Postmenarcheal Adolescent Girls Research Articles

Bone Mineral Density and Serum Bone Turnover Markers among Post-Menarchal Girls from Rural South India.

The data on the bone mineral density (BMD) and bone turnover markers (BTMs) in Indian adolescents are limited. To assess BMD at lumbar spine (LS, L1-L4) and femoral neck (FN) in South Indian post-menarchal girls and correlate it with dietary calcium intake (mg/day), physical activity score and post-menarchal years. The study also assessed serum BTMs and their correlation with chronological age in the study population. This cross-sectional study included apparently healthy post-menarchal adolescent girls aged 12-16 years randomly selected from the community. Participants with vitamin D deficiency were excluded. The data on calcium intake and physical activity were obtained using validated questionnaires. All participants were evaluated with serum calcium, 25-hydroxy vitamin D, parathyroid hormone, N-terminal propeptide of type 1 collagen (P1NP) and Beta-CrossLaps (CTx) and BMD at LS and FN using dual X-ray absorptiometry (DXA). EpiData version 3.1 was used for the data entry. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Continuous variables were expressed as mean ± SD. Pearson's correlation coefficient (r) was calculated, and two-tailed Kendall's tau-b test was used for assessing correlation of all nonparametric measures. A total of 103 participants were screened, and data from 77 were analysed. There was a significant positive correlation of BMD at LS with chronological age (r: +0.235, P = 0.036), but not at FN. Positive correlation of BMD with increase in post-menarchal years was also noted at LS (r: +0.276, P = 0.015). There was no significant association of BMD with calcium intake and physical activity scores at both sites. There was a significant negative correlation of serum BTMs with age CTx (r: -0.596, P = 0.0001) and P1NP (r: -0.505, P = 0.0001). This study provides insight into the reference BMD range at LS spine and FN in South Indian rural post-menarchal adolescent girls. BMD positively correlated, whereas BTMs negatively correlated with age. The study also provides the first Indian reference range for serum BTMs in this age group.

Comparison of awareness and perception of menstrual hygiene between pre and postmenarchal adolescents of North India: A cross-sectional study

Context:Menstruation is a normal physiologic phenomenon. Due to lack of awareness regarding menstrual hygiene among adolescent girls in India, majority have unhygienic practices which make them vulnerable to various adverse health and social outcomes.Aims and Objective:The aim of this study was to compare the awareness and perception of pre- and postmenarchal adolescent girls regarding menstrual hygiene.Settings and Design:A hospital-based cross-sectional study was conducted by the Department of Obstetrics and Gynaecology and Paediatrics of a Government tertiary care center, Lucknow, Uttar Pradesh for 6 months from 1 July 2019 to 31 December 2019.Material and Methods:The study was undertaken among 120 adolescent girls between 09 and 19 years of age. Premenarchal age group was from 9 to 12 years and postmenarchal was 13–19 years. All the adolescent girls who fulfilled the inclusion criteria were subjected to a pretested prevalidated semi-structured questionnaire assessing their awareness and perceptions regarding menstrual hygiene.Result:Of 120 respondents, 43 girls were aware of menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in the case of 49 (49.65%) girls. A total of 57 girls believed it as a physiological process. 32 (53.3%) girls knew the use of sanitary pads during menstruation. Regarding restrictions practiced, 136 (85%) girls practiced different restrictions during menstruation.Conclusion:Adolescent girls, being vulnerable, need to have adequate and correct awareness regarding menstrual hygiene. This will protect them from risk of developing reproductive or sexually transmitted infections (RTI/STI) which is a burden on our society and render many females infertile and cause other adverse health outcomes.

