Association of body composition and age at menarche in girls and adolescents in the Brazilian Legal Amazon

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[ "autoresLista" => "Ivanice Fernandes Barcellos Gemelli, Edson dos Santos Farias, Poli Mara Spritzer" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ivanice Fernandes Barcellos" "apellidos" => "Gemelli" "email" => array:1 [ 0 => "igemelli500@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Edson dos Santos" "apellidos" => "Farias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Poli Mara" "apellidos" => "Spritzer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Medicina, Pós-Graduação em Ginecologia e Obstetrícia (PPGGO), Porto Alegre, RS, Brazil" "etiqueta" => "a" "identificador" => 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58616 ] ] "descripcion" => array:1 [ "en" => "Cumulative distribution of the proportion of age at menarche of schoolgirls in the city of Porto Velho, Rondônia, Brazil. 2014–2015." ] ] ] "textoCompleto" => "IntroductionPuberty is defined as the period when secondary sexual characteristics and sexual reproduction capacity develop; menarche is an event identified as a marker of reproductive maturity, but this does not occur simultaneously with psychosocial maturity. While genetic factors are the main determinants for puberty onset, other factors appear to be involved, such as nutritional status, general health, and psychological status.<a class="elsevierStyleCrossRef" href="#bib0145">1</a> Age at menarche varies considerably in different countries, but different studies report that this event has been occurring earlierfor the last three decades in different parts of the world.<a class="elsevierStyleCrossRefs" href="#bib0150">2–5</a> In this sense, a tendency has been shown for an earlier age of onset of breast development, as well as an association with a higher BMI.<a class="elsevierStyleCrossRef" href="#bib0170">6</a> Evidence shows an association between excess weight and age at menarche; indeed, there appears to be a coincidence between the worldwide epidemic of obesity and this anticipation on sexual maturation.<a class="elsevierStyleCrossRefs" href="#bib0155">3–5</a>Earlier puberty may lead to negative consequences and health outcomes, such as low self-esteem, adolescent body dissatisfaction, eating disorders, and early sexual initiation, as well as increased risk for diabetes mellitus and breast cancer in adulthood.<a class="elsevierStyleCrossRef" href="#bib0150">2</a> As a consequence of profound biopsychosocial alterations and proximity to sexual maturation, adolescents are the target of worldwide studies to provide opportunities for the prevention of health problems. New studies tend to deepen the associations already reported with an approach in relation to menarche and body variables.Therefore, the aim of the present study was to analyze the association between age at menarche and variables of body composition in girls in the northern region of Brazil, the Brazilian Legal Amazon.MethodsThis was a school-based cross-sectional study carried out in the city of Porto Velho, Rondônia, with 428,527 inhabitants, located in the southwest of the Brazilian Legal Amazon. The estimated total population of enrolled students, attending primary and secondary schools in Porto Velho was 26,546 students, distributed in the 8- to 16-year age range, in the period from November 2014 to December 2015 period, according to the State Secretariat of Education (Rondônia). The schools were stratified according to the number of students using the simple randomization technique of pairing-proportionality with students from public, 479 (44.48%) and private schools, 598 (55.52%).The equation, no=1/Eo2n=N.n/N+no,<a class="elsevierStyleCrossRef" href="#bib0175">7</a> was used to calculate the sample size, based on a prevalence of 50% for excess weight, 3% margin of error, 95% confidence interval, which led to a total of 1026 participants. Considering the loss and refusal of 100 girls (9.75%), the study was conducted with 926 participants. After data collection for analysis, the girls were divided into two groups: those who had undergone menarche (G1; n=727; 72.5%) and those who had not (G2; n=199; 21.5%).The selection process was conducted in three stages: first, a stratified sample proportional to the number of schools in each stratum (north, south, east, and west areas) of the city was made; in the second stage, schools were selected through a proportional random selection in each stratum; in the third stage, the classes were randomly selected, from which all female students were invited to participate in the study. This sampling process ensured that each student had the same chance of being selected. Inclusion criteria were all students and parents who had signed the informed consent form and agreed to participate in this two-stage study: stage 1 questionnaire for the identification of the presence and absence of menarche; and stage 2 anthropometric measurements (body weight, body height, and BMI).Mean age at menarche was determined using the conventional method by questioning the girl if she had had her first menstruation. For positive responses, a retrospective questionnaire was used seeking to identify the day, month, and year of the event. Sexual maturity was assessed through self-assessment with comparison to pictures of the five breast development classification stages (B1–B5), according to criteria described by Marshall and Tanner (1969).<a class="elsevierStyleCrossRef" href="#bib0180">8</a> Girls who had attained B2 or higher with menstruation were considered at menarche, and age at menarche was calculated.Body height was measured using a portable stadiometer according to protocol recommended by Petroski,<a class="elsevierStyleCrossRef" href="#bib0185">9</a> and body weight and BMI using a tetrapolar bioelectrical impedance analyzer (InBody, RJ, Brazil), according to protocol recommended by the National Institutes of Health.<a class="elsevierStyleCrossRef" href="#bib0190">10</a> The team, which was previously trained to apply the questionnaire and take measurements, was made up of a physician-researcher and medical school students; all work was conducted in the school environment.In the descriptive analysis, cumulative frequency of age was calculated. The Kolmogorov and Shapiro–Wilk normality test was used to verify whether the following data were normally distributed: body weight (kg), body height (cm), and BMI z-score (kg/(E[m])2, fat mass (kg) and muscle mass (kg), according to the groups, using as comparison between the two groups the mean, standard deviation, and Student's t-test for independent samples when the distribution was considered normal (p>0.05), and the median, interquartile range, and Mann–Whitney's U test for two independent samples for non-normal distribution (p<0.05), with significance level of p<0.05.Multivariate logistic regression was also performed, estimating the effect of fat and muscle mass on adjusted age at menarche. From logistic regression, odds ratios and 95% confidence intervals (95% CI) were obtained. A p-value <0.05 was considered significant. All statistical analyses were performed using the statistical software package SPSS, version 17.0.The study was approved by the Research Ethics Committee of the Federal University of Rondônia on 07/16/2014, CAAE:335422014.0.0000.5300. Regulatory norms for research involving human beings were followed in accordance with Resolution No. 466/2012, certified by the National Health Council on December 12, 2012.ResultsThe final sample consisted of 926 female schoolchildren, with 727 (72.5%) reporting the presence of menarche and 199 (21.5%) the absence of menarche. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the cumulative distribution of the proportion of age at menarche. Of the 524 girls aged ≤11 years, 381 had undergone menarche, corresponding to 72.70% of the total for age. At 12 years of age, this percentage increased by 10%, at 13 years by 7.9%, at 14 years by 2.8%, and finally at 15 years it increased by 7%, totaling 100% of girls who had undergone menarche (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that at the age groups of ≤11 and 12 years, girls in the G1 were significantly heavier than those in the G2 (p≤0.001). Concerning body height, girls were taller in the G1, at age groups of ≤11, 12 (p≤0.005) and 13 years (≤0.001). When BMI was assessed according to Z-score, using a cutoff point greater than or equal to Z-score +1 (percentile 85) for overweight, no statistical differences were observed between the groups. Fat mass was higher in G1 vs. G2 at all ages, with statistical significance at ≤11, 12 (p≤0.005), and ≥14 years (p≤0.001). Higher muscle mass was also observed in the G1 when compared with G2 at ages ≤11, 12 (p≤0.005), and 13 years (p≤0.001).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The logistic regression analysis for the chance of having undergone menarche, adjusted for chronological age, indicated an odds ratio of 1.04 (95% CI 1.00–1.09, p=0.041) for each 1kg increment in fat mass and an odds ratio of 1.17 (95% CI 1.08–1.27, p<0.001) for each 1kg increment in muscle mass.DiscussionIn the present study, the occurrence of menarche was associated with changes in body composition, more strongly with gain in body fat and muscle mass. When comparing G1 with G2, the variables of body composition presented significant differences, and the ages of 11 and 12 years showed to be the point of greatest interest.Based on this study, 72.7% of the girls at 11 years of age had already undergone menarche. Data published with the same group of girls found the mean age of menarche was 11.52 years.<a class="elsevierStyleCrossRef" href="#bib0195">11</a> Similar studies performed in two cities in southeastern Brazil in 2012 and 2014 found that the mean age of menarche occurred between 12 and 12.2 years.<a class="elsevierStyleCrossRefs" href="#bib0200">12–14</a> In this manner, the present results reveal that in the northern region of Brazil, the Brazilian Legal Amazon, not only menarche occurs at an earlier age when comparing with data from the southeast region, but also that when reaching the age of 13 years, 90.2% of the girls had already undergone menarche, of whom only 17.5% had had menarche between 12 and 13 years of age, confirming that the percentage with the greatest impact was in the age group of up to 11 years.In 1969, Marshall and Tanner,<a class="elsevierStyleCrossRef" href="#bib0180">8</a> studying a group of British girls, found a mean age at menarche of 13.47±0.10, and emphasized the importance of the nutritional status on the age of menarche. Since then, a decrease in age at menarche has been observed, both in developed and developing countries, and studies from around the world have sought to clarify the relationship between the shift in age at menarche and its possible driving factors, among them being genetics, environment, seasonality, nutritional status, and physical activity; menarche was also used as an indicator of socio-economic change, as it suffers interference from the environment.<a class="elsevierStyleCrossRefs" href="#bib0205">13,15,16</a> Using this approach, a Brazilian study in the city of Jundiaí found that the mean age at menarche in 2010 was 12.08 years; in the same study in 2001, the mean age was 12.35 years.<a class="elsevierStyleCrossRef" href="#bib0205">13</a> Similarly, a decreasing trend in age at menarche has been observed for the past 20 years in countries in the Americas, Europe, and Asia.<a class="elsevierStyleCrossRefs" href="#bib0220">16,17</a>In the United States, Anderson et al.<a class="elsevierStyleCrossRef" href="#bib0230">18</a> investigated changes in age at menarche, showing that the mean age for this event in American girls decreased from 12.75 to 12.54 over a 20-year period. In addition, mean age at menarche has decreased over the last 40 years, attributing such reduction to an increase in girls’ obesity.<a class="elsevierStyleCrossRef" href="#bib0235">19</a> Other factors have also been proposed as impacting on the decline of the age of menarche, including social, economic, health, and nutrition improvement.<a class="elsevierStyleCrossRef" href="#bib0200">12</a>For the northern region of Brazil, only comparative data from previous decades are available, referring to the rural Caboclo population, resident on the banks of the Amazon River, on the Island of Ituqui (Pará-Brazil), in 1996 and 1997, in which girls aged 8–19 years and women from 20 to 92 years were analyzed. This study found a mean age at menarche of 12.29 years and considered that the advance in the age at menarche in that population reflected the changes in healthcare and nutrition that occurred in Brazil at the late 1960s.<a class="elsevierStyleCrossRef" href="#bib0240">20</a>Regarding the body composition of the adolescents in the study groups (G1 and G2), significant differences were observed for all variables for those aged less than or equal to 11 and 12 years; only the Z-score for BMI did not present a significant difference for such ages. At 13 years the body height and muscle mass remained significant and, at 14 years, only body fat (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). These findings are in agreement with recent studies, even though most of them did not address all the variables reported in the present study and in which the groups were divided regarding menarche, since this event corresponds to the final phase of pubertal evolution. Wang,<a class="elsevierStyleCrossRef" href="#bib0245">21</a> in a data analysis from NHANESIII (The Third National Health and Nutrition Examination Survey), observed that the onset of sexual maturation (SM) is positively associated with the risk of overweight and obesity. These findings were consistent with a more recent longitudinal study that assessed the association between SM, excess weight, and central adiposity in girls and boys aged 8–18 years and found that weight is negatively associated with SM in boys, but in girls this association is positive and they present greater central adiposity.<a class="elsevierStyleCrossRef" href="#bib0250">22</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Regarding the logistic regression findings, using chronological age as an adjustment factor, the adjusted odds showed that the risk of occurrence of menarche for each 1kg of fat was 1.04 times higher; for each 1kg of muscle, 1.17 times higher. Similarly to the findings of Oliveira et al.,<a class="elsevierStyleCrossRef" href="#bib0250">22</a> who concluded that both genders are taller and heavier in cases of early SM, a positive association with body fat in girls was observed in that study.Regarding the relationship between weight gain and SM, some studies report that, in order to initiate menstruation, girls need to reach an estimated minimum weight of around 47.8kg,<a class="elsevierStyleCrossRef" href="#bib0205">13</a> data consistent with the present study. However, the association between BMI and age at menarche is still not consensual; it has been observed in some studies,<a class="elsevierStyleCrossRef" href="#bib0230">18</a> while others reported no association.<a class="elsevierStyleCrossRef" href="#bib0235">19</a> Moreover, studies addressing the nutritional transition conducted in the 1980s, coincident with the increase in overweight and obesity rates in children and adolescents worldwide, have also shown that age at menarche has been decreasing each decade,<a class="elsevierStyleCrossRef" href="#bib0255">23</a> and this observation was associated with the weight excess rates.<a class="elsevierStyleCrossRefs" href="#bib0195">11,12</a>Comparing an international<a class="elsevierStyleCrossRef" href="#bib0230">18</a> and a Brazilian<a class="elsevierStyleCrossRef" href="#bib0205">13</a> study with the results of the present study, it was observed that in the northern Brazilian Legal Amazon region, menarche not only occurs at an earlier age, but also that the girls who had undergone menarche presented higher levels of body fat and excess weight, findings consistent with a study conducted in Kuwait that found an association between age at menarche and excess weight in schoolchildren.