Nutritional status and age at menarche in a rural area of Bangladesh

A cohort study of the association between prenatal arsenic exposure and age at menarche in a rural area, Bangladesh

BACKGROUND

Millions of individuals worldwide, particularly in Bangladesh, are exposed to arsenic, mainly through drinking water from tube wells. Arsenic is a reproductive toxicant, but there is limited knowledge of whether it influences pubertal development.

OBJECTIVES

We evaluated the association between prenatal arsenic exposure and age at menarche.

METHODS

This prospective study was based on data from two studies conducted in Matlab, Bangladesh-the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial and the Health Consequences of Arsenic in Matlab (AsMat) study. We included 809 MINIMat girls who participated in assessing age at menarche from July 2016 to June 2017 and had prenatal arsenic exposure data through the AsMat study via measurements in tube well water used by the mothers during pregnancy. The exposure was categorized into <10, 10-49, 50-99, 100-199, and ≥200 µg/L. We used Kaplan-Meier and Cox proportional hazards analyses with adjustment for potential confounders to evaluate the association between arsenic exposure and age at menarche. The results were presented by adjusted hazards ratio (aHR) with a 95% confidence interval (CI).

RESULTS

The median arsenic concentration in tube well water consumed by pregnant women was 80 µg/L (interquartile range 2-262 µg/L), and 55% drank water with concentrations above Bangladesh's acceptable value of 50 µg/L. The median age at menarche was 13.0 years. The unadjusted analysis revealed 3.2 months delay in menarche for girls exposed to arsenic concentrations ≥200 µg/L compared with the girl exposed to arsenic concentrations <10 µg/L. Girls exposed to the same higher arsenic concentrations were 23% (aHR 0.77, 95% CI: 0.63-0.95) less likely to have reached menarche than girls exposed to low arsenic concentrations.

CONCLUSIONS

Increased levels of prenatal arsenic exposure were associated with older age at menarche. This delay may indicate endocrine disruptions that could potentially result in adverse health consequences in later life. This finding, along with other severe adverse health reinforces the need for arsenic mitigation at the population level.

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.

Marriage Age, Social Status, and Intergenerational Effects in Uganda

This study examines whether Ugandan women who marry at younger ages fare differently on a wide range of later-life outcomes than women who marry at later ages. Using a nationally representative data set, I identify the plausibly causal impacts of women's marriage age by using age at menarche as an instrumental variable. Results indicate that a one-year delay in marriage for Ugandan women leads to higher educational attainment (0.5-0.75 years), literacy (10 percentage points), and labor force participation (8 percentage points). I also explore intergenerational effects of later marriage and find that the children of mothers who marry later have higher BMI (0.11 kg/m²) and hemoglobin levels (0.18 g/dl), and they are also less likely to be anemic (4 percentage points). Finally, I present evidence suggesting that the observed effects might be mediated through an enhancement of women's agency within their household and positive assortative matching in the marriage market. By pointing to the beneficial consequences of delaying marriage, this research calls for concerted policy action to prevent child marriage.

Medieval menarche: Changes in pubertal timing before and after the Black Death

OBJECTIVES

Bioarcheological evidence suggests stature increased in males but decreased in females after the Black Death (1348-1350 CE). Because tradeoffs between growth and reproduction can result in earlier ages at menarche and lower limb length, we assess menarcheal age between 1120 and 1540 CE to better understand the health of medieval adolescent females before and after the plague.

MATERIALS AND METHODS

Our sample comprises 74 adolescent females from St. Mary Spital, London (1120-1540 CE) within the age range during which menarche occurs (10-25 years). They were assessed as being pre- or post-menarcheal and divided into three groups: Early Pre-Black Death (n = 13), Late Pre-Black Death (n = 38), and Post-Black Death (n = 23). Changes in the ages of pre- and post-menarcheal females were assessed using Mann-Whitney tests.

RESULTS

The average age of post-menarcheal females increased from the Early- to Late Pre-Black Death periods and declined after the Black Death.

CONCLUSIONS

Short stature can reflect unfavorable growth environments, while younger menarcheal age indicates improved living conditions. The paradoxical pattern of female, but not male, stature reduction after the Black Death might reflect the association of early menarche with lower limb length and signal that adolescent females experienced improved health conditions after the epidemic. Our focus on pre- and post-menarche within a limited age span provides a novel approach for inferring average ages of menarche over time. Pathways to skeletal development and reproductive investment are part of an integrated system, providing a bridge between life history research in bioarchaeology and human biology.

Early age at menarche and its associated factors in school girls (age, 10 to 12 years) in Bangladesh: a cross-section survey in Rajshahi District, Bangladesh

Background

Early onset of menarche is one of the most important factors for breast cancer and other associated health hazards. The aim of this study was to investigate the early age at menarche and its associated factors in school girls (age, 10–12 years) in Rajshahi District, Bangladesh.

Methods

Data was collected from Rajshahi District, Bangladesh, using multistage random sampling. Independent sample t test and binary logistic regression model were used in this study. A total number of 386 school girls aged 10–12 years were considered as a sample for this study.

