Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
E
v
al
ua
ti
o
n
and
Rese
arch in
Education (I
JE
RE)
V
o
l.4
,
No
.2
,
Jun
e
2
015
, pp
. 71
~75
I
S
SN
: 225
2-8
8
2
2
71
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJERE
Nutritional Status and Age at
Menarche on Fe
male Students
of Junior High S
c
hool
Rihul H
u
snul
Juliyatmi,
Lin
a
H
a
n
d
ayani
Department o
f
P
ublic Health, Universi
tas Ahmad
Dahlan, Yog
y
ak
arta, Indon
esia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Ma
rc
h 3, 2015
Rev
i
sed
Ap
r
20
, 20
15
Accepted
May 16, 2015
Menarche is the first menstrual period
as one of the sign of pub
erty
. Th
er
e
are m
a
n
y
fa
ctor
s
m
a
y
aff
ect th
e
age at m
e
narch
e
s
u
ch as
nutriti
onal s
t
atus
,
genet
i
c,
environ
m
ental cond
ition
s
, soci
oeconom
i
c
status,
and edu
cat
ion. T
h
e
purpose of this research is to det
e
rm
ine the rel
a
ti
onship between nutrition
a
l
status and ag
e
of menarche on
female
studen
t
of junior high
school Ali
M
a
ks
um
Krapyak, Ban
t
ul
, Yo
g
y
ak
art
a
.
The r
e
s
earch
em
plo
y
ed a
cros
s
s
ection
a
l res
earc
h
des
i
gn.
The nu
m
b
er
of this sam
p
le was 81 fem
a
le studen
t
s
that de
term
ined
b
y
to
tal sam
p
lin
g. The st
atist
i
ca
l
test used was Chi Square
.
The res
u
lts
of t
h
is
res
earch s
h
o
w
ed that the
r
e
was
a relat
i
ons
hip between
nutrition
a
l sta
t
us and the age of
m
e
narc
he on fe
m
a
le student of junior high
school Ali Maksum Krapy
a
k, Bantul, Yo
g
y
akar
ta (p value = 0.00
2) and the
ratio
prevalen
ce was 3.077 (9
5% CI = 1.67
5 – 5.650)
; it
means that
respondents who have
abnormal nutriti
onal status get 3.007
times greater
chance of experiencing abnor
mal me
narche than respondents
who have
normal nutrition
a
l status.
Keyword:
Fem
a
l
e
st
ude
nt
M
e
narc
he
M
e
nst
r
ual
Nu
t
r
itio
n
a
l stat
u
s
Puberty
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Lina Handayani
Depa
rt
m
e
nt
of
Pu
bl
i
c
Heal
t
h
,
Uni
v
ersitas A
h
m
a
d
Da
hlan
Jal
a
n P
r
o
f
.
D
r
.
Soe
pom
o, S
.
H
.
, Ja
nt
ura
n
,
W
a
r
u
n
g
bot
o
Um
bul
har
j
o
55
61
2,
Y
o
gy
aka
r
t
a
, I
n
d
o
n
esi
a
Em
a
il: l
i
n
a
fk
m
@
g
m
ail.co
m
1.
INTRODUCTION
Menarche
is the first menstrual pe
riod as one of the sign of puberty
[
1
]
.
Afte
r ex
perie
n
cin
g
m
e
narc
he, the
r
e
will b
e
so
m
e
o
t
h
e
r chang
e
s that su
pp
ort rep
r
o
d
u
c
tiv
e
fun
c
tio
n, su
ch
as
b
r
east g
r
o
w
t
h
, th
e g
r
o
w
t
h
of fi
n
e
h
a
irs
in certain area
s, a
n
d the
gr
o
w
t
h
o
f
fat
hi
ps
. I
n
E
n
gl
an
d,
t
h
e a
v
era
g
e a
g
e
o
f
m
e
narche
i
s
1
3
.
1
y
ear
s
ol
d
whi
l
e
the ave
r
age a
g
e of m
e
narche
on B
u
ndi tribe in Papua Ne
w Gu
in
ea is
18
.8
years
o
l
d
[2
]. Th
e
d
a
ta resu
lt of
Risk
esd
a
201
0 show
ed th
at t
h
e ag
e
o
f
m
e
n
a
r
c
h
e
in
In
donesia v
a
r
i
ed
b
e
t
w
een 9-2
0
year
s
o
l
d and
t
h
e
av
er
ag
e
age
of m
e
narc
he i
s
at
13 y
e
a
r
s ol
d
.
I
n
Y
ogy
akart
a
, t
h
e a
v
er
age a
g
e
of m
e
narche
was
bet
w
een
1
3
-
1
4 y
e
ars
ol
d.