<a class="elsevierStyleCrossRef" href="#bib0260">24</a>In this regard, research has shown that puberty begins earlier in obese girls (20% to 30% higher than normal) than in girls with normal weight; in contrast, girls with malnutrition experience a delay in menstruation.<a class="elsevierStyleCrossRef" href="#bib0265">25</a> Indeed, evidence indicates that childhood obesity is a predictor of early puberty.<a class="elsevierStyleCrossRefs" href="#bib0200">12,23</a> An increase in body fat mass may be a significant signal to cause leptin secretion, stimulating the hypothalamus, and consequently an excessive secretion of GnRH, stimulating the pituitary–ovary axis and starting the pubertal development.<a class="elsevierStyleCrossRef" href="#bib0265">25</a>In turn, girls who reported menarche (G1) at age 11 gained more body fat when compared to those reporting menarche at age 14, despite the fact that body fat did not present any difference between the ages in the group that did not report menarche (G2). This fact may suggest that the precocity of menarche follows from a greater gain of fat, which is a consequence of menarche and not a determinant, a fact already reported by the Fels Longitudinal Study,<a class="elsevierStyleCrossRef" href="#bib0235">19</a> which suggested that early menarche is a marker of body fat.Moreover, when analyzing <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, 11-year-old girls presented a 10-cm (p<0.001) height difference between G1 and G2, and at 14 years the difference in absolute values significantly reduced showing a slight upward inversion for the G2 (1.61m for G1 vs. 1.64m for G2). This finding is in agreement with the most recent studies regarding the influence of menarche on body height, showing that, regardless of age at menarche, the peak of growth spurt occurs naturally without difference between the final height in the two groups. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> showed no significant difference between the two groups in final height, which occurred around 16 years of age. The study by Marshall and Tanner<a class="elsevierStyleCrossRef" href="#bib0180">8</a> stated that girls who mature earlier reach the same final height than those who reach maturity later. Other authors found a difference of 1cm between the girls, those who menstruate later being taller, but this difference was not considered statistically significant.<a class="elsevierStyleCrossRef" href="#bib0270">26</a>In girls, growth spurt most often marks the onset of puberty, and accounts for 82.5% of their adult stature; therefore, pubertal gain represents approximately 20% of their final height,<a class="elsevierStyleCrossRef" href="#bib0270">26</a> which maintains a correlation of 0.81 (considered moderately high) with the girl's height at the beginning of the spurt.There are differences regarding the timing of the growth spurt. The final height of an individual is the height reached when growth has ceased, that is, their height in adult age. Prader,<a class="elsevierStyleCrossRef" href="#bib0275">27</a> referring to the First Zurich Longitudinal Growth Study, considered that 99% of the final height was reached at 15.2 years in girls and 16.8 years in boys.In addressing the outcome of early sexual maturation, a recent study concluded that girls who reach menarche earlier show a greater number of sexually transmitted diseases and gestation up to the age of 18 years.<a class="elsevierStyleCrossRef" href="#bib0280">28</a> In turn, subfertility appears to be related, at least partially, to the reduction of ovulation frequency, and body weight seems to be a regulator of hypothalamic-pituitary-gonadal axis activity.Finally, besides the outcomes of anticipated age at menarche and its association with excess weight, this issue brings about a worldwide health concern. In fact, in addition to the association of fat with the occurrence of menarche, the results from the present study also point to an association of muscle weight with age of menarche. This finding may bring new insight to questions on the causes of pubertal precocity, making it possible to analyze other aspects of modifiable factors, not just body fat, even in the presence of a high prevalence of excess weight. This is confirmed by the fact that the adjusted odds ratio for the risk of occurrence of menarche was associated with greater muscle mass; and considering that the variation in height and muscle was present, and albeit smaller, it was more stable for all ages. Such findings may be associated with growth, suggesting the need for a greater emphasis in this area. Low levels of estradiol inhibit IgF1, but higher levels act as a stimulus, and sources of estrogen of external origin may be an interesting path to be explored in this context; especially because this was a group of adolescents from the Brazilian Legal Amazon, where lifestyle characteristics and regional particularities may represent a point of interference in the hormonal axis which determines the timing of puberty.Consideration should be given to the fact that the present study did not evaluate the occurrence of menarche; therefore, the data were only from the date of collection, other studies found have the same bias.<a class="elsevierStyleCrossRef" href="#bib0210">14</a> The scarcity of Brazilian studies and the absence of previous comparative studies in the northern region of Brazil limit the comparative and evolutionary pattern of this association, valuing the percentage of risk.Despite the impact of the association presented here, other studies that address body composition and age at menarche are necessary to better clarify the relevance of such findings for the future health of these adolescents.Informed consentThe study was approved by the Research Ethics Committee of the Federal University of Rondônia on 07/16/2014, CAAE:335422014.0.0000.5300. Regulatory norms for research involving human beings were followed in accordance with Resolution number 466/2012, certified by the National Health Council on December 12, 2012, with necessary prior written consent from school directors and parents/guardians.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1322281" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1219608" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1322280" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1219609" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Informed consent" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack456117" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-28" "fechaAceptado" => "2018-09-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1219608" "palabras" => array:3 [ 0 => "Menarche" 1 => "Body composition" 2 => "Body height" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1219609" "palabras" => array:3 [ 0 => "Menarca" 1 => "Composição corporal" 2 => "Altura corporal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo analyze the association between age at menarche and variables of body composition in girls from the Northern region of Brazil, the Brazilian Legal Amazon. MethodThe sample was composed of 926 school girls, aged between 8 and 18 years, divided into two groups, those who had (G1; n=727; 72.5%) and had not undergone menarche (G2; n=199; 21.5%), from public and private schools, using the stratified random proportional sampling technique. Weight, fat weight, muscle weight, and body mass index were measured using bioimpedance analysis. Body height was measured using a stadiometer. Age at menarche was obtained using the conventional method. For the evaluation of sexual maturation, self-assessment was performed according to criteria described by Tanner. ResultsThe highest cumulative distribution of menarche was found at age 11, and presented significant differences between G1 and G2 at ages 11 and 12 years in all variables of body composition, except body mass index Z-score. Fat and muscle mass were associated with age at menarche. ConclusionThe present results support the notion of menarche anticipation in girls from Brazilian Amazon and its association with body composition. Further studies are needed to investigate the influence of other possible factors that may interfere with the time of growth spurt, thus determining the timing of puberty in these girls in comparison to other regions of Brazil." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoAnalisar a associação entre idade da menarca e variáveis da composição corporal em meninas na região norte do Brasil, a Amazônia brasileira. MétodoA amostra foi composta por 926 meninas em idade escolar, entre 8 e 18 anos, divididas em dois grupos, com presença de menarca (G1), n=727 (72,5%) e ausência (G2) n=199 (21,5%), provenientes de escolas públicas e privadas, com a técnica de amostragem aleatória estratificada proporcional. Peso, massa de gordura, massa muscular e índice de massa corporal foram medidos através da análise de bioimpedância. A altura foi medida com um estadiômetro. A idade da menarca foi obtida pelo método status quo. Para a avaliação da maturação sexual, a autoavaliação foi realizada de acordo com os critérios descritos por Tanner. ResultadosA maior distribuição cumulativa da menarca foi encontrada aos 11 anos, e apresentou diferenças significativas entre a presença e ausência de menarca aos 11 e 12 anos em todas as variáveis de composição corporal, exceto o escore-z do índice de massa corporal. Massa de gordura e massa muscular foram associadas com a idade da menarca. ConclusãoOs resultados apresentados corroboram a antecipação da menarca em meninas da Amazônia brasileira e sua associação com a composição corporal. Mais estudos são necessários para investigar a influência de outros possíveis fatores que podem interferir na época do estirão de crescimento e determinar, assim, a ocorrência da puberdade em meninas amazônicas em comparação com as de outras regiões do Brasil." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Gemelli IF, Farias ES, Spritzer PM. Association of body composition and age at menarche in girls and adolescents in the Brazilian Legal Amazon. J Pediatr (Rio J). 2020;96:240–6." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 753 "Ancho" => 2083 "Tamanyo" => 58616 ] ] "descripcion" => array:1 [ "en" => "Cumulative distribution of the proportion of age at menarche of schoolgirls in the city of Porto Velho, Rondônia, Brazil. 2014–2015." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "AM, age at menarche; BM, body mass." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col">AM (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Weight<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Height<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Z-score BMI<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Fat mass<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Muscle mass<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a></th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">G2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">≤11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">524 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">39.1 (34.1–45.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">52.0<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (46.5–61.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.47±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.57<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a>±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">0.30±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">0.31±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">8.90 (6.3–14.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">15.90<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (11.5–21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">15.0 (13.2–17.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">19.7<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (17.6–21.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">237 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">40.9 (36.7–48.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">50.6<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (45.5–56.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.52±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.58<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a>±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">0.26±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">0.27±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">8.70 (6.1–13.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">13.60<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (10.5–18.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">16.9 (14.5–18.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">19.5<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> (17.8–21.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">52.1 (40.5–56.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">50.0 (46.0–59.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.55±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.69<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a>±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">−0.32±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">0.05±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">9.90 (7.90–17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">13.70 (11.2–18.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">16.7 (14.9–19.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">19.3<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> (17.5–21.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">≥14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">47.0 (46.2–47.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">52.6 (47.3–59.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.64±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">1.61±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">−0.32±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">−0.15±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">9.0 (8.9–9.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">14.9<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> (11.5–21.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">19.8 (19.6–20.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="middle">19.8 (17.7–22.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2266513.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Mann–Witney test: represented by median and interquartile." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Student's t-test: represented by mean and standard deviation." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "p<0.001." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "p<0.05 for comparisons between G1 and G2." ] ] ] "descripcion" => array:1 [ "en" => "Mean, standard deviation, median, and interquartile of weight (kg), body height (m), Z-score BMI, fat mass (kg), and muscle mass (kg) according to age and absence (G1) and presence (G2) of menarche in schoolgirls in the city of Porto Velho, Rondônia, Brazil, 2014–2015." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted odds ratios (95% CI)<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.04 (1.00–1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.1 7(1.08–1.27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2266512.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "Adjusted for chronological age." ] ] ] "descripcion" => array:1 [ "en" => "Multiple analysis to associate the presence of age at menarche (AM) in schoolgirls with the variables included in the model." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between puberty and weight, height and body mass index in a developing community" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. 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Associação da composição corporal e idade da menarca em meninas e adolescentes na Amazônia Brasileira

Ivanice Fernandes Barcellos Gemellia,

