SynthesisFrontiers in public health2026
Age at menarche in South Asia: an interplay of sociodemographic, nutritional, lifestyle, anthropometric, biological, and environmental factors-a systematic review.
Synthesis in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Age at menarche is a dynamic indicator of a female's health trajectories. Despite its relevance, the cohesive synthesis of its multifactorial determinants in South Asia is lacking, limiting the targeted public health strategies. This review examines the sociodemographic, nutritional, lifestyle, anthropometric, biological, and environmental determinants of age at menarche among females aged 8-21 years across South Asia. Methods: A systematic review of observational studies on determinants of age at menarche was conducted. Adhering to PRISMA guidelines, articles published between January 2014 and May 2025 were identified from ScienceDirect, PubMed, Web of Science, and Google Scholar. Methodological quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Due to significant heterogeneity across the studies, findings were narratively synthesized precluding meta-analysis. Results: Out of 729 articles, 18 studies from South Asian countries were included. The mean age at menarche clustered between 12 and 13 years across the studies. Menarche <12 years of age was associated with urban residence, a higher socioeconomic status, higher BMI, inadequate sleep and physical activity, higher consumption of fruits, vegetables, and non-vegetarian diet, excessive screen time, low birth weight, absence of biological father, mothers' age at menarche and exposure to environmental factors. On the contrary, the age of menarche >14 years of age was associated with rural residence, lower socioeconomic status, stunting and underweight. Conclusion: While heredity, demographics, and early-life programming influence age at menarche, modifiable nutrition and lifestyle factors are critical determinants in South Asia. Targeted interventions focusing on these determinants could reduce the burden of metabolic and growth-related disorders among adolescent females. Paucity of studies in South Asian countries is a critical evidence gap that needs attention to better inform policies for adolescent health. Systematic Review Registration: INPLASY, Identifier: INPLASY202610051.
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