Results

This study revealed that more than 48% girls already attained menarche within the age of 12 years, among them 25.6%, 41.0%, and 58.3% girls experienced menarche at the age of 10, 11, and 12 years, respectively. It was observed that the menarcheal girls were significantly taller (p < 0.01) and heavier (p < 0.01) than non-menarcheal girls. The menarcheal girls’ mothers were heavier (p < 0.01), shorter (p < 0.01), had more BMI (p < 0.01), reached menarche (p < 0.05) earlier than non-menarcheal girls’ mothers. Menarcheal girls had less number of siblings (p < 0.01) and lower order of birth (p < 0.05) than non-menarcheal girls. After controlling the effect of other factors, multiple logistic regression model demonstrated that obese girls were more likely to attain menarche than under- [AOR = 0.279, CI 95% 0.075–0.986; p < 0.05] and normal [AOR = 0.248, CI 95% 0.082–0.755; p < 0.05] weight girls. Urban school girls had more chance to get menarche than rural school girls at same age (AOR = 0.012, 95% CI 0.003–0.047; p < 0.01).

Conclusions

Therefore, modern lifestyle changes may have the important factors for early age at menarche of the studied girls in Bangladesh.

Changes in the prevalence of overweight/obesity and adiposity among pre-school children in Kraków, Poland, from 2008 to 2018

Socioeconomic changes occurring over time influence the lifestyle choices of a population, and these can significantly affect children’s body weight and composition. The aim of this study was to assess the changes in prevalence of overweight, obesity and adiposity in pre-school children in Poland between 2008 and 2018. Body height, body weight and subscapular and triceps skinfolds were measured in 2167 children aged 3–7 years from Kraków. Body mass index and adiposity (percentage body fat, %BF) were calculated for the children, who were then categorized as underweight, normal weight, overweight or obese according to Cole’s cut-off points. Adiposity was categorized according to the z-scores for %BF as low (<−1), normal (−1 to 1) or high (>1). Differences between cohorts were analysed using the chi-squared test. Only the decrease in the prevalence of obesity in 5-year-old girls was found to be statistically significant. However, some overall tendencies were noted. Decreases in the prevalence of underweight, overweight and obesity were observed for both sexes, as well as in the incidence of high adiposity in boys and low adiposity in girls. Increases in the prevalence of high adiposity in girls and low adiposity in boys were also noted. There was no significant change in the prevalence of overweight and obesity among pre-school children over the study decade, and the visible tendencies included decreases in the prevalence of excess body weight and adiposity as well as underweight and low body fat. Also, the visible trends in adiposity were mostly negative. Further studies should, however, also consider the levels of physical fitness and activity of children, as these have a crucial influence on the measured characteristics.

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.

The relationship among the age at menarche, anthropometric characteristics, and socio-economic factors in Bengali girls from Kolkata, India

OBJECTIVES

The aim of the study was to measure the causal effect of selected socio-economic factors and anthropometrical characteristics on the menarche occurrence.

METHODS

The sample consisted of 2195 Bengali girls (aged 7-21) from middle-class families, from Kolkata city, India. The age at menarche was recorded from the retrospective data and status quo method. The causal effect of anthropometric and socio-economic variables on menarche occurrence was estimated by the nonparametrical analysis of survival probability (survival random forest).

RESULTS

In the examined cohort menarche occurred, on average, at 11.8 years of age. The probability of menarche occurrence amplified with the increasing values of factors such as body mass index, height-for-age z-scores, number of family members, household rooms, and toilets, but decreased when expenditures increased. The relation maintained a similar pattern of causal effect with girls' age.

CONCLUSIONS

A complex pattern of relationship among sexual development, physique, and socio-economic characteristics was defined. The tendency toward early menarche, along with the observed causal relationships indicate that the analyzed sample is nearing the characteristics and standards of living noted in other middle and even high-income countries in the world.

Patterns and risk factors of double burden of malnutrition among adolescent girls and boys in Indonesia

OBJECTIVES

As an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12-18 years in Indonesia.

METHODS

A cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents' nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight.

RESULTS

About a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49-0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51-0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33-0.88). Older adolescents aged 15-18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42-2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30-0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27-2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40-0.90).

CONCLUSION

Indonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants.

Is the timing of menarche correlated with mortality and fertility rates?

Timing of menarche has largely been studied in the context of a secular trend. However, since mortality and fertility rates are fundamental demographic factors linked to a population’s developmental and reproductive characteristics, we expect that the timing of menarche, a precondition to reproduction, is also associated with these vital rates. We conduct an analysis of 89 countries and 21 demographic, socioeconomic, nutritional, and educational variables selected for their known influence on menarche. Model results predict that a country’s fertility and adult female mortality rates are significant predictors of mean age at menarche, while other covariates are not. Specifically, menarche is delayed in countries with high mortality and high fertility, which may be proxies for assessing overall environmental quality. We emphasize that, for a comprehensive understanding of the timing of menarche, it is critical to take into account both individual- and population-level influences.

Pattern of pubertal changes in Calabar, South South Nigeria

Introduction

Puberty is an essential physiologic process that is characterized by the appearance of secondary sexual features. Secular changes in puberty occur from one generation to another and need to be documented. The assessment of pubertal stages in a child is only useful if recent and reliable reference data from the same population is available for comparison. The study aimed to profile clinical normative sexual maturity characteristics for children in Calabar, South-South Nigeria.

Methods

A cross-section of primary and secondary school pupils aged 6-18 years in the city of Calabar, Nigeria were randomly selected for the study. Sexual maturating rating was assessed using the pubertal staging for breast development and pubic hair as described by Marshall and Tanner (Tanner staging). Testicular volume in boys was measured using the Prader orchidometer. Menarche and “voice break” were established by recall of the event by the girls and boys respectively.