The age
of m
e
narc
he ha
p
p
en
earl
i
e
r i
n
w
o
m
e
n w
ho l
i
v
e i
n
u
r
b
a
n
areas th
an
th
ose wh
o
are in
ru
ral liv
ing
,
and
it was also slower in
wo
m
e
n
with
h
eav
y
work [3
].
Facto
r
s affectin
g th
e ag
e
o
f
men
a
rch
e
in
cl
u
d
e
nu
trition
a
l statu
s
,
g
e
n
e
tic, env
i
ro
n
m
en
tal co
nd
itio
ns,
soci
oec
o
nom
i
c
st
at
us, and ed
ucat
i
on [
4
]
.
Fr
om
t
h
e fact
ors
m
e
nt
i
oned
,
n
u
t
r
i
t
i
onal
st
at
us becom
e
s an im
po
rt
an
t
fact
or t
h
at
m
u
st
be co
nsi
d
e
r
ed
. R
e
search
es c
a
rri
ed
o
u
t
i
n
so
m
e
count
ri
es o
n
e o
f
w
h
i
c
h s
h
owe
d
t
h
at
gi
rl
s
wi
t
h
m
a
l
nut
ri
t
i
on st
at
us wo
ul
d ex
peri
e
n
ce m
e
narche
del
a
y
com
p
ared t
o
gi
rl
s wi
t
h
go
o
d
n
u
t
ri
t
i
onal
st
at
us [5]
.
T
h
e
main
cau
se of t
h
e d
e
lay is du
e to
a
dec
r
ease i
n
cal
o
r
i
e
s, p
r
ot
ei
n, an
d
ot
he
r
nut
ri
ent
s
w
h
i
c
h t
h
e
n
i
m
pact
on t
h
e
pr
o
duct
i
o
n o
f
go
na
dot
ro
pi
n
ho
rm
one. The
ener
gy
nee
d
s of gi
rl
s i
n
t
h
e age o
f
1
0
-
12 y
ears we
re 2
0
5
0
kcal
,
whi
l
e
t
h
ose
w
h
o were
1
3
-
1
5
y
ears ol
d nee
d
2
3
5
0
kcal
.
The producti
on of
gonadotropin
horm
one i
s
infl
uenc
ed by nut
riti
on. Good nutrition
will accelerate
t
h
e fo
rm
ati
o
n
of g
ona
d
o
t
r
o
p
i
n
h
o
rm
one
and
ot
he
r ho
r
m
ones t
h
at
affect
t
h
e com
i
ng
of m
e
narche. Th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
22
I
J
ERE
Vo
l.
4
,
N
o
.
2
,
Jun
e
201
5 :
7
1
– 75
72
p
r
ob
lem
s
wh
ich
often
o
c
cu
r
in
ado
l
escen
ts were i
n
suffici
en
t nu
tritio
n
a
l
in
tak
e
and
excess nu
trien
t
i
n
tak
e
.
B
o
t
h
o
f
t
h
e pr
obl
em
s great
l
y
affect
t
h
e con
d
i
t
i
on o
f
t
h
e b
ody
w
h
i
c
h t
h
e
n
ga
ve an i
m
p
act
on t
h
e rep
r
od
uct
i
v
e
sy
st
em
of
ho
r
m
ones t
h
at
wi
l
l
affect
t
h
e
occ
u
r
r
ence
o
f
m
e
narche
[
6
]
No
rm
al
growt
h
i
n
ad
ol
esce
nt
s re
qui
re
d a
go
o
d
an
d we
l
l
-
bal
a
nce
d
n
u
t
ri
t
i
onal
st
at
us
. N
u
t
r
i
t
i
onal
status was good when
necess
a
ry nutrie
n
ts such as prot
eins
, fats, carbohy
d
rates, m
i
nerals, vitamins, and water
are use
d
by the body in accorda
n
ce with the re
qui
rem
e
nt
s. In order to determ
ine
the nutritional status in
adol
esce
nt
s
we
use
d
t
h
e
b
ody
m
a
ss i
nde
x f
o
rm
ul
a based
o
n
ag
e o
r
c
o
m
m
onl
y
abbre
v
i
a
t
e
d t
o
B
M
I
-
f
o
r
-
age:
m
o
n
ito
rin
g
nu
tritio
n
a
l statu
s
,
esp
ecially with
reg
a
rd
t
o
d
e
fi
ciencies and overweight [7
]. Based
on
th
is matter,
th
e research
ers were in
terested
in
stud
yin
g
t
h
e relatio
n
s
hi
p
bet
w
een
nut
ri
t
i
onal
st
at
us an
d age o
f
m
e
narche o
n
fem
a
l
e
st
udent
s i
n
ju
ni
o
r
hi
g
h
sch
o
o
l
Al
i
M
a
ksum
Krap
y
a
k, B
a
nt
ul
,
Y
ogy
a
k
art
a
. T
h
e
reaso
n
f
o
r c
h
oosi
n
g
th
is scho
o
l
was th
at all th
e female stu
d
e
n
t
s
at th
is sc
h
ool
t
e
nd t
o
c
ons
um
e t
h
e sam
e
foo
d
eve
r
y
day
,
b
u
t
t
h
ey
have
va
ri
ed
ag
es o
f
m
e
narche
.
