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Indian Journal of Community Medicine

Nutritional Status and Menarche in Adolescent Girls in an Urban Resettlement Colony of South Delhi

Author(s): A. Acharya,V. P. Reddaiah, N. Baridalyne

Vol. 31, No. 4 (2006-10 - 2006-12)

A. Acharya,V. P. Reddaiah, N. Baridalyne

Introduction

Nutrition has an important bearing on age at menarche. Adolescents gain 50% of adult weight and more than 20% of their adult height during this period. Menarche is attained earlier by well nourished adolescents1 A minimal amount of body fat is essential for initiation of menarche.

In India urban population is about 28% out of which around 45% are living in metropolitan cities. About 30% of the metropolitan population is living in slum clusters and resettlement colonies. Neglect of this huge population will have major repercussions in the future. So keeping this in mind, this study was carried out with the following objectives: 1) To assess the nutritional status of adolescent girls (10- 19 years). 2) To determine the association between age at menarche and nutritional status.

Material and Methods

This was a community based cross-sectional study, carried out in Dr. Ambedkar Nagar, an urban resettlement colony in New Delhi. Out of the 6 blocks, two were selected which were near our mobile health clinic for the reasons of convenience. A sample size of 250 female adolescents in the age group 10- 19 years was calculated for the study. Taking the proportion of under nutrition amongst adolescents as 50% based on a previous study in Varanasi2 and absolute error of 10%, a design effect as two, and 25% or more for non-response, unavailability etc; the final sample size was 250. A house – to - house visit was made to collect the necessary information by using a pre-tested semi-structured interview schedule. An informed verbal consent was taken from girls who were eighteen years and above, and from a responsible adult who was present at the time of interview for girls less than eighteen years. The data were collected in May-June 2004. Height and weight for all the study subjects were measured by a single investigator (AA) using standard procedures. Nutritional Status was calculated as BMI [Wt (kg)/ Ht (m2)] and compared with published ICMR standards3.

Results

Almost equal number of the adolescents belonged to 10- 14 years and 15-19 years age group, i.e., 128 and 122 respectively. The mean age was 14.42 years. (S.D 2.6). About 66.4% (166) had attained menarche, 29% (48) in less than 15 years and 71% (118) in more than 15 years age group. The mean age at menarche in those who had attained menarche (n=166) was 13.34 years (S.D 1.26). All the adolescents were unmarried. Eighty-five percent of the girls were attending school at the time of the study. The mean BMI was 16.8 (Range 7.5-30.2). It was seen that one fourth of the girls (n= 62) had normal BMI. Majority (74%) were under nourished, out of which 96 (38.4%) had

BMI less than 16, 61(24.4%) had BMI between 16-17.4 and 28 (11.2%) had BMI between 17.5 to 18.4. Only 3 girls were overweight. None of the girls were obese. However, the level of malnutrition in the 10-14 year age group was 86.7% (111/128) compared to 60.7% (74/122) in 15-19 years age group and this difference was statistically significant (p=0.000).

Table I. Relationship of BMI to Menarche in Adolescents.

BMI Menarche Attained
Group Yes No Total
<16 36 (37.5) 60 (62.5) 96 (100)
16-18.5 69 (77.53) 20 (22.47) 89 (100)
≥ 18.5 61 (93.85) 4 (6.15) 65 (100)
Total 166 (66.4) 84 (33.6) 250 (100)

Figure in parenthesis are percentage χ2 trend =62.825 p= <0.001 Menarche was attained by 64.4% (166/250) of the adolescents. As age advances more would attain menarche. Among the adolescents of age group 10-14 years, 37.5% (48/128) attained menarche compared to 96.7% (118/122) adolescents of 15-19 years age and the difference was statistically significant (p=0.001).

Nutritional status has an important role in attainment of menarche, as nutritional status improves, age at menarche is lowered. It was seen that as the BMI increased, the number of girls attaining menarche also increased. This trend was statistically significant (Chi-square for trend p=<0.00). There was also a statistically significant difference between the mean BMI of those girls who had attained menarche (mean BMI 17.83) and those who had not attained menarche (mean BMI 14.83), p=<0.001). To examine the role of nutritional status on menarche, attainment of menarche was tested against current nutritional status (assuming that it was same at the time of attaining menarche). 30.6 % (34/111) attained menarche in those with BMI<18.5 compared to 82.3% (14/17) who attained menarche in those with BMI ≥18.5 among the 10-14 years adolescents. The difference was statistically significant (p=<0.001). However, attainment of menarche was 95.9% among those with BMI<18.5 compared to 97.9% among those with BMI >18.5 in the adolescents of 15-19 years age group. This difference was not significant statistically (p=0.9) as with increasing age most would attain menarche by 19 years except those with severe malnutrition. As expected, age was associated positively with attainment of menarche. Logistic regression analysis showed that when age was controlled, BMI was independently associated with menarche status [OR =1.2, p=0.02, 95% C.I (1.02 – 1.49)]. For each unit increase in BMI, there is 24% chance of attaining menarche in adolescent girls.

Discussion

In a study carried out in an urban slum of Varanasi, 51.43% adolescent girls were malnourished2. This is slightly less than the present study probably because the age group of adolescent girls in their study was 13-18 years. There was a statistically significant negative association between level of malnutrition in 10-14 years age group vs. 15-19 years age group.(p=<0.001).This means that as age advances, the level of malnutrition decreases. In comparison with ICMR standards3 the mean Height (cm) and the mean weight (kg) of the adolescents were almost similar except at ages 11, 15, 16 years where the mean heights were more than that of the reference standard (ICMR). Similarly at ages 11, 15, I6,17 years the adolescents weight was more than the ICMR standards. (Data not shown). The mean age at menarche was 13.34 years (S.D 1.26) which is similar to studies carried out in other places in India4. Menarche was attained by 66.4% of adolescents. Delayed menarche may be a sign of malnutrition; as nutritional status improves, the age at menarche is lowered. In a study carried out in Nigerian schoolgirls, it was shown that nutritional status was strongly and positively associated with age at menarche, which is similar to the present study5.

A major limitation of this study is that the above observations may be true only for the study population because of convenient sample and cannot be generalized to other adolescent girls belonging to different socio-economic or cultural backgrounds.

In conclusion, in this study, the rate of under nutrition amongst adolescent girl was very high (74%). The nutritional status was associated with age at menarche. The higher the nutritional status, the lower is the age at menarche.

References

  1. Bharati P, Bharati S. Relation Between menarcheal age and nutritional anthropometry in urban girls of the Howrah District, West Bengal, India. Anthropol Anz 1998, 56(1):57-61.
  2. Singh N, Mishra C P. Nutritional status of Adolescent girls of a slum community of Varanasi. Indian J Public Health. 2001:45(4):128-134.
  3. Growth and physical development of Indian infants and children. Technical Report series No. 18. Indian Council of Medical Research. Ansari Nagar, New Delhi, 1989.
  4. Garg S, Sharma N, Sahays R. Socio-cultural Aspects of menstruation in an urban slum in Delhi, India. Reprod Health Matters; 2001 9(17):16-25.
  5. Abioye-Kuteyi EA, Ojofeitimi EO, Aina Ol, Kio F, Aluko Y, Mosuro O. The infl uence of socioeconomic and nutritional status on menarche in Nigerian school girls. Nutr Health. 1997:11(3):185-95.

Centre for Community Medicine, All India Institute of Medical sciences, Ansari Nagar New Delhi-110029 E-mail: [email protected] Received: 12.05.05

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