Puberty, the transition from childhood to adult body size and sexual maturity, is a complex multistaged process involving growth acceleration, weight gain and the appearance of secondary sexual physical features over a 2- to 3-year period
1. Early onset and progression of puberty is seen in some overweight and obese children. In addition to its psycho-social and public health implications, early puberty is associated with increased long-term risk for diseases including obesity, diabetes and cancer
3. The stages of puberty and their transitions are difficult to measure accurately
1. Epidemiological studies often use age at menarche, the onset of the first menstrual period in girls, to indicate the timing of puberty, as this distinct event is often well recalled many years later
1. Girls with earlier menarche are heavier and taller than other girls during childhood; they remain heavier but are shorter as adults
3, reflecting their earlier cessation of growth. Twins studies estimate that 44–95% of the variance in age at menarche may be heritable
1. However, specific common genetic variants that influence the timing of puberty have not yet been convincingly demonstrated
4.
To identify common variants associated with the timing of puberty, we conducted a genome-wide association (GWA) study for age at menarche in 4,714 women from two general population studies and one obese case study using the same Affymetrix GeneChip 500K array (
Supplementary Note online). Only one SNP, rs314276 in intron 2 of
LIN28B on chromosome 6 (MAF 0.33), reached genome-wide statistical significance (
P = 1.5 × 10
−8,
Supplementary Fig. 1 online). In these GWA studies overall each major C allele at rs314276 was associated with a mean 0.22 years (95% CI = 0.14–0.29) earlier age at menarche.
SNP rs314276 lies in a region of high linkage disequilibrium (LD); although no other SNPs in this region were directly genotyped in these arrays, imputation to HapMap build 35 revealed a further 11 SNPs in
LIN28B that were associated with age at menarche at
P < 0.5 × 10
−7 (). The minor allele at a neighboring SNP, rs314277, 337 bp downstream of rs314276, was recently robustly associated with taller adult height
5. In our GWA studies imputed rs314277 genotypes showed only nominal association with age at menarche (
P = 0.005). However, as there was low LD between rs314276 and rs314277 (
r2 = 0.23; D = 1.0) we took both SNPs forward to initial replication.
Study of mothers from the ALSPAC cohort (
N = 6,456) confirmed the association between rs314276 and age at menarche (
P = 6.6 × 10
−5). Each common C allele was associated with a mean 0.10 years (95% CI = 0.07–0.13) earlier menarche, the association seemed to be linear (
Supplementary Fig. 2 online) and rs314276 explained 0.2% of the variance in age at menarche. In contrast, the adjacent SNP rs314277 was not associated with age at menarche (
P = 0.08). In multiple regression analysis including both SNPs, rs314276 (
P = 0.0006), but not rs314277 (
P = 0.6), was associated with age at menarche. The association between rs314276 and age at menarche was further confirmed in women from the EPIC-Norfolk cohort (
P = 8.7 × 10
−6,
N = 8,411), the MRC National Study of Health and Development (NSHD) (
P = 0.02;
N = 948) and the British 1958 Birth Cohort (B58C) (
P = 0.007;
N = 558; and
Supplementary Fig. 2). In a meta-analysis of all replication studies (total
N = 16,373 women), each rs314276 C allele was associated with 0.12 years earlier menarche (95% CI = 0.08–0.16;
P = 2.8 × 10
−10; ). Notably, the pooled regression coefficient in the replication studies was only around half of that in the GWA studies (heterogeneity between initial and replication studies:
P = 0.02; ), likely reflecting the ‘winner's curse’ phenomenon.
Although menarche represents the completion of female sexual maturation and attainment of reproductive capacity, the onset of puberty in girls typically occurs 2-3 years earlier and is manifested by the onset of breast growth and acceleration in height and weight gain. To explore its association with the timing of pubertal onset, we genotyped rs314276 in various childhood studies (see for summary).
| Table 1Summary of the pubertal and growth phenotype associations with LIN28B rs314276 genotype |
In ALSPAC girls (
N = 4,271), the common C allele at rs314276 was associated with earlier onset of breast development (, log-rank test:
P = 0.001). At age 10.75 years each C allele was associated with a 20% increased likelihood of breast development (odds ratio (OR) = 1.20, 95% CI = 1.06–1.35;
P = 0.003). In the cross-sectional European Youth Heart Study (EYHS), across all age groups from 9 to 16 years the common C allele at rs314276 was associated with more advanced breast stage in girls (OR = 1.26, 95% CI = 1.05–1.52;
P = 0.006;
N = 1,044) ( and
Supplementary Table 1 online). In ALSPAC girls, the rs314276 C allele was associated with a faster tempo of growth in height between ages 7 and 11 years (
P = 0.00008), and relative acceleration in weight (
P = 0.0003) and body mass index (BMI) (
P = 0.03) ().
