A mixed-longitudinal study on the pattern of pubertal growth: relationship to socioeconomic status and caloric-intake--IV

The pubertal growth pattern was observed on 791 girls belonging to upper and low SES. These girls ranged between 7-16 years. The effect of calorie intake on the pubertal growth was also ascertained. The development of breast was first to appear at the age of 8.25 years. It was followed by pubic and axillary hair development. The mean age of menarche was 12 years and 12.8 years for USES and LSES, respectively. The onset of menarche, breast and pubic hair was significantly delayed in LSES girls by 0.8 years. Menarche was found to correlate better with breast development than pubic or axillary hair. The girls on adequate calories showed early onset of breast, pubic hair and axillary hair development and of menarche. Similarly, these girls attained mature stage (adult) of these variables earlier compared to those who were on inadequate calories. However, intermittent developmental stages of pubic hair and axillary hair showed no consistency with intake of calories. The girls on inadequate calories showed approximately one year late onset of breast and pubic hair development. The present observations suggest that the onset of puberty is strongly influenced by environment but its attainment is under the genetical control.     

Menarcheal Age and Growth Pattern of Indian Girls Adopted in Sweden: I. Menarcheal Age

ABSTRACT. The median menarcheal age of 107 girls adopted from India by families in Sweden was 11.6 years, which was significantly lower than in Swedish and most Indian studies. Five girls had menarche before the age of 9 years, the earliest at 7.3 years. Those who arrived at a later age had earlier menarche. No differences in menarcheal age were found with respect to geographic origin. The reasons for the earlier pubertal maturation are not clear. Factors associated with the rapid transition from an underprivileged to a privileged environment are probably involved, besides genetic determinants. The serious medical, social and emotional consequences of very early pubertal development necessitate further clarification of the underlying mechanisms.     

Menarcheal age and growth pattern of Indian girls adopted in Sweden. I. Menarcheal age

The median menarcheal age of 107 girls adopted from India by families in Sweden was 11.6 years, which was significantly lower than in Swedish and most Indian studies. Five girls had menarche before the age of 9 years, the earliest at 7.3 years. Those who arrived at a later age had earlier menarche. No differences in menarcheal age were found with respect to geographic origin. The reasons for the earlier pubertal maturation are not clear. Factors associated with the rapid transition from an underprivileged to a privileged environment are probably involved, besides genetic determinants. The serious medical, social and emotional consequences of very early pubertal development necessitate further clarification of the underlying mechanisms.     

Pubertal correlates in black and white girls

OBJECTIVES: Since pubertal maturation is an important covariate in studies that evaluate physical and social changes that occur during the teen years, we examined pubertal parameters in a group of US girls. STUDY DESIGN: Black and white girls recruited at age 9 were followed annually for 10 years. Preece-Baines model 1 was used to estimate tempo and growth parameters. The temporal trend between age of menarche and onset of puberty was calculated. RESULTS: The study included 615 (77.2% prepubertal) white and 541 (49.4% prepubertal) black participants. Mean onset of puberty was 10.2 and 9.6 years in white and black girls, respectively, menarche was 12.6 and 12.0, achievement of Tanner growth stage 5 was 14.3 and 13.6, and achievement of adult height was 17.1 and 16.5 years. The Pearson's correlation coefficient between menarche and onset of puberty was .37. CONCLUSIONS: Menarche is often used as a marker for onset of puberty and for timing of puberty. Data gathered over the past 20 years suggest only moderate correlation between menarche and onset of puberty (.37-.38), which has decreased significantly during the last 50 years. This suggests the existence of both similar and unique factors that impact the age at onset of puberty and age at menarche.     

Evaluation of gonadal function following long-term treatment for acute lymphoblastic leukemia in girls

Twenty-four girls were studied following long-term treatment (mean: 50 months) for acute lymphoblastic leukemia; 14 were prepubertal and 10 pubertal. Follow-up during endocrine studies ranged from 2 months to 6.7 years (mean: 2.3 years). Five of 14 prepubertal patients started clinical pubertal development at a normal age and were reevaluated during puberty, increasing the pubertal group to 15 patients. Thirteen of 15 pubertal patients had received cranial radiotherapy. Ten of 15 pubertal patients started menses during the endocrine study. Although age of menarche was normal, in nine patients it was below the normal mean. Except for the remaining patient, all had received cranial cobalt therapy. In 6 of 19 patients bone age was significantly accelerated. Serum gonadotrophin response to LH-RH was normal in 13 prepubertal patients and in 10 pubertal patients. In 3 of 10 pubertal patients follicle-stimulating hormone (FSH) values were temporarily elevated. Only one pubertal patient had oligoamenorrhea. Five patients were studied by measuring serum progesterone on days 19-22 of the cycle to determine corpus luteum function. Three of them showed progesterone levels compatible with adequate corpus luteum function (6, 19, and 12 ng/ml, respectively) and two presented low progesterone levels (2 ng/ml), probably because of their short gynecological age (0.24 and 0.3 years, respectively). This study suggests that neither the disease nor the long-term antileukemia therapy seems to injure gonadal function in girls. A tendency to early sexual development was observed, which may be related to cranial cobalt therapy.     