2.
R
E
SEARC
H M
ETHOD
Thi
s
resea
r
ch
was co
n
duct
e
d
at
juni
or
hi
g
h
scho
ol
Al
i
M
a
ks
um
Krapy
a
k, B
a
nt
ul
, Y
o
gy
aka
r
t
a
i
n
Decem
ber 2014. This
research
was an analytical study
e
m
ploying cross-sectiona
l research design. The
p
opu
latio
n
of
th
is research
was all fe
m
a
le
stu
d
e
n
t
s in
this j
u
n
i
o
r
h
i
gh
scho
o
l
with
the to
tal o
f
9
2
fe
m
a
le
st
ude
nt
s. T
h
e
sam
p
l
e
sel
e
ct
ion
was
do
ne
by
t
o
t
a
l
sam
p
l
i
ng
wi
t
h
t
o
o
k
al
l
st
udent
s
becom
e
t
h
e research
p
opu
latio
n–
and
who
were willin
g
to
b
e
respo
n
d
e
n
t
s were 81
fem
a
le
stu
d
e
n
t
s.
Th
e ind
e
p
e
nd
en
t v
a
riab
le in
th
is research
was th
e
nu
tritio
n
a
l status ob
t
a
in
ed
b
y
m
eas
u
r
em
en
ts of
wei
g
ht
and
hei
ght
by
cat
eg
or
y
usi
ng t
h
e
pa
ram
e
t
e
r va
l
u
es B
M
I z-score t
h
r
o
ug
h
Worl
d Heal
t
h
O
r
ga
ni
zat
i
o
n
(
W
HO
) A
n
t
h
r
o
Pl
us
20
0
5
p
r
og
ram
and gr
o
upe
d i
n
t
o
t
w
o
cat
egi
r
i
e
s base
d o
n
st
an
dar
d
devi
at
i
o
n (S
D
)
:
norm
a
l
(-
2 S
D
u
p
t
o
1
SD)
an
d a
b
no
r
m
al
whi
c
h c
o
n
s
i
s
t
s
of
ve
ry
t
h
i
n
(<
-
3
S
D
)
,
thi
n
(
-
3
S
D
u
p
to
<-2
SD
),
fat
(>
1
SD
up
t
o
2
S
D
),
and
o
b
ese
(>
2 S
D
). T
h
e
de
pen
d
e
n
t
vari
ab
le in
th
is
research was th
e
ag
e at m
e
n
a
rch
e
th
at
categorized as
norm
al (11-
13
year
s)
an
d
ab
nor
m
a
l
th
at co
n
s
ists
of
ear
l
y
(
<
11
year
s)
, and
d
e
layed
(
>
13
years). Th
e con
f
ou
nd
ing
v
a
riab
le in th
is res
earch
wa
s
the
psychological as
pect,
social e
nvi
ronm
ental factors
,
and s
o
cio ec
onom
i
c status.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Uni
v
ari
a
te An
al
ysi
s
a)
The fre
q
u
ency
di
st
ri
b
u
t
i
o
n
o
f
nut
ri
t
i
onal
st
at
us vari
a
b
l
e
Nut
r
itional status of fem
a
le stude
nt
s in
junior high sc
hool
Ali Ma
ksum
was determ
ined according t
o
t
h
e cat
eg
ory
o
f
t
h
e b
ody
m
a
ss i
nde
x f
o
rm
ul
a base
d o
n
a
g
e
(B
M
I
-
f
o
r-a
ge
).
The m
easure
m
ent
of B
M
I
-
f
o
r
-
age
was done
by using scales as a device to m
e
asure
weig
ht
and m
i
crot
oi
se as a devi
ce t
o
m
easure hei
g
h
t
. The
fre
que
ncy
di
st
r
i
but
i
o
n
of
n
u
t
r
i
t
i
onal
st
at
us
o
n
res
p
o
n
d
ent
s
i
n
t
h
i
s
re
searc
h
c
a
n
be see
n
i
n
T
a
bl
e 1
.
