A study to determine age at menarche and its relationship with nutritional and socio-demographic status in selected government schools Belagavi, Karnataka: A cross-sectional study

Introduction

Adolescence is a phase or a period of life where there is a difference between being a child and becoming an adult. This transition from childhood to adulthood is adolescence.1, 2 Adolescence is a phase of remarkable growth. During this phase, 20% of height, 50% of weight and 45% of body mass increase, and also red blood cell increases in size. According to WHO and many other studies adolescents’ growth and development is closely related to dietary intake and nutritional status.3 So, there is a high demand for nutrients that is both macronutrients like carbohydrates, proteins, fat and micro nutrients like vitamins and minerals, during adolescence there will be increasing need of nutrients compared to another life cycle because it is a growing period.4 Adolescent growth and development are mainly affected by nutritional status. An adolescent who consumes more calories and protein will tend to have early menarche which is further implicated in diseases.5

Menarche is a crucial time in a girl’s life that affects the reproductive life health and well-being of women.6 Menstrual cycle is physiological changes, including the secretion of oestrogens from the ovaries it is an important indicator of women’s reproductive health.7, 8 Menarche is the occurrence of first menstrual blood flow or menses in a female adolescent. When ovulation does not lead to fertilisation, menstruation ensues. It happens every 28 days, by a cycle length ranging from 21 to 35 days, most periods continue between 3 to 7 period, and also in some girl’s menses last more than 10 days which is considered abnormal.9 Early menarche is considered to be more vulnerable to psychosocial, physical as well as mental well-being problems like obesity, diabetes, risky sexual behaviour and breast cancer. So, it is critical to be aware of the variables which affect menarcheal age. These include genetic, socioeconomic status, diet, exercise, education, environment hereditary factor, psychological stress.10, 11

Nutritional status and socio-demographic status become an important role in the attainment of menarche. Girls with good nutritional status will get menarche in proper age compared to malnutrition girls and overweight girls. In case of malnutrition in girls, the age of menarche will be delayed because of improper or decrease calories, protein and other micro and macro nutrients which then impact on the gonadotrophin hormone. The energy need of girls in the age of 10-19 years is 2050 to 2750kcal as per RDA. Good nutrition will help in the formation of gonadotrophin hormone and other hormones which affect upcoming menarche. So, both excess nutritional intake and insufficient nutritional intake will greatly affect the condition of the body.12, 13

According to the studies lower socio-demographic status will delay the age of menarche, by this nutritional status is also affected because of lack of nutrition and poor knowledge about the food products. Because of low income they are unable to buy the food products which are essentially rich in vitamins and minerals which our body needs during the reproductive life. Even the area of living also matters because some areas will be far away from the city or the town where grocery shops are not available where they are living, because of difficulty in travelling they eat the food which is available in that area.14, 15, 16

After nutrition and socioeconomic status next comes BMI which is sensitive indicator which affects menarcheal age. BMI has linked to early onset of puberty and menarche. Early menarche was known to be a risk factor for disease, such as obesity, metabolic syndrome, cardiovascular disease, diabetes, breast cancer, as well as increased risk of death from ischemic heart disease. The health research community is paying attention to the declining age of menarche. Early menarche causes the epiphyseal plates to close prematurely, and as a result, women who attain menarche at a young age have a shorter final height than other women, as well as a higher risk of cancers related to female hormones, such as breast cancer and endometrial cancer, due to increased oestrogen exposure.17

Hence, the current study is planned to find the menarche age and how the nutritional status and socio-demographic status will affect the menarche age in the adolescent girls of selected government schools, Belagavi city, India.

Materials and Methods

Results

Table 1 shows that mean age of menarche was 12.4±1.0 years.

Table 2 shows there was no association between age at menarche and socio-demographic status (P value 0.05).

Table 3 shows that there was association between age at menarche andmenarcheal characteristics i.e., body ache, amount of blood flow, days of blood flow (P value 0.05).

Table 4 shows there was no association between age at menarche and anthropometric measurements.

Table 5 shows that there was association between age at menarche and nutritional status of participants. (P value 0.005 & 0.01) There was Pearson correlation between energy, carbohydrate & fat.

Table 6 compares nutritional status of participants with RDA, only carbohydrates was associated with RDA when compared to other nutrients.

Among the study population, most of the participants attained menarche in 12.4 years of age and standard deviation was 1.0.

In the Table 2, socio-demographic factors were not associated with age of menarche. Socio-demographic status and age of menarche were statistically not significant (p value 0.05).

In the Table 3, body ache, amount of blood flow, and days of blood flow were associated with menarcheal age, while other symptoms were not associated with menarcheal age. (significant at the 0.05 level)

In the Table 4, it showed that there was no association between menarcheal age and anthropometric measurements.

In the Table 5 correlation, nutritional status was associated with the age of menarche. As it shows that energy (0.05), carbohydrate (0.01), and iron (0.01) were significant at the age of menarche and there was a Pearson correlation between energy (Kcal), protein (g) and carbohydrate (g). Nutritional status and menarche age both were statistically significant factors (p values of 0.05, 0.01).

Discussion

Adolescence is a stage or era of life in which there is a distinction between being a child and becoming an adult. Adolescence is the transition from childhood to adulthood. Adolescence is a period of rapid development. Menstrual period is a major turning point in a girl's life that has an impact on her reproductive health and well-being. Menarche occurs when a female adolescent experiences her first menstrual blood flow, often known as menses. When ovulation is not followed by fertilisation, menstruation ensues. Menarche at a young age has been connected to an increased risk of obesity, diabetes, risky sexual behaviour and breast cancer, among other psychosocial, physical, and mental health issues. As a result, it's critical to understand the elements that influence menarche age. The present study was conducted among 116 school going girls aged 11 to 16 years to determine the age at menarche and to find the age at menarche is associated with nutrition and socio-demographic status of individuals.

Limitation

The study's key drawbacks were that it was conducted only in government schools with a limited sample group, so it was only true in these observations, but it could be different in the urban population. This was a questionnaire-based study, so the results were solely dependent on the subjects' responses. However, we should have double-checked with their parents. I was unable to complete it.

Recomendations

Source of Funding

Not receive any funding.

Conflict of Interests

No conflict of interests.

Ethical Approval

Ethical clearance was obtained from Institutional Ethical and Research Committee, Jawaharlal Nehru Medical College, KAHER, Belagavi.