Nutritional factors affecting the menarcheal state of adolescent school girls in Alexandria

The nutritional status of adolescents plays a dominant role in determining the maturation status. The aim of the present work was to assess the mean age of menarche and the main nutritional factors affecting it. A cross-sectional study of 1606 girls was conducted in primary and preparatory schools in Alexandria. Every girl was subjected to anthropometric assessment including weight, height, mid upper arm circumference (MUAC), waist circumference, hip circumference and triceps skin-fold thickness. BMI and body fat percentage were calculated. A 24 hours diet recall method was used to assess the dietary intake. The mean age of menarche was 11.98+/-0.96 years. The mean MUAC, triceps skin-fold thickness, waist circumference and hip circumference were significantly higher among menstruating girls as compared to non-menstruating. (p<0.01). Only 7.5% of the females less than the 5th percentile of BMI (thinness) were menstruating, while the corresponding figure for those at or more than 85th percentile (overweight) was 65.6% and this was statistically significant (X 2 (2) =102.8, P<0.001). Girls who attained menstruation demonstrated a higher significant mean percent of body fat (43.40+/-10.0) as compared to non menstruating ones (35.41+/-7.87), ( t=17.09, P<0.001). The oldest age at menarche was noted when the protein, iron and caloric intake was less than 80% of the RDAs. However after adjustment of other variables direct relation was detected between age of girls and their age of menarche and those in private school had earlier age of menarche than those in governmental one. The nutritional status of the adolescents had a significant association with the onset of menstruation and the age at menarche.     

Age of Onset, Nutritional Determinants, and Seasonal Variations in Menarche in Rural Bangladesh

Menarche is an important milestone in the development of female adolescents. The study assessed the age at menarche using recall, its seasonality, and association with marital and nutritional status (using midupper arm circumference [MUAC]) among 3,923 female adolescents aged 12–19 years in a rural area of Bangladesh. At the time of assessment, most (88%) adolescents had attained menarche at the mean (standard deviation [SD]) age of 12.8 (1.4) years. Age of onset of menarche among married adolescents (13%) occurred earlier than in those who were unmarried (12.6±1.3 years vs 12.9±1.4 years, p<0.01). Age at menarche was negatively associated with MUAC after adjusting for age and marital status (β=−0.10, p<0.01). More than 50% of the adolescents had an onset of menarche during winter (χ ²=634.97; p<0.001), with peaks in December and January. In this rural population, the current age at menarche was found to be slightly lower than the previous estimates of 13.0 years in Bangladesh. An early onset of menarche was associated with season and better nutritional status of the female adolescents and may be associated with early marriage.Key words: Age at menarche, Marital status, Menarche, Nutritional status, Seasonality, Bangladesh     

广东汉族女生营养状况体脂含量与月经初潮相关性

探讨广东省青春期汉族女生营养状况、体脂含量与月经初潮发生的关系,为制定促进女生青春期性发育的政策和干预措施提供科学依据.方法 采取分层整群抽样方法,抽取广州、湛江和韶关4 782名9~ 16岁女生作为调查对象,进行问卷调查和体格发育测量,评价其营养状况,了解月经初潮情况.结果 调查对象月经初潮发生率城市地区为63.0%,农村地区为59.0%;城、乡营养不良比例分别为8.8%,12.6%,营养过剩比例分别为11.5%,7.2%.控制城乡、年龄等因素后,Logistic回归结果显示,与正常体重女生相比,营养不良女生发生月经初潮可能性较小(OR=0.32,P<0.05);另外,女生皮下脂肪积累越多,发生月经初潮的可能性越大(OR=1.03,P<0.05);睡眠时间与月经初潮的发生呈负相关(OR=0.77,P<0.05).结论 青春期女生营养状况水平、体脂含量与月经初潮的发生呈正相关,应制定相关干预措施促进女生青春期性发育.     

