Mi-Kyoung Kwon; Eun Min Seo; Kyong Park

doi:10.4163/jnh.2015.48.4.344

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Kwon, Seo, and Park: Determinants of age at menarche in Korean elementary school girls∗

Research Article

Commun Sci Disord 2015;48(4):344-351.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.4.344

Determinants of age at menarche in Korean elementary school girls^∗

Mi-Kyoung Kwon^1,^∗∗, Eun Min Seo^2,^∗∗, Kyong Park^1,^2,^†

¹Department of Nutrition Management, Graduate School of Environment and Public Health Studies, Yeungnam University, Daegu 705-717, Korea

²Department of Food and Nutrition, Yeungnam University, Gyeongbuk 712-749, Korea

^†To whom correspondence should be addressed. tel: +82-53-810-2879, e-mail: kypark@ynu.ac.kr

^∗ This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014R1A1A3049866).

^∗∗ These two authors contributed equally to this study.

Received 17 February 2015 Revised 16 March 2015 Accepted 24 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

During the recent decades, the age at menarche continued to decline in Korea and worldwide. Prior studies have suggested that early menarche may increase the risk of various social, psychological, and physical health problems in young adolescent girls, but little is known about the determinants associated with early menarche. The purpose of this study is to evaluate independent determinants of early menarche among 5th~6th female graders in South Korea.

Methods:

Our analysis was conducted in 95 menarcheal girls and 95 age-matched premenarcheal girls residing in Daegu, South Korea. Demographic and lifestyle characteristics were collected using survey questionnaires for children and parents. Dietary information was assessed by 2 day~24 hour food records and survey questionnaires, which were completed by both children and their parents. Anthropometric data were obtained from the student health check-ups at the school.

Results:

A multiple logistic regression analysis using a conditional likelihood method was performed for simultaneous evaluation of several risk factors. There were significant differences in that higher proportion of obesity (OR, odds ratio = 5.60, 95% CI, confidence interval = 1.34~23.42), shorter sleep duration (OR = 0.45, 95% CI = 0.23~0.87), and younger mother's age at menarche (OR = 0.64, 95% CI = 0.44~0.93) were observed in the menarcheal group compared to the premenarcheal group.

Conclusion:

These findings indicate a possible association of sleep duration, mother's menarcheal age, and obesity with age at menarche. A well-planned, prospective cohort study is warranted to examine causal relationship.

Keywords: age at menarche, puberty, growth, obesity, determinants

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Fig. 1.

Mean frequency of consumption of protein-rich foods consumed by menarcheal group and premenarcheal group. The differences between menarcheal group and premenarcheal group were tested by paired t-test, and error bars represent 95% confidence intervals. ∗∗p < 0.01, significantly different from control. “Yogurt and cheese” included liquid, curd and beverage types of yogurts and processed cheese. “Meat” included beef, pork, chicken, and processed meat. “Fish” included all types of fish, shrimp, crab, and common squid.

Table 1.

General characteristics of girls, parents, and family according to menarcheal status (n = 190)

	Menarcheal group	Premenarcheal group	p value¹⁾
	(n = 95)	(n = 95)	p value¹⁾
Age (years)			NS
10	6 (6.3)	5 (5.3)
11	52 (54.7)	53 (55.8)
12	37 (39.0)	37 (39.0)
Anthropometric measures of children
Height (cm)	153.6 ± 0.5	146.9 ± 0.6	∗∗∗
Weight (kg)	49.0 ± 0.9	40.2 ± 0.8	∗∗∗
Rohrer Index (kg/cm³X10⁷)			∗
Underweight (< 110)	10 (10.5)	22 (23.2)
Normal (110 ~< 141)	51 (53.7)	51 (53.7)
Obesity (≥ 141)	34 (35.8)	22 (23.2)
Sleep duration (hours/day)	8.3 ± 0.1	8.6 ± 0.1	∗∗∗
Exercise time (min/week)	122.0 ± 9.2	134.7 ± 15.2	NS
Number of family members			NS
3 or less	16 (16.8)	13 (13.7)
4	57 (60.0)	52 (54.7)
5	15 (15.8)	19 (20.0)
6 or more	7 (7.4)	11 (11.6)
Monthly household income (10,000 won)	410.7 ± 21.2	380.6 ± 21.3	NS
Father's characteristics
Age (years)	43.7 ± 0.4	42.6 ± 0.4	NS
Body mass index (kg/m²)	23.9 ± 0.3	23.7 ± 0.3	NS
Education			NS
High school graduation or less	32 (34.8)	29 (32.6)
College graduation or more	60 (65.2)	60 (67.4)
Mother's characteristics
Age (years)	40.3 ± 0.4	40.2 ± 0.4	NS
Age at menarche (years)	13.8 ± 0.1	14.4 ± 0.1	∗∗
Childbirth age	28.4 ± 0.4	28.3 ± 0.4	NS
Body mass index (kg/m)	21.2 ± 0.3	21.1 ± 0.2	NS
Education			NS
High school graduation or less	45 (47.9)	46 (51.1)
College graduation or more	49 (52.1)	44 (48.9)