Nutritional status and age of menarche in adolescent girls in urban and rural area schools

Background: There are various factors that influences the age of menarche which includes genetic, nutritional status, socioeconomic status and environmental conditions. Further it has also proved that the malnutrition has delayed the age of menarche. Thus, the present study focuses on the study of relation between the nutritional status and age of menarche among the adolescent girls in a rural and urban area in Tamil Nadu, India.Methods: It is a community based cross-sectional study done in the adolescent girls of age between 11 to 15 years studying in school in the city of Chennai, India and surrounding rural areas. A total of 602 post-menarcheal adolescent girls were included in the study. The participants who were post-menarcheal were asked to recall the year and month of menarche and was noted. To assess the nutritional status, the parameters weight, height and waist circumference were determined.Results: The association between the age of menarche and BMI was studied. The study showed that there was an association with a Pearson coefficient (r) value of - 0.252 which is statistically significant (p˂0.001). The association between the age of menarche and waist to height ratio was studied. The study showed that there was an association with a Pearson coefficient (r) value of - 0.261 which is statistically significant (p˂0.001).Conclusions: This study has confirmed that the nutritional status has association with the age of menarche and is the contribution to the reduction in the mean of age of menarche in this geographical area.

A Comparative Study of Beliefs and Attitude Towards Menstruation among Urban and Rural Postmenarcheal Adolescent Girls of Delhi NCR

A Comparative Study of Beliefs and Attitude Towards Menstruation among Urban and Rural Postmenarcheal Adolescent Girls of Delhi NCR

Wnt Signaling-Related Osteokines and Transforming Growth Factors Before and After a Single Bout of Plyometric Exercise in Child and Adolescent Females.

This study examined resting levels of catabolic and anabolic osteokines related to Wnt signaling and their responses to a single bout of plyometric exercise in child and adolescent females. Fourteen premenarcheal girls [10.5 (1.8) y old] and 12 postmenarcheal adolescent girls [15.0 (1.0) y old] performed a plyometric exercise trial. One resting and 3 postexercise blood samples (5min, 1h, and 24h postexercise) were analyzed for sclerostin, dickkopf-1 (DKK-1), osteoprotegerin (OPG), receptor activator of nuclear factor kappa-β ligand (RANKL), and transforming growth factors (TGF-β1, TGF-β2, and TGF-β3). Premenarcheal girls had significantly higher resting sclerostin, TGF-β1, TGF-β2, and TGF-β3 than the postmenarcheal girls, with no significant time effect or group-by-time interaction. DKK-1 was higher in premenarcheal compared with postmenarcheal girls. There was an overall significant DKK-1 decrease from baseline to 1h postexercise, which remained lower than baseline 24h postexercise in both groups. There was neither a significant group effect nor group-by-time interaction in OPG, RANKL, and their ratio. RANKL decreased 5min postexercise compared with baseline and remained significantly lower from baseline 24h following the exercise. No changes were observed in OPG. OPG/RANKL ratio was significantly elevated compared with resting values 1h postexercise. In young females, high-impact exercise induces an overall osteogenic effect through a transitory suppression of catabolic osteokines up to 24h following exercise.

Emotional Reaction to Menarche and Menstrual Attitudes

The goal of this study was to examine current attitudes toward menstruation in adolescent postmenarcheal girls in relation to age at menarche, time since menarche had occurred, preparedness, and emotional reaction to menarche. Postmenarcheal adolescent girls from primary and secondary schools (N = 246) participated in the study, with an average age of 15.1 years and average age at menarche 12.4 years. Participants filled out the adapted version of Adolescent Menstrual Attitude Questionnaire (AMAQ; Marvan & Molina, 2002), Expected/Experienced Emotions related to Menarche Scale (Emo-M; Nakić Radoš, Mužinić Bikić, & Roso Perić, in press), Preparedness for the Menarche (PM; Rodriguez White, 2013), and Pubertal Development Scale (PDS; Petersen, Crockett, Richards, & Boxer, 1988). The two-way ANOVA showed that early maturers (≤11 years at menarche) had significantly higher level of negative attitudes than average maturers (12 years) and late maturers (≥13 years). Both early and average maturers had a higher level of secretive attitudes than late maturers. However, this effect was present only if menarche occurred in less than two years. Regression analyses showed that higher level of pleasant emotions at menarche predicted higher level of positive attitudes toward menstruation (45.2% variance explained). Lower age at menarche, less time from the menarche, and a higher level of unpleasant emotions at menarche predicted higher levels of secretive attitudes (35.1% variance explained) and negative attitudes (22.7% variance explained). In conclusion, age at menarche, time for adaptation to menstruation, and initial emotional reaction to menarche are significant determinants of menstrual attitudes in adolescent girls. Education and preparing girls for menstruation at early stages of puberty is necessary. Keywords: menarche, menstruation, attitudes, emotions, puberty

Ovarian Torsion in the Normal Ovary: A Diagnostic Challenge in Postmenarchal Adolescent Girls in the Emergency Department.