Secular trends in the distributions of the breast cancer risk factors--menarche, first birth, menopause, and weight--in Hiroshima and Nagasaki, Japan

The results of a mail survey completed by approximately 21,000 female atomic bomb survivors in Hiroshima and Nagasaki in 1970 are studied with respect to menarche, first birth, menopause, and weight. These known risk factors for breast cancer can be used to explain some but not all of the differences in Japanese and US breast cancer rates. The results for age at menarche are the most striking, with the presence of a strong secular trend. The average age at menarche in Japan was observed to decrease from 16.4 years for women born in 1902 to 14.4 years for women born in 1942. However, a temporary increase was observed in women whose menarche was expected to occur during the war years of the early 1940s. Differences between US and Japanese women were also observed in age at first birth and nulliparity rates. Age at menopause was similar for the two groups, although US women have a considerably higher rate of surgically induced menopause. Within each birth cohort, it is shown that body weight is negatively correlated with age at menarche and positively correlated with age at menopause.     

Nutritional deprivation in childhood and the body size, activity, and physical work capacity of young boys.

Clinical nutritional status and physical work capacity at submaximal level were assessed in 96 rural Hyderbad boys, 14 to 17 years of age. Data available on the previous nutritional status of these children when they were 5 years of age were used for classifying them into different nutritional grades. Factors responsible for undernutrition childhood continued to operate on later growth. Both height and weight at 5 years correlated well (P less than 0.001) with current height and weight. About 64% (P less than 0.001) of the variation in physical work capacity at a heart rate of 170/min (physical work capacity 170 kpm/min) could be explained by the differences in current body weight; habitual physical activity explained another 10% (P less than 0.001) of the variation. Malnutrition in early childhood continuing into adolescence could be considered to have adversely affected their work capacity by influencing their body weight. However, even severe undernutrition during childhood had no effect on work performance, when expressed in terms of unit weight. But for the same work load, undernourished subjects had to use significantly higher heart rate at moderate work level as compared to their counterparts.     

Relationships of age at menarche and menopause, and reproductive year with mortality from cardiovascular disease in Japanese postmenopausal women: the JACC study

BACKGROUND: Early menopause is associated with increased risk of coronary heart disease in Caucasian women. However, this association has not been examined in Asian women. METHODS: We conducted a 10-year cohort study of 37,965 Japanese post-menopausal women aged 40-79 years in the Japan Collaborative Cohort (JACC) Study. Causes of death were determined based on the International Classification of Disease. RESULTS: There were 487 mortality of stroke and 178 mortality of coronary heart disease. Late menarche or early menopause, or shorter duration of reproductive period was not associated with risk of mortality from coronary heart disease. However, compared with women with age at menarche < or =13 years, those with age at menarche > or =17 years tended to have increased risk of mortality from stroke: the multivariable hazard ratio was 1.32 (95% confidence interval [CI]: 0.93-1.87, p = 0.10). Compared with women with age at menopause of > or =49 years, those with age at menopause of <49 years tended to have increased risk of coronary heart disease among women aged 40-64 years; the multivariable hazard ratio was 1.85 (95% CI: 0.92-3.73, p = 0.08). CONCLUSIONS: The possible association between early menopause and coronary heart disease among middle-aged women was consistent with the result of observational studies for Caucasian women, and can be explained by a protective effect of endogenous estrogen on the development of atherosclerosis.     

Prenatal factors, childhood growth trajectories and age at menarche

BACKGROUND: In recent studies a larger birth size has been shown to delay the timing of menarche. The mechanisms underlying this association are not clear, however, as birthweight is a predictor of body size in childhood, and a large body size is known to be associated with an early onset of menarche. METHODS: Data from a representative British cohort of 2547 girls born in 1946 who were followed prospectively throughout childhood were used. Information was available on prenatal characteristics, birthweight, height, weight and social circumstances during childhood, and on age at menarche. Random coefficients models were used to estimate the individual trajectories in height and body mass index (BMI) up to age 7 years. The parameters identified by these models were then included in Weibull survival models for the timing of menarche together with birthweight. RESULTS: Birthweight was found to positively influence height and BMI values at age 2 years, but not to affect their rates of change from age 2 to 7 years. Initial analyses showed low birthweight to be associated with an early onset of menarche, but after controlling for growth in infancy this effect was reversed, with girls who were heavy at birth reaching menarche earlier than others with similar infant growth. Rapid growth in infancy was also related to early pubertal maturation. The effects of birthweight and infant growth disappeared, however, when further controlled for growth from age 2 to 7 years. CONCLUSIONS: The effects of birthweight and growth in infancy on the timing of menarche seem to be mediated through growth in early childhood. These findings are consistent with the possibility that timing of menarche may be set in utero or early in life, although it may be modified by changes in body size and composition in childhood.     

