Puberty and Influencing Factors in Schoolgirls Living in Istanbul: End of the Secular Trend?

Department of Pediatric Endocrinology, Marmara University, School of Medicine, Istanbul, Turkey.
PEDIATRICS (Impact Factor: 5.47). 06/2011; 128(1):e40-5. DOI: 10.1542/peds.2010-2267
Source: PubMed


To (1) establish the median ages at menarche and pubertal stages and investigate influential factors and (2) assess the secular trend in reaching puberty in a transitional society.
A probit method was used to calculate the median age at menarche and pubertal stages from a cross-sectional study of 4868 healthy schoolgirls (aged 6-18 years) in Istanbul, Turkey. The findings were compared with those from a similar study performed 4 decades earlier. Logistic regression was used to analyze the associations between the odds of attaining puberty stages and putatively influential factors. Simple statistical models were used to test the effects of BMI and consumption of certain foods on the onset of menarche.
The median age at menarche is 12.74 years. The median ages at breast stages 2 through 5 are 9.65, 10.10, 11.75, and 14.17 years, respectively, and at pubic-hair stages 2 through 5 are 10.09, 11.19, 12.33, and 14.68 years, respectively. Girls from upper socioeconomic classes are more likely to reach menarche and B4 and B5 stages. Higher BMI seems to be a promoting factor for attaining menarche. Intrauterine growth and gestational age had no effect. The average age at menarche was not associated with the consumption of milk, eggs, chicken, or fish.
The secular trend in puberty is probably about to end in Turkey. Although the median ages at the breast stages show a decreasing trend, the median age at menarche is approximately the same as it was 4 decades ago. Socioeconomic status and BMI are important, and related, factors that affect the age at menarche and pubertal stages.

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Available from: Serap Turan, Sep 15, 2015
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    • "There are many reports about the decline in age of onset of puberty, particularly among girls, all around the world, including Turkey (38). Although our study has some limitations due to the smallness of the sample size, this is the first study determining the relationship between urinary BPA levels and ICPP in non-obese Turkish girls. "
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    ABSTRACT: Ob­jec­ti­ve: Bisphenol A (BPA) is an industrial chemical, particularly used to harden plastics. BPA is thought to have negative health effects on both laboratory animals and humans. Consider ing the decline in age of onset of puberty noted in recent years, particularly among girls, the importance of BPA as an estrogenic endocrine disruptor has increased. In this study, we aimed to determine urinary BPA levels in girls with idiopathic central precocious puberty (ICPP). Methods: Non-obese girls newly diagnosed with ICPP (n=28, age 4-8 years) constituted the study group. The control group consisted of 25 healthy age-matched girls with no history of ICPP or any other endocrine disorder. Urinary BPA levels were measured by using high-performance liquid chromatography. Results: In the ICPP group, urinary BPA levels were significantly higher compared to the control group [median 8.34 (0.84-67.35) μg/g creatinine and 1.62 (0.3-25.79) μg/g creatinine, respectively (OR=8.68, 95% CI:2.03-32.72, p=0.001)]. There was no marked correlation between urinary BPA levels and body mass index in either group. In the ICPP group, no significant correlations were found between urinary BPA levels and serum luteinizing hormone, follicle-stimulating hormone and estradiol levels. Conclusions: To our knowledge, this is the first study evaluating the urinary BPA levels in Turkish girls with ICPP. Our results indicate that the estrogenic effects of BPA may be an etiologic factor in ICPP.
    Journal of Clinical Research in Pediatric Endocrinology 03/2014; 6(1):16-21. DOI:10.4274/Jcrpe.1220
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    • "Menarcheal age in girls in Turkey varies in different studies and study populations: 12.36 years in 1975, 13.28 years in 1996, 12.2 and 12.41 years in 2008 and 12.74 years in 2011 [34]–[38]. Bundak et al. as well as Atay et al. found no evidence for a secular trend in age at menarche in girls in Turkey in the last three decades [39]–[41]. Age at menarche in Turkish girls living in Germany in 1985 was 12.90 years, this is comparable to median age at menarche (12.80 years) in girls of Turkish descent in our study 12 years later (1997). [42] Interestingly, in girls from Turkish and Moroccan descent living in the Netherlands age at menarche decreased at a higher pace than it did in Dutch girls. "
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    ABSTRACT: To assess and compare the secular trend in age at menarche in Dutch girls (1955-2009) and girls from Turkish and Moroccan descent living in the Netherlands (1997-2009). Data on growth and maturation were collected in 20,867 children of Dutch, Turkish and Moroccan descent in 2009 by trained health care professionals. Girls, 9 years and older, of Dutch (n = 2138), Turkish (n = 282), and Moroccan (n = 295) descent were asked whether they had experienced their first period. We compared median menarcheal age in 2009 with data from the previous Dutch Nationwide Growth Studies in 1955, 1965, 1980 and 1997. Age specific body mass index (BMI) z-scores were calculated to assess differences in BMI between pre- and postmenarcheal girls in different age groups. Median age at menarche in Dutch girls, decreased significantly from 13.66 years in 1955 to 13.15 years in 1997 and 13.05 years in 2009. Compared to Dutch girls there is a larger decrease in median age of menarche in girls of Turkish and Moroccan descent between 1997 and 2009. In Turkish girls age at menarche decreased from 12.80 to 12.50 years and in Moroccan girls from 12.90 to 12.60 years. Thirty-three percent of Turkish girls younger than 12 years start menstruating in primary school. BMI-SDS is significantly higher in postmenarcheal girls than in premenarcheal girls irrespective of age. There is a continuing secular trend in earlier age at menarche in Dutch girls. An even faster decrease in age at menarche is observed in girls of Turkish and Moroccan descent in the Netherlands.
    PLoS ONE 04/2013; 8(4):e60056. DOI:10.1371/journal.pone.0060056 · 3.23 Impact Factor
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    • "BMI SDS was significantly higher in CPP than in PT and PPb cases, indicating that high BMI and obesity may be associated with early onset of breast development (26). "
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    ABSTRACT: Objective: The aim of this study was to evaluate the girls referred to the pediatric outpatient clinic with a presumptive diagnosis of early puberty due to early onset of breast development or pubarche. Methods: Within the study period, we evaluated 289 subjects referred for concerns about early onset of puberty. History, anthropometric data, bone age (BA), hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and dehydroepiandrosterone sulfate, as well as pelvic ultrasonography (USG)-derived ovarian and uterine volumes were analyzed. Results: Of the 289 girls referred for early onset of pubertal development, 64 (22.1%) had false alarms for puberty. Of the remaining 225 girls, 41 (18.2%) were diagnosed as premature pubarche, 56 (24.9%) as premature thelarche (PT), and 128 (56.9%) as precocious puberty (PP). Girls with early-onset puberty had more advanced BA, greater uterine and ovarian volumes, and also higher LH values than subjects with PP and PT. Nearly half of these girls were 7-8 years of age. Body mass index (BMI) standard deviation score was significantly higher in the PP cases. Conclusions: There is a need for primary care physicians to be more knowledgeable on puberty and on puberty problems. There seems to be a preponderance of PP in 7-8-year-old children . Increased BMI may have a role in the trend towards earlier onset of puberty Conflict of interest:None declared.
    Journal of Clinical Research in Pediatric Endocrinology 12/2012; 4(4):208-12. DOI:10.4274/jcrpe.736
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