BackgroundOvarian torsion can be seen in the otherwise-normal ovary and is a challenging issue in the emergency department. The aims were (1) to evaluate and compare the surgically verified ovarian torsion cases in otherwise-normal ovaries and ovaries including a mass or cyst and (2) to investigate whether the normal-appearing ovaries on ultrasound examination affected the diagnosis of ovarian torsion or not.Material/MethodsA retrospective cohort study design was used. The medical records of all postmenarchal adolescent girls with surgically verified ovarian torsion treated in a university hospital from 2010 to 2016 were reviewed.ResultsTwenty-nine post-menarchal girls were identified. The subjects were divided into two groups. Eight girls (group 1) had ovarian torsion in a normal ovary, and twenty-one girls (group 2) had ovarian torsion including a mass or cyst. The median ages of group 1 and 2 were 13 and 14 years, respectively. Abdominal pain was the main presenting symptom for all cases in both groups. Doppler flow studies were abnormal in 6/9 (66.6%) in group 1 and 12/21 (57.1%) in group 2. The time from first admission to the operation was statistically longer in group 1 than in group 2 (34.5±24.3 hours vs. 19.5±9.2 hours, respectively; p=0.001). The longitudinal axis of uterine size was significantly shorter in group 1 than in group 2 (34.3±2.9 mm vs. 47.6±4.5 mm, respectively; p=0.001).ConclusionsOvarian torsion in adolescent girls can be seen within the otherwise-normal ovary. The normal-appearing ovaries on ultrasound in the emergency department may lead to delay in the diagnosis of ovarian torsion in adolescent girls.

Effect of Extended 30 μg Ethinyl Estradiol with Continuous Low-Dose Ethinyl Estradiol and Cyclic 20 μg Ethinyl Estradiol Oral Contraception on Adolescent Bone Density: A Randomized Trial

Study ObjectiveTo compare changes in lumbar spine bone mineral density after 12 months of a 91-day extended regimen or 28-day combined oral contraceptive with those in a healthy reference group not using hormonal contraceptives. DesignPhase 2, multicenter, open-label, randomized, controlled study. SettingForty-five academic centers, clinical research centers, and community practices in the United States. ParticipantsEight hundred twenty-nine postmenarcheal adolescent girls aged 12-18 years. InterventionsAdolescents were randomly assigned to 91-day levonorgestrel (LNG)/ethinyl estradiol (EE) extended regimen (84 days of LNG 150 μg/EE 30 μg with 7 days of EE 10 μg [LNG/EE extended regimen]) or 28 days of LNG/EE (21 days of LNG 100 μg/EE 20 μg with 7 days of placebo [LNG/EE 21/7]) for 12 months. A reference group not seeking hormonal contraception was also evaluated. Main Outcome MeasuresThe primary end point was mean percent change in lumbar spine bone mineral density measured using dual-energy x-ray absorptiometry. ResultsOf 1361 adolescents randomized/enrolled, 829 were included in the primary analysis. Mean changes in lumbar spine bone mineral density were +2.26% with LNG/EE extended regimen, +1.45% with LNG/EE 21/7, and +2.50% in the reference group. Noninferiority of the LNG/EE extended regimen compared with the reference group was shown. A statistically significant treatment difference was found between LNG/EE 21/7 and the reference group (1.05%; 95% confidence interval, 0.61%-1.49%) but not between LNG/EE extended regimen and the reference group (0.23%; 95% confidence interval, −0.20% to 0.67%). No new safety signals were noted. ConclusionCompared with the reference group, bone accrual was statistically significantly lower among LNG/EE 21/7 users but not among LNG/EE 30-μg extended regimen users. Additional research is needed to clarify the clinical relevance of these findings.