Biosocial Correlates of Nutrition and Chronic Energy Deficiency among Adult Females of two Ecological Zones in Madhya Pradesh and Uttarakhand, India

The paper aims to draw out biosocial correlates of nutrition through body mass index (BMI) and chronic energy deficiency (CED). The findings are based on cross-sectional data of 446 women aged 18-60 years from six different endogamous groups of two ecological zones. The mean age of studied women varied from 31 to 36 years. The mean age at menarche was found to be 14.50±1.32 years. Similarly mean age at menopause was found to be 46.22±4.00 years. The mean of reproductive life span varied from 27 to 35 years. Average number of pregnancies per women was 4.44±2.52, average foetal loss was 0.11, children surviving per women was 3.61, whereas average child loss per women was found to be 0.62 and average family size was 9.51. Variations in mean BMI kg/m2 between populations ranged between 18.56 and 20.71. Prevalence of CED was highest among the Brahmin women of Uttarakhand (58.3%) followed by Ahirwar of Madhya Pradesh (47.1%). Incidence of CED was found lowest among Brahmin women of Madhya Pradesh (24.0%). Linear regression coefficient (b ± standard error) of BMI on Cormic Index for these women was 33.1 ± 8.1 (t=4.0, p=0.001), and correlation coefficient (R) was 0.189. Out of 6 anthropometric variables considered for regression analysis, 5, namely weight, hip circumference, waist circumference, mid arm circumference and sitting height showed significant correlations with BMI. Significant differences in sitting height and Cormic Index of women from the hills and plains indicate the role of ecology in shaping its habitants. Out of 9 demographic variables, only age of respondent and family size were found to have a significant impact on low BMI status. The present study postulates that the nutritional status of women has improved over the last decades.     

青春期女性骨发育、月经初潮与身高突增关系研究

目的研究青春期女性骨发育、月经初潮与身高突增关系，为提高青春期女性身体素质提供依据。方法2002年对贵阳市9—15岁健康女性248名测量身高，调查月经初潮发生情况，拍摄左手腕骨X光片，依据X光片用Grave法划分身高突增期，并作1a身高追踪。结果9岁组的个体约有5／6已进入了青春期身高突增，并有部分高峰期个体；身高突增高峰(PHV)发生在Grave骨化指标的钩骨第二期(H-2)和／或第三指中节指骨骺成骺帽(MP3=)的同时，1a的身高追踪结果与Grave的青春期突增分期法的结论一致。结论Grave法可用于中国女性青春期突增的判断。但综合考虑Grave指标、年龄和月经初潮可更好地判断和预测女性的青春期身高突增过程。     

Socio-demographic Factors Associated with Body Mass Index of Female Adolescent Students in Semnan City, Iran

Malnutrition among adolescents is not only an important health problem but also an economic development problem in Iran and other developing countries. The home environment is found to be related to the development of malnutrition in children. Information on this relationship is important to identify the target risk groups for nutritional intervention. The objective of this study was to determine the association between socio-demographics with BMI status in high school adolescent girls in Semnan. In a cross- sectional study, using two-stage random sampling, 256 girl students aged 14-18 years were randomly selected from eight Semnan high schools. Weight and height were measured and BMI was calculated. Weight status was determined based on the CDC 2000 reference for BMI-for-age. Data on socio-demographic factors like age, age at menarche, family size, parental education, parental job and economic status was collected through a questionnaire. Age at menarche and mother's literacy had significant association with weight status (P =0.031, P =0.001 respectively). Logistic regression analyses showed mother's literacy and age at menarche were strong predictors for overweight but not for under weight. Increasing maternal nutritional knowledge is necessary to initiate changes in nutritional conduct. In addition, a longitudinal study of adolescent nutrition and its associated factors is suggested.     