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igemelli500@hotmail.com

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, Edson dos Santos Fariasb, Poli Mara Spritzerc

a Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Medicina, Pós-Graduação em Ginecologia e Obstetrícia (PPGGO), Porto Alegre, RS, Brazil

b Universidade Federal de Rondônia (UNIR), Departamento de Educação Física, Porto Velho, RO, Brazil

c Universidade Federal Rio Grande do Sul (UFRGS), Departamento de Fisiologia, Porto Alegre, RS, Brazil

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a tendency has been shown for an earlier age of onset of breast development&#44; as well as an association with a higher BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> Evidence shows an association between excess weight and age at menarche&#59; indeed&#44; there appears to be a coincidence between the worldwide epidemic of obesity and this anticipation on sexual maturation&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Earlier puberty may lead to negative consequences and health outcomes&#44; such as low self-esteem&#44; adolescent body dissatisfaction&#44; eating disorders&#44; and early sexual initiation&#44; as well as increased risk for diabetes mellitus and breast cancer in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> As a consequence of profound biopsychosocial alterations and proximity to sexual maturation&#44; adolescents are the target of worldwide studies to provide opportunities for the prevention of health problems&#46; New studies tend to deepen the associations already reported with an approach in relation to menarche and body variables&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; the aim of the present study was to analyze the association between age at menarche and variables of body composition in girls in the northern region of Brazil&#44; the Brazilian Legal Amazon&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a school-based cross-sectional study carried out in the city of Porto Velho&#44; Rond&#244;nia&#44; with 428&#44;527 inhabitants&#44; located in the southwest of the Brazilian Legal Amazon&#46; The estimated total population of enrolled students&#44; attending primary and secondary schools in Porto Velho was 26&#44;546 students&#44; distributed in the 8- to 16-year age range&#44; in the period from November 2014 to December 2015 period&#44; according to the State Secretariat of Education &#40;Rond&#244;nia&#41;&#46; The schools were stratified according to the number of students using the simple randomization technique of pairing-proportionality with students from public&#44; 479 &#40;44&#46;48&#37;&#41; and private schools&#44; 598 &#40;55&#46;52&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The equation&#44; no<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#47;Eo<span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">N</span>&#46;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>no&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> was used to calculate the sample size&#44; 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south&#44; east&#44; and west areas&#41; of the city was made&#59; in the second stage&#44; schools were selected through a proportional random selection in each stratum&#59; in the third stage&#44; the classes were randomly selected&#44; from which all female students were invited to participate in the study&#46; This sampling process ensured that each student had the same chance of being selected&#46; Inclusion criteria were all students and parents who had signed the informed consent form and agreed to participate in this two-stage study&#58; stage 1 questionnaire for the identification of the presence and absence of menarche&#59; and stage 2 anthropometric measurements &#40;body weight&#44; body height&#44; and BMI&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Mean age at menarche was determined using the conventional method by questioning the girl if she had had her first menstruation&#46; For positive responses&#44; a retrospective questionnaire was used seeking to identify the day&#44; month&#44; and year of the event&#46; Sexual maturity was assessed through self-assessment with comparison to pictures of the five breast development classification stages &#40;B1&#8211;B5&#41;&#44; according to criteria described by Marshall and Tanner &#40;1969&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> Girls who had attained B2 or higher with menstruation were considered at menarche&#44; and age at menarche was calculated&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Body height was measured using a portable stadiometer according to protocol recommended by Petroski&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a> and body weight and BMI using a tetrapolar bioelectrical impedance analyzer &#40;InBody&#44; RJ&#44; Brazil&#41;&#44; according to protocol recommended by the National Institutes of Health&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a> The team&#44; which was previously trained to apply the questionnaire and take measurements&#44; was made up of a physician-researcher and medical school students&#59; all work was conducted in the school environment&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the descriptive analysis&#44; cumulative frequency of age was calculated&#46; The Kolmogorov and Shapiro&#8211;Wilk normality test was used to verify whether the following data were normally distributed&#58; body weight &#40;kg&#41;&#44; body height &#40;cm&#41;&#44; and BMI <span class="elsevierStyleItalic">z</span>-score &#40;kg&#47;&#40;<span class="elsevierStyleItalic">E</span>&#91;<span class="elsevierStyleItalic">m</span>&#93;&#41;<span class="elsevierStyleSup">2</span>&#44; fat mass &#40;kg&#41; and muscle mass &#40;kg&#41;&#44; according to the groups&#44; using as comparison between the two groups the mean&#44; standard deviation&#44; and Student&#39;s <span class="elsevierStyleItalic">t</span>-test for independent samples when the distribution was considered normal &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and the median&#44; interquartile range&#44; and Mann&#8211;Whitney&#39;s <span class="elsevierStyleItalic">U</span> test for two independent samples for non-normal distribution &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; with significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Multivariate logistic regression was also performed&#44; estimating the effect of fat and muscle mass on adjusted age at menarche&#46; From logistic regression&#44; odds ratios and 95&#37; confidence intervals &#40;95&#37; CI&#41; were obtained&#46; A <span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05 was considered significant&#46; All statistical analyses were performed using the statistical software package SPSS&#44; version 17&#46;0&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committee of the Federal University of Rond&#244;nia on 07&#47;16&#47;2014&#44; CAAE&#58;335422014&#46;0&#46;0000&#46;5300&#46; Regulatory norms for research involving human beings were followed in accordance with Resolution No&#46; 466&#47;2012&#44; certified by the National Health Council on December 12&#44; 2012&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The final sample consisted of 926 female schoolchildren&#44; with 727 &#40;72&#46;5&#37;&#41; reporting the presence of menarche and 199 &#40;21&#46;5&#37;&#41; the absence of menarche&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the cumulative distribution of the proportion of age at menarche&#46; Of the 524 girls aged &#8804;11 years&#44; 381 had undergone menarche&#44; corresponding to 72&#46;70&#37; of the total for age&#46; At 12 years of age&#44; this percentage increased by 10&#37;&#44; at 13 years by 7&#46;9&#37;&#44; at 14 years by 2&#46;8&#37;&#44; and finally at 15 years it increased by 7&#37;&#44; totaling 100&#37; of girls who had undergone menarche &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that at the age groups of &#8804;11 and 12 years&#44; girls in the G1 were significantly