Levonorgestrel-Releasing Intrauterine Device Use in Female Adolescents with Heavy Menstrual Bleeding and Bleeding Disorders: Single Institution Review

Study ObjectiveTo identify complications and efficacy of the levonorgestrel-releasing intrauterine device (LNgIUD) in adolescents with heavy menstrual bleeding (HMB) and bleeding disorders (BD). Design, Setting, and ParticipantsA retrospective chart review of 13 postmenarchal adolescent girls with HMB/BD who underwent placement of an LNgIUD. InterventionsPlacement of an LNgIUD. Main Outcome MeasuresPrimary outcome was to identify complications from placement of an LNgIUD. Secondary outcome was to evaluate the efficacy of the LNgIUD in adolescents with BD. ResultsThirteen patients met study criteria. The mean age of diagnosis of HMB was 14.08 ± 1.75 years. BD or bleeding risk factor diagnoses included low von Willebrand (VW) activity in 5, type I VW disease in 5, type IIM VW disease in 1, low VW activity and factor 7 deficiency in 1, and acquired VW disease and factor 7 deficiency in 1. Before LNgIUD placement, other hormonal therapy (n = 13) and hemostatic therapy (antifibrinolytic agents, desmopressin acetate; n = 8) yielded poor control of HMB. The LNgIUD was placed using anesthesia with periprocedure hemostatic therapy with no complications. All patients reported significant improvement in HMB after LNgIUD placement and 60% achieved amenorrhea, with mean time to improvement of 94 ± 69 days. Mean hemoglobin and ferritin levels increased after LNgIUD placement compared with before LNgIUD placement values (P = .02, P = .0085, respectively). Use of supplemental hormonal and hemostatic agents decreased (n = 4) after LNgIUD placement. None required LNgIUD removal; 1 spontaneously expelled the LNgIUD with subsequent replacement. ConclusionStudy results indicated the LNgIUD is an effective therapeutic option in postmenarchal adolescents with HMB due to BD/bleeding risk factor with minimal complications, high compliance rate, improvement in HMB and anemia, and no periprocedural bleeding with hemostatic management.

Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders.

BackgroundConsidering the prevalence of obesity in society it can be expected that some adolescents with an eating disorder (ED) start weight loss from an overweight and present at a near-normal weight. Presently, the influence of premorbid BMI on clinical characteristics of adolescent girls presenting with an ED has ben studied.MethodPremorbid growth charts were available for 275 postmenarcheal adolescent girls presenting with an ED (anorexia nervosa = 27, (subthreshold) bulimia nervosa = 9, restrictive EDNOS = 239). Initial assessment included measurement of weight and length, physical examination, blood sampling and administration of the Eating Disorder Examination-Questionnaire youth version (EDE-Q).ResultsDespite greater weight loss girls with a high premorbid body mass index (BMI) had a higher BMI at presentation compared to those with a lower premorbid BMI. Although not underweight some presented with clinical and laboratory signs of starvation. These signs were related to not only low BMI but also to rapid and large weight loss. Their EDE-Q scores did not differ from those of girls who presented with an underweight.ConclusionGirls with a restrictive ED and premorbid overweight may present with a near-normal BMI. They can nevertheless be medically compromised and have eating disturbed cognitions at the level of underweight girls. They should not be regarded as having a less severe ED but merit full assessment and a start of treatment.

Use of a Gonadotropin-releasing Hormone Analog to Treat Idiopathic Central Precocious Puberty Is Not Associated with Changes in Bone Structure in Postmenarchal Adolescents

