Child-related and parental predictors for thelarche in a general population of girls: the PANIC study

Pediatr Res. 2020 Oct;88(4):676-680. doi: 10.1038/s41390-020-0802-0. Epub 2020 Feb 12.


Background: Obesity has been associated with earlier thelarche, whereas other predictors for it remain unclear.

Methods: We studied child-related and parental predictors for earlier thelarche in 195 girls aged 6-8 years followed up for 2 years. A physician evaluated breast development by inspection and palpation. Body fat percentage (BF%) was measured by dual-energy X-ray absorptiometry, diet by food records, and physical activity and sedentary time by body movement and heart rate monitors. Parental education, smoking, and alcohol consumption and household income were assessed by questionnaires. Gestational age, birth weight, and maternal prepregnancy BMI were obtained from hospital registers. Predictors for thelarche were examined using logistic regression analysis adjusted for age and follow-up time.

Results: The incidence of thelarche during 2 years increased by 11% (OR 1.11, CI 1.06-1.17, p < 0.001) for 1 unit increase in baseline BF%. Girls with a smoking parent had a 2.64 (95% CI 1.21-5.77, p = 0.015) times higher incidence of thelarche than other girls. The associations of lower parental education and higher maternal prepregnancy BMI with the higher incidence of thelarche were largely explained by BF%. Other possible predictors were not associated with thelarche.

Conclusions: Higher BF% and exposure to tobacco smoke are independent predictors for earlier thelarche.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adipose Tissue*
  • Adiposity
  • Alcohol Drinking
  • Birth Weight
  • Body Mass Index*
  • Breast / growth & development*
  • Child
  • Diet
  • Educational Status
  • Family
  • Feeding Behavior
  • Female
  • Finland
  • Heart Rate
  • Humans
  • Incidence
  • Movement
  • Parents
  • Pediatric Obesity / complications*
  • Puberty, Precocious / complications*
  • Smoking
  • Social Class
  • Tobacco Smoke Pollution / adverse effects*


  • Tobacco Smoke Pollution