Pubertal breast development in primary school girls in Sokoto, North-western Nigeria

Impact of Small-Quantity Lipid-Based Nutrient Supplements on Pubertal Status of 9-13-Year Olds: A Follow-Up Study of the iLiNS-DYAD-Ghana Trial

Background

Early and delayed puberty are both associated with adverse health and psychosocial outcomes.

Objectives

We assessed the impact of provision of small-quantity lipid-based nutrient supplement (SQ-LNS) to mothers during pregnancy and 6 mo postpartum and to their children aged 6-18 mo, on pubertal status.

Methods

This study was a follow-up to a partially double-blind randomized controlled trial. At ≤20 wk, 1320 females were randomly assigned to receive daily: iron and folic acid during pregnancy and placebo 0-6 mo postpartum; or multiple micronutrients during pregnancy and 0-6 mo postpartum; or SQ-LNS during pregnancy and 0-6 mo postpartum and to their children from 6 to 18 mo. We re-enrolled 966 and 919 children at 9-11 y and 11-13 y, respectively. We calculated a total pubertal status score based on the Petersen Pubertal Development Scale (PDS) to assess growth spurt, skin changes, body hair, facial hair, voice break, breast development, and menstruation. Pubertal status was regressed on child's age to generate age-adjusted PDS z-scores (aPDSZ); we performed interaction and mediation analyses.

Results

Mean ± standard deviation aPDSZ did not differ between the SQ-LNS and non-LNS groups at 9-11 y (0.01 ± 0.95 compared with -0.01 ± 0.98; P = 0.958) but was more advanced in the SQ-LNS group at 11-13 y (0.07 ± 1.04 compared with -0.04 ± 0.98; P = 0.049) in the adjusted model. The effect of SQ-LNS varied by sex (P-interaction = 0.003) and household asset index z-score (P-interaction = 0.002): Puberty was more advanced in the SQ-LNS compared with non-LNS group among females (P = 0.007) but not males (P = 0.877), and within lower (P = 0.002) than average (P = 0.436) and higher (P = 0.332) socioeconomic households.

Conclusion

Provision of SQ-LNS during the first 1000 d of life advanced pubertal status among females.

Trial registration number

This trial was registered at clinicaltrials.gov as NCT00970866 (https://clinicaltrials.gov/ct2/show/record/NCT00970866).

Anthropometric status, body composition and timing of pubertal milestones in Sub-Saharan Africa: a systematic review

BACKGROUND

With the rise of the triple burden of malnutrition, the changing nutrition situation in Sub-Saharan Africa may be associated with changes in pubertal timing of adolescents. The purpose of this review was to summarize the association between nutritional status and pubertal milestones among children in SSA.

METHOD

A search of publications was conducted in PubMed and Scopus on 1st April 2023. Observational studies with children aged 0 to 22 years, that reported nutritional status and association with pubertal milestones in SSA were selected for review. Risk of bias was assessed using the NOS and results were presented using the PRISMA.

RESULTS

Twenty-three studies published from 1992 to 2021 reporting data from nine countries and a total of 21,853 children were included in this review. Mean menarche age relative to nutritional status varied from 17.2 years in stunted adolescents in Senegal to 13.3 (in the underweight), 13.9 (in normal weight girls), and 14.1 (in overweight girls) years in adolescents in Ethiopia. Adolescents who were not stunted in Kenya and those with higher height-for-age z-scores (HAZ) and body mass index (BMI) in South Africa had more advanced breast development. Pubic hair development was positively associated with HAZ and BMI z-scores (BMIZ) at 5 years in South Africa and overweight and obesity in adolescents in Nigeria. Attainment of voice break in adolescent boys in Nigeria was associated with lower likelihood of stunting and underweight. In a study in Zambia, earlier onset and more rapid progression of genital development assessed by testicular volume in boys was associated with increased height and arm muscle.

CONCLUSIONS

Higher BMI, height, weight, and triceps skinfolds are significantly associated with advanced pubertal development in SSA. In SSA, less than one-third of the countries have published any research studies on nutritional status and pubertal milestones. Future studies should focus on detailed assessment of pubertal development and associated nutritional factors in both male and female adolescents in SSA.

PROSPERO REGISTRATION

CRD42022350048.

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

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

Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis

IMPORTANCE

The initial clinical sign of pubertal onset in girls is breast gland development (thelarche). Although numerous studies have used recalled age at menarche (first menstruation) to assess secular trends of pubertal timing, no systematic review has been conducted of secular trends of thelarche.

OBJECTIVES

To systematically evaluate published data on pubertal timing based on age at thelarche and evaluate the change in pubertal onset in healthy girls around the world.

DATA SOURCES

A systematic literature search was performed in PubMed and Embase of all original peer-reviewed articles published in English before June 20, 2019.

STUDY SELECTION

Included studies used clinical assessment of breast development in healthy girls and used adequate statistical methods, including the reporting of SEs or CIs. The quality of the articles was evaluated by assessing study design, potential sources of bias, main characteristics of the study population, and methods of statistical analysis.

DATA EXTRACTION AND SYNTHESIS

In accordance with PRISMA guidelines, all articles were assessed for eligibility independently by 2 authors. Weighted regression analysis was performed using a random-effects model.

MAIN OUTCOMES AND MEASURES

Studies examining age at thelarche (development of Tanner breast stage 2) in healthy girls.

RESULTS

The literature search resulted in a total of 3602 studies, of which 30 studies fulfilled the eligibility criteria. There was a secular trend in ages at thelarche according to race/ethnicity and geography. Overall, the age at thelarche decreased 0.24 years (95% CI, -0.44 to -0.04) (almost 3 months) per decade from 1977 to 2013 (P = .02).

CONCLUSIONS AND RELEVANCE

The age at thelarche has decreased a mean of almost 3 months per decade from 1977 to 2013. A younger age at pubertal onset may change current diagnostic decision-making. The medical community needs current and relevant data to redefine "precocious puberty," because the traditional definition may be outdated, at least in some regions of the world.

Age of pubertal events among school girls in Lagos, Nigeria

BACKGROUND

Globally, there is a secular trend towards the reduced age for sexual maturity and menarche. This study aimed to determine the current age and factors associated with attainment of various stages of puberty in Nigerian girls.

METHODS

This study was a cross-sectional study involving 800 girls aged 6-15 years. The subjects were selected by stratified random sampling method from schools in Oshodi Local Government Area, Lagos State. They were interviewed and a physical examination was carried out to classify them into the various Tanner stages of breast and pubic hair maturational stages.

RESULTS

The median age of girls at first stage of breast maturation (B2), first stage of pubic hair development (PH2) and at menarche were 9.0, 9.0 and 12.0 years, respectively. Breast development was significantly related to normal nutritional status (adjusted odds ratio [AOR] 4.5, p<0.001), overweight (AOR 40.2, p<0.001), obesity (AOR 154.2, p<0.001) and upper social class (AOR 15.7, p<0.031). Pubic hair development was significantly related only to overweight (AOR 4.7, p<0.007) and obesity (AOR 15.7, p<0.001) while achievement of menarche was significantly related to overweight (AOR 0.1, p=0.005), obesity (AOR 0.1, p=0.0009), high social class (AOR 4.7, p<0.001) and being a member of the Hausa tribe (AOR 35.8, p<0.029).

CONCLUSIONS

There is decline in age of pubertal maturation of girls in Nigeria and the major contributory factors appear to be overweight and obesity. These findings are consistent with the pattern in developed countries.