Study ObjectivesTo evaluate bone quantity and quality in postmenarchal adolescents treated for idiopathic central precocious puberty (CPP) in childhood with a gonadotropin-releasing hormone analog (GnRHa) and to determine the serum concentrations of bone remodeling markers. Design and ParticipantsThis cross-sectional study included 53 postmenarchal adolescent girls who were divided into 2 groups: 27 adolescents who were treated with GnRHa in childhood for idiopathic CPP (the CPP group) and 26 women who presented with physiological development of secondary sex traits (the control group). Interventions: None. Main Outcome MeasuresWeight, height, body mass index, age at menarche, time since menarche, body composition, bone mineral density (BMD), bone quality, and serum insulin, glucose, osteocalcin, and carboxyl-terminal telopeptide of type I collagen concentrations were compared in the 2 groups. BMD data were analyzed by using both dual-energy x-ray absorptiometry (DXA) and osteosonography, and body composition was measure with the use of DXA and electrical bioimpedance. ResultsBMD and bone quality did not differ significantly between the CPP and control groups when analyzed by using DXA or osteosonography. Serum osteocalcin concentration was significantly lower (P = .02) in the CPP than in the control group. Insulin was higher in the CPP group, and hyperinsulinemia was an independent predictor of bone quantity and quality assessed by using osteosonography. Body mass index and percent fat were determined by using DXA, and the duration of use of GnRHa treatment and the time since GnRHa discontinuation were not independent predictors of bone quantity and quality. ConclusionPostmenarchal adolescents treated with GnRHa for CPP in childhood did not show a reduction in bone quantity or quality.

Menstruation: Experiences of adolescent slum dwelling girls of Siliguri City, West Bengal, India

Background: Adolescence is defi ned as the teenage period of life, involving major biological changes and psycho-social development. In adolescence, the girls fi rst experience menstruation and good hygiene is essential during this period. Menstrual hygiene is an issue that is insuffi ciently acknowledged and has not received adequate attention in the reproductive health in developing countries. Aim: To elicit the knowledge, attitude and practice of menstrual hygiene in adolescent slum dwelling girls of Siliguri city. Subjects and Methods: A cross sectional, community based study was conducted in slums of Siliguri city of West Bengal and cluster sampling was used to select 798 post menarcheal adolescent girls residing in the slums. Data on knowledge, attitude and practices regarding menstruation were collected with the help of a pre-tested and semi-structured schedule. Simple descriptive statistics were used to analyse the data using SPSS 16 software (Chicago IL, USA). Descriptive statistics were applied to calculate proportion, mean and standard deviation and Chi square test was used to test the association between categorical variables and a P<0.05 was considered significant. Results: The knowledge of the respondents was assessed and it was found that only 23.4% (187 out of 798) knew about menstruation before menarche, whereas 653 out of 798 girls remarked sanitary napkins as the ideal absorbent. Regarding attitude towards menstruation, 55% of girls attributed menstruation as a debilitating event and 37.6% of them agreed that their periods resulted in no negative eff ect. When enquired about the menstrual practices 71.3% used sanitary napkins as absorbent material. Majority of the study participants had fair knowledge and practice about menstruation. Conclusion: The results of the present study highlights the fact that more eff orts should be made to create awareness about hygienic practices during menstrual period, especially in underserved areas like slums. Keywords: Adolescents, attitude, knowledge, menstrual hygiene, practice, slums

Abstract A26: Dietary intake and C-peptide levels in adolescent girls: Results from the Dietary Intervention Study in Children (DISC)

