Abstract
PurposeEarly puberty is associated with adverse health outcomes. To identify potential modifiable factors for puberty timing, we examined the associations of prepubertal childhood macronutrient intakes with puberty timing in boys and girls.MethodsIn the Avon Longitudinal Study of Parents and Children, macronutrient intakes at age 6 years were predicted using random intercepts linear regression models of dietary data at 3, 4, 7 (assessed by food frequency questionnaires) and 7.5 years (by 3-day food diaries). Timings of puberty onset (Tanner stage 2 genital or breast (B2) development) and puberty completion (voice breaking (VB) or menarche) were calculated from annual parental and child reports at 8–17 years. Age at peak height velocity (PHV) was derived from repeated height measurements at 5–20 years. Linear regression models were fit to estimate the associations of total energy (TEI) and macronutrient intakes (carbohydrate, fat, protein) with puberty timing traits, adjusting for maternal and infant characteristics.ResultsAmong 3811 boys, higher TEI, but no macronutrient, was associated with earlier VB. Among 3919 girls, higher TEI was associated with earlier ages at B2, PHV, and menarche. Higher protein intake but not carbohydrate or fat intake (in energy partition models) and substitution of dietary protein for carbohydrate (in nutrient density and residual models) was associated with earlier B2, PHV, and menarche in girls. Findings were not attenuated on additional adjustment for body fat percentage during adolescence.ConclusionsThese findings suggest habitual total energy intakes in children, and protein intakes in girls, as potential modifiable determinants of puberty timing.
Highlights
Puberty is the transition from childhood to adult body appearance and attainment of reproductive capacity, a process that takes 2–3 years
In energy partition models (Supplementary Table 9), while higher plant protein intake was associated with earlier voice breaking (VB) in boys, higher intakes of animal protein and plant protein were associated with earlier B2, peak height velocity (PHV), and menarche in girls. These associations persisted in nutrient density and residual models (Supplementary Table 9), which tested the substitution of protein types for carbohydrates. In this long follow-up British study from 3 to 17 years old, we observed that higher childhood habitual intakes of total energy, and of protein at the expense of carbohydrate, were associated with subsequent earlier timings of puberty onset and completion, in girls
The findings for protein intake were consistent in different energy adjustment models
Summary
Puberty is the transition from childhood to adult body appearance and attainment of reproductive capacity, a process that takes 2–3 years. The timing of puberty is typically indicated in boys by age at onset of genital development or voice breaking and in girls by the age at onset of breast development or menarche, and these timings have become earlier over the last decades worldwide [1,2,3,4]. A recent systematic review estimated that a significant proportion of type 2 diabetes may be attributed to early menarche timing among white British women [8] These findings highlight the need to identify potentially modifiable factors that determine puberty timing. It is well recognised that girls who experience rapid childhood growth and have overweight or obesity tend to progress through puberty earlier than their peers [9, 10] Such findings raise the possibility that dietary intakes, whether or not acting through child growth and obesity, may be potential modifiable determinants of puberty timing [11]
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