Characteristics of pubertal development in a multi-ethnic population of nine-year-old girls☆
Introduction
Puberty, characterized by the development of secondary sexual characteristics, begins approximately 3 years before menarche. Pubertal onset is modestly correlated with age at menarche 1., 2.. Early maturation has been linked to adverse health outcomes including insulin resistance, breast cancer, and cardiovascular disease 3., 4.. Age at menarche varies by geography (5), has declined secularly (6), and differs by race/ethnicity (7). Similar trends, though not well documented, may exist for age of pubertal onset (8). A recent study of over 17,000 US girls found that African-American girls began menses approximately 8.5 months earlier than white girls; pubertal breast and hair development began on average 1 and 1.5 years, respectively, earlier in African-American girls (7). Mexican-American girls are believed to have similar or slightly later reproductive development than Caucasian girls (9). Yet little published information on maturation in other US Hispanics is available. As reproductive characteristics such as birthweight differ among Hispanic subgroups, it is plausible that reproductive development also varies (10).
Acknowledged disparities in the age at menarche imply that environmental factors influence reproductive development, but determinants of earlier maturation are unclear. Adiposity has been consistently, positively associated with onset of menses 11., 12., 13.. Other factors, including height, diet, and physical activity, have also been linked with menarche, though less consistently 14., 15., 16., 17., 18.. Whether these characteristics affect pubertal development is unknown 13., 15., 19.. We undertook a study of African-American, Hispanics, and Caucasian girls to examine pubertal development in relation to body size, physical activity, and diet.
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Methods
A cross-sectional study was undertaken in New York City from Spring 1997 to Fall 1998. Nine-year-old girls of African-American, Hispanic, or Caucasian race/ethnicity, visiting the Mount Sinai Hospital Pediatric Clinic or a nearby pediatric private practice for a wellness visit were eligible. Girls with existing endocrine disorders were ineligible. Of 224 girls invited to participate, 200 (89%) were eligible, agreed to do so, and had either parental or guardian-signed informed consent. Refusal (n
Results
Figure 1 displays the distributions of breast and hair Tanner stage; more girls were considered pubertal for breast (52%) than for pubic hair development (32%). Pubertal girls were slightly older and their mothers were less educated than prepubertal girls (Table 1). Of 186 girls, 54 were African-American, 70 were Hispanic, and 62 were Caucasians. Among mothers of Hispanic girls, 59% were US born, 26% were born in Puerto Rico, 10% were born in the Dominican Republic, and 5% were born in other
Discussion
Our study is among few that have examined early pubertal development, and is the first to do so among African-American, Caucasian, and Hispanic girls. A large percent of our population had Caribbean maternal ancestry, another unique study feature. Indeed, the percent of our girls with ancestry in the Caribbean Islands may be larger, because the only information available on the girls' ancestry was maternal birthplace. Advanced breast and hair pubertal status was more common among older girls as
Acknowledgements
Support by grants from EPA R825816, CDC CCU300860, AICR 97A057 and from the Rubin Shulsky Philanthropic Fund of the Jewish Communal Fund is gratefully acknowledged. We thank Nell Maloney, Nicole Serra, and Danielle Taylor-Thomas for recruiting patients and for assistance in interpretation of the clinical data; Dr. Nathan Kase and Dr. Neil Leleiko for guidance in the study design and in clinical interpretations; and Yannis Jeminai for programming support.
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This work is supported by the US Army Medical Research and Materiel Command under Award Number DAMD 17-99-1-9303. The views, opinions and/or findings contained in this document are those of the author(s) and should not be construed as on official Department of the Army position, policy, or decision unless so designated by other documentation. In the conduct of research where humans are the subjects, the investigator(s) adhered to the policies regarding the protection of human subjects as prescribed by 45 CFR 46 and 32 CFR 219 (Protection of Human Subjects).