Results

A total of 2,830 children were seen, 1542 (54.5%) boys and 1288 (45.5%) girls. The mean age of onset of pubic hair was 11 years in both boys and girls. Pubertal testicular volume of 4 mls was seen in boys at a mean age of 11 years. Breast development in girls occurred at mean age of 11 years and menarche at 13 years.

Conclusion

in this study, the onset of puberty is occurring at an earlier age than previously reported in Nigeria with a secular trend of a decreasing age at onset of puberty. These sexual characteristics are rather occurring at similar ages reported from western countries.

The association between daily 500 mg calcium supplementation and lower pregnancy-induced hypertension risk in Bangladesh

BACKGROUND

Evidence suggests that daily supplementation of 1500 to 2000 mg of calcium during pregnancy reduces pregnancy-induced hypertension (PIH). However, the evidence on the efficacy of low-dose calcium supplementation on PIH is limited. This paper assesses the longitudinal correlation between low-dose calcium intake (500 mg daily) and change in blood pressure during pregnancy among a homogeneous population in terms of hypertension and pre-eclampsia.

METHODS

The study followed a retrospective cohort study design, and was carried out among 11,387 pregnant women from 10 rural upazilas (sub-districts) of Bangladesh where maternal nutrition initiative (MNI), implemented by Building Resources Across Communities (BRAC), was ongoing. The modified Poisson regression model was used to estimate the association (risk ratio) between consumption of calcium tablets and PIH.

RESULTS

The present research found that women who consumed 500 mg/d calcium tablets for more than 6 months during their pregnancy had a 45% lower risk of developing hypertension compared to those who consumed less calcium (RR = 0.55, 95% CI = 0.33-0.93).

CONCLUSIONS

Daily supplementation of 500 mg oral calcium during pregnancy for at least 180 tablets is associated with a considerably reduced risk of PIH, but this study is unable to confirm whether this association is causal. The causal relationship needs to be confirmed through a large scale randomized controlled trial.

Age at menarche and its socioeconomic determinants among female students in an urban area in Bangladesh

This cross-sectional study aimed to determine the age at menarche and its socioeconomic determinants among urban female students (n=680) in Bangladesh. The mean age of the respondents was 14±1.43years. Majority of the respondents were unmarried (98.4%). The mean age at menarche was 11.6±3.6years, median 12years. Almost one-third (35.7%) of the participants had menarche at the age of 12years. There was no statistically significant difference between age at menarche before and after 12years with the socio-economic characteristics, except education (p=<0.001). In the multivariate model, only higher education was statistically significant predictor of age at menarche.

A comparative study of nutritional status and foodstuffs in adolescent girls in iran

BACKGROUND

The prevalence of obesity and overweight in children and adolescents is increasing world-wide. Obesity in children and adolescents is a major risk factor for diabetes, heart diseases, hypertension, and cancer in adulthood.

AIM

The aim of the study was to compare the nutritional status and food-stuffs among high-school girls in Arak, Iran, in matter of body mass index (BMI) and associated factors.

SUBJECTS AND METHODS

A cross-sectional survey of a representative sample of 278 adolescents was conducted in six randomly chosen high-schools. Height and weight of students were collected using standard methods and the BMI calculated and BMI percentiles of these girls are compared with the Center of Disease Control and Prevention (CDC) reference data. The 5(th), 8(th), and 95(th) percentiles of the CDC were adopted as cut-off points for underweight, overweight and obese girls, respectively. Data were analyzed using SPSS by analysis of variance and Chi-square tests.

RESULTS

On the basis of CDC, the overall prevalence rates of underweight, overweight, and obesity were estimated 10.1% (28/278), 12.9% (36/278), and 1.4% (4/278), respectively. There was no significant difference between nutritional knowledge scores and the rate of physical activities in various groups. The mean age at menarche was significantly higher among the obese girls (P = 0.02). Consumption of ice-cream and chocolate was significantly higher in the obese girls group (P = 0.03).

CONCLUSION

According to the present study, the prevalence of overweight and obesity in high-school girls of Arak is lower than that of many other parts of Iran and some neighboring countries, which are at the high-risk of overweight and obesity. This study warrants the necessity of paying attention to promote healthy life-style and weight control. The earlier age of menarche is alarming.

Relationship of menstrual irregularities to BMI and nutritional status in adolescent girls

Objective: To evaluate the effect of Body Mass Index and nutritional status on the menstrual pattern in adolescent girls

Methods: Four hundred one adolescent girls who attained menarche were selected from five schools in Hyderabad. The data was collected by trained medical undergraduate and postgraduates by interviewing adolescent school girls using a pre-designed pre-tested questionnaire. BMI was calculated using the formula: BMI (kg/m²) = Weight (kg) / Height 2 (m²). Hb was estimated by Sahlis method using a haemoglobinometer. Data was analyzed using SPSS 11.0.

Results: The mean age of the girls was 14.96 +/- 1.5 years. Three hundred and five (76%) of the girls had a normal menstrual cycle, twenty-eight (7 %) had frequent periods, fifty-two (13%) had infrequent periods and sixteen (4%) of the girls had totally irregular cycles and a pattern could not be determined. Three hundred and five (76%) of girls had a normal menstrual flow, sixty-eight (17%) had heavy flow and twenty-eight (7%) had scanty flow. One hundred fifty two (38%) of girls complained of premenstrual symptoms. Two hundred thirty one (60%) girls were clinically anemic. Two hundred and seventy seven (69%) had a BMI between 18.5 - 24.9 kg/m^2. One hundred and eight (27%) were underweight with a BMI of 14 – 18.49kg/m², while sixteen (4%) were overweight with BMI 25 – 29.99 kg/m². A statistically significant relationship was found between BMI and social class (P<0.001) and BMI and menstrual pattern P<0.001).