Tabl
e
1. T
h
e
n
u
t
r
i
t
i
onal
st
at
u
s
o
f
r
e
sp
o
nde
nt
s
Tab
l
e 1
sho
w
s th
at th
e m
a
j
o
rity o
f
resp
ond
en
ts in
th
is
research
h
a
d
no
rm
al n
u
t
rition
a
l statu
s
wh
ich
num
bere
d t
o
6
7
pe
o
p
l
e
wi
t
h
a perce
n
t
a
ge
o
f
8
2
.
7
%. T
h
e c
a
t
e
go
ry
of
n
u
t
r
i
t
i
onal
st
at
us b
a
sed o
n
B
M
I
-
f
o
r
-
age
wh
ich
is co
nsid
ered
norm
a
l
is b
e
tween
-2 SD up
to
1
SD wh
ile th
e o
n
e
con
s
id
ered
abno
rm
al in
clu
d
es
resp
o
nde
nt
s
wi
t
h
t
h
e cat
eg
o
r
y
of
very
t
h
i
n
i
s
<-3
SD
, t
h
in
i
s
b
e
tween
-3
SD up
to <-2
SD,
fat is b
e
tween
>
1
SD
u
p
t
o
2
S
D
,
an
d
obe
se i
s
>
2
SD
.
b)
The a
g
e
of
m
e
narc
he
The a
g
e
of
menarche
of fe
m
a
l
e
st
udent
s
i
n
j
u
ni
o
r
hi
g
h
sch
o
o
l
Al
i
M
a
ks
um
were
m
easured
by
que
st
i
o
n
n
ai
re
.
The a
g
e
of
m
e
narc
he
o
n
t
h
e
r
e
sp
on
de
nt
s i
n
t
h
i
s
re
searc
h
ca
n
be see
n
i
n
Ta
bl
e 2
.
Nutritional Status
Nu
m
b
e
r
Percentage
(%)
Norm
al 67
82.
7
Abnorm
a
l 14
17.
3
T
o
tal
81
100
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
ERE
I
S
SN
:
225
2-8
8
2
2
N
u
t
r
i
t
i
onal
St
a
t
us
an
d A
g
e
at
Men
arche
o
n
Fem
a
l
e
St
ude
n
t
s of
J
uni
or
Hi
gh
Sc
h
ool
(
R
i
h
ul
H
u
s
nul
Jul
i
y
at
mi
)
73
Tabl
e
2. T
h
e
a
g
e at
m
e
narche
o
f
re
sp
o
nde
nt
s
Tabl
e 2 s
h
o
w
s t
h
at
t
h
e
m
a
jo
ri
t
y
of res
p
on
de
nt
s i
n
t
h
i
s
researc
h
ha
d n
o
rm
al
m
e
n
a
rche
whi
c
h
num
bere
d t
o
5
8
pe
opl
e wi
t
h
a perce
n
t
a
ge o
f
71
.6
%. Th
e cat
ego
r
y
of t
h
e age at
m
e
narche st
at
us
wh
i
c
h i
s
st
at
ed t
o
be
n
o
r
m
a
l
i
s
m
e
narc
he e
xpe
ri
ence
d
by
r
e
sp
o
nde
nt
s bet
w
een
t
h
e
ages
of
1
1
t
o
1
3
y
ears
.
On
t
h
e
ot
he
r
hand, t
h
e age
at
m
e
narche
category that is stated
t
o
b
e
abn
o
r
m
a
l
i
n
cl
udes ea
rl
y
m
e
narche
w
h
i
c
h w
a
s
expe
ri
ence
d
by
resp
o
nde
nt
s at
t
h
e age
of <
1
1
y
ears an
d l
a
t
e
m
e
narche
w
h
i
c
h i
s
ex
peri
e
n
ce
d by
resp
o
nde
n
t
s at
the age
of >
13 years.
3.
2.
B
i
vari
a
te An
a
l
ysi
s
Th
e an
alysis in
th
is research was cond
u
c
ted
b
y
cro
ss tabu
latio
n
aim
e
d
to
lo
ok
at th
e
relatio
n
s
h
i
p
bet
w
ee
n t
h
e
i
n
depe
n
d
ent
va
ri
abl
e
s (t
he
nut
ri
t
i
onal
st
at
us
) a
n
d
t
h
e
de
pen
d
e
nt
va
ri
abl
e
(t
he a
g
e at
m
e
narche
)
.
Th
e statistical test con
d
u
c
ted
was C
h
i-
squ
a
re with si
gn
ifican
ce lev
e
l of
p <
0
.
