Puberty, obesity and ethnicity

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Lay and medical sources state that children enter puberty earlier now than in past decades. Although it is clear that puberty and menarche currently begin at younger ages than they did in past centuries, a comparison of the onset of puberty during the few past decades is more difficult to interpret. African-American girls do start puberty earlier and menarche is earlier than in White girls, and the gap between the two has widened during the past 20 years. This change between ethnic groups might be due to an increasing difference in body mass index (BMI) values. Greater BMI values are associated with pubertal onset or menarche; thus, if BMI continues to increase in childhood, earlier puberty might well be found in the general population in the future. In the absence of accurate data from the past or definitive studies at present, however, it cannot be stated with assurance that puberty today starts significantly earlier than it did in the past 4–5 decades across the whole population.

Section snippets

How is the age of puberty noted?

Endocrine changes of puberty are continuous and complex and involve many organs (reviewed in Ref. [3]), but secondary sexual development is described by a few stages or events. Breast development (‘thelarche’, the onset of breast development) follows the secretion of ovarian estrogen, whereas the development of female pubic hair (‘adrenarche’ or ‘pubarche’, the onset of pubic hair development) is caused by androgens from the adrenal glands or ovaries. Estrogen secretion and androgen secretion

Reported age of menarche

Although menarche occurs years after the onset of puberty in girls, it is a singular event and many studies use menarche as a proxy for the onset of puberty. Unfortunately, the time reported between the onset of puberty and menarche varies with the age of onset of puberty such that the earlier the age of onset of puberty in normal girls, the longer the duration until menarche and vice versa [14]. Thus, the tempo of puberty might change with the age of onset of puberty; however, only definitive

Historical studies on the age of menarche

The average age of menarche in ‘developed’ Western European countries decreased by 2–3 months per decade over the past 150 years 19, 20. This secular trend slowed or ceased in countries such as the USA, Australia, Britain and Holland in women born around 1940 (reviewed in Ref. [3]), presumably owing to improved socio-economic status and health 21, 22, 23. However, a continuing decline in the age of menarche has been reported in regions of Denmark, Spain, Brazil and other areas 24, 25, 26.

More recent studies on the age of menarche

Large national studies of pubertal development in the USA have been recently re-analyzed with new statistical techniques applied to subgroups of the population chosen for particular characteristics. Thus, the reported age of any stage of pubertal development might differ between publications (Table 1) 30, 31, 32, 33, 34.

Several studies show an earlier age of menarche in African-American versus White girls, and a widening of this difference over the past few decades. The Bogalusa Heart Study

Development of physical changes of puberty in girls

The US National Health Examination Survey (NHES) describes the age of attainment of various (Tanner) stages of puberty in girls aged between 12 and 17 years. This study has been useful to define the upper limits of normal pubertal development, but it started at too advanced an age to be informative about the lower limits [34]. Nonetheless, the results of this study, with extrapolation, and those of earlier ones (e.g. see Ref. [51]) set the lower range of normal puberty to 8 years in girls. A

Development of physical changes of puberty in boys

Standards of the ages of male development are supported by the cross-sectional NHES cycle III of 1966–1970 [58], which started at age 12 years and, as with its data on girls, cannot determine the lower limit of pubertal development without extrapolation. In clinical practice, lower limits of normal puberty have been set to 9 years of age on the basis of this study, the findings of Tanner [5] and the results of earlier studies [59].

In a longitudinal study of 78 Caucasian boys aged from 9.5 to 16

Development in boy and girls

The most recent comprehensive evaluation compared data available from the US HES (3042 White boys, 478 African-American boys, 2065 White girls and 505 African-American girls, 1966–1970), the Hispanic Health and Nutrition Examination Survey (717 Mexican-American boys and 512 Mexican-American girls, 1982–1984) and the NHANES III study (259 White boys, 411 African-American boys, 291 White girls, 415 African-American girls, 576 Mexican-American boys and 512 Mexican-American girls, 1988–1994) [64].

Concluding remarks

How do we assimilate all of these sometimes contradictory data? There seems to be no consistently supported evidence for a significant change in the onset age of puberty in the USA on the basis of (admittedly limited) data that have been so often collected in such differing ways that a cross-comparison is flawed. It is clear that the African-American girls develop before White girls, regardless of socio-economic issues. Furthermore, there is evidence that a rising BMI is associated with earlier

Acknowledgements

I wish to thank the Rumsey Community Fund for support of this work.

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