Conclusion: The study concludes that a majority of the girls had clinically obvious nutritional deficiency diseases. Out of the four hundred and one girls who were checked, two hundred thirty one were found to be anemic. Majority of the girls (84%) had a normal menstrual pattern, normal BMI and attained menarche before the age of 16. Overweight girls had infrequent periods.

Relationship of age at menarche on anthropometric index and menstrual irregularity in late adolescent girls in Seoul

PURPOSE

To examine the relationship between menarcheal age and anthropometric indices and menstrual irregularity in late adolescent girls in Seoul.

METHODS

We surveyed 4,218 fertile adolescent girls between the ages of 16 and 18 years to determine their anthropometric indices and menarcheal age. Measurements were taken from June 2008 to October 2009 at seven girl's high schools in Seoul, Korea. Participants were offered self-report questionnaire as a survey tool that included questions on anthropometric indices (height, weight, waist circumference), menarcheal age, menstrual pattern, frequency of menstruation per year.

RESULTS

THE PARTICIPANTS WERE CATEGORIZED INTO THREE GROUPS BASED ON MENARCHEAL AGE: early menarche group (younger than 2 standard deviations [SD]), mid menarche group (within ±2 SD), late menarche group (older than 2 SD). The mean age of early menarche group was 9.9±0.2 years, mid menarche group 12.5±0.9 years, late menarche group 15.1±0.3 years (P < 0.001). Heights were recorded as 160.4±5.2 cm, 161.8±4.9 cm, 162.3±4.7 cm in early, mid, and late menarche group, respectively (P = 0.001). Body mass index (BMI) and waist circumference significantly were lager in early menarche group than mid and late menarche ones (P < 0.001). The menarcheal age had a positive correlation with height and negative correlations with weight, BMI, waist circumference (P < 0.001). The prevalence of oligomenorrhea was more frequent in late menarche group than early and mid menarche group.

CONCLUSION

The menarcheal age have positive relationship with height and inverse relationship with BMI and waist circumference in late adolescent girls in Seoul. Late menarcheal girls are disposed to have menstrual irregularity compared to early menarcheal girls.

First birth interval, an indicator of energetic status, is a predictor of lifetime reproductive strategy

OBJECTIVES

Women should differ in their reproductive strategies according to their nutritional status. We tested a hypothesis that women who have a good nutritional status early in life, as indicated by a shorter waiting time to the first birth (first birth interval, FBI), are able to afford higher costs of reproduction than women who have worse nutritional condition.

METHODS

We collected data on 377 women who got married between the years 1782 and 1882 in a natural fertility population in rural Poland. The study group was divided into tertiles based on the length of FBI.

RESULTS

Women with the shortest FBI had a higher number of children (P = 0.005), higher number of sons (P = 0.01), and shorter mean interbirth intervals (P = 0.06). Women who had ever given birth to twins had shorter FBI than women of singletons (20.1 and 26.1 months, respectively; P = 0.049). Furthermore, women with a shorter FBI, despite having higher costs of reproduction, did not have a different lifespan than women with a longer FBI.

CONCLUSIONS

Our results suggest that women who were in better energetic condition (shorter length of FBI), achieved higher reproductive success without reduction in lifespan. FBI reflects interindividual variation, which may result from variation in nutritional status early in life and thus may be a good predictor of subsequent reproductive strategy. We propose to use FBI as an indicator of women's nutritional status in studies of historical populations, especially when information about social status is not available.

Age at menarche of university students in Bangladesh: secular trends and association with adult anthropometric measures and socio-demographic factors

Age at menarche has been shown to be an important indicator for diseases such as breast cancer and ischaemic heart disease. The aim of the present study was to document secular trends in age at menarche and their association with anthropometric measures and socio-demographic factors in university students in Bangladesh. Data were collected from 995 students from Rajshahi University using a stratified sampling technique between July 2004 and May 2005. Trends in age at menarche were examined by linear regression analysis. Multiple regression analysis was used to assess the association of age at menarche with adult anthropometric measures and various socio-demographic factors. The mean and median age of menarche were 13.12+/-1.16 and 13.17 years, respectively, with an increasing tendency among birth-year cohorts from 1979 to 1986. Menarcheal age was negatively associated with BMI (p<0.01), but positively associated with height (p<0.05). Early menarche was especially pronounced among students from urban environments, Muslims and those with better educated mothers. Increasing age at menarche may be explained by improved nutritional status among Bangladeshi populations. Early menarche was associated with residence location at adolescence, religion and mother's education.

