Body mass index in children and adolescents according to age and pubertal stage.
OBJECTIVE
To evaluate the dependence of body mass index (BMI) values on pubertal stage in subjects similar in age.


METHODS
Height and weight were recorded cross-sectionally in school subjects from three provinces in central Italy. The subjects were subdivided into three groups: (1) 4271 school subjects (2125 males and 2146 females; 8.5-15.5 y old), in whom the pubertal development was also recorded, were selected to subdivide BMI values according to pubertal stage and age; (2) 6345 females (10.5-14.5 y old), who were asked whether or not they had had their first menstrual period, were selected to subdivide BMI values according to age in pre-menarche and post-menarche girls, separately; and (3) 1919 females (10.5-14.5 y old), who had presented their menarche within the previous 6 months, were selected to subdivide short-term post-menarche BMI values according to age.


RESULTS
The medians and interquartile ranges of BMI varied according to age and pubertal stage. Kruskall-Wallis test performed in subjects similar in age demonstrated that significant differences existed among the medians of BMI values of subjects at different pubertal stages in 12-14-y-old males (P<0.05), and in 11-14-y- old females (P<0.001). The difference also proved to be significant between stage I and stage II (P<0.05) in 10-y-old females, but not in 10-11-y-old males. The Kruskal-Wallis test performed in subjects similar in pubertal stage demonstrated that significant differences among the medians of BMI at different ages existed only in females at stages II and III. A significant positive trend was observed in both genders according to pubertal stage for BMI values of subjects similar in age (z-test for trend, P<0.01). On the contrary, a negative age trend proved to be significant in females at stages I (P<0.01), II (P<0.01) and III (P<0.001), but not in males when the subdivision of BMI was made according to age in subjects similar in pubertal stage. BMI values were significantly higher in post-menarche girls as compared to pre-menarche girls similar in age (P<0.001). However, at partial regression analysis BMI values were influenced by pubertal stage and, to a lesser extent, by age, but not by menarcheal status. An inverse association between short-term post-menarche BMI and age was observed, with the highest values in girls presenting menarche at 11 y of age (P<0.05). The negative trend was demonstrated at the z-test for trend (P<0.001).


CONCLUSIONS
BMI values depend on pubertal degree of maturation, especially in girls. This influence should be taken into account when BMI is evaluated in adolescents.


BACKGROUND
University of Perugia, Region of Umbria.
Bini
V
V
Dipartimento di Scienze Ostetriche, Ginecologiche e Pediatriche-Sezione di Endocrinologia e Diabetologia dell'età evolutiva, Università di Perugia, Perugia, Italy.
Celi
F
F
Berioli
M G
MG
Bacosi
M L
ML
Stella
P
P
Giglio
P
P
Tosti
L
L
Falorni
A
A
D000293:Adolescent; D000375:Aging; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008572:Menarche; D011627:Puberty; D012016:Reference Values; D012044:Regression Analysis