0
5
. To
cal
cu
late th
e
probab
ility
of t
h
e ris
k
s
we
re h
o
w
m
a
ny
tim
e
s the
increa
se or the
dec
r
e
a
se of the
risk
s on
th
e
sam
p
le, it was seen
from
th
e
value of
rati
o prevale
n
t
(RP) w
ith
95% c
o
nfidence i
n
tervals.
The
res
u
l
t
o
f
t
h
e
bi
va
ri
at
e an
al
y
s
i
s
bet
w
ee
n
n
u
t
r
i
t
i
onal
st
at
us a
n
d
age
of
m
e
narche i
s
s
h
o
w
n i
n
t
h
e
Tabl
e 3.
Tabl
e
3. T
h
e
re
l
a
t
i
onshi
p
bet
w
een
nut
ri
t
i
onal
st
at
us an
d t
h
e a
g
e at
m
e
narche
Nutritional
Status
Age of M
e
nar
c
he
Am
ount Sig.
RP
(
95 % CI
)
Norm
al Abnorm
a
l
N %
N
%
N
%
0.
002
3.
077
(
1
.
675 – 5.
650)
Abnorm
a
l 5
6.
2
9
11.
1
14
17.
3
Norm
al 53
65.
4
14
17.
3
67
82.
7
T
o
tal 58
71.
6
23
28.
4
81
100
On th
e Tab
l
e
3, it can
b
e
seen th
at th
e
resu
lts o
f
th
e C
h
i square was ob
ta
ined from
significance
value
(p val
u
e)
= 0.
0
01
at
α
= 0.0
5
wi
t
h
p <
α
, bu
t still fo
u
n
d
a cell wh
ich
h
a
d
a v
a
lu
e of exp
e
cted
co
un
t less th
an
5
that is
on cell
b, t
h
us t
h
e
res
earche
r
use
d
a
n
alterna
tive t
e
st nam
e
ly fisher exact
test, so th
at t
h
e
v
a
lu
e
o
f
significa
nce (p value
)
becam
e 0.002.
Base
d
on t
h
ese re
sult
s it can be c
o
nclude
d that the
r
e was a
relations
hi
p
bet
w
ee
n n
u
t
r
i
t
i
onal
st
at
us a
nd a
g
e o
f
m
e
narc
he o
n
fe
m
a
l
e
st
udent
s
of j
u
ni
or
hi
g
h
sch
o
o
l
Al
i
M
a
ksum
K
r
ap
yak, Ban
t
u
l
,
Y
o
g
y
ak
ar
ta. Judg
ing
f
r
o
m
th
e v
a
l
u
e
o
f
r
a
t
i
o
pr
ev
alen
t (
R
P)
th
at
w
a
s 3.07
7 (9
5% CI =
1
.
6
75
– 5
.
6
5
0
)
,
i
t
m
ean t
h
at
re
sp
o
nde
nt
s
wh
o
ha
ve ab
n
o
rm
al
nut
ri
t
i
onal
st
at
u
s
get
3
.
0
0
7
t
i
m
es great
er c
h
ance o
f
expe
ri
enci
ng
a
b
n
o
r
m
a
l
m
e
nar
c
he t
h
a
n
res
p
o
nde
nt
s
w
h
o
ha
ve
no
rm
al
nut
r
i
t
i
onal
st
at
us.
3.
3.
Discussion
M
o
st
resp
o
nde
nt
s ha
ve n
o
rm
al
nut
ri
t
i
onal
st
at
us wi
t
h
a perce
n
t
a
ge
of
82
.7
%. I
n
ad
d
i
t
i
on t
o
t
h
e
resp
o
nde
nt
s
w
i
t
h
n
o
rm
al
nut
ri
t
i
on, t
h
ere
w
e
re 1
7
.
3
%
o
f
resp
o
nde
nt
s
w
i
t
h
ab
no
rm
al
nut
ri
ent
t
h
at
was t
h
e
category of t
h
in, fat, and obese. T
h
e
vari
ous
categ
ori
e
s o
f
nut
ri
t
i
onal
st
at
us
hap
p
e
n
beca
u
s
e
aft
e
r
expe
ri
enci
ng
m
e
narche s
o
m
e
fem
a
l
e
st
udent
s of
Al
i
M
a
ksum
got
t
h
ei
r
wei
ght
i
n
c
r
ea
se causi
n
g
cha
nge i
n
eat
i
ng ha
bi
t
s
d
u
e t
o
fea
r
o
f
o
b
esi
t
y
so t
h
at
t
h
ey
t
e
nd t
o
di
d w
r
o
n
g
di
et
a
nd
oft
e
n re
d
u
c
e
t
h
e fre
q
u
enc
y
of
eat
i
ng.