GENDER AND RURAL–URBAN DIFFERENCES IN THE NUTRITIONAL STATUS OF IN-SCHOOL ADOLESCENTS IN SOUTH-WESTERN NIGERIA

This study assessed gender and rural/urban differences in height and weight, and the prevalence of stunting, underweight and overweight of school-going adolescents in south-west Nigeria, using 2007 WHO reference values for comparison. The influence of sexual maturity and the socio-demographic correlates of growth performance were also examined. In this cross-sectional study, 924 male (51.4%) and 875 female (48.6%) students (1799 in total) aged 10–19 years from eighteen schools in Ibadan (five rural, nine urban public and four urban private) were interviewed and examined. Although males were significantly taller than females (p<0.05), stunting was more pronounced for males, who were 7.5 cm shorter than the 2007 WHO reference, compared with females who were 3.5 cm shorter. Body mass index (BMI) for girls was also greater than for boys (p<0.05). Rural adolescents had lower heights and BMIs compared with those in urban areas. The mean height of male adolescents in rural schools fell below 2 SDs of the 2007 WHO reference between 14 and 17 years, while heights of males and females in private schools were similar to the median 2007 WHO standard. Low height-for-age was observed in 282 adolescents (15.7%), which, after multivariate analysis, was significantly associated with school type, gender, number of mother's children and puberty onset. Adolescents in rural schools were much more likely to be stunted than those in urban private schools (AOR 13.1; 95% CI 5.2–33.2) and males were three times more likely to be stunted compared with females (AOR 3.3; 95% CI 2.4–1.4). Low BMI-for-age was observed in 240 adolescents (18.9%), with correlates similar to stunting. Adolescents at the pre-puberty stage were twice as likely to have low BMI-for-age (OR 2.0; 95% CI 1.6–2.5) than those with signs of puberty. There were 2.3% overweight adolescents, who were significantly more likely to be female, in private school and post-pubertal. Innovative interventions for Nigerian adolescents, especially rural inhabitants and males, are needed to reduce the prevalence of stunting and underweight.

Food consumption patterns of Nigerian adolescents and effect on body weight

OBJECTIVE

Association between nutritional status of adolescents and food consumption pattern.

DESIGN

Data on number of meals and snacks consumed daily were collected using structured questionnaires. Nutritional status was assessed as weight-for-age body mass index score less than fifth percentile of the National Center for Health Statistics/World Health Organization International Growth Reference.

SETTING

Cross-sectional studies of adolescents using multistage random sampling procedure.

PARTICIPANTS

401 adolescents from 32 secondary schools in Osun State, Nigeria.

ANALYSIS

Frequency counts, percentages, and cross-tabulation analysis were used to analyze data, analysis of variance was used to test the differences, as well as chi-square analysis. Level of significance was taken at .05 and .01 levels.

RESULTS

66.1% of adolescents ate 3 meals daily; this percentage was higher among rural (75.4%) than urban (61.4%) children (P < .001). About 33.0% consumed snacks daily but to a varying degree, which was higher among urban than rural adolescents (P = .002). Prevalence of underweight was 20.1%, more common in rural (22.1%) than urban adolescents (18.7%). Underweight prevalence was highest among those who ate 3 meals and no snacks daily (28.6%) and least among those who ate 3 meals and snacks twice daily (15.9%).

CONCLUSION

Snacks are important in food consumption among adolescents; when snacks are consumed in addition to 3 meals, they will improve the nutritional status of adolescents.

Childhood nutrition and later fertility: pathways through education and pre-pregnant nutritional status

Better childhood nutrition is associated with earlier physical maturation during adolescence and increased schooling attainment. However, as earlier onset of puberty and increased schooling can have opposing effects on fertility, the net effect of improvements in childhood nutrition on a woman's fertility are uncertain. Using path analysis, we estimate the strength of the pathways between childhood growth and subsequent fertility outcomes in Guatemalan women studied prospectively since birth. Height for age z score at 24 months was positively related to body mass index (BMI kg/m2) and height (cm) in adolescence and to schooling attainment. BMI was negatively associated (-0.23 +/- 0.09 years per kg/m2; p < .05) and schooling was positively associated (0.38 +/- 0.06 years per grade; p < .001) with age at first birth. Total associations with the number of children born were positive from BMI (0.07 +/- 0.02 per kg/m2; p < .05) and negative from schooling (-0.18 +/- 0.02 per grade; p < .01). Height was not related to age at first birth or the number of children born. Taken together, childhood nutrition, as reflected by height at 2 years, was positively associated with delayed age at first birth and fewer children born. If schooling is available for girls, increased growth during childhood will most likely result in a net decrease infertility.

Predictors of stunting and thinness in post-menarcheal adolescent girls in rural Bangladesh

Objective

To assess the nutritional status and risk factors of undernutrition in post-menarcheal girls in rural northern Bangladesh.

Design

Cross-sectional data on anthropometric measurements, dietary intake, work activity, morbidity and socio-economic status were collected from 12- to 19-year-old primigravidae (n 209) and never-pregnant adolescents (n 456) matched on age and time since menarche. Multiple regression analyses were conducted to determine predictors of stunting, thinness, upper-arm muscle (UAMZ) and fat area Z-scores (UAFZ) among the adolescent girls.

Results

A large proportion of adolescents (49 %) were stunted (height-for-age Z-score <−2) and underweight (40 %; weight-for-age Z-score <−2), but not thin (BMI-for-age <5th percentile; ∼10 %). The mean (sd) UAMZ and UAFZ of the adolescent girls was −0·3 (0·64) and −0·9 (0·40), respectively. Lean mass increased whereas fat mass declined with age. Both stunting and thinness were positively associated with age and time since menarche (P < 0·05). Young age (12–14 years) and literacy were protective against stunting among pregnant adolescents (OR = 0·29, 95 % CI 0·09, 0·88 and OR = 0·50, 95 % CI 0·26, 0·96, respectively). Having symptoms of diarrhoea or dysentery (OR = 7·40, 95 % CI 1·43, 38·29) predicted thinness and was associated with lower UAMZ and UAFZ among never-pregnant girls (both P < 0·05). Performing light-to-moderate activities was protective against thinness among never-pregnant girls (OR = 0·43, 95 % CI 0·22, 0·82), whereas pregnant adolescents who performed high levels of strenuous activities had greater UAMZ (P < 0·05).