Abstract Background: Adolescence is the time period of greatest breast development. Diet during this time has been hypothesized to be associated with later breast cancer risk through its effect on insulin resistance. C-peptide is a good indicator of insulin production and higher levels in adulthood have been associated with insulin resistance. Information on dietary predictors of C-peptide levels in adolescence, however, is limited. Objectives: To examine associations between dietary intake of selected nutrients [fat, animal and vegetable protein, carbohydrate, lactose, fructose, glucose, galactose, sucrose, starch, fiber, calcium, zinc, iron, and sodium] and serum C-peptide in adolescent girls. Methods: The current study includes 155 postmenarcheal adolescent girls 14.6-to-18.9 yrs (mean: 16.6 ± 0.9 yrs) who attended the last visit of the DISC. Intervention and control group data are combined. Dietary intake was assessed via 3 averaged, nonconsecutive 24–hour dietary recalls with nutrient intakes estimated using Nutrition Data System v20. Serum C-peptide levels were determined by electrochemiluminescence immunoassay. Nutrients were selected based on those associated in the literature with insulin or C-peptide and availability in our data set. Associations between nutrients and C-peptide were estimated using unadjusted and adjusted Pearson's correlation analyses. Adjusted geometric means of C-peptide were also calculated within quartiles of each nutrient with linear trends calculated across quartiles. Adjusted analyses included age, time since menarche and energy intake. Associations were also examined using forward-selection multivariable linear regression (p&amp;lt;0.05) including age, time since menarche, body mass index (BMI)-for-age-percentile, total fat, energy intake, starch, and either fiber or vegetable protein intake in analyses. To mitigate skewness, nutrients and C-peptide were log transformed; thus, β coefficients represent percentage changes in C-peptide for 1% increases in nutrient intakes. Results: In correlation analyses the following dietary variables were significant predictors of C-peptide (p&amp;lt;0.05): total fat, vegetable protein, starch and fiber. Adjusted Pearson's correlation coefficients were 0.17, -0.19, -0.17 and -0.20, respectively. In adjusted analyses, trends in geometric means of C-peptide across quartiles of nutrients were significant for vegetable protein (p=0.048) and fiber (p=0.027). For the lowest to the highest quartiles of dietary fiber intake, geometric means of C-peptide were 643 pmol/L (95% CI: 547, 755), 593 pmol/L (95% CI: 501, 702), 592 pmol/L (95% CI: 504, 695), and 490 pmol/L (95% CI: 417, 577). In multivariable linear regression analyses, vegetable protein and fiber intake were examined in separate models due to collinearity (r=0.749, p&amp;lt;0.0001). In forward selection multivariable analyses, only BMI-for-age percentile (β=0.004, p=0.004) and fiber intake (β=-0.305, p=0.009) remained as significant predictors of C-peptide. In a similar model, vegetable protein was not a significant predictor. Conclusion: This study suggests dietary fiber intake in adolescent girls is inversely associated with serum C-peptide, a marker of insulin resistance, after adjustment for BMI-for-age-percentiles. To our knowledge, no previous studies have examined this association in adolescence. Citation Format: Zhenzhen Zhang, Jean M. Kerver, Joseph C. Gardiner, Joanne F. Dorgan, Ellen M. Velie. Dietary intake and C-peptide levels in adolescent girls: Results from the Dietary Intervention Study in Children (DISC). [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A26.

Geometric Indices of Hip Bone Strength in Obese, Overweight, and Normal-Weight Adolescent Girls

The aim of this study was to compare hip bone strength indices in obese, overweight, and normal-weight adolescent girls using hip structure analysis (HSA). This study included 64 postmenarcheal adolescent girls (14 obese, 21 overweight, and 29 normal weight). The 3 groups (obese, overweight, and normal weight) were matched for maturity (years since menarche). Body composition and bone mineral density (BMD) of whole body, lumbar spine, and proximal femur were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate hip bone strength, DXA scans were analyzed at the femoral neck (FN) at its narrow neck (NN) region, the intertrochanteric (IT), and the femoral shaft (FS) by the HSA program. Cross-sectional area and section modulus were measured from hip BMD profiles. Total hip BMD and FN BMD were significantly higher in obese and overweight girls in comparison with normal-weight girls (p < 0.05). However, after adjusting for weight, using a one-way analysis of covariance, there were no significant differences among the 3 groups regarding HSA variables. This study suggests that in obese and overweight adolescent girls, axial strength and bending strength indices of the NN, IT, and FS are adapted to the increased body weight.