Growth and Sexual Maturation in Paediatric Patients Treated by Dialysis and Following Kidney Transplantation

Linear growth and sexual maturation were assessed in 48 children during dialysis treatment and in 68 children following renal transplantation. Height at the onset of haemodialysis treatment was more than 2 SD below the mean in 33% of prepubertal children. During dialysis treatment most children showed a progressive deterioration in SD score. The onset of puberty and sexual maturation was delayed but was in accordance with bone age. After transplantation 59% of prepubertal children had a normal height increment. Onset of puberty was recorded at a chronological age of 14.6 ± 1.9 years in boys and 13.3 ± 1.9 years in girls. The peak of the pubertal growth spurt was 6.6 ± 1.6 cm/year in boys and 6.5 ± 2.9 cm/year in girls. The duration of pubertal development in transplanted children was within normal limits. In transplanted girls menarche was achieved at a mean chronological age of 15.9 years and bone age of 12.9 years. Adult height was achieved at a mean age of 20.3 years in men and 18.7 years in women. Overall, one third of the children attained an adult height more than 2 SD below the mean. These data indicate that poor growth is achieved in most children on dialysis treatment; following transplantation normal growth may be restored. However, poor growth before kidney transplantation and the loss of growth potential during pubertal development have a great influence on adult height.     

Bone growth from 11 to 17 years: relationship to growth, gender and changes with pubertal status including timing of menarche

The tempo and change in bone growth during puberty in relation to physical growth is described in a cohort of 56 boys and 52 girls. Distal forearm bone width, mineral content and volumetric density, anthropometry and pubertal status were measured at ages 11, 13, 15 and 17 y, and bone age at 17 y. Bone width and mineral content increased independently with age for each pubertal stage. Volumetric density fell during early puberty and then increased rapidly. Maximal increase of all bone variables occurred earlier in girls than in boys and earliest for bone width, then mineral content, then density. In girls most change occurred in the 12 mo before and after menarche. The degree of tracking was similar to that for height. Bone growth followed physical growth but at a slower tempo. By age 17 y boys had attained 86% of the reference adult bone mineral content and volumetric density; girls had attained 93% of the reference adult bone mineral content and 94% of volumetric density. Those skeletally mature at 17 y had greater mineral content and volumetric density. To maximize peak bone mass, modifiable environmental factors should be optimized before the onset of puberty and be maintained throughout this period of rapid growth and beyond attainment of sexual maturity.     

Growth and sexual maturation in children after kidney transplantation

Linear growth and sexual maturation were assessed in 68 long-term pediatric renal allograft recipients (43 boys) receiving daily or alternate-day prednisone therapy. Growth was analyzed both during the prepubertal period and during puberty. Height at transplantation was greater than 2 SD below the mean in 34.2% of prepubertal children. After the first posttransplant year, 59.2% of the prepubertal children had a normal height increment (greater than 4.8 cm/yr). Onset of puberty was recorded at a chronologic age of 14.6 +/- 1.9 years in boys and 13.3 +/- 1.9 years in girls. Height at onset of puberty related to chronologic age was -2.4 +/- 1.3 SD. Height velocity during puberty was within normal limits in 62.5% of the children. No significant difference in pubertal growth was detected in patients who had received transplants before and after the onset of puberty. Duration of pubertal development was within normal limits. In girls, menarche was achieved at a mean chronologic age of 15.9 years and bone age 12.9 years. Adult height was attained at an average age of 20.3 years in boys and 18.7 years in girls. Overall, one third of the children attained an adult height greater than 2 SD below the mean. Our data indicate that although poor growth before kidney transplantation has a great influence on adult height, the loss of growth potential during pubertal development seems even more important.     

