Title: How does BMI correlate with menarche onset? Evidence from the Italian HBSC cross-
sectional study
Version: 1 Date: 24 Sep 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: I have major problems with this manuscript.  The authors have
employed a large sample of 15 year olds from all parts of Italy to examine the relationship.
between BMI and age at menarche based on recall and that much is fine.  However there are
problems with data presentation and interpretation and the overall writing style, particularly the
introduction
REQUESTED REVISIONS:
1. The introduction needs a lot of work.  The first 5 paragraphs discuss adolescence and obesity
in general terms but do not focus on the reasons for doing the study.  Paragraphs 1 and 2 should
be deleted and 3-5 should be shortened and focused. We already know from many studies that
obesity is associated with earlier puberty and menarche.  What NEW information was this study
intended to provide, other than region-specific rates of obesity and mean age at menarche which
may be of limited interest to readers outside of Italy. 2. It is stated in the abstract and results
that "Region-level median age at menarche ranged between 12 years/5 months and 13 years/4
months."  This is not the real story, which is that for every region but one, the mean age at
menarche was 12 years and 5 or 6 months and for only one region was it higher at 13 years
and 4 months.  Also I do not understand why the figure for months does not correspond to
the years and moths figure. So while the % overweight or obese varied a lot, from 6-24%, the
mean age at menarche varied vary little, which is not what the manuscript says.  Thus I question
the value of what was found in the region by region analysis. 3.   Results paragraph 2:  This
sentence is clearly incorrect "In 95% of individuals, age (at menarche) ranged between 9 and 11
years and 7 months. "  Did they mean between 9 years and 14 years and 7 months? 4. Results
paragraph 4: This sentence seems to be in error "As the region-level prevalence of overweight
ranged between 6% and 24%, the maximum difference observed in the age at menarche was
79 weeks (approximately 20 months).  My reading of the data in Table 1 is that the maximum
difference between 12 years and 5 months anbd 13 years and 4 months was 11 months. 5. In
paragraph 2 of the discussion, it is stated that "In particular, the lowest median ages at menarche
were observed in southern regions, where the predominance of overweight is higher."  I did
not see the data that the authors used to draw this conclusion. 6. The discussion should do a
better job of emphasizing how their findings add to the already large body of literature on the
subject, in addition to providing data on Itialian girls. 7. The conclusion section should succinctly
summarize the key findings of the study, not speculate on subjects not specifically addressed
in the study
ADDITIONAL REQUESTS/SUGGESTIONS:
I have listed the major ones in the previous section, but my overall impression is that the writing
does not flow from one point to the next but tends to ramble.