Pubertal Assessment Method and Baseline Characteristics in a Mixed Longitudinal Study of Girls

Cincinnati Children's Hospital Medical Center, Adolescent Medicine (ML 4000), and Department of Environmental Health, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2010; 126(3):e583-90. DOI: 10.1542/peds.2009-3079
Source: PubMed


The objective of this study was to describe the assessment methods and maturation status for a multisite cohort of girls at baseline recruitment and at ages 7 and 8 years.
The method for pubertal maturation staging was developed collaboratively across 3 sites. Girls at ages 6 to 8 years were recruited at 3 sites: East Harlem, New York; greater Cincinnati metropolitan area; and San Francisco Bay area, California. Baseline characteristics were obtained through interviews with caregivers and anthropometric measurements by trained examiners; breast stage 2 was defined as onset of pubertal maturation. The kappa statistic was used to evaluate agreement between master trainers and examiners. Logistic regression models were used to identify factors that are associated with pubertal maturation and linear regression models to examine factors that are associated with height velocity.
The baseline cohort included 1239 girls. The proportion of girls who had attained breast stage 2 varied by age, race/ethnicity, BMI percentile, and site. At 7 years, 10.4% of white, 23.4% of black non-Hispanic, and 14.9% of Hispanic girls had attained breast stage>or=2; at 8 years, 18.3%, 42.9%, and 30.9%, respectively, had attained breast stage>or=2. The prime determinant of height velocity was pubertal status.
In this multisite study, there was substantial agreement regarding pubertal staging between examiners across sites. The proportion of girls who had breast development at ages 7 and 8 years, particularly among white girls, is greater than that reported from studies of girls who were born 10 to 30 years earlier.