Maturational tempo differences in relation to the timing of the onset of puberty in girls

AIM: To determine maturational tempo differences related to the timing of pubertal onset in girls. METHODS: We studied longitudinally 307 prepubertal Greek schoolgirls. Age at onset of puberty (B2), peak height velocity (PHV) and age at menarche were recorded. Age at onset of puberty quartiles were determined in order to define girls as early maturers (<9.2 years) and late maturers (>10.6 years). Due to dropout from the study, results for menarche are reported for 182 girls. RESULTS: Median (1st-3rd quartile) time span from B2 to PHV was longer for early maturers than for average and late maturers, 1.6 (1.0-2.2) years, 1.1 (0.7-1.7) years and 0.9 (0.3-1.1) years, respectively, p < 0.001). There was no significant difference in PHV, in the time interval from PHV to menarche and in adult height (for 75 girls) with respect to whether girls matured early, average or late. CONCLUSION: A compensatory delay in the maturational tempo in early-maturing girls and a catch-up mechanism in late-maturing girls was shown. The maturational differences manifest as differences in the time span from the onset of puberty to PHV. Early pubertal maturation in girls does not compromise adult height and is not always followed by early menarche.     

Onset of puberty at eight years of age in girls determines a specific tempo of puberty but does not affect adult height

AIMS: To analyse the effect of early puberty (onset between 7.5 and 8.5 y) on pubertal growth and adult height in girls, and the implications of this effect for the age limit for normal onset of puberty. METHODS: Longitudinal study in Reus (Spain) of 32 girls with early puberty until they reached adult height. Data from these girls were compared with longitudinal data from girls (116) from the same population with normal onset at 10 (n = 37), 11 (n = 47), 12 (n = 19) and 13 (n = 13)y. We analysed height, target height, adult height, pubertal height increase, duration of pubertal growth, age at menarche and time to menarche. RESULTS: The adult height of girls with early puberty (160.9 +/- 5.4cm) was similar to that of girls with onset at later ages (p = not significant). In these girls, puberty lasted 5.4 +/- 0.7 y and the mean growth during puberty was 31.1 +/- 3.5 cm. As the age of onset of puberty increases, the duration of puberty and mean growth during puberty progressively decreased (p < 0.001). Girls with early puberty reached menarche at a mean age of 10.9 +/- 1.0 y, 3.2 +/- 0.9 y after onset of puberty, and this time span was greater than in the other groups. CONCLUSION: Girls with onset of puberty at 8 y show all the compensatory phenomena related to height at onset, pubertal duration and height increase during puberty. These phenomena cause their adult height to be similar to that of girls who begin puberty at the age of 10 to 13 y.     

Pubertal development in The Netherlands 1965-1997

We investigated pubertal development of 4019 boys and 3562 girls >8 y of age participating in a cross-sectional survey in The Netherlands and compared the results with those of two previous surveys. Reference curves for all pubertal stages were constructed. The 50th percentile of Tanner breast stage 2 was 10.7 y, and 50% of the boys had reached a testicular volume of 4 mL at 11.5 y of age. Median age at menarche was 13.15 y. The median age at which the various stages of pubertal development were observed has stabilized since 1980. The increase of the age at stage G2 between 1965 and 1997 is probably owing to different interpretations of its definition. The current age limits for the definition of precocious are close to the third percentile of these references. A high agreement was found between the pubic hair stages and stages of pubertal (genital and breast) development, but slightly more in boys than in girls. Menarcheal age was dependent on height, weight, and body mass index. At a given age tall or heavy girls have a higher probability of having menarche compared with short or thin girls. A body weight exceeding 60 kg (+1 SDS), or a body mass index of >20 (+1 SDS), has no or little effect on the chance of having menarche, whereas for height such a ceiling effect was not observed. In conclusion, in The Netherlands the age at onset of puberty or menarche has stabilized since 1980. Height, weight, and body mass index have a strong influence on the chance of menarche.     

Combined influence of early sexual maturation and central adiposity on subsequent stature

Introduction Shorter adult stature has been attributed to early sexual maturation, as well as early adiposity, but it is not clear if these factors are interrelated.Results and discussion A number of 1,605 Norwegian adolescents were followed from early (baseline) to late adolescence (follow-up). Maturational timing was assessed by self-reports of pubertal status (pubertal development scale, PDS) in boys and age at menarche (AAM) in girls. Height, weight and waist circumference were measured at baseline and at follow-up. Differences in height at follow-up and height gain related to the timing of sexual maturation and the level of central adiposity (i.e. high or low waist circumference) at baseline were estimated using general linear modelling. At follow-up, the median height was 180 cm in boys and 167 cm in girls. Early maturing boys and girls with relatively high central adiposity at baseline were, on average, 5.7 cm (P value<0.001) and 3.6 cm (P value<0.001) taller than early maturing boys and girls with low central adiposity. Differences in stature related to central adiposity were less pronounced for intermediate and late maturing boys and girls. The height was lowest in boys (176.6 cm) and girls (163.8 cm) who had matured early and had low central adiposity at baseline. Height gain during follow-up was independent of the level of central adiposity, but was closely related to the timing of sexual maturation. The association between the early timing of sexual maturation and subsequent height was modified by the level of central adiposity in early adolescence.Conclusion The results suggest that early maturity combined with adiposity yields higher stature than early maturity and leanness.     

