using interview-administered questionnaires. Height, sitting-height, hip and waist circumference were measured using standardised techniques.

Results: Urban and rural black South African women differed in their age at menarche (at ages 12.7 and 14.5 years, respectively). In urban women, a one-year increase in age at menarche was associated with a 0.65 cm and 0.16% increase in height and relative leg-length ratio, respectively. In both settings, earlier age at menarche and shorter relative leg-length were independently associated with an increase in waist circumference.

Conclusions: In black South African women, the earlier onset of puberty, and consequently an earlier growth cessation process, may lead to central fat mass accumulation in adulthood.

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 in relation to prenatal rainy season exposure and altitude of residence: results from a nationally representative survey in a tropical country

Intrauterine exposure to the rainy season in the tropics may be accompanied by high rates of infection and nutritional deficiencies. It is unknown whether this exposure is related to the extrauterine timing of development. Our aim was to evaluate the relations of prenatal exposure to the rainy season and altitude of residence with age at menarche. The study included 15,370 girls 10 to <18 years old who participated in Colombia's 2010 National Nutrition Survey. Primary exposures included the number of days exposed to the rainy season during the 40 weeks preceding birth, and altitude of residence at the time of the survey. We estimated median menarcheal ages and hazard ratios with 95% confidence interval (CI) according to exposure categories using Kaplan-Meier cumulative probabilities and Cox proportional hazards models, respectively. All tests incorporated the complex survey design. Girls in the highest quintile of gestation days exposed to the rainy season had an earlier age at menarche compared with those in the lowest (adjusted hazard ratios (HR)=1.08; 95% CI 1.00-1.18, P-trend=0.03). Girls living at altitudes ⩾2000 m had a later age at menarche compared with those living <1000 m (adjusted HR=0.88; 95% CI 0.82-0.94, P-trend <0.001). The inverse association between gestation days during the rainy season and menarche was most apparent among girls living at altitudes ⩾2000 m (P, interaction=0.04). Gestation days exposed to the rainy season and altitude of residence were associated with the timing of sexual maturation among Colombian girls independent of socioeconomic status and ethnicity.

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.