heavier than those in the G2 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Concerning body height&#44; girls were taller in the G1&#44; at age groups of &#8804;11&#44; 12 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; and 13 years &#40;&#8804;0&#46;001&#41;&#46; When BMI was assessed according to <span class="elsevierStyleItalic">Z</span>-score&#44; using a cutoff point greater than or equal to <span class="elsevierStyleItalic">Z</span>-score &#43;1 &#40;percentile 85&#41; for overweight&#44; no statistical differences were observed between the groups&#46; Fat mass was higher in G1 <span class="elsevierStyleItalic">vs</span>&#46; G2 at all ages&#44; with statistical significance at &#8804;11&#44; 12 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; and &#8805;14 years &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Higher muscle mass was also observed in the G1 when compared with G2 at ages &#8804;11&#44; 12 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; and 13 years &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The logistic regression analysis for the chance of having undergone menarche&#44; adjusted for chronological age&#44; indicated an odds ratio of 1&#46;04 &#40;95&#37; CI 1&#46;00&#8211;1&#46;09&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41; for each 1<span class="elsevierStyleHsp" style=""></span>kg increment in fat mass and an odds ratio of 1&#46;17 &#40;95&#37; CI 1&#46;08&#8211;1&#46;27&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; for each 1<span class="elsevierStyleHsp" style=""></span>kg increment in muscle mass&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the present study&#44; the occurrence of menarche was associated with changes in body composition&#44; more strongly with gain in body fat and muscle mass&#46; When comparing G1 with G2&#44; the variables of body composition presented significant differences&#44; and the ages of 11 and 12 years showed to be the point of greatest interest&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Based on this study&#44; 72&#46;7&#37; of the girls at 11 years of age had already undergone menarche&#46; Data published with the same group of girls found the mean age of menarche was 11&#46;52 years&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> Similar studies performed in two cities in southeastern Brazil in 2012 and 2014 found that the mean age of menarche occurred between 12 and 12&#46;2 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#8211;14</span></a> In this manner&#44; the present results reveal that in the northern region of Brazil&#44; the Brazilian Legal Amazon&#44; not only menarche occurs at an earlier age when comparing with data from the southeast region&#44; but also that when reaching the age of 13 years&#44; 90&#46;2&#37; of the girls had already undergone menarche&#44; of whom only 17&#46;5&#37; had had menarche between 12 and 13 years of age&#44; confirming that the percentage with the greatest impact was in the age group of up to 11 years&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In 1969&#44; Marshall and Tanner&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> studying a group of British girls&#44; found a mean age at menarche of 13&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;10&#44; and emphasized the importance of the nutritional status on the age of menarche&#46; Since then&#44; a decrease in age at menarche has been observed&#44; both in developed and developing countries&#44; and studies from around the world have sought to clarify the relationship between the shift in age at menarche and its possible driving factors&#44; among them being genetics&#44; environment&#44; seasonality&#44; nutritional status&#44; and physical activity&#59; menarche was also used as an indicator of socio-economic change&#44; as it suffers interference from the environment&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#44;15&#44;16</span></a> Using this approach&#44; a Brazilian study in the city of Jundia&#237; found that the mean age at menarche in 2010 was 12&#46;08 years&#59; in the same study in 2001&#44; the mean age was 12&#46;35 years&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> Similarly&#44; a decreasing trend in age at menarche has been observed for the past 20 years in countries in the Americas&#44; Europe&#44; and Asia&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the United States&#44; Anderson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> investigated changes in age at menarche&#44; showing that the mean age for this event in American girls decreased from 12&#46;75 to 12&#46;54 over a 20-year period&#46; In addition&#44; mean age at menarche has decreased over the last 40 years&#44; attributing such reduction to an increase in girls&#8217; obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> Other factors have also been proposed as impacting on the decline of the age of menarche&#44; including social&#44; economic&#44; health&#44; and nutrition improvement&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">For the northern region of Brazil&#44; only comparative data from previous decades are available&#44; referring to the rural <span class="elsevierStyleItalic">Caboclo</span> population&#44; resident on the banks of the Amazon River&#44; on the Island of Ituqui &#40;Par&#225;-Brazil&#41;&#44; in 1996 and 1997&#44; in which girls aged 8&#8211;19 years and women from 20 to 92 years were analyzed&#46; This study found a mean age at menarche of 12&#46;29 years and considered that the advance in the age at menarche in that population reflected the changes in healthcare and nutrition that occurred in Brazil at the late 1960s&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the body composition of the adolescents in the study groups &#40;G1 and G2&#41;&#44; significant differences were observed for all variables for those aged less than or equal to 11 and 12 years&#59; only the <span class="elsevierStyleItalic">Z</span>-score for BMI did not present a significant difference for such ages&#46; At 13 years the body height and muscle mass remained significant and&#44; at 14 years&#44; only body fat &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; These findings are in agreement with recent studies&#44; even though most of them did not address all the variables reported in the present study and in which the groups were divided regarding menarche&#44; since this event corresponds to the final phase of pubertal evolution&#46; Wang&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> in a data analysis from NHANESIII &#40;The Third National Health and Nutrition Examination Survey&#41;&#44; observed that the onset of sexual maturation &#40;SM&#41; is positively associated with the risk of overweight and obesity&#46; These findings were consistent with a more recent longitudinal study that assessed the association between SM&#44; excess weight&#44; and central adiposity in girls and boys aged 8&#8211;18 years and found that weight is negatively associated with SM in boys&#44; but in girls this association is positive and they present greater central adiposity&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding the logistic regression findings&#44; using chronological age as an adjustment factor&#44; the adjusted odds showed that the risk of occurrence of menarche for each 1<span class="elsevierStyleHsp" style=""></span>kg of fat was 1&#46;04 times higher&#59; for each 1<span class="elsevierStyleHsp" style=""></span>kg of muscle&#44; 1&#46;17 times higher&#46; Similarly to the findings of Oliveira et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> who concluded that both genders are taller and heavier in cases of early SM&#44; a positive association with body fat in girls was observed in that study&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding the relationship between weight gain and SM&#44; some studies report that&#44; in order to initiate menstruation&#44; girls need to reach an estimated minimum weight of around 