PEDIATRICS Vol. 108 No. 2 August 2001, pp. 347-353
Earlier Onset of Puberty in Girls: Relation to Increased Body Mass Index and Race
Received May 15, 2000; accepted Dec 28, 2000.
,, §,
, and
From the * Department of Pediatrics, Virginia Commonwealth
University School of Medicine, Richmond, Virginia; Objective. A recent study conducted
by the Pediatric Research in Office Settings network provided evidence
that girls in the United States, especially black girls, are starting
puberty at a younger age than earlier studies had found, but the
reasons for this are not known. Because nutritional status is known to
affect timing of puberty and there is a clear trend for increasing
obesity in US children during the past 25 years, it was hypothesized
that the earlier onset of puberty could be attributable to the
increasing prevalence of obesity in young girls. Therefore, the
objective of this study was to reexamine the Pediatric Research in
Office Settings puberty data by comparing the age-normalized body mass index (BMI-ZS; a crude estimate of fatness) of girls who had breast or
pubic hair development versus those who were still prepubertal, looking
at the effects of age and race.
Results. For white girls, the BMI-ZS were markedly higher
in pubertal versus prepubertal 6- to 9-year-olds; for black girls, a
smaller difference was seen, which was significant only for
9-year-olds. Higher BMI-ZS also were found in girls who had pubic hair
but no breast development versus girls who had neither pubic hair nor
breast development. A multivariate analysis confirms that obesity (as
measured by BMI) is significantly associated with early puberty in
white girls and is associated with early puberty in black girls as
well, but to a lesser extent.
Conclusions. The results are consistent with obesity's
being an important contributing factor to the earlier onset of puberty
in girls. Factors other than obesity, however, perhaps genetic and/or
environmental ones, are needed to explain the higher prevalence of
early puberty in black versus white girls.
Pediatric
Research in Office Settings, American Academy of Pediatrics, Elk Grove
Village, Illinois; § Department of Pediatrics, University of Vermont
College of Medicine, Burlington, Vermont; Department of Statistics,
University of Chicago, Chicago, Illinois; and ¶ School of Public
Health, Department of Maternal and Child Health, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina.
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