Conclusion

Undernutrition was widespread among this post-menarcheal adolescent population. Younger and literate adolescents were less likely to be stunted, whereas thinness and body composition were associated with morbidity and work activity.

Age at menarche in Turkish adolescents in Kahramanmaras, Eastern Mediterranean region of Turkey

OBJECTIVES

To determine the age at menarche in adolescents in the Eastern Mediterranean city of Kahramanmaras, Turkey.

METHODS

The study was conducted in primary and high schools of Kahramanmaras, during the academic year 2003-2004. Data of 8212 female students were collected by using a standard questionnaire. Mean and median ages at menarche (with 95% confidence intervals) were calculated by Kaplan-Meier survival analysis. Also, probit analysis was performed to determine the age at menarche for all girls by estimating the age at which 10, 25, 50, 75 and 90% of the girls reached menarche.

RESULTS

According to the answers obtained through the questionnaire, 5506 (67.5%) of 8161 respondents had had their menarche. Mean age at menarche was 13.04 years (95% CI: 13.01-13.06), and median age 13.00 years (95% CI: 12.97-13.03). According to probit analyses, the probability of menstruating before the age of 11.48 years was 10% and before 15.08 years 90%.

CONCLUSION

We provide data about age at menarche in Kahramanmaras, an Eastern Mediterranean city of Turkey.

Menstrual pattern and common menstrual disorders among university students in Turkey

BACKGROUND

Menstrual disorders may affect the life of adolescents and young adult women, and may sometimes cause serious problems. The patterns of menstrual cycles were analyzed for association with age of menarche, prevalence of menstrual irregularity, dysmenorrhea, prolonged menstrual bleeding, and effect of menstrual disorders, especially dysmenorrhea, on social activities and school attendance among the female students.

METHODS

A total of 480 students were randomly selected and asked to complete an the anonymous questionnaire of 25 items.

RESULTS

The mean age of the subjects at menarche was 12.8 +/- 1.3 years with a range of 9-17 years. The duration between two periods and the menstrual flow were 27.7 +/- 2.5 days and 5.8 +/- 1.4 days, respectively. The prevalence of menstrual irregularity, prolonged menstrual bleeding and dysmenorrhea were 31.2%, 5.3% and 89.5%, respectively. Approximately 10% of dysmenorrheic subjects had severe dysmenorrhea; and school absenteeism and need to consult a physician were more common in those subjects. The first source of their knowledge about menarche and menstruation was their mothers in 211 subjects (54%); only 18 subjects (4.6%) were given a lecture about menstruation and menarche at school.

CONCLUSION

The prevalence of dysmenorrhea and menstrual irregularity was high, and most adolescents have inappropriate and insufficient information about menstrual problems. Hence, an education program is needed at the end of primary school about menarche and menstrual problems.

Effect of arsenic on the onset of menarcheal age

Ground water arsenic contamination is a major problem in the Bengal Delta plain. The present study investigates the effect of arsenic exposure on age at menarche in North 24-Parganas district, one of the worst affected districts. A higher mean menarcheal age of 12.50 years is reported from women residing in four arsenic affected villages in as compared to a control village (11.71 years). The differences in menarcheal age between three of the four affected villages and the control village are statistically significant (p < 0.05). The study indicates that arsenic exposure can have a negative effect on menarcheal age.

Childhood conditions influence adult progesterone levels

BACKGROUND

Average profiles of salivary progesterone in women vary significantly at the inter- and intrapopulation level as a function of age and acute energetic conditions related to energy intake, energy expenditure, or a combination of both. In addition to acute stressors, baseline progesterone levels differ among populations. The causes of such chronic differences are not well understood, but it has been hypothesised that they may result from varying tempos of growth and maturation and, by implication, from diverse environmental conditions encountered during childhood and adolescence.

METHODS AND FINDINGS

To test this hypothesis, we conducted a migrant study among first- and second-generation Bangladeshi women aged 19-39 who migrated to London, UK at different points in the life-course, women still resident in Bangladesh, and women of European descent living in neighbourhoods similar to those of the migrants in London (total n = 227). Data collected included saliva samples for radioimmunoassay of progesterone, anthropometrics, and information from questionnaires on diet, lifestyle, and health. Results from multiple linear regression, controlled for anthropometric and reproductive variables, show that women who spend their childhood in conditions of low energy expenditure, stable energy intake, good sanitation, low immune challenges, and good health care in the UK have up to 103% higher levels of salivary progesterone and an earlier maturation than women who develop in less optimal conditions in Sylhet, Bangladesh (F9,178 = 5.05, p < 0.001, standard error of the mean = 0.32; adjusted R(2) = 0.16). Our results point to the period prior to puberty as a sensitive phase when changes in environmental conditions positively impact developmental tempos such as menarcheal age (F2,81 = 3.21, p = 0.03) and patterns of ovarian function as measured using salivary progesterone (F2,81 = 3.14, p = 0.04).