47&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> data consistent with the present study&#46; However&#44; the association between BMI and age at menarche is still not consensual&#59; it has been observed in some studies&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> while others reported no association&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> Moreover&#44; studies addressing the nutritional transition conducted in the 1980s&#44; coincident with the increase in overweight and obesity rates in children and adolescents worldwide&#44; have also shown that age at menarche has been decreasing each decade&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> and this observation was associated with the weight excess rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Comparing an international<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> and a Brazilian<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> study with the results of the present study&#44; it was observed that in the northern Brazilian Legal Amazon region&#44; menarche not only occurs at an earlier age&#44; but also that the girls who had undergone menarche presented higher levels of body fat and excess weight&#44; findings consistent with a study conducted in Kuwait that found an association between age at menarche and excess weight in schoolchildren&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In this regard&#44; research has shown that puberty begins earlier in obese girls &#40;20&#37; to 30&#37; higher than normal&#41; than in girls with normal weight&#59; in contrast&#44; girls with malnutrition experience a delay in menstruation&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a> Indeed&#44; evidence indicates that childhood obesity is a predictor of early puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#44;23</span></a> An increase in body fat mass may be a significant signal to cause leptin secretion&#44; stimulating the hypothalamus&#44; and consequently an excessive secretion of GnRH&#44; stimulating the pituitary&#8211;ovary axis and starting the pubertal development&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In turn&#44; girls who reported menarche &#40;G1&#41; at age 11 gained more body fat when compared to those reporting menarche at age 14&#44; despite the fact that body fat did not present any difference between the ages in the group that did not report menarche &#40;G2&#41;&#46; This fact may suggest that the precocity of menarche follows from a greater gain of fat&#44; which is a consequence of menarche and not a determinant&#44; a fact already reported by the Fels Longitudinal Study&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> which suggested that early menarche is a marker of body fat&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Moreover&#44; when analyzing <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; 11-year-old girls presented a 10-cm &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; height difference between G1 and G2&#44; and at 14 years the difference in absolute values significantly reduced showing a slight upward inversion for the G2 &#40;1&#46;61<span class="elsevierStyleHsp" style=""></span>m for G1 <span class="elsevierStyleItalic">vs</span>&#46; 1&#46;64<span class="elsevierStyleHsp" style=""></span>m for G2&#41;&#46; This finding is in agreement with the most recent studies regarding the influence of menarche on body height&#44; showing that&#44; regardless of age at menarche&#44; the peak of growth spurt occurs naturally without difference between the final height in the two groups&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> showed no significant difference between the two groups in final height&#44; which occurred around 16 years of age&#46; The study by Marshall and Tanner<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> stated that girls who mature earlier reach the same final height than those who reach maturity later&#46; Other authors found a difference of 1<span class="elsevierStyleHsp" style=""></span>cm between the girls&#44; those who menstruate later being taller&#44; but this difference was not considered statistically significant&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In girls&#44; growth spurt most often marks the onset of puberty&#44; and accounts for 82&#46;5&#37; of their adult stature&#59; therefore&#44; pubertal gain represents approximately 20&#37; of their final height&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> which maintains a correlation of 0&#46;81 &#40;considered moderately high&#41; with the girl&#39;s height at the beginning of the spurt&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">There are differences regarding the timing of the growth spurt&#46; The final height of an individual is the height reached when growth has ceased&#44; that is&#44; their height in adult age&#46; Prader&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> referring to the First Zurich Longitudinal Growth Study&#44; considered that 99&#37; of the final height was reached at 15&#46;2 years in girls and 16&#46;8 years in boys&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In addressing the outcome of early sexual maturation&#44; a recent study concluded that girls who reach menarche earlier show a greater number of sexually transmitted diseases and gestation up to the age of 18 years&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> In turn&#44; subfertility appears to be related&#44; at least partially&#44; to the reduction of ovulation frequency&#44; and body weight seems to be a regulator of hypothalamic-pituitary-gonadal axis activity&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Finally&#44; besides the outcomes of anticipated age at menarche and its association with excess weight&#44; this issue brings about a worldwide health concern&#46; In fact&#44; in addition to the association of fat with the occurrence of menarche&#44; the results from the present study also point to an association of muscle weight with age of menarche&#46; This finding may bring new insight to questions on the causes of pubertal precocity&#44; making it possible to analyze other aspects of modifiable factors&#44; not just body fat&#44; even in the presence of a high prevalence of excess weight&#46; This is confirmed by the fact that the adjusted odds ratio for the risk of occurrence of menarche was associated with greater muscle mass&#59; and considering that the variation in height and muscle was present&#44; and albeit smaller&#44; it was more stable for all ages&#46; Such findings may be associated with growth&#44; suggesting the need for a greater emphasis in this area&#46; Low levels of estradiol inhibit IgF1&#44; but higher levels act as a stimulus&#44; and sources of estrogen of external origin may be an interesting path to be explored in this context&#59; especially because this was a group of adolescents from the Brazilian Legal Amazon&#44; where lifestyle characteristics and regional particularities may represent a point of interference in the hormonal axis which determines the timing of puberty&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Consideration should be given to the fact that the present study did not evaluate the occurrence of menarche&#59; therefore&#44; the data were only from the date of collection&#44; other studies found have the same bias&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a> The scarcity of Brazilian studies and the absence of previous comparative studies in the northern region of Brazil limit the comparative and evolutionary pattern of this association&#44; valuing the percentage of risk&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Despite the impact of the association presented here&#44; other studies that address body composition and age at menarche are necessary to better clarify the relevance of such findings for the future health of these adolescents&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committee of the Federal University of Rond&#244;nia on 