INDIAN PEDIATRICS 383 VOLUME 53 __ MAY 15, 2016 Age of Onset of Puberty in Apparently Healthy School Girls from Northern India * RAJESH KHADGAWAT, RK MARWAHA, $ NEENA MEHAN, * VINEET SURANA, * AASHIMA DABAS, # V SREENIVAS, * M ASHRAF GAINE AND * NANDITA GUPTA From Departments of * Endocrinology & Metabolism and # Biostatistics, All India Institute of Medical Sciences; $ Sur Homeopathic Medical College, Hospital and Research Centre, and International Life Sciences Institute; New Delhi, India. Correspondence to: Major General RK Marwaha, Flat No. 17, Gautam Apartments, Gautam Nagar, New Delhi 110 049, India. marwaha_ramank@hotmail.com. Received: July 28,2015; Initial review: October 09, 2015; Accepted: March 15, 2016 Objective: To determine the age of pubertal onset and menarche in school-going girls, and to assess the impact of obesity on pubertal timing. Design: Cross-sectional Setting: Seven schools across Delhi, India. Participants: 2010 school girls, aged 6-17 years Methods: Anthropometric measurement and pubertal staging was performed for all subjects. Menarche was recorded by ‘status quo’ method. Body mass index was used to define overweight/obesity. Serum gonadotropins and serum estradiol were measured in every sixth participant. Main outcome measure: Age at thelarche and menarche— T he onset of puberty results from activation of complex neuroendocrine regulatory mechanisms resulting in release of pulsatile GnRH secretion but the exact mechanism of this activation is still unclear [1]. The secular trends of decrease in average menarcheal age are documented in literature between the mid-19th and the mid-20th century [1]. However, recent studies have reported a relatively slow decline, no change or modest increase in the average menarcheal age [2,3]. A recently published review on impact of body fat and timing of puberty concluded earlier onset of puberty in girls with increased body mass index (BMI) [4]. However, a study on Indian Bengali girls showed no correlation between menarcheal age and BMI [5]. Thus, there is paucity of data on impact of increasing obesity on pubertal development and progression in Indian children. We therefore conducted this study to assess age of menarche, and impact of obesity on pubertal development in apparently healthy Indian school children, aged 6-17 years. METHODS This cross-sectional study was carried out in seven schools selected from seven out of 11 districts of Delhi representative of all geographical regions (North, South, East, West and Central region) after obtaining permission from school management. All these schools were private schools catering to middle or upper socio-economic status, and were selected as per convenience. All seven schools which were approached agreed to participate. analyzed for entire cohort and stratified based on body mass index. Results: Median (95% CI) ages of thelarche, pubarche and menarche were 10.8 (10.7-10.9) y, 11.0. y (10.8-11.2) y and 12.4 y (12.2-12.5) y. Overweight/obese girls showed six months earlier onset of thelarche and menarche than those with normal BMI (P<0.05). Serum gonadotropins did not vary significantly in overweight/obese subjects. Conclusion: The study provides the normative data for pubertal growth in Indian girls. Pubertal onset occurs earlier in overweight and obese girls. Keywords: Adolescent, Menarche, Obesity, Pubarche, Thelarche. RESEARCH P H P H P H P H PAPER They were given detailed written information sheet regarding the study, to be sent to parents of all eligible children. Interaction with parents was undertaken to clear their queries about the study. Written informed consent from parents / guardians and verbal assent was taken from the children who participated in the study. The study was approved by Institutional ethics committee, All India Institute of Medical Sciences (AIIMS), New Delhi. Apparently healthy girls aged between 6 and 17 years Accompanying Editorial: Pages 379-80.