The Function of Ethnicity, Income Level, and Menstrual Taboos in Postmenarcheal Adolescents’ Understanding of Menarche and Menstruation

The purpose of this study was to examine differences in knowledge about menstruation, feelings of preparation for menarche, and menstrual attitudes of early adolescent girls from different ethnic groups and income levels. An interaction between ethnicity and income level was also investigated. Participants were 165 postmenarcheal adolescent girls’ (ages 11–15) from Pittsburgh, Pennsylvania, USA, who were categorized into four groups: higher income European Americans, lower income European Americans, higher income African Americans, and lower income African Americans. It was predicted that African Americans, lower income participants, and lower income African Americans would score lower on a menstrual knowledge test, report feeling less prepared for menarche, and report more negative menstrual attitudes (i.e., fewer positive feelings about menstruation, more negative feelings about menstruation, and less openness toward menstruation) than European Americans, higher income participants, and any other income level and ethnicity grouping. Not all hypotheses were fully supported. Participants’ lacked accurate menstrual knowledge and felt unprepared for menarche, but menstrual attitudes were ambivalent. Ethnicity and income level alone did not play a substantial role in girls’ understanding of menarche and menstruation; however, they did interact. Overall, higher income European Americans fared better than the other participants. Theories and research regarding girls’ understanding of menarche and menstruation must take sociocultural factors into account.

Metabolic dysfunction in late-puberty adolescent girls with type 1 diabetes: Relationship to physical activity and dietary intakes

At puberty, type 1 diabetes (T1D) among young girls can lead to excess body weight, insulin resistance, deterioration of glycaemic control and dyslipidaemia. Although biological factors contribute largely to such metabolic dysfunction, little is known of the role of behavioural factors such as physical activity and diet. This study investigated the association between metabolic dysfunction measured after a 12-h overnight fast and behavioural factors, including diet (4-day diary) and physical activity (validated questionnaire), in 19 postmenarchal adolescent girls with T1D compared with 19 healthy girls. T1D girls displayed higher levels of fat mass, insulin resistance (higher plasma glucose, serum leptin and waist-to-hip ratios) and dyslipidaemia (higher LDL-C and apolipoprotein B levels, lower HDL-C and apolipoprotein A-1 levels). Also, contrary to what is usually observed in T1D adults, serum adiponectin, an important vessel protector, was not raised in T1D adolescent girls compared with healthy controls. Quantity and quality of dietary macronutrient intakes as well as physical activity levels were comparable in both groups, although the T1D girls with the poorest metabolic profiles reported having the healthiest diets (fewer total calories, more protein and less carbohydrates). However, in T1D girls, less physical activity and more time spent watching television were associated with poorer metabolic profiles (higher waist-to-hip ratios, fat mass and leptin levels, and lower adiponectin, HDL-C and apolipoprotein A-1 levels). Collectively, these data suggest that physical inactivity is linked to metabolic dysfunction to a greater extent than unhealthy dietary habits in postmenarchal T1D adolescent girls.

Site-specific effects of trunk fat mass on bone mineral density in a group of adolescent girls

Summary Introduction The aim of this study was to explore the relation between trunk fat mass on one hand and non-dominant arm (non-weight-bearing site) bone mineral density (BMD) and total hip (weight-bearing site) BMD on the other hand in a group of adolescent girls. Subjects and methods This study included 45 post-menarchal adolescent (aged 13–20 years) girls. Anthropometric characteristics (height and weight) were measured and body mass index (BMI) was calculated. Body composition (lean mass, fat mass, body fat percentage and trunk fat mass), BMC and BMD of the left arm and total hip BMD were assessed by dual-energy X-ray absorptiometry (DXA). The tissue composition of the left arm was determined from the regional analysis of the whole-body DXA scan. The arm region included the hand, forearm, and arm, and was separated from the trunk by an inclined line crossing the scapulo-humeral joint. Results Trunk fat mass was strongly correlated to total hip BMD (r = 0.57; P Conclusion This study suggests that trunk fat mass is a positive determinant of total hip BMD but not of non-dominant arm BMD in adolescent girls.