07&#47;16&#47;2014&#44; CAAE&#58;335422014&#46;0&#46;0000&#46;5300&#46; Regulatory norms for research involving human beings were followed in accordance with Resolution number 466&#47;2012&#44; certified by the National Health Council on December 12&#44; 2012&#44; with necessary prior written consent from school directors and parents&#47;guardians&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the association between age at menarche and variables of body composition in girls from the Northern region of Brazil&#44; the Brazilian Legal Amazon&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The sample was composed of 926 school girls&#44; aged between 8 and 18 years&#44; divided into two groups&#44; those who had &#40;G1&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>727&#59; 72&#46;5&#37;&#41; and had not undergone menarche &#40;G2&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>199&#59; 21&#46;5&#37;&#41;&#44; from public and private schools&#44; using the stratified random proportional sampling technique&#46; Weight&#44; fat weight&#44; muscle weight&#44; and body mass index were measured using bioimpedance analysis&#46; Body height was measured using a stadiometer&#46; Age at menarche was obtained using the conventional method&#46; For the evaluation of sexual maturation&#44; self-assessment was performed according to criteria described by Tanner&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The highest cumulative distribution of menarche was found at age 11&#44; and presented significant differences between G1 and G2 at ages 11 and 12 years in all variables of body composition&#44; except body mass index <span class="elsevierStyleItalic">Z</span>-score&#46; Fat and muscle mass were associated with age at menarche&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The present results support the notion of menarche anticipation in girls from Brazilian Amazon and its association with body composition&#46; Further studies are needed to investigate the influence of other possible factors that may interfere with the time of growth spurt&#44; thus determining the timing of puberty in these girls in comparison to other regions of Brazil&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analisar a associa&#231;&#227;o entre idade da menarca e vari&#225;veis da composi&#231;&#227;o corporal em meninas na regi&#227;o norte do Brasil&#44; a Amaz&#244;nia brasileira&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A amostra foi composta por 926 meninas em idade escolar&#44; entre 8 e 18 anos&#44; divididas em dois grupos&#44; com presen&#231;a de menarca &#40;G1&#41;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>727 &#40;72&#44;5&#37;&#41; e aus&#234;ncia &#40;G2&#41; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>199 &#40;21&#44;5&#37;&#41;&#44; provenientes de escolas p&#250;blicas e privadas&#44; com a t&#233;cnica de amostragem aleat&#243;ria estratificada proporcional&#46; Peso&#44; massa de gordura&#44; massa muscular e &#237;ndice de massa corporal foram medidos atrav&#233;s da an&#225;lise de bioimped&#226;ncia&#46; A altura foi medida com um estadi&#244;metro&#46; A idade da menarca foi obtida pelo m&#233;todo <span class="elsevierStyleItalic">status quo</span>&#46; Para a avalia&#231;&#227;o da matura&#231;&#227;o sexual&#44; a autoavalia&#231;&#227;o foi realizada de acordo com os crit&#233;rios descritos por Tanner&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A maior distribui&#231;&#227;o cumulativa da menarca foi encontrada aos 11 anos&#44; e apresentou diferen&#231;as significativas entre a presen&#231;a e aus&#234;ncia de menarca aos 11 e 12 anos em todas as vari&#225;veis de composi&#231;&#227;o corporal&#44; exceto o escore-z do &#237;ndice de massa corporal&#46; Massa de gordura e massa muscular foram associadas com a idade da menarca&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Os resultados apresentados corroboram a antecipa&#231;&#227;o da menarca em meninas da Amaz&#244;nia brasileira e sua associa&#231;&#227;o com a composi&#231;&#227;o corporal&#46; Mais estudos s&#227;o necess&#225;rios para investigar a influ&#234;ncia de outros poss&#237;veis fatores que podem interferir na &#233;poca do estir&#227;o de crescimento e determinar&#44; assim&#44; a ocorr&#234;ncia da puberdade em meninas amaz&#244;nicas em compara&#231;&#227;o com as de outras regi&#245;es do Brasil&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Gemelli IF&#44; Farias ES&#44; Spritzer PM&#46; Association of body composition and age at menarche in girls and adolescents in the Brazilian Legal Amazon&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;240&#8211;6&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cumulative distribution of the proportion of age at menarche of schoolgirls in the city of Porto Velho&#44; Rond&#244;nia&#44; Brazil&#46; 2014&#8211;2015&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AM&#44; age at menarche&#59; BM&#44; body mass&#46;</p>"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Boden"
                            1 => "D&#46;M&#46; Fergusson"
                            2 => "L&#46;J&#46; Horwood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Child Adolesc Psychiatr"
                        "fecha" => "2011"
                        "volumen" => "50"
                        "paginaInicial" => "132"
                        "paginaFinal" => "140"
                      ]
                    ]
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                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack456117"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0175" class="elsevierStylePara elsevierViewall">The authors wish to thank the medical school students who assisted in the collection of data&#44; and the schoolteachers for their patience and valuable assistance&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00217557/0000009600000002/v1_202003290632/S0021755718306363/v1_202003290632/en/main.assets"
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    "identificador" => "10179"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
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    ]
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  ]
  "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009600000002/v1_202003290632/S0021755718306363/v1_202003290632/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718306363?idApp=UINPBA000049"
]

Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2018.10.012

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Year/Month	Html	Pdf	Total

2024 November	6	11	17
2024 October	35	26	61
2024 September	53	32	85
2024 August	51	47	98
2024 July	55	53	108
2024 June	34	23	57
2024 May	43	20	63
2024 April	47	27	74
2024 March	57	24	81
2024 February	48	29	77
2024 January	44	39	83
2023 December	32	21	53
2023 November	42	36	78
2023 October	36	38	74
2023 September	28	34	62
2023 August	32	22	54
2023 July	37	12	49
2023 June	34	10	44
2023 May	44	16	60
2023 April	32	19	51
2023 March	49	25	74
2023 February	35	17	52
2023 January	34	24	58
2022 December	38	29	67
2022 November	54	31	85
2022 October	55	36	91
2022 September	37	37	74
2022 August	42	33	75
2022 July	26	26	52
2022 June	30	35	65
2022 May	24	27	51
2022 April	47	35	82
2022 March	27	48	75
2022 February	30	25	55
2022 January	18	18	36
2021 December	10	22	32
2021 November	8	15	23
2021 October	14	15	29
2021 September	11	6	17
2021 August	6	11	17
2021 July	6	7	13
2021 June	6	9	15
2021 May	17	17	34
2021 April	13	20	33
2021 March	21	25	46
2021 February	13	8	21
2021 January	13	11	24
2020 December	14	10	24
2020 November	20	16	36
2020 October	23	6	29
2020 September	21	14	35
2020 August	33	5	38
2020 July	22	6	28
2020 June	16	4	20
2020 May	42	20	62
2020 April	30	46	76
2020 March	25	18	43
2020 February	56	22	78
2020 January	52	28	80
2019 December	29	18	47
2019 November	25	4	29
2019 October	26	19	45
2019 September	25	15	40
2019 August	10	7	17
2019 July	10	10	20
2019 June	16	18	34
2019 May	14	9	23
2019 April	34	22	56
2019 March	7	6	13
2019 February	2	2	4

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