Published online February 1, 2008
PEDIATRICS Vol. 121 Supplement February 2008, pp. S172-S191 (doi:10.1542/peds.2007-1813D)

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SUPPLEMENT ARTICLE

Examination of US Puberty-Timing Data from 1940 to 1994 for Secular Trends: Panel Findings

Susan Y. Euling, PhD^a, Marcia E. Herman-Giddens, PA, DrPH^b, Peter A. Lee, MD, PhD^c, Sherry G. Selevan, PhD^a, Anders Juul, MD, DMSc^d, Thorkild I.A. Sørensen, MD, DMSc^e, Leo Dunkel, PhD^f, John H. Himes, PhD, MPH^g, Grete Teilmann, MD, PhD^d and Shanna H. Swan, PhD^h

^a National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Washington, DC
^b Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
^c Department of Pediatrics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
^d University Department of Growth and Reproduction, Rigshospitalet, Blegdamsvej, Copenhagen, Denmark
^e Danish Epidemiology Science Centre, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
^f Division of Endocrinology DIabetes and Metabolic Diseases, Hospital for Children and Adolescents, Biomedicum, University of Helsinki
^g Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
^h Department of Family & Communty Medicine, University of Missouri, Columbia, Missouri

Whether children, especially girls, are entering and progressing through puberty earlier today than in the mid-1900s has been debated. Secular trend analysis, based on available data, is limited by data comparability among studies in different populations, in different periods of time, and using different methods. As a result, conclusions from data comparisons have not been consistent. An expert panel was asked to evaluate the weight of evidence for whether the data, collected from 1940 to 1994, are sufficient to suggest or establish a secular trend in the timing of puberty markers in US boys or girls. A majority of the panelists agreed that data are sufficient to suggest a trend toward an earlier breast development onset and menarche in girls but not for other female pubertal markers. A minority of panelists concluded that the current data on girls' puberty timing for any marker are insufficient. Almost all panelists concluded, on the basis of few studies and reliability issues of some male puberty markers, that current data for boys are insufficient to evaluate secular trends in male pubertal development. The panel agreed that altered puberty timing should be considered an adverse effect, although the magnitude of change considered adverse was not assessed. The panel recommended (1) additional analyses of existing puberty-timing data to examine secular trends and trends in the temporal sequence of pubertal events; (2) the development of biomarkers for pubertal timing and methods to discriminate fat versus breast tissue, and (3) establishment of cohorts to examine pubertal markers longitudinally within the same individuals.

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Key Words: puberty • secular trends • puberty • menarche • Tanner stage • precocious puberty • growth and development

Abbreviations: Bn—breast development Tanner stage n • PHn—pubic hair development Tanner stage n • PROS—Pediatric Research in Office Settings • NHANES—National Health and Nutrition Examination Survey • HPA—hypothalamic-pituitary-adrenal • Gn—genital development Tanner stage n • HPG—hypothalamic-pituitary-gonadal • SES—socioeconomic status • NHES—National Health Examination Survey • HHANES—Hispanic Health and Nutrition Examination Survey

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Accepted Sep 5, 2007.

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