The influence of sexual maturation on blood pressure and body fatness in African-American adolescent girls and boys

Association between precocious puberty and obesity risk in children: a systematic review and meta-analysis

Objectives

The aim of this study was to evaluate the potential association between early onset puberty and the risk of different forms of obesity in children.

Methods

The databases PubMed, EMBASE, Web of Science and Cochrane Library were systematically searched for relevant studies. The odds ratio (OR) and 95% confidence interval (CI) of obesity in precocious puberty were calculated using Stata software 14.0. A fixed-effects model was used if P > 0.1 and I2 ≤ 50%. Otherwise, a random-effects model was used. Publication bias was assessed using funnel plots and Egger's test.

Result

The pooling analysis showed that precocious puberty in girls was associated with a higher risk of obesity (OR = 1.98; 95% CI: 1.76-2.24; I2 = 0.00%, P < 0.001). Girls with a history of precocious puberty were found to have an increased risk of general obesity (OR = 2.03; 95% CI: 1.62-2.55; I2 = 22.2%, P < 0.001), central obesity (OR = 1.96; 95% CI: 1.70-2.26; I2 = 0.00%, P < 0.001), and overweight (OR = 2.03; 95% CI: 1.68-2.46; I2 = 5.1%, P < 0.001). The pooled analysis showed that precocious puberty in boys was not associated with an increased risk of obesity (OR = 1.14; 95% CI: 0.86-1.51; I2 = 50.6%, P = 0.369). In boys, the occurrence of precocious puberty was not associated with an elevated risk of general obesity (OR = 0.96; 95% CI: 0.40-2.27; I2 = 79.6%, P = 0.922), central obesity (OR = 1.17; 95% CI: 0.96-1.43; I2 = 0.00%, P = 0.125), or overweight (OR = 1.03; 95% CI: 0.56-1.88; I2 = 74.4%, P = 0.930).

Conclusion

This meta-analysis suggests that the onset of puberty at an early age in girls is associated with an increased risk of obesity, however precocious puberty in boy was not associated with an increased risk of obesity. These findings highlight that precocious puberty should be considered an independent risk factor for obesity in girls.

Systematic Review Registration

CRD42023404479.

Relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers

This study aimed to investigate the relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. This was a population-based cross-sectional study, conducted with 345 teenagers, aged 10 to 19 years, between 2018 and 2020. In this study, data referent to sociodemographic and anthropometric variables, blood pressure, and sexual maturation were collected. The data analysis was performed by applying the Principle Component Analysis (PCA), which generated three components and then tested the correlation between sexual maturation and the generated components. Most of the teenagers were female (53%), normotensive (66.1%), and with a normal weight (73%). A positive correlation was found between breast development and component 1 and component 2, as well as a negative correlation between the breasts and component 3. In the boys, the development of genitals and pubic hair was positively correlated with component 2 and inversely correlated with component 3. It could therefore be concluded that there is a relationship between sexual maturation and the anthropometric and blood pressure indicators, which proved to be representative variables for cardiovascular risk in teenagers, even if not in their entirety.

Relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers

Abstract This study aimed to investigate the relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. This was a population-based cross-sectional study, conducted with 345 teenagers, aged 10 to 19 years, between 2018 and 2020. In this study, data referent to sociodemographic and anthropometric variables, blood pressure, and sexual maturation were collected. The data analysis was performed by applying the Principle Component Analysis (PCA), which generated three components and then tested the correlation between sexual maturation and the generated components. Most of the teenagers were female (53%), normotensive (66.1%), and with a normal weight (73%). A positive correlation was found between breast development and component 1 and component 2, as well as a negative correlation between the breasts and component 3. In the boys, the development of genitals and pubic hair was positively correlated with component 2 and inversely correlated with component 3. It could therefore be concluded that there is a relationship between sexual maturation and the anthropometric and blood pressure indicators, which proved to be representative variables for cardiovascular risk in teenagers, even if not in their entirety.

Stress coping strategies and stress reactivity in adolescents with overweight/obesity

This study explored the associations between the frequency and effectiveness of habitual stress coping strategies on physiological and psychological stress responses to an acute laboratory stressor in adolescents with overweight/obesity (51 adolescents; 47% female; ages 14-19 years). Coping strategies were assessed using the Schoolager's Coping Strategies Inventory. Acute physiological stress responses were measured as salivary cortisol and α-amylase output during the Trier Social Stress Test and during a control condition. Acute psychological stress was measured using a Likert-type scale, and systolic blood pressure (SBP) and heart rate were measured at baseline. Results revealed that higher coping effectiveness was associated with lower log-based α-amylase during the stress (β = -0.025, p = 0.018) and control (β = -0.030, p = 0.005) conditions, but not with cortisol across either condition (all ps > 0.05). SBP moderated the association between coping effectiveness and α-amylase during the stress condition, with higher coping effectiveness associated with lower α-amylase only among individuals with lower SBP (β = 0.002, p = 0.027). Coping frequency was not associated with cortisol responses, neither was habitual stress coping strategies associated with psychological stress (all ps > 0.05). These findings provide preliminary evidence that effective use of stress coping strategies may provide a dampening effect on sympathetic activity in an at-risk adolescent population.

Sedentary behavior is more related with cardiovascular parameters in normal weight than overweight adolescents

This study analyzed the relationship between sedentary behavior and cardiovascular parameters in normal weight and overweight adolescents. The sample included 449 boys and 555 girls with mean age of 13 years from public schools, which were divided into five geographical regions, with data collections performed in one selected school from each region. Sedentary behavior was assessed by screen time on TV, computer, videogame and cell phone/tablet, with good reliability in adolescents. Physical activity was assessed by Baecke's questionnaire, validated for adolescents. Measures of body weight, height and waist circumference were collected. Adolescents were classified as overweight or normal weight by cut-off points of body mass index for age and sex. Cardiovascular parameters were evaluated by oscillometric device and heart rate by specific monitor. Computer use was positively related to systolic blood pressure (SBP) (β = 0.35; 95%CI = 0.07-0.62) and diastolic blood pressure (DBP) (β = 0.25; 95%CI = 0.05-0.44) in normal weight but not in overweight adolescents. Similar results were observed for cell phone/tablet in SBP (β = 0.46; 95%CI = 0.20-0.72) and DBP (β = 0.36; 95%CI = 0.18-0.54), only for normal weight. The cluster of screen time was related to SBP in normal weight (β = 0.44; 95%CI = 0.03-0.84) and overweight (β = 0.60; 95%CI = 0.01-1.19). Screen time in computer and cell phone/tablet was more related to cardiovascular parameters in normal weight than overweight adolescents.

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study)

OBJECTIVE

Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents.

METHOD

The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied.

RESULTS

Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP.

CONCLUSIONS

Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Association of Sleep Duration and Blood Pressure in Adolescents: A Multicenter Study

BACKGROUND

Evidence suggests that sleep duration is related to blood pressure (BP), but the findings are still inconsistent for adolescents.

OBJECTIVE

To analyze the association between sleep duration and BP in Brazilian adolescents between 12 and 17 years of age.

METHODS

This study is part of the Study of Cardiovascular Risk in Adolescents (ERICA), a multicenter, school-based, cross-sectional study in 273 municipalities in Brazil. The sample consisted of 65,643 adolescents. Sleep duration was measured by a subjective method, and BP was measured by the oscillometric method. Multiple linear regression analyses were performed to evaluate the association between sleep duration and BP.

RESULTS

The mean sleep duration was 8.14 hours (± 1.40), with significant difference between the groups according to BP levels (P < 0.0001). The mean systolic and diastolic BP were 110.59 (± 11.87) and 65.85 (± 7.94) mm Hg, respectively, in the group of adolescents. Sleep duration was significantly associated with BP. Each increase 1 hour in sleep was associated with BP reduction in both sexes combined (P < 0.0001). Considering the effects of covariates, each increase 1 hour in sleep was associated with systolic BP (SBP) reduction among boys (P = 0.004) and SBP elevation among girls (P = 0.009), after full adjustment.

CONCLUSION

The results suggest that each increase in sleep duration was associated with SBP elevation among girls. Such findings may have important implications for cardiovascular health in adolescence.

Performance of simplified tables for high blood pressure screening in a European pediatric population

OBJECTIVE

We assessed the performance of the simplified American Academy Pediatrics (AAP) 2017 guideline table and a simplified table based on the Fourth Report blood pressure (BP) reference tables for high BP screening compared with the European Society Hypertension 2016 guideline diagnostic thresholds.

METHODS

We obtained data from a cross-sectional, school-based screening study in north Greece during 2013-2016. BP was measured by mercury sphygmomanometer. The simple tables' performance for high BP was assessed by receiver operator characteristic curve analysis, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

The study population included 1846 children aged 6-12 years and 986 adolescents aged 13-18 years. Compared with the European Society Hypertension 2016 classification, the AAP 2017 simple table showed AUC 0.93, sensitivity 95.5%, specificity 91.6%, PPV 35.9%, and NPV 99.7%, whereas the Fourth Report one showed AUC 0.96, sensitivity 99.2%, specificity 93.2%, PPV 42.1%, and NPV 99.9%. Comparing the prevalence of high BP by the two tables, we found agreement in 96.9% of the participants, and disagreement in 3.1% (kappa coefficient = 0.85, P < 0.001). 20.8% of the adolescents classified for further screening by the Fourth Report, but not by the AAP 2017 simple table, had BP levels at the high-normal category.

CONCLUSION

Simple tables for BP screening based on age present good performance to identify children and adolescents with high BP levels. However, they may provide high rate of false positive results, and the simple table by the AAP 2017 guideline may fail to classify some adolescents eligible for further BP evaluation.

Pubertal Timing and Cardiometabolic Markers at Age 16 Years

OBJECTIVE

To examine the association between pubertal timing and cardiometabolic markers among adolescents.

STUDY DESIGN

We used data from Dutch adolescents participating in a birth cohort study. The study population for the current study consisted of 799 adolescents of whom data were available for at least 1 of the exposure variables (pubertal timing and/or age at menarche) and any of the cardiometabolic markers (waist circumference, cholesterol, blood pressure [BP], glycated hemoglobin) measured at age 16 years. Adolescents self-reported pubertal development at ages 11, 14, and 16 years. We categorized participants with early (84 girls, 88 boys), intermediate (240 girls, 211 boys), or late pubertal timing (89 girls, 85 boys). We estimated differences in cardiometabolic markers using linear regression analysis.

RESULTS

Girls with early pubertal timing had 1.54 cm larger waist circumference (95% CI .05; 3.03) and 3.98 mm Hg higher systolic BP (95% CI 1.69; 6.27) at age 16 years than girls with intermediate pubertal timing. The association with systolic BP remained after adjusting for childhood body mass index (BMI) (age 8 years) but attenuated after adjusting for BMI in adolescence (age 16 years). Boys with early pubertal timing had 0.79 mmol/mol lower glycated hemoglobin (95%CI -1.38; -0.20) than boys with intermediate pubertal timing.

CONCLUSIONS

Girls with early pubertal timing had unfavorable BP levels at age 16 years, independent of BMI in childhood. Girls and boys with late pubertal timing had a tendency for lower waist circumference, but no differences in other cardiometabolic markers. Late pubertal timing does not appear to be a risk factor for unfavorable cardiometabolic markers in adolescence.

Maternal Age of Menarche and Blood Pressure in Adolescence: Evidence from Hong Kong's "Children of 1997" Birth Cohort

Background

Age of puberty has declined substantially in developed settings and is now declining in the rest of the world with economic development. Early age of puberty is associated with non-communicable diseases in adulthood, and may be a long-term driver of population health with effects over generations. In a non-Western setting, we examined the association of maternal age of menarche with blood pressure in late childhood/adolescence.

Methods

We used generalised estimating equations to estimate the adjusted association of maternal age of menarche with age-, sex- and height-adjusted blood pressure z-score from 10 to 16 years in Hong Kong’s population-representative birth cohort, “Children of 1997” (n = 8327). We also assessed whether associations were mediated by body mass index (BMI) or pubertal stage.

Results

Earlier maternal age of menarche was associated with higher systolic blood pressure in adolescence [-0.02 z-score per year older maternal age of menarche, 95% confidence interval (CI) -0.04 to -0.003]. The association of maternal age of menarche with systolic blood pressure was mediated by adiposity and/or pubertal stage at 11 years. Maternal age of menarche was not associated with diastolic blood pressure.

Conclusion

Earlier maternal age of puberty was associated with higher systolic blood pressure, largely mediated by adiposity, highlighting the importance of tackling childhood obesity as a public health priority in view of the secular trend of declining age of puberty.

Correlates of Blood Pressure According to Early, On Time, and Late Maturation in Adolescents

The aim of this study was to estimate the prevalence and correlates of blood pressure (BP) according to somatic maturation in Southern Brazilian adolescents. A total of 1321 adolescents participated in the study (732 girls), aged between 10 and 16 years, enrolled in public schools. The assessment of BP was performed using oscillometric equipment. Measurements of body weight, height, waist circumference, and skinfold thickness were performed. Somatic maturation was estimated by the age at peak height velocity. Behavioral and hereditary variables were obtained using a questionnaire. Early-maturing adolescents had the highest prevalence of high BP (28%; 95% confidence interval, 24.6-33.5) compared with other maturational groups (P=.003). In late-maturing adolescents, the variables associated with BP were paternal hypertension (systolic BP: β=4.9; diastolic BP: β=5.3) and early physical activity (systolic BP: β=-4.0; diastolic DBP: β=-3.6). In average-maturing adolescents, waist circumference (systolic BP: β=0.3), body mass index (diastolic BP: β=0.5), and mother's hypertension (diastolic BP: β=1.8) were positively related to BP. In early-maturing adolescents, only waist circumference (systolic BP: β=0.3; diastolic BP: β=0.3) was associated with BP. The authors conclude that the prevalence of high BP is greater in adolescents with early maturity and the outcome appears to be related to biological indicators in this group. On the other hand, in late-maturing adolescents, behavioral and hereditary variables are more related to BP.

Associations of pubertal stage and body mass index with cardiometabolic risk in Hong Kong Chinese children: A cross-sectional study

BACKGROUND

Puberty is associated with a clustering of cardiometabolic risk factors (CMRFs) during adolescence that are manifested in later life. Although anthropometric variables such as body mass index (BMI) can predict cardiometabolic risk in children and adolescents, it is not clear whether there is an interaction between pubertal stage and BMI associated with cardiometabolic risk in this age group. This paper examines the association of pubertal stage and BMI with CMRFs in Hong Kong Chinese children.

METHODS

A cross-sectional school-based study was conducted among 1985 (95.1%) students aged 6 to 18 years. Fasting lipid profile and plasma glucose, blood pressure, body weight, body height and waist circumference were measured. A self-reported pubertal stage questionnaire was used to assess pubertal stage of participants. Two cardiometabolic risk scores, alpha and beta, were constructed to quantify cardiometabolic risk. Cardiometabolic risk score alpha refers to the sum of z-scores of sex-specific, age-adjusted waist circumference, height-adjusted systolic and diastolic blood pressure, fasting plasma glucose, triglyceride and low-density lipoprotein cholesterol, and minus z-score of sex-specific age-adjusted high-density lipoprotein cholesterol. Cardiometabolic risk score beta includes all components of risk score alpha except waist circumference.

RESULTS

The interaction of BMI z-score (ZBMI) and pubertal stage demonstrated a further increase in variance explained in both the cardiometabolic risk scores alpha and beta (0.5% and 0.8% respectively) in boys and (0.7% and 0.5% respectively) in girls.

CONCLUSIONS

Pubertal stage has an interaction effect on the association of cardiometabolic risk by BMI in boys and may have a similar but