In boys, the onset and progression of puberty are manifested by a gradual enlargement of the external genitalia and the spread of pubic hair. By convention these characteristics are categorized into five stages of sexual maturation; however, in epidemiological studies these stages are difficult to assign accurately. Equivalent to menarche in girls, voice breaking in boys represents a distinct event, which typically occurs abruptly in late puberty
6. In NSHD men (
N = 1,027) at age 15 years the common C allele at rs314276 was associated with more advanced pubic hair stage (
P = 0.05), more advanced voice breaking status (
P = 0.006) and also more advanced tempo of height growth (
P = 0.03), but no apparent difference in genital size ( and
Supplementary Table 2 online). In ALSPAC boys (total
N = 4,588), the C allele at rs314276 was associated with more advanced pubic hair at age 13 years (OR for a one-stage advance in pubic hair stage per C allele = 1.19, 95% CI = 1.04–1.35;
P = 0.01), and with a faster tempo of growth in height between ages 7 and 11 years (
P = 0.03;
Supplementary Fig. 3 online). In the smaller sample of EYHS boys (total
N = 910, no association was found with genital or pubic hair stages at ages 9–11 years or 14–16 years (
Supplementary Table 1).
In contrast to their relatively taller stature during childhood, men and women with early puberty are shorter as adults, owing to their earlier cessation of growth, but they remain heavier and more overweight
3. Consistent with its associations with earlier puberty, the rs314276 C allele was also associated with shorter adult height in ALSPAC mothers (mean ± s.e.m. difference: −0.37 ± 0.12 cm per C allele,
P = 0.002), EPIC-Norfolk women (−0.36 ± 0.10 cm,
P = 0.0002) and EPIC-Norfolk men (−0.30 ± 0.11 cm,
P = 0.006). In multiple regression among ALSPAC mothers including both rs314276 and rs314277, rs314276 (
P = 0.003) but not rs314277 (
P = 0.3) was associated with adult height. In contrast to the findings with adult height, rs314276 showed no association with adult weight, BMI, waist circumference or percentage body fat (all
P > 0.10, see
Supplementary Table 3 online)
Several candidate genes, encoding regulators of sex steroid secretion and action, have been proposed to regulate the timing of puberty; however, no common variants have yet been established
4. In our GWA studies, SNPs in
FGFR1, GOLT1A, KISS1, LEPR and
SHBG showed modest associations with age at menarche (0.01 <
P < 0.05;
Supplementary Table 4 online). Our study therefore reinforces the merits of the genome-wide compared to the candidate gene approach, although much larger studies will be needed to identify the likely large number of SNPs associated with timing of puberty.
A recent GWA study for adult height identified rs314277 as one of ten loci with robust associations (
P = 5.9 × 10
−9 in 15,821 individuals), whereas rs314276 showed far weaker association (
P ~ 1 × 10
−4); however, rs314276 was not directly genotyped in many of those samples
5. In our study, where both SNPs were directly genotyped, the effects of rs314277 on height were explained by rs314276. rs314276 lies in a large LD block of around 200 kb that covers the 5′ region and first three exons of
LIN28B. Imputation revealed a further 11 SNPs that were in complete LD with rs314276 and that also reached genome-wide association with age at menarche. Fine mapping studies in similar populations of European ancestry are therefore unlikely to be able to distinguish the causal variant(s) from other linked variants.
LIN28B has two isoforms
7 distinguished by the presence or truncation of a highly conserved cold-shock domain (CSD), which is crucial for protein function
2. Different
LIN28B isoforms could therefore contribute to the heritability of the timing of growth and development.
LIN28B shows high sequence, structural and functional homology with
LIN28 on chromosome 1 (ref.
7); however, we found no association with 12 directly genotyped or imputed SNPs in
LIN28 (all
P > 0.2; see
Supplementary Table 4). Both
LIN28B and
LIN28 show similar sequence homology to the heterochronic gene
lin-28 in
Caenorhabditis elegans7. Deleterious mutations in
lin-28 produce an abnormal rapid tempo of development through larval stages to adult cuticle formation
8. Conversely, enhancement of
lin-28 expression by deletion of regulatory elements delays larval stage progression
9. Both
LIN28B and
LIN28 encode potent and specific regulators of pre-processing of the let7 family of microRNAs
2 and regulate cell pluripotency
10 and cancer growth
7.
In conclusion, we have identified SNP rs314276, or another related variant within LIN28B, as the first genetic marker associated with the timing of pubertal growth and development and in both girls and boys. Our findings suggest the conservation of a fundamental cell regulatory system that controls the tempo of somatic development and also suggest a physiological role for microRNA processing in the timing of human growth and development.