Abstract
Whether physical development and rapid growth during the first 2 years of life are associated with puberty onset in girls remains unclear. To examine the associations of infant physical development and rapid growth with the timing of puberty onset in girls. This prospective birth cohort study included girls whose mothers had participated in a randomized, double-blind cluster trial of micronutrient supplementation with a daily capsule of folic acid, iron and folic acid, or multiple micronutrients during pregnancy. A total of 547 singleton girls in rural western China who were born after 2004 were followed up at 3, 6, 12, and 24 months of age and were eligible for long-term follow-up. Of these, 294 adolescent girls (aged 10-12 years), representing 53.7% of the total sample, were included in the follow-up interview that was conducted from June 1 through December 31, 2016. Data analyses were conducted from November 1, 2019, to May 30, 2020. Infant weight and length were assessed at birth and 3, 6, 12, and 24 months of age. Rapid growth, defined as a weight-for-age or length-for-age z score increase of greater than 0.67, was calculated during 5 periods: birth to 3 months, birth to 6 months, 6 to 12 months, 12 to 24 months, and birth to 24 months of age. Puberty stage was assessed using the standardized Tanner staging system. Onset of puberty was defined as attaining Tanner stage 2 of breast development or pubic hair growth, and the corresponding age at follow-up was recorded. Of 294 girls included in the analysis (mean [SD] age, 11.25 [0.57] years), the median age of puberty onset was 11 (interquartile range, 10-11) years. A significant association with puberty onset was found for infancy weight-for-age z score at 12 months of age (adjusted hazard ratio [HR], 1.20; 95% CI, 1.01-1.44) and rapid weight gain from birth to 24 months of age (adjusted HR, 1.40; 95% CI, 1.01-1.93) and birth to 3 months of age (adjusted HR, 1.39; 95% CI, 1.02-1.91). However, length-related indicators during early life were not associated with adolescent puberty onset. This study found that a higher weight-for-age z score and rapid weight gain during infancy, particularly from birth to 3 months of age, were associated with an increased likelihood of puberty onset in girls. These findings suggest that weight-related indicators may serve as proxies of puberty onset among adolescent girls.
Highlights
A significant association with puberty onset was found for infancy weight-for-age z score at 12 months of age and rapid weight gain from birth to 24 months of age and birth to 3 months of age
Lengthrelated indicators during early life were not associated with adolescent puberty onset
This study found that a higher weight-for-age z score and rapid weight gain during infancy, from birth to 3 months of age, were associated with an increased likelihood of puberty onset in girls
Summary
Growing evidence indicates that puberty onset has been occurring at an earlier age in girls.[1,2] This may increase the risk of diseases in adulthood, such as breast, ovarian, and endometrial cancers, metabolic syndrome, and cardiovascular disease.[3,4] A worldwide meta-analysis[1] concluded that age at puberty onset among girls has decreased by approximately 3 months per decade from 1977 to 2013.The literature to date has largely focused on secular increases in body mass index (BMI) in early childhood and their associations with the timing of puberty (ie, menarche and puberty onset),[5] with higher BMI in childhood associated with earlier puberty.[6,7] It remains unclear whether body size during the first 2 years of life, a critical window that lays the foundation for long-term health outcomes, is associated with puberty. Few studies have examined the association of rapid weight gain in infancy with puberty, and limited assessments have been performed.[12,13] The DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study from Germany[12] assessed rapid weight gain with measurements at birth and at 24 months of age. Another birth cohort from South Africa focused on transient rapid weight gain from birth to 12 months of age.[13] a study with multiple prospective measures of growth during the first 2 years of life is needed to determine the specific period associated with the timing of puberty
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