Menarcheal age among urban Kenyan primary school girls

Aim: To determine the mean menarcheal age among urban primary school girls in Kenya. Subjects and methods: A structured questionnaire was administered to 820 primary grade 6–8 girls aged between 12 and 17 years in five public primary schools, Langata division of Nairobi West district, Nairobi Kenya. The girls came from low and middle socioeconomic status residences. Declared menarcheal age by recall to the nearest month was recorded. Data were analysed using SPSS version 15.0 for windows. The results are presented using tables and bar charts. Results: The mean menarcheal age was 12.5 ± 2.8 years with peak at 12–14 years. A substantial number of girls (10.8%) attained menarche before the age of 11 years, with 2% of them attaining it before 10 years. None attained menarche before nine or after 16 years. Of those who attained early menarche, 64.3% were from middle while only 35.7% came from low socioeconomic status residence, respectively. Conclusion: Mean menarcheal age of 12.5 years is lower than previously reported with over 10% of the girls attaining menarche by 11 years. Early commencement of reproductive health education and follow‐up for complications of early menarche is recommended.     

Shortened and diminished pubertal growth in boys and girls treated for acute lymphoblastic leukaemia

Statural growth during puberty was studied longitudinally in 28 patients treated for acute lymphoblastic leukaemia. All patients received prophylactic cranial irradiation. The age at diagnosis was below 7 years, the age at final investigation was above 16 years for girls and above 18 years for boys. Growth was analysed using the Kernel estimation. In girls the onset of puberty and menarche was at a younger age, as compared to reference values, and the duration of the pubertal growth spurt was shorter. Compared to early maturing girls, the growth velocity at peak height velocity was lower. This resulted in a final height which was shorter than expected on the basis of the height standard deviation score before the start of puberty. In boys the duration of the pubertal growth spurt was shorter and the height gain during the growth spurt less than in the reference population. In both sexes the bone age development was accelerated.     

VI. Somatic pubertal development.

The pubertal development of 212 randomly selected Swedish urban children has been investigated as part of a prospective longitudinal study of growth and development. The timing and pattern of pubertal changes were in agreement with the findings in other contemporary studies. The good agreement with data on pubertal development reported in other investigations of Swedish children indicates that the present sample was representative of contemporary Swedish children. Two procedures of assessment of secondary sex characters - clinical examination and whole-body photography - have been compared and contrasted. A clinical examination is less laborious and resource-consuming and also has psychological advantages but should be supplemented in boys by the estimation of testicular volume (orchidometry). In girls the two methods have similar precision and reliability. The first pubertal changes may be observed before 9 years in girls (breast development) and before 10 years in boys (genital development). On average the first change takes place about one year earlier in girls than in boys. Peak height velocity (PHV) is an early event during puberty in girls and a relatively late event during puberty in girls and a relatively late one in boys, the sex difference in mean age being about two years. In girls, menarche is a late event, always occurring after PHV. At the age of 13-14 years some boys and girls have not yet begun theri pubertal development, while others have reached the adult stage.     

Impact of timing of pubertal maturation on growth in black and white female adolescents: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVES: To evaluate the impact of early, mid-onset, and late maturation, as assessed by timing of menarche, on height, height velocity, weight, body mass index, and sum of skinfolds in a group of white and black girls. STUDY DESIGN: The Growth and Health Study recruited 9- and 10-year-old girls from Richmond, California, Cincinnati, Ohio, and Washington, DC. There were 616 white and 539 black participants recruited at age 9 and 550 white and 674 black participants recruited at age 10. Participants were seen annually for 10 visits. Longitudinal regression models were used to test for differences in each growth measure by timing of menarche across all ages and to determine whether these differences change with age. RESULTS: Mean age at menarche among white participants was 12.7 years, and among black participants, 12.0 years. According to race-specific 20th and 80th percentiles, early maturers were tallest at early ages and shortest after adult stature had been attained. Peak height velocity and post-menarche increment in stature were greatest in early maturers and least in late maturers. Weight was greatest in early and least in late maturers, as was body mass index. Sum of skinfolds was also greatest in early and least in late maturers. There was no impact of timing of maturation on two common measures of regional fat distribution. CONCLUSIONS: Girls who matured early were shorter in early adulthood, despite having greater peak height velocity and post-menarchal increment in height. Throughout puberty, early maturers had greater ponderosity and adiposity, although there was no association with regional distribution of fat.     