Values are mean ± SE or n (%).

¹⁾ p values are derived from paired t-test for continuous variables or χ test for categorical variables. Statistical significance was defined as at ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001, and NS for not significant.

Table 2.

Nutrient intakes as percentage of KDRIs¹⁾ according to menarcheal status among elementary school girls (n = 190)

	Menarcheal group	Premenarcheal group	p value²⁾
	(n = 95)	(n = 95)	p value²⁾
%KDRIs
Energy (EER³⁾)	101.6 ± 3.0	100.9 ± 2.2	NS
Protein (RNI⁴⁾)	191.8 ± 8.1	191.8 ± 5.3	NS
Calcium (RNI)	62.8 ± 3.1	66.1 ± 2.4	NS
Phosphorus (RNI)	110.1 ± 3.7	112.4 ± 2.8	NS
Iron (RNI)	114.4 ± 6.4	134.9 ± 15.1	NS
Sodium (AI⁵⁾)	253.2 ± 8.4	269.3 ± 7.3	NS
Potassium (AI)	68.9 ± 2.5	72.2 ± 1.8	NS
Zinc (RNI)	127.7 ± 4.5	130.3 ± 3.7	NS
Vitamin A (RNI)	129.6 ± 6.7	127.4 ± 5.8	NS
Vitamin B₁ (RNI)	145.6 ± 15.9	133.0 ± 12.6	NS
Vitamin B₂ (RNI)	124.5 ± 5.5	119.8 ± 3.9	NS
Vitamin B₆ (RNI)	194.5 ± 7.1	188.3 ± 4.7	NS
Niacin (RNI)	136.0 ± 7.8	138.2 ± 5.2	NS
Vitamin C (RNI)	85.3 ± 5.8	93.6 ± 4.6	NS
Folate (RNI)	69.7 ± 2.9	69.9 ± 2.3	NS
Vitamin E (AI)	149.0 ± 5.6	154.4 ± 5.9	NS
% from total energy intake
Carbohydrate	54.9 ± 0.8	56.0 ± 0.6	NS
Protein	15.5 ± 0.3	15.7 ± 0.2	NS
Fat	29.6 ± 0.6	28.3 ± 0.5	NS

Values are mean ± SE (continuous variables).

¹⁾ KDRIs: dietary reference intakes for Koreans

²⁾ The differences between menarcheal and premenarcheal group were tested by paired t-test, and statistical significance was defined as at p < 0.001, and NS for not significant.

³⁾ EER: estimated energy requirements

⁴⁾ RNI: recommended nutrient intake

⁵⁾ AI: adequate intake

Table 3.

Odds ratios and 95% confidence intervals for having ear menarche in relation to suspected risk factors among elementa school girls (n = 190)

	Odds ratio (95% CI¹⁾
Rohrer index (kg/cm³ × 10⁷)²⁾
Normal (110 ~< 141)	2.77 (0.72 ~ 10.67)
Obesity (≥ 141)	5.60 (1.34 ~ 23.42)
Sleep duration (hours/day)	0.45 (0.23 ~ 0.87)
Mother's age at menarche (years)	0.64 (0.44 ~ 0.93)
Monthly household income (10,000 won)	1.00 (0.99 ~ 1.00)

¹⁾ CI: confidence interval

²⁾ Reference: underweight (< 110)

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