    • "Menarche and consequent menstruation is an important milestone in the process of physical, emotional, and sexual maturation. It also reveals, to the female, the normal functioning of her reproductive system (Biro et al., 2010; Gaudineau et al., 2010; Rees, 1993). Menstruation plays an important role in emotional regulation, and causes many symptoms such as headaches, fatigue, feeling of weight gain, abdominal and breast swelling, back pain, and joint pain (Wu et al., 2014). "
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    ABSTRACT: Objectives: The purpose of this study was to examine the relationship between girls' sexual maturation (age of menarche) and physical activity and sedentary behaviors. Methods: Data were collected from a national representative sample of girls in 2010 (pre-menarcheal girls n = 583, post-menarcheal girls n = 741). Physical activity (times/week and hours/week) and screen-based sedentary time (minutes/day) including television/video/DVD watching, playing videogames, and computer use were self-reported. Results: Pre-menarcheal girls engaged significantly more times in physical activity in the last 7 days than post-menarcheal girls (3.5 ± 1.9 times/week vs. 3.0 ± 1.7 times/week, P < 0.001). There was no significant difference between pre-menarcheal and post-menarcheal girls in time (hours/week) spent in physical activity. Post-menarcheal girls spent significantly more minutes per day than pre-menarcheal girls watching TV, playing videogames, and using computers on weekdays (TV: 165.2 ± 105.8 vs. 136.0 ± 106.3, P < 0.001; videogames 72.0 ± 84.8 vs. 60.3 ± 78.9, P = 0.015; computer: 123.3 ± 103.9 vs. 82.8 ± 95.8, P < 0.001) and on weekends (TV: 249.0 ± 116.2 vs. 209.3 ± 124.8, P < 0.001; videogames: 123.0 ± 114.0 vs. 104.7 ± 103.5, P = 0.020; computer: 177.0 ± 122.2 vs. 119.7 ± 112.7, P < 0.001). After adjusting analyses for age, BMI, and socioeconomic status, differences were still significant for physical activity and for computer use. Conclusion: Specific interventions should be designed for girls to increase their physical activity participation and decrease time spent on the computer, for post-menarcheal girls in particular. Am. J. Hum. Biol., 2015. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Dec 2015 · American Journal of Human Biology
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    • "Tanner self-assessment has been proposed as an alternative in various studies [5]. This involves showing photographs (with or without explanatory text) to the girl allowing her to examine at a mirror to categorize her stage of breast development [6]. "
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    ABSTRACT: Background Early puberty onset has been related to future chronic disease; however breast bud assessment in large scale population studies is difficult because it requires trained personnel. Thus our aim is to assess the validity of self and maternal breast bud detection, considering girl’s body mass index (BMI) and maternal education. Methods In 2010, 481 girls (mean age = 7.8) from the Growth and Obesity Chilean Cohort Study were evaluated by a nutritionist trained in breast bud detection. In addition, the girl(n = 481) and her mother(n = 341) classified the girl’s breast development after viewing photographs of Tanner stages. Concordance between diagnostics was estimated (kappa, Spearman correlation) considering girls’ BMI and mother’s educational level. Results 14% of the girls presented breast buds and 43% had excess weight (BMI z-score > 1, World Health Organization 2007). Self-assessment showed low concordance with the evaluator (K < 0.1) and girls with excess weight over-diagnosed more than girls of normal weight (44% vs. 24%, p-value < 0.05). Instead, mothers showed good concordance with the evaluator (K = 0.7, 95% confidence interval (CI) = 0.6-0.9), even in overweight girls and/or in mothers with low education (K = 0.7, 95% CI = 0.6-0.8). Conclusions Mothers were able to adequately evaluate the appearance of breast bud despite low educational level and girls’ excess weight. Mother could be a useful resource for defining puberty onset in epidemiological studies, particularly developing countries.
    Full-text · Article · Aug 2014 · BMC Women's Health
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    • "Prospective cohort study and part of the Puberty Studies of the Breast Cancer and Environment Research Program (BCERP) [27]. The overarching goal of this longitudinal investigation is to identify genetic and environmental risk factors related to altered timing of puberty onset in girls. "
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    ABSTRACT: Childhood obesity and early puberty are intermediate risk factors for later metabolic and reproductive disorders including diabetes, polycystic ovarian syndrome (PCOS), and breast cancer. Atypical methylation patterns in genes related to hormone and adipose metabolism, such as CYP19A1 (aromatase) and PPARG (peroxisome proliferator-activated receptor gamma), are associated with alterations in gene expression which may contribute to pathogenesis of these diseases. If present in early life, it is conceivable similar methylation aberrations may result in hormone perturbations that alter pubertal timing. We used Cox proportional hazard models to investigate whether promoter methylation of CYP19A1 and PPARG, independently or in concert with body weight, was associated with age at breast (B2) or pubic hair development (PH2) when assayed in saliva DNA collected from a cohort of New York City, Black and Hispanic girls (N = 130) enrolled in a study of pubertal timing between 6-8 years of age. An inverse association between CYP19A1 methylation and risk of early PH2 was suggested (HR = 0.95, 95% CI = 0.90-1.00, p = 0.05). CYP19A1 methylation also appeared to modify risk of early B2 associated with body weight. Specifically, compared to normal weight girls with 'high' CYP19A1 methylation, significantly increased risk of early B2 was observed in overweight girls with 'low' but not 'high' CYP19A1 methylation (HR = 2.15; 95% CI = 1.23- 3.76). However, in formal tests for effect modification, the interaction between body weight and methylation did not reach statistical significance (p for interaction = 0.085). PPARG methylation was not significantly associated with PH2 or B2. Though limited by sample size, our findings suggest methylation of CYP19A1, a critical gene in estrogen biosynthesis, may influence timing of breast development in overweight girls. Consistent with emerging reports, these data support the notion that epigenetic marks in surrogate tissues may improve risk prediction when added to standard plasma and anthropometric indicators, and warrant further study.
    Full-text · Article · Mar 2014 · BMC Pediatrics
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