Introduction: Nutritional status is a well-known determinant of pubertal development and age at menarche. In low-resource settings, puberty onset usually takes place at an older age. Epidemiological and adoption studies have indicated that early life undernutrition that is followed by catch-up growth may result in early puberty and younger age at menarche. In turn, early puberty might be associated with an increased risk of adult chronic diseases. This paper aims to analyse the association between size at birth, infancy and childhood stunting, recovery from stunting, and the pubertal development in a rural Bangladeshi cohort.

Methods: The participants in the present study were children whose mothers participated in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial. Pregnant women were identified in early pregnancy, and a birth cohort was followed from birth to puberty. The sample analysed included 994 girls and 987 boys aged from 12 to 15 years. Puberty assessment was done by evaluating the breast, testicle and hair developments according to Tanner. The age at menarche was recorded and, additionally, in boys data from pre-pubertal and two consecutive pubertal height measurements six months apart were used to determine whether the pubertal growth spurt had started or not. Size at birth, infancy and childhood stunting, and recovery from stunting were modeled with age at menarche by Cox’s proportional hazards analyses, and with pubertal onset in boys by logistic regression. 

Results: The median age at menarche was 13.0 years (95% CI 13.0-13.1). Adolescents, who had reached a later stage of puberty and had a younger age at menarche, had mothers who were heavier, more educated, and belonged to a higher socioeconomic group. There was no difference in age at menarche between girls that were small or appropriate for gestational age at birth. Boys born small for gestational age entered their pubertal growth spurt later than those with appropriate weight. Children who were stunted had later pubertal development, age at menarche and timing of growth spurt than non-stunted children. Children who recovered from stunting had similar pubertal development, age at menarche, and timing of growth spurt in boys as non-stunted children. 

Conclusion: Infant and childhood stunting was associated with later pubertal development. Infant or young child recovery from stunting was not associated with earlier puberty in comparison with non-stunted children.

STUNTING, RECOVERY FROM STUNTING AND PUBERTY TIMING IN THE MINIMAT COHORT, BANGLADESH