CONCLUSIONS

This research demonstrates that human females use an extended period of the life cycle prior to reproductive maturation to monitor their environment and to modulate reproductive steroid levels in accordance with projected conditions they might encounter as adults. Given the prolonged investment of human pregnancy and lactation, such plasticity (extending beyond any intrauterine programming) enables a more flexible and finely tuned adjustment to the potential constraints or opportunities of the later adult environment. This research is the first, to our knowledge, to demonstrate a postuterine developmental component to variation in reproductive steroid levels in women.

Folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh

BACKGROUND

Indian Asian men residing in the United Kingdom have a higher prevalence of hyperhomocysteinemia than do their European counterparts. This has been largely attributed to dietary deficiencies in cobalamin associated with vegetarianism among these Indian Asians.

OBJECTIVE

We aimed to ascertain the prevalence of folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh.

DESIGN

Plasma concentrations of homocysteine, folate, and cobalamin and urinary concentrations of creatinine were assessed in 1650 adults in Bangladesh.

RESULTS

The prevalence of hyperhomocysteinemia (men: >11.4 micromol/L; women: >10.4 micromol/L) was markedly (P < 0.0001) greater among men (63%; x +/- SD: 15.3 +/- 9.5 micromol/L) than among women (26%; 9.5 +/- 4.7 micromol/L). Folate was lower (9.8 +/- 6.5 and 12.3 +/- 7.6 nmol/L, respectively), whereas cobalamin was higher (281 +/- 115 and 256 +/- 118 pmol/L, respectively) (P < 0.0001 for both) among men than among women. Folate explained 15% and cobalamin explained 5% of the variation in homocysteine concentrations. For men, folate (P = 0.005) and cobalamin (P = 0.03) were positively correlated with urinary creatinine. Smoking (P < 0.0003) and betelnut use (P < 0.0002) were independent negative predictors of folate.

CONCLUSIONS

Bangladeshi men have a high prevalence of hyperhomocysteinemia, which is more closely associated with folate than with cobalamin, although other factors, eg, smoking and betelnut use, may also contribute to its cause. The positive correlations between urinary creatinine and plasma folate and cobalamin were unanticipated and could suggest that, in marginal nutrition, these vitamins may be limiting for creatine biosynthesis.

The factors affecting the relation between the menarcheal age of mother and daughter

BACKGROUND

Menarche is one of the most important biologic signals in the life of a woman. Menarche is a biological variable which has a significant genotypic component in girls. In recent years, many studies reporting the earlier onset of menarche owing to the improvement of socio-economic conditions have been published.

DESIGN

We asked some questions about menarche to 1017 female students studying in the high schools of Manisa region in order to determine the menarcheal age and the correlation of menarcheal age between the mothers and daughters in our region.

RESULTS

The mean age at menarche for the girls was 12.82+/-1.07 years and for the mothers was 13.6+/-1.39 years. The mean menarcheal age of the mothers was higher than the mean menarcheal age of the girls (P<0.001). This difference persisted independent of the socio-economic status, nutritional state and physical activity of the girls. There was a significant correlation between the menarcheal age of the girls and their mothers (r=0.262, P<0.001). This correlation existed in all the girls with different socio-economic status, nutritional state and physical activity. However, this correlation disappeared in girls with body mass index (BMI)>25 (r=0.04, P=0.813). In girls with BMI<25, there was a correlation between the menarcheal age of the girls and mothers (r=0.282, P<0.001).

CONCLUSION

These results suggest that the menarche occurs earlier in the daughters than their mothers. The correlation between the menarcheal age of the girls and their mothers persists under all circumstances except in obesity. The mother's menarcheal age is a good predictor of the daughter's menarcheal age in non-obese girls and the BMI is an important factor.

Prevalence and severity of malnutrition and age at menarche; cross-sectional studies in adolescent schoolgirls in western Kenya

OBJECTIVE

Nutritional status is an important marker of overall health and linear growth retardation has serious long-term physiological and economic consequences. Approximately 35 and 29% of preschool children in sub-Saharan Africa are stunted and underweight, respectively. There is relatively little information available about the nutritional status in adolescents, the age group with the highest growth velocity after infancy. We conducted a series of cross-sectional surveys to determine the prevalence and main risk groups for malnutrition and to describe the associations between age, sexual maturation and nutritional status in adolescent schoolgirls in western Kenya.

DESIGN

Three cross-sectional surveys; one in Mumias, using random sampling in all schools, and two surveys in Asembo, using a multi-stage random sample design.

SETTING

Public primary schools in two different rural malaria endemic areas in western Kenya with high levels of malnutrition in preschool children.

SUBJECTS

In all, 928 randomly selected adolescent schoolgirls aged 12-18 y.

RESULTS

Overall prevalence of stunting and thinness was 12.1 and 15.6%, respectively. Of the total, 2% were severely stunted. Menarche and start of puberty were delayed by approximately 1.5-2 y compared to a US reference population. The prevalence of stunting and thinness decreased with age and mean height for age z-scores converged towards the median of the US reference curve. Girls who had not yet started menstruating were more likely to be stunted than the girls of the same age who were post-menarche.

CONCLUSIONS

Stunting and thinness are common in young adolescent schoolgirls in these poor rural settings in western Kenya, but the prevalence decreases with age, providing observational support that children catch up on incomplete growth attained earlier in life due to a maturational delay of 1.5-2 y allowing prolonged growth.

