{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:08:40Z","timestamp":1792616920836,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Adolescence"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Sexual development in females and males are routinely measured according to the Tanner Stages. Sparse data exist on the timing of pubertal milestones in Pakistan. To fill this gap, the age of attainment of pubertal milestones and their relationship with nutritional status was explored among children and adolescents living in the rural district of Matiari, Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Anthropometry, nutrition biomarkers and Tanner Stage were assessed among girls aged 9.0\u201314.9 years (n\u00a0=\u00a0723) and boys aged 10.0\u201315.9 years (n\u00a0=\u00a0662) who were free from known disease in the rural District of Matiari, Pakistan. Median age was calculated for all Tanner Stages and menarche. Multivariable linear regressions were undertaken to determine covariates associated with the timing (age) of pubertal milestones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among participants living in this rural community, the median age of puberty onset for girls was 11.9 years (95%CI:10.9; 12.5) and boys was 12.3 years (95%CI:11.5; 12.9). Age at first menarche was 12.9 years (95%CI:12.1; 13.3). Undernutrition was widespread among adolescents in this community. Thirty\u2010seven percent of females and 27.0% of males were stunted while 20.5% of females and 31.3% of males were thin. Only 8% (n\u00a0=\u00a058) of females and 12% (n\u00a0=\u00a078) of males were free from any nutrient deficiency with most adolescents having two or three nutrient deficiencies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Undernutrition (stunting or thinness) was associated with relatively older ages for early puberty stages but not puberty completion. This may decrease the duration of the pubertal growth spurt and curtail potential catch\u2010up growth that may occur during puberty. Efforts to decrease nutrient deficiencies, stunting and thinness beyond childhood should be made in rural Pakistan.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.adolescence.2021.02.002","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T05:27:13Z","timestamp":1613885233000},"page":"58-66","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":15,"title":["The relationship between pubertal timing and under\u2010nutrition in rural Pakistan"],"prefix":"10.1002","volume":"88","author":[{"given":"Susan C.","family":"Campisi","sequence":"first","affiliation":[{"name":"Centre for Global Child Health Hospital for Sick Children Peter Gilgan Centre for Research and Learning (PGCRL) 686 Bay Street, 11th Floor, Suite 11.9805 Toronto ON M5G 0A4 Canada"},{"name":"Department of Nutritional Sciences University of Toronto 1 King's Circle College Toronto Ontario M5S 1A8 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khadija N.","family":"Humayun","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health Aga Khan University Stadium Road, PO Box 3500 Karachi 74800 Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqub","family":"Wasan","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health Aga Khan University Stadium Road, PO Box 3500 Karachi 74800 Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajid B.","family":"Soofi","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health Aga Khan University Stadium Road, PO Box 3500 Karachi 74800 Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Islam","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health Hospital for Sick Children Peter Gilgan Centre for Research and Learning (PGCRL) 686 Bay Street, 11th Floor, Suite 11.9805 Toronto ON M5G 0A4 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad","family":"Hussain","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health Aga Khan University Stadium Road, PO Box 3500 Karachi 74800 Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agha","family":"Shakeel","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health Aga Khan University Stadium Road, PO Box 3500 Karachi 74800 Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Vandermorris","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health Hospital for Sick Children Peter Gilgan Centre for Research and Learning (PGCRL) 686 Bay Street, 11th Floor, Suite 11.9805 Toronto ON M5G 0A4 Canada"},{"name":"Hospital for Sick Children Division of Adolescent Medicine 555 University Ave Toronto ON M5G 1X8 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olle","family":"S\u00f6der","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology Division Department of Women's and Children's Health, Tomtebodav\u00e4gen 17A Karolinska Institutet SE\u201017176 Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqar A.","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Centre for Global Child Health Hospital for Sick Children Peter Gilgan Centre for Research and Learning (PGCRL) 686 Bay Street, 11th Floor, Suite 11.9805 Toronto ON M5G 0A4 Canada"},{"name":"Department of Nutritional Sciences University of Toronto 1 King's Circle College Toronto Ontario M5S 1A8 Canada"},{"name":"Centre of Excellence in Women and Child Health Aga Khan University Stadium Road, PO Box 3500 Karachi 74800 Pakistan"},{"name":"Dalla Lana School of Public Health University of Toronto 155 College Street 6th Floor Toronto ON M5T 3M7 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20138587(15)00418\u20130"},{"issue":"5","key":"e_1_2_16_3_1","first-page":"629","article-title":"Factors contributing to early menarche in school girls","volume":"66","author":"Ahmed S.M.","year":"2016","journal-title":"Journal of Pakistan Medical Association"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13336"},{"key":"e_1_2_16_5_1","unstructured":"Z.Bhutta S.Zaidi A.Habib M.Hussain.Pakistan national nutrition Survey Retrieved from Pakistan:http:\/\/ecommons.aku.edu\/pakistan_fhs_mc_women_childhealth_paediatr\/2622011"},{"issue":"3","key":"e_1_2_16_6_1","first-page":"425","volume":"18","author":"Biro F.M.","year":"2007","journal-title":"Puberty. 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Published by Elsevier Ltd. All rights reserved.","name":"copyright","label":"Copyright"}]}}