Provision of Micronutrient Powder in Response to the Cyclone Sidr Emergency in Bangladesh: Cross-Sectional Assessment at the end of the Intervention

Micronutrient powder has been endorsed as an effective means to improve the micronutrient status of emergency-affected populations. To document the experience and findings of a cross-sectional assessment of the micronutrient powder program implemented as part of the emergency response to Cyclone Sidr. Micronutrient powder was distributed to 100,714 children under 5 years of age and 59,439 pregnant or lactating women severely affected by Cyclone Sidr in Bangladesh. A cross-sectional assessment, including hemoglobin and anthropometric measurements, was conducted after the completion of the micronutrient powder program among children under 5 years of age, lactating mothers, and postmenarcheal adolescent girls in the intervention area. Comparison groups for each, drawn from the control area, which had not received micronutrient powder, were assessed at the same time. The prevalence of anemia among children under 5 years of age was approximately 80% in both areas. Among children in the intervention area, those who consumed at least 75% of the micronutrient powder sachets had a lower prevalence of stunting than those who consumed less than 75% of the sachets (40% vs. 52%, p < .05). Among lactating mothers in the intervention area, the prevalence rates of thinness and anemia were lower among those who consumed at least 75% of the sachets than among those who consumed less than 75% of the sachets (thinness, 31% vs. 46%, p < .05; anemia, 50% vs. 61%, p = .07). For adolescent girls in the intervention and control areas, none of whom had received micronutrient powder, the prevalence rates of anemia were 52% and 45%, respectively (p = .05). Micronutrient powder may reduce anemia among lactating mothers, when the compliance rate is high. Anemia prevalence prior to micronutrient powder distribution had not been investigated and could have been higher among children and lactating mothers in the intervention than in the control area, resulting in the negation of the potential positive impact of micronutrient powder on anemia.

Birth weight is an independent determinant of whole body bone mineral content and bone mineral density in a group of Lebanese adolescent girls

The aim of this study was to explore the relation between birth weight and bone mass in a group of adolescent girls. This study included 40 post-menarchal adolescent (aged 13-20 years) girls. Anthropometric characteristics (height and weight) were measured and birth weights were obtained from the obstetric records. Body composition, bone mineral content (BMC) and bone mineral density (BMD) of the whole body (WB) were assessed by dual-energy X-ray absorptiometry (DXA). Calculations of the ratio BMC/height and of the bone mineral apparent density (BMAD) were completed for the WB. Birth weight was positively correlated to BMC and to the ratio BMC/height even after adjusting for weight and maturation index (years since menarche). Finally, birth weight was correlated to BMD even after adjusting for weight. In conclusion, this study suggests that birth weight is an independent determinant of whole body BMC and BMD in adolescent girls.

Predictors of stunting and thinness in post-menarcheal adolescent girls in rural Bangladesh

To assess the nutritional status and risk factors of undernutrition in post-menarcheal girls in rural northern Bangladesh. Cross-sectional data on anthropometric measurements, dietary intake, work activity, morbidity and socio-economic status were collected from 12- to 19-year-old primigravidae (n 209) and never-pregnant adolescents (n 456) matched on age and time since menarche. Multiple regression analyses were conducted to determine predictors of stunting, thinness, upper-arm muscle (UAMZ) and fat area Z-scores (UAFZ) among the adolescent girls. A large proportion of adolescents (49 %) were stunted (height-for-age Z-score <-2) and underweight (40 %; weight-for-age Z-score <-2), but not thin (BMI-for-age <5th percentile; approximately 10 %). The mean (sd) UAMZ and UAFZ of the adolescent girls was -0.3 (0.64) and -0.9 (0.40), respectively. Lean mass increased whereas fat mass declined with age. Both stunting and thinness were positively associated with age and time since menarche (P < 0.05). Young age (12-14 years) and literacy were protective against stunting among pregnant adolescents (OR = 0.29, 95 % CI 0.09, 0.88 and OR = 0.50, 95 % CI 0.26, 0.96, respectively). Having symptoms of diarrhoea or dysentery (OR = 7.40, 95 % CI 1.43, 38.29) predicted thinness and was associated with lower UAMZ and UAFZ among never-pregnant girls (both P < 0.05). Performing light-to-moderate activities was protective against thinness among never-pregnant girls (OR = 0.43, 95 % CI 0.22, 0.82), whereas pregnant adolescents who performed high levels of strenuous activities had greater UAMZ (P < 0.05). Undernutrition was widespread among this post-menarcheal adolescent population. Younger and literate adolescents were less likely to be stunted, whereas thinness and body composition were associated with morbidity and work activity.