Determination of Relative Timing of Pubertal Maturation through Ordinal Logistic Modeling: Evaluation of Growth and Timing Parameters

Abstract 

Purpose

(1) To propose a new method using statistical modeling to determine relative timing of pubertal maturation; (2) to validate the new method by evaluating its relationship with pubertal growth and timing parameters, including age at menarche, age onset of areolar maturation, age of peak height velocity, age at attainment of adult height, adult height, peak height velocity, body mass index, and percent body fat; and (3) to contrast the new method with relative timing of menarche on these pubertal parameters.

Background

The timing of puberty has a well-known impact on anthropometric and psychosocial outcomes. Multiple methods have been used to determine pubertal timing, but all with limitations. A uniformly applicable method is needed for different study designs and study populations.

Methods

Using the National Heart Lung and Blood Institute Growth and Health Study data, an ordinal logistic modeling was used to assess relative timing of pubertal maturation.

Results

The proposed method demonstrated good reliability and strong associations with all pubertal timing parameters, also body mass index and percent body fat. Timing was not significantly associated with adult height and peak height velocity.

Conclusions

The proposed method is highly feasible, easy to implement, and valid. The study demonstrated important differences between the relationships of relative timing of secondary sexual characteristics and the timing of menarche on pubertal parameters. The study also demonstrates that individuals with early or late timing at one point of time are likely to maintain the same relative timing throughout puberty.

Keywords: Timing of puberty, Ordinal logistic regression, Statistical modeling, Validation, Generalize estimating equation (GEE)