Oth
e
r nu
tritio
nal p
r
ob
lem
th
at o
ccurs on
female stu
d
e
n
t
s
o
f
j
u
n
i
or h
i
gh
sch
o
o
l
Ali Mak
s
u
m
was th
e
lack
o
f
kn
owled
g
e
ab
ou
t
n
u
t
ritio
n
,
esp
ecially related
t
o
the diet m
a
tter to
decrea
se
of
weight, m
o
st of them
who
were d
i
et
on
ly con
s
u
m
e food
wh
ich
th
ey b
e
liev
e
can
lo
se wei
g
ht with
ou
t
p
a
yin
g
atten
tio
n to
the
adeq
uacy
of
n
u
t
r
i
e
nt
s
nee
d
e
d
by
t
h
e b
o
d
y
.
The m
i
ssunde
rst
a
n
d
i
n
g
of
n
u
t
r
i
e
nt
i
n
ad
ol
escent
s
es
peci
al
l
y
i
n
th
o
s
e
who
go
on
a d
i
et to
m
a
i
n
tain
th
eir slend
e
rn
ess
b
y
ap
plyin
g
wron
g
n
u
tritio
n
a
l
m
a
in
ten
a
n
ce
p
r
i
n
cip
l
e will
cau
se nu
tritio
nal
d
i
sord
ers [8
].
M
o
st
of t
h
e re
spo
n
d
e
n
t
s
hav
e
norm
a
l
age at
m
e
narche wi
t
h
a perce
n
t
a
ge
of 7
1
.
6
%. B
e
s
i
des, 2
8
.
4
%
of re
sp
o
nde
nt
s
have a
b
n
o
rm
al
age of m
e
nar
c
he wi
t
h
t
h
e c
a
t
e
go
ry
of ea
rl
y
m
e
narche an
d l
a
t
e
m
e
narch
e
. The
vari
et
y
o
f
cat
e
g
o
r
y
of m
e
narc
he i
s
ca
use
d
by
m
a
ny
fact
ors.
Age of M
e
nar
c
he
Nu
m
b
er
Per
centage
(
%
)
Norm
al 58
71.
6
Abnorm
a
l 23
28.
4
T
o
tal
81
100
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
22
I
J
ERE
Vo
l.
4
,
N
o
.
2
,
Jun
e
201
5 :
7
1
– 75
74
Fem
a
l
e
st
uden
t
s experi
e
n
ci
n
g
earl
y
m
e
nar
c
he i
n
t
h
i
s
st
u
d
y
were
14
.8
% whi
c
h of t
h
em
have t
h
e
nut
ri
t
i
onal
st
at
us o
f
fat
an
d
obe
se cat
ego
r
i
e
s. The f
act
ors that cause early
m
e
na
rche
were m
acron
ut
ri
ent
con
s
um
pt
i
on
f
act
ors,
l
i
f
est
y
l
e
fact
o
r
s,
pa
rent
s’
in
co
me
f
a
c
t
o
r
s,
an
d
spor
ts f
acto
r
s
[9
].
Th
e stud
en
ts ex
p
e
rien
ci
n
g
late
m
e
n
a
rch
e
in th
is stu
d
y
were 1
3
.6% wh
ich
o
f
th
em
h
a
ve n
u
t
rition
a
l
status with thi
n
category. On
e
of t
h
e factors
whic
h cause the late
m
e
narc
he in adolescent
s
is height status that
i
s
short
or st
u
n
t
i
ng. A
d
ol
esce
nt
s wi
t
h
st
u
nni
ng
nut
ri
t
i
onal
s
t
at
us expe
ri
enc
e
m
e
narche sl
o
w
er t
h
a
n
t
h
ose
wh
o
h
a
v
e
no
rm
al n
u
t
ritio
n
a
l status. Sho
r
t
h
e
igh
t
statu
s
will affect rep
r
od
u
c
tive d
e
v
e
l
o
p
m
en
t in
ad
o
l
escen
t
s [10
]
.
M
o
st
l
y
resp
on
dent
s
wi
t
h
no
r
m
al
nut
ri
t
i
onal
st
at
us (i
n
d
e
x
W /
A) e
x
peri
e
n
ce m
e
narche
at
age o
f
<1
2.
5
y
ears,
whi
l
e
resp
o
nde
nt
s wi
t
h
t
h
e
n
u
t
ri
t
i
onal
st
at
us
of
st
u
n
t
i
n
g
m
o
st
l
y
experi
e
n
ce
m
e
narche at
a
g
e>
12
.5
y
ears
[1
1]
.