Prevalence of iron deficiency among schoolchildren of different socio-economic status in urban Turkey

OBJECTIVE

To investigate the prevalence of iron deficiency among schoolchildren of different socio-economic status (SES), living in the three largest cities of Turkey.

DESIGN

Cross-sectional study.

SETTINGS

Primary schools of Istanbul, Ankara and Izmir.

SUBJECTS

Schoolchildren aged 12 and 13 y (males: 504; females: 510) from nine primary schools. Inclusion of subjects in the study was on a voluntary basis.

METHODS

Data were obtained on children SES, anthropometry, haematological and biochemical indices of iron status and consumption of food items related to dietary iron bioavailability. One-way analysis of variance was mainly applied, for the evaluation of the tested hypotheses, using Bonferroni correction in order to take into account the inflation of Type I error.

RESULTS

Iron deficiency (serum ferritin <15 microg/l) prevalence was 17.5% among boys and 20.8% among girls. Furthermore, iron deficiency was significantly more prevalent among boys of lower SES, who were also found to have significantly lower levels of serum iron, serum ferritin, transferrin saturation, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration compared to those of higher SES. In terms of dietary factors affecting iron bioavailability, low SES boys exhibited significantly higher frequency of tea consumption and lower frequency of citrus fruit, red meat and fish consumption, compared to their higher SES counterparts.

CONCLUSION

The prevalence of iron deficiency was relatively high, particularly among lower SES schoolboys. Higher tea and lower citrus fruits, red meat and fish consumption by boys of lower SES may provide an indication about the possible role of certain dietary patterns in the different manifestation of this medical condition among the socio-economic groups. However, further research is needed.

Effects of different socioeconomic conditions on menarche in Turkish female students

PURPOSE

The aim of this study was to determine the age at menarche, the menarcheal features, and the association between menarcheal age and socioeconomic status in an urban area in Turkey. In addition, we tried to assess whether there is a relationship between age at menarche and body composition.

METHODS

We asked some questions about menarche of 1017 female adolescent students in the high schools of Manisa region. Height and weight were measured. The body mass index (BMI; kg/m2) was used as an index of relative weight. Adolescent girls were grouped into three socioeconomic status according to the educational and occupational levels of their parents. The age at menarche and the menarcheal pattern were evaluated according to the socioeconomic status.

RESULTS

The ages of girls involved in the study ranged between 14 and 18 years, with a mean of 15.7+/-1.1 years. Although the menarcheal age was found to be lower in girls with higher socioeconomic status, there was no significant difference between the three different socioeconomic status. In all of the three groups, menarche was more common in summer and fall than in spring and winter. Although the mother was an important source of knowledge in all groups, it was significantly more important in the group with high socioeconomic status. Adolescent girls with low socioeconomic status had fewer premenstrual complaints. However, there was no significant difference between the groups. We found an inverse correlation between menarcheal age and postmenarcheal weight and the BMI (r=-0.14, p=0.000). However, there was no correlation between menarcheal age and postmenarcheal height.

CONCLUSION

These results indicate that as the social status differences decrease, the difference observed in menarcheal age and pattern disappears in urban areas of developing countries. Menarcheal age may be an indicator of socioeconomic development. It does not influence postmenarcheal height; however, as menarcheal age decreases, BMI increases.

Early puberty in adopted children

Early puberty is frequently observed in adopted children. In various studies, early puberty has been associated with decreased final height. In Europe, studies were undertaken to treat early puberty in adopted children with GnRH agonist. This article reviews the current understanding of early puberty in adopted children, including prevalence, background and treatment options. Data from the European studies are briefly described. Besides auxological aspects, psychological items are addressed as well. Studies on the psychological effect of early puberty in adopted children are reported. Future issues include further study in the mechanism of early puberty in adopted children, evaluation of final height results of the growth studies and quality of life assessments in this specific group of children.

Human resistance to Plasmodium falciparum increases during puberty and is predicted by dehydroepiandrosterone sulfate levels

Immunity to Plasmodium falciparum develops slowly in areas of endemicity, and this is often ascribed to poorly immunogenic or highly variant parasite antigens. However, among populations newly exposed to malaria, adults acquire immunity more rapidly than children. We examined the relationship between pubertal development and resistance to P. falciparum. During two transmission seasons in western Kenya, we treated the same cohort of young males to eradicate P. falciparum and then obtained blood smears each week for 4 months. We determined pubertal development by Tanner staging and by levels of dehydroepiandrosterone sulfate (DHEAS) and testosterone in plasma. In multivariate and age-stratified analyses, we examined the effect of pubertal development on resistance to malaria. In both seasons (n = 248 and 144 volunteers, respectively), older males were less susceptible than younger males. Age-related decreases in the frequency and density of parasitemia were greatest during puberty (15- to 20-year-olds). DHEAS and testosterone were significant independent predictors of resistance to P. falciparum parasitemia, even after accounting for the effect of age. Fifteen- to 20-year-old males with high DHEAS levels had a 72% lower mean parasite density (P<0.01) than individuals with low DHEAS levels. Similarly, 21- to 35-year-old males with high DHEAS levels had a 92% lower mean parasite density (P<0.001) and 48% lower frequency of parasitemia (P<0.05) than individuals with low DHEAS levels. These data suggest that the long period needed to attain full immunity could be explained as a consequence of host development rather than as the requirement to recognize variant or poorly immunogenic parasite antigens.