The relationship between pubertal timing and under-nutrition in rural Pakistan

Susan C. Campisi, Khadija N. Humayun, Yaqub Wasan, Sajid B. Soofi, Muhammad Islam, Amjad Hussain, Agha Shakeel, Ashley Vandermorris, Olle Söder, Zulfiqar A. Bhutta

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)


Introduction: 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. Methods: Anthropometry, nutrition biomarkers and Tanner Stage were assessed among girls aged 9.0–14.9 years (n = 723) and boys aged 10.0–15.9 years (n = 662) 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. Results: 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-seven 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 = 58) of females and 12% (n = 78) of males were free from any nutrient deficiency with most adolescents having two or three nutrient deficiencies. Conclusions: 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-up growth that may occur during puberty. Efforts to decrease nutrient deficiencies, stunting and thinness beyond childhood should be made in rural Pakistan.

Original languageEnglish
Pages (from-to)58-66
Number of pages9
JournalJournal of Adolescence
Publication statusPublished - Apr 2021


  • Nutrient deficiencies
  • Puberty
  • Stunting
  • Tanner stage
  • Undernutrition


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