{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T14:02:38Z","timestamp":1762956158936,"version":"3.40.5"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T00:00:00Z","timestamp":1572393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100011103","name":"Sixth Framework Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011103","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess factors associated with the timing of puberty onset (Tanner Stage Breast 2\/Genital 2) among adolescents living in an urban slum in Karachi, Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Girls enrolled at 8\u201010\u00a0years (n\u00a0=\u00a01009) and boys 9\u201011\u00a0years (n\u00a0=\u00a0863) were followed every 6\u00a0months from 2006 to 2010. Parametric survival analysis for interval\u2010censored data was used to estimate median age at puberty onset and assess the association between exposures and timing of puberty onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall median age at Tanner Stage Breast 2 (AAB2) was 10.1\u00a0years (95% CI: 10.1; 10.5), and the median age at Tanner Stage Genital 2 (AAG2) was 10.1\u00a0years (95% CI: 10.1; 10.6). Stunting delayed AAB2 1\u00a0year and AAG2 about 6\u00a0months when compared to non\u2010stunted peers. In the multivariable model, after adjusting for age at enrolment, stunting, thinness and vitamin A deficiency (VAD) were significantly associated with delayed AAB2, while stunting and anaemia were significantly associated with delayed AAG2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among adolescents living in the Karachi slum, stunting and highly prevalent anaemia delayed AAG2, while stunting, thinness and VAD delayed AAG2. Parental and household factors were not significantly associated with the timing of puberty onset.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.15053","type":"journal-article","created":{"date-parts":[[2019,10,13]],"date-time":"2019-10-13T06:04:44Z","timestamp":1570946684000},"page":"1019-1025","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Later puberty onset among chronically undernourished adolescents living in a Karachi slum, Pakistan"],"prefix":"10.1111","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1072-9228","authenticated-orcid":false,"given":"Susan C.","family":"Campisi","sequence":"first","affiliation":[{"name":"Department of Nutritional Sciences Faculty of Medicine University of Toronto Toronto ON Canada"},{"name":"Peter Gilgan Centre for Research and Learning (PGCRL) Center for Global Child Health Hospital for Sick Children Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8580-2154","authenticated-orcid":false,"given":"Khadija N.","family":"Humayun","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health The Aga Khan University Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4553-8130","authenticated-orcid":false,"given":"Arjumand","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health The Aga Khan University Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Lou","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3769-9025","authenticated-orcid":false,"given":"Olle","family":"S\u00f6der","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet Widerstr\u00f6mska Huset Karolinska University Hospital Solna Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0637-599X","authenticated-orcid":false,"given":"Zulfiqar A.","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences Faculty of Medicine University of Toronto Toronto ON Canada"},{"name":"Peter Gilgan Centre for Research and Learning (PGCRL) Center for Global Child Health Hospital for Sick Children Toronto ON Canada"},{"name":"Centre of Excellence in Women and Child Health The Aga Khan University Karachi Pakistan"},{"name":"Dalla Lana School of Public Health University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,30]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_10_2_1","DOI":"10.1111\/jora.12402"},{"doi-asserted-by":"publisher","key":"e_1_2_10_3_1","DOI":"10.1542\/peds.2008-2638"},{"unstructured":"PSUP Team Nairobi.Slum Almanack 2015 2016: tracking improvements in the lives of slum dwellers. 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