Based
on t
h
e
biva
riate analysis so that
obtain th
e si
gni
fi
cant
val
u
e (
p
val
u
e
)
are
0.
0
02
fr
om
t
h
i
s
resu
lt, it can
be con
c
lud
e
d
that th
ere was a
relatio
n
s
h
i
p
b
e
tw
een nu
tr
itional statu
s
an
d the ag
e of
m
e
n
a
rch
e
on
fem
a
le stu
d
e
n
t
s o
f
jun
i
o
r
h
i
gh
sch
o
o
l
A
li M
a
k
s
u
m
K
r
ap
yak
,
Ban
t
u
l
, Y
ogyak
a
rta. In
additio
n
,
seeing
fro
m
th
e
rat
i
o
p
r
e
v
al
ent
val
u
e
(R
P
)
3.
07
7
(9
5% C
I
= 1.
6
75
–
5.
6
5
0
)
,
i
t
m
eans t
h
at
resp
o
nde
nt
s
w
ho
ha
ve a
b
n
o
rm
al
nut
ri
t
i
onal
st
at
us
get
3
.
0
0
7
t
i
m
es great
er
ch
ance
of e
x
peri
enci
n
g
a
b
n
o
r
m
a
l
m
e
narche
t
h
an re
sp
o
nde
nt
s
w
h
o
have
n
o
r
m
a
l
nut
ri
t
i
onal
st
at
u
s
.
Th
e ag
e at m
e
n
a
rch
e
is influen
ced
b
y
sev
e
ral fact
ors,
one o
f
wh
ich
is t
h
e nu
trition
a
l statu
s
. Gi
rls
with
less nu
tritio
n
a
l statu
s
will ex
p
e
rien
ce late
m
e
n
a
rch
e
co
m
p
ared
to
girls with
goo
d
n
u
t
ritio
n
a
l statu
s
[5
]
.
The e
xpl
a
n
at
i
o
n st
at
ed
by
K
a
rt
o
no
(1
9
9
2
)
t
h
at
m
e
narche
occurs at a c
e
rtain wei
ght
of a ce
rtain a
g
e in a
w
o
m
a
n
[6
].
Nu
t
r
itio
u
s
food
s and
h
i
gh
fat fo
od
fro
m
an
im
a
l
p
r
od
u
c
ts will
lead
g
i
rls to
g
a
in
weig
h
t
. It can
increase t
h
e le
vel of the e
s
tr
o
g
en
h
o
rm
one
whi
c
h t
h
e
n
ca
u
s
es hi
g
h
c
h
ol
es
t
e
rol
.
It
ha
ppe
n
s
n
o
t
o
n
l
y
beca
use
of
t
h
e fat
fr
om
t
h
e b
ody
c
o
m
pos
i
t
i
on fact
ors
b
u
t
al
so f
o
od
i
n
t
a
ke a
n
d
t
h
e a
b
se
nce
of
wea
k
e
n
di
sease.
The rel
a
t
i
o
ns
h
i
p bet
w
e
e
n
n
u
t
r
i
t
i
onal
st
at
us
and a
g
e
o
f
m
e
n
a
rch
e
was in
lin
e with
th
e
research
on
fem
a
l
e
st
udent
s o
f
j
uni
or
hi
g
h
sc
h
ool
Sha
f
i
y
y
a
t
u
l
Am
ali
y
y
a
h a
n
d
N
u
rul
Hasa
na
h i
n
M
e
dan
whi
c
h st
a
t
e t
h
at
the nutritional
status affects
the age
of
m
e
n
a
rch
e
[12
]
. It
was also
co
nsisten
t
with
the research
on
fem
a
le
st
ude
nt
s o
f
st
at
e ju
ni
or
hi
g
h
sch
ool
2
2
B
a
n
d
ar Lam
p
u
ng
t
h
at
t
h
ere was
a rel
a
t
i
onshi
p
bet
w
ee
n n
u
t
r
i
t
i
onal
statu
s
and
th
e ag
e
o
f
m
e
n
a
rch
e
. Respon
den
t
s who
h
a
ve h
i
gh
n
u
t
ritio
n
a
l status or abo
v
e
no
rm
al will
expe
rience m
e
narc
he at the fast level of age
while res
p
o
n
d
e
nt
s wh
o ha
ve
nut
ri
t
i
onal
st
at
us i
n
t
h
e bel
o
w l
e
vel
will ex
p
e
rien
ce m
e
n
a
rch
e
at
th
e slow lev
e
l
o
f
ag
e, an
d
resp
ond
en
ts
wh
o
h
a
v
e
no
rm
al n
u
t
ritio
n
a
l status will
expe
rience
m
e
narc
he at
the
norm
al age too
[13].