天津市部分女性高血压危险因素的探讨

对天津市河东区居民中301例女性原发性高血压病人进行了1:1配对病例对照研究。经条件Logistic回归模型分析,与高血压有关的危险因素是:体重(OR=1.17,95% CI:1.12~1.23),高血压家族史(OR=2.18,95% CI:1.49~3.21),人均收入(OR=0.73,95% CI:0.56~0.94),心率(OR=2.30,95% CI:1.41~3.76),初潮年龄(OR=0.90,95% CI:0.82~0.99)。经体重的混杂调整后,除初潮年龄外其他因素的OR值仍有统计学显著性意义。未发现绝经年龄、产次、初产年龄、服避孕药史和吸烟与高血压有关。     

Status of adolescent girls in a rural south Indian population

The objectives were to assess the nutritional status of rural adolescent girls, to measure their knowledge about maternal and child nutritional needs, to measure their dietary intake, and to determine the sociocultural aspects of these girls. 47 adolescent girls aged 13-18 years attending a workshop on health and development organized by the Center of Maternal and Child Health, Vellore, India, participated. Their height and weight were measured; their hemoglobin concentration was determined; and other relevant data were collected about diet, knowledge, and nutrition by means of interviews and group discussions. 55% were agricultural laborers, while the remaining 45% worked occasionally. 14% had primary, 12% had secondary, and 10.2% had high school level education. In addition to attending school, 16.3% worked on the farm and 12% picked flowers. The mean height of all the age groups was below the expected standard for the age group. The growth of 34.7% of the subjects was very poor. The difference in height was much more significant in the younger age group (13-15 years) than in the older age group (16-18 years). Although all the subjects were normal for weight for height, only 51.2% had normal weight for their age group. The overall mean hemoglobin value was 10.0 g/dl. 73.5% of the subjects had a hemoglobin value below 12 g/dl (WHO standard) and could be classified as anemic. The mean hemoglobin level increased with increasing age, the lowest being at the age of 13 (9.8 g/dl) and the highest at the age of 17 years (11.9 g/dl). The mean age of menarche was 14.3 years. The diet was predominantly rice. Consumption of vegetables, milk, and meat was very low, which might have been responsible for the high prevalence of anemia in the girls. 91% of them were not aware that anemia could result from menstrual blood loss. 75% of them were aware of nutritional blindness and 48% of protein energy malnutrition. The girls reported sex discrimination in school and in the family.     

Age at menarche in relation to adult height: the EPIC study

In the last two centuries, age at menarche has decreased in several European populations, whereas adult height has increased. It is unclear whether these trends have ceased in recent years or how age at menarche and height are related in individuals. In this study, the authors first investigated trends in age at menarche and adult height among 286,205 women from nine European countries by computing the mean age at menarche and height in 5-year birth cohorts, adjusted for differences in socioeconomic status. Second, the relation between age at menarche and height was estimated by linear regression models, adjusted for age at enrollment between 1992 and 1998 and socioeconomic status. Mean age at menarche decreased by 44 days per 5-year birth cohort (beta = -0.12, standard error = 0.002), varying from 18 days in the United Kingdom to 58 days in Spain and Germany. Women grew 0.29 cm taller per 5-year birth cohort (standard error = 0.007), varying from 0.42 cm in Italy to 0.98 cm in Denmark. Furthermore, women grew approximately 0.31 cm taller when menarche occurred 1 year later (range by country: 0.13-0.50 cm). Based on time trends, more recent birth cohorts have their menarche earlier and grow taller. However, women with earlier menarche reach a shorter adult height compared with women who have menarche at a later age.     

Underweight,stunting and wasting in Black and White South African schoolchildren: malnutrition or adaptation?