Secular trend in the sexual maturation of Southern Chinese girls

In 1993, a cross-sectional study of sexual maturation of normal Chinese schoolgirls was performed in Hong Kong. The aim of the study was to obtain an up-to-date reference for normal pubertal development in Chinese girls. Breast development was assessed in 3749 girls aged 7–19 y, and pubic hair rating was assessed in 3745 girls. Menstrual status was recorded in 6467 girls over 6 y of age. The median age of onset of puberty as indicated by breast stage II or above was 9. 78 (95% CI 9. 70–9. 85) y. The median age of onset of pubic hair development was 11. 64 (95% CI 11. 56–11. 72) y. The median age of menarche was 12. 38 (95% CI 11. 98–12. 78) years. Percentile values for the age at which each puberty staging appeared were constructed and incorporated into the height-for-age charts. When comparison is made with similar studies done in 1962 and 1979, a significant downward secular trend in sexual maturation is observed ( p < 0. 01). Except for breast development the downward secular trend in sexual maturation appears to be diminishing and may be coming to a halt in the Chinese girls in Hong Kong. Their median ages of sexual maturation are now among one of the earliest medians recorded in the world population studied.     

Long-term effects of early kwashiorkor compared with marasmus. I. Physical growth and sexual maturation

Physical growth and sexual maturation were measured in a follow-up study of Barbadian girls and boys aged 11-18 years with histories of kwashiorkor (n = 54) or marasmus (n = 56) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 59). Girls with histories of marasmus had significant delays in the onset of menarche compared with healthy comparison girls. However, their rate of growth during the previous 2 years was accelerated, and the differences in size were smaller than at the earlier testing, confirming catch-up. This pattern was not evident for girls with histories of kwashiorkor, who did not differ from the healthy comparison girls on either onset of menarche, Tanner ratings of sexual maturation, or measures of physical growth. In contrast, boys with histories of kwashiorkor or marasmus did not differ from healthy comparison boys in physical growth or Tanner ratings at these ages.     

Growth prognosis and growth after menarche in primary hypothyroidism.

The long term growth of 20 girls and nine boys with juvenile primary hypothyroidism was studied until they reached final height. At diagnosis the girls had a mean age of 8.8 years (range 3.0-13.0); mean bone age was 5.4 years. The mean age of the boys at diagnosis was 9.5 years (range 3.7-14.2); mean bone age was 6.3 years. The patients were treated with thyroxine 100 micrograms/m2/day and serum thyroxine concentrations were maintained in the normal range. During treatment the rate of skeletal maturation exceeded the change in chronological age. Initial mean height SD score for bone age before treatment in the girls was +0.59 and after 11 years of treatment fell to -0.55 Mean height SD score for bone age in the boys decreased from +1.6 to -0.87 during treatment. In the girls the onset of puberty was 1.2 years later than the normal population but the duration of puberty was reduced. Mean age (SD) of menarche was 13.8 (1.7) years. The pattern of growth in girls with treated hypothyroidism was abnormal as growth continued after menarche, at a time when normal girls have almost stopped growing. During the second year after menarche our patients still had a mean growth velocity of 4.1 cm/year. Our data suggest that juvenile primary hypothyroidism results in a permanent height deficit. In addition, there is a loss of the normal harmony between growth and sexual maturation in girls, despite adequate treatment, in that growth continues for much longer after menarche than in normal girls.     

Assessment of Pubertal Development in Iranian Girls

Objective

We estimated pubertal development of 7,493 normal Iranian girls aged 6 to 20 years in a cross-sectional study.

Methods

Pubertal stages were assessed according to Tanner. The mean ages to achieve secondary sexual characteristics as well as the mean age at menarche were estimated. Weight and height were measured and body mass index (BMI) was calculated. Reference curves for different breast stages and menarche were constructed. The percentiles for attaining each stage were compared to data proposed by Tanner.

Findings

The mean age at breast bud stage (B2) was 10.10, pubic hair stage (P2) was 9.83, and menarche age was 12.55 years. The anthropometric variables were interpreted in different maturity stages. The mean age at attainment of puberty was compared with those of other populations.

Conclusion

Not only the onset of puberty in Iranian girls but also the duration of puberty is similar to data from most other countries. A lower age limit for the definition of precocious puberty than the traditional 8 years is documented for Iranian girls. However, it should be noted that considering the rate of evolution of pubertal findings is more important than the age of their appearance.