I
t
w
a
s a
l
so
con
s
is
te
n
t
w
ith
th
e r
e
s
e
ar
ch of
g
i
r
l
s
in Sa
bzevar,
Ira
n that
si
gni
fi
cant
rel
a
t
i
o
n
bet
w
een B
M
I an
d m
e
narche ag
e (p=
0
.02). The res
u
lt
s indicated that the
m
e
narche a
g
e
and B
M
I a
r
e s
i
gni
fi
ca
nt
l
y
rel
a
t
e
d an
d t
h
e
hi
ghe
r t
h
e B
M
I
t
h
e Lo
wer t
h
e
m
e
narche a
g
e
[1
4]
.
Su
bject
s
w
h
o
ha
d at
t
a
i
n
e
d
m
e
narche i
n
earl
y
ad
ol
esc
e
nce
ha
d
hi
g
h
e
r B
M
I t
h
a
n
t
h
ei
r
pre
-
m
e
narcheal
co
un
terp
arts
[15
]
. Delayed men
a
rch
e
m
a
y b
e
a sign
of
m
a
ln
u
t
rition
sin
c
e as nu
tritio
n
a
l
statu
s
im
p
r
o
v
e
s; th
e
attain
m
e
n
t
o
f
men
a
rch
e
is lo
wered
.
Attain
m
e
n
t
o
f
m
e
n
a
rche
decreas
e
s
whe
n
BMI increase
s
. T
h
ere is a
cor
r
el
at
i
on
bet
w
een B
M
I an
d
at
t
a
i
n
m
e
nt
of
m
e
narche a
n
d
also, the
r
e is a
correlation
be
tween ea
rly obesity
and ea
rl
y
onset
of m
e
narche.
Gi
rl
s wi
t
h
ea
rl
y
onset
o
f
m
e
n
a
rch
e
h
a
d
h
i
gher BMI th
an
tho
s
e with
late on
set
of
m
e
narche
[
16]
.
Th
e cur
r
e
n
t
r
e
sear
ch
f
i
nd
ing
is si
milar
to
th
e f
i
n
d
i
n
g
o
f
a stu
d
y
in
In
d
i
a
[
1
7
]
. Th
e study f
o
un
d
that
nut
rition status associate
d
with ag
e at m
e
narc
he.
The
highest t
h
e nutrition status, the low is the a
g
e a
t
m
e
narche
. Ga
y
o
l
,
M
e
ht
a an
d Ka
ur al
so f
o
u
n
d
t
h
at
m
e
narche i
s
del
a
y
e
d d
u
e t
o
u
n
d
e
rn
ut
ri
t
i
on a
n
d
as t
h
e
nut
ri
t
i
onal
st
at
us i
m
pro
v
ed
,
at
t
a
i
n
m
e
nt
of
m
e
narche i
s
l
o
were
d
[1
8]
. Si
m
ondo
n
et al
[1
9]
i
n
Se
ne
ga
l
al
so
concl
ude
d t
h
at
t
h
e age at
m
e
narche i
s
del
a
y
e
d, p
r
oba
bl
y
du
e t
o
m
a
l
nut
ri
t
i
on
[1
9]
. M
p
ora
et al
[20]
al
so fo
u
nd
th
at ag
e
at m
e
n
a
rch
e
d
e
p
e
n
d
e
n
t
on
nu
tritio
nal statu
s
in
No
rth
e
rn
Ug
and
a
.
4.
CO
NCL
USI
O
N
There
was
a re
l
a
t
i
onshi
p
bet
w
een
n
u
t
r
i
t
i
o
n
a
l
st
at
us an
d t
h
e a
g
e at
m
e
narche
o
n
fem
a
le st
ude
nt
s
of
Juni
or
Hi
g
h
Scho
ol
Al
i
M
a
ksum
. M
o
st
of t
h
e fem
a
l
e
st
udent
s i
n
j
u
ni
o
r
hi
gh sc
ho
ol
Al
i
M
a
ksum
were i
n
no
rm
al
nut
ri
t
i
onal
st
at
us. M
o
s
t
of t
h
e fem
a
l
e
st
ude
nt
s i
n
Ju
n
i
or Hi
g
h
Sc
ho
ol
Al
i
M
a
ksum
have n
o
rm
al
age o
f
menarche
(between the a
g
es of 11 t
o
13 y
ears).Teach
ers nee
d
to pay a
ttention the
problem
s of
nutritional
st
at
us o
n
fem
a
le st
u
d
ent
s
e
s
pe
ci
al
l
y
t
hose w
h
o
oft
e
n
go
o
n
d
i
et
.
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