Prevalences of underweight for age in South African schoolchildren rose from seven years to reach high levels during puberty. In Black children at the height of the pubertal growth spurt, half to three-quarters were underweight for age and hence classifiable as “malnourished”. However, percentages fell rapidly to one-fifth or less at 17 years. High prevalences of stunting were common in Blacks. Wasting occurred in similar proportions of urban Black compared with White children, i.e., the large majority of both Blacks and Whites were normally proportioned; younger children were more wasted than older pupils.Factors additional to nutrition appear to share in the regulation of growth. In Whites on adequate diets, there were (i) similar patterns, but smaller rises in underweight prevalences over the growth spurt, also (ii) small but not insignificant prevalences of stunting: (iii) closely similar “normal” patterns of weight for height occurred in Whites as well as Blacks, and (iv) in Blacks the sharp fall in prevalences of underweight and wasting, after the rapid growth phase, occurred without any dietary intervention.A plea is made to use not only weight, but height, particularly relative to weight, at all ages, in assessing nutritional status and “at risk” groups. The stunted and wasted child is likely to be at greater risk than a similarly stunted but normally proportioned or overweight child—both could be underweight for age. Further definitive studies are required.     

The relationship between age of menarche and mental distress in Norwegian adolescent girls and girls from different immigrant groups in Norway: results from an urban city cross-sectional survey

Lower age of menarche has been associated with increased mental distress among adolescent girls. The association might be mediated via body image, as girls with early menarche tend to have higher weight than those with late onset menarche. Many of the existing studies of menarche and mental distress are based on samples of white, western girls. The aim of the study was to analyze the association between age of menarche and mental distress among Norwegian girls and girls from different immigrant groups, and to study the effect of body mass index (BMI) and the difference between current and desired weight, on the relationship between age of menarche and mental distress. The study was a cross-sectional population-based self-report survey of all 10th grade pupils in Oslo for two consecutive years. A total of 3694 girls (91%) participated, one quarter of which were first or second generation immigrants. The Hopkins Symptom Checklist-10 was used to measure mental distress. An inverse, linear association between age of menarche and mental distress was found for both Norwegian girls and girls from all the immigrant groups. Regardless of immigrant status, girls with early onset menarche had higher BMI and higher difference in current and desired weight than those with late onset menarche. In linear regression, the difference in current and desired weight was more strongly associated with mental distress both among the Norwegian girls and girls from immigrant groups than age of menarche and BMI when controlling for social and behavioral factors. Early age of menarche might serve as a predictor for psychopathology in Norwegians girls as well as in girls from different immigrant groups. The association between age of menarche and mental distress might be mediated via differences in current and desired weight.     

Influence of perinatal factors on the onset of puberty in boys and girls: implications for interpretation of link with risk of long term diseases.

The authors examined the hypothesis that perinatal factors influence the onset of puberty. Children born as singletons in Uppsala, Sweden, in 1973-1977 were followed for height development before and during their school years (through 16 years of age). In all, 62 children born after preeclampsia, 129 born prematurely, 90 born small for gestational age, 175 born large for gestational age, 49 born short for gestational age, and 38 born tall for gestational age were compared with 688 "normal" children. Differences in age and height at puberty onset and age at menarche were analyzed using the t test and analyses of covariance. For boys, the mean age at puberty onset did not differ between normal boys and those with perinatal factors. Boys born small or short for gestational age were 4 cm shorter than normal boys, and those born large for gestational age were 3 cm taller than normal boys. Among girls, patterns for differences in height were similar. Girls born small for gestational age were 5 months younger than normal girls at the onset of puberty and menarche. Patterns of early childhood growth seemed to explain the relations between these perinatal factors and height and age at puberty. The authors conclude that body size at birth affects stature at puberty; in girls, smallness for gestational age is associated with earlier puberty. Associations between intrauterine exposures and disease risk may be confounded by, or mediated through, effects on adolescence.     

基于国内外不同标准的苏州市6~17岁儿童青少年营养状况的比较

目的 比较最新颁布的儿童青少年消瘦超重肥胖国家标准与WHO及国际标准,描述苏州市6~17岁儿童青少年营养状况。 方法 选取苏州市7 340名6~17岁儿童青少年,男性3 821名,女性3 519名,测量其身高、体重,计算体质指数。分别采用WHO标准、国际标准、中国标准进行评价。 结果 依据WHO标准、国际标准、中国标准,消瘦检出率分别为2.3%,8.4%,5.2%(两两比较均P<0.05);超重检出率分别为20.0%,19.6%,17.4%(中国标准低于WHO和国际标准,P<0.05);肥胖检出率分别为11.5%,6.7%,14.1%(两两比较均P<0.05)。与此同时,不同年龄、性别分组,基于不同标准的营养状况差异不同。WHO和国际标准一致性(Kappa=0.705)、中国和国际标准一致性(Kappa=0.692)低于WHO和中国标准对不同营养状况检出率的一致性(Kappa=0.811)。 结论 儿童营养健康(消瘦、超重、肥胖)成为苏州的重要公共卫生问题。中国标准与WHO及国际标准检出情况存在一定差异,应谨慎使用。     

Ability of young women to recall past body size and age at menarche

OBJECTIVE: The ability of young women (n = 132, average age 17 years) to recall body size and age at menarche was examined. The use of body silhouettes to assist women in recalling their body size at menarche and to represent their current body size was also evaluated. RESEARCH METHODS AND PROCEDURES: Subjects, who previously participated in a cohort study, were asked to recall height and weight at the time of menarche, to select body silhouettes that best reflected their body shape at the time of menarche and their current body shape, and to recall age at menarche. Two sets of body silhouettes were developed, one representative of an adult body shape and another representative of an adolescent body shape. RESULTS: Pearson correlation coefficients between the adult and adolescent body figures and actual body mass index (BMI; kg/m(2)) at the time of menarche were not significantly different (r = 0.82 for adult figures vs. r = 0.72 for adolescent figures, p > 0.05). The correlation between actual BMI at the time of menarche and body silhouette (r = 0.77, all subjects) was similar to the correlation between actual and recalled BMI at the time of menarche (r = 0.83) as well as the correlation between current BMI and current body silhouette (r = 0.75). Recalled and actual ages at menarche were highly correlated (r = 0.83). DISCUSSION: The recall of body shape was considered to be a less precise measure of body size than asking about height and weight, but use of body silhouettes may offer advantages in certain situations.     

Weight change in relation to natural menopause and other reproductive and behavioral factors in Japanese women

PURPOSE: To evaluate the effect of menopause on weight change in Japanese women. METHODS: Community-based sample of 828 Japanese women who were premenopausal and aged 40 to 54 years completed a self-administered questionnaire asking information on demographic factors, body size, reproductive history and dietary and behavioral factors in 1992. They responded to a follow-up questionnaire asking weight and menopausal status in 1998. RESULTS: Women gained weight modestly, on average, 0.17 kg during the 6-year study period. Weight gain was significantly higher in women who remained premenopausal at follow-up than those who had natural menopause during the study period. Weight gain was significantly associated with early menarche in women who had natural menopause and with high parity in women remained premenopausal. CONCLUSION: Reproductive factors rather than sociodemographic and behavioral factors appeared to be associated with weight change during the perimenopausal period. Onset of menopause may diminish weight gain. In contrast, early menarche and high parity showed relationships with weight gain.     

Height Growth and Percentage of Body Fat in Relation to Early Menarche in Girls from Merida,Yucatan, Mexico

Early menarche (EM) (i.e., age at menarche [AAM] <12 years of age) is related to short height and higher body fatness. In a mixed-longitudinal study done in Merida, Yucatan, height, body mass index (BMI), and percentage of body fat (BF%) were recorded at a one-year interval among 258 postmenarcheal (EM = 94) girls. Anthropometric measurements were recorded of the age cohorts in 2008–09 when participants were 13–17 years of age (baseline), and in the one-year follow-up study (± 6 days) the girls were 14–18 years of age. The BF% was estimated through bioelectrical impedance analysis. Mean AAM was 10.59 years in EM girls and 12.54 years in not early menarche (NEM) girls. Height growth (cm/year) was greater in NEM girls. Mean values of BMI, BF%, and frequencies of stunting (low height-for-age) and excess weight (overweight + obesity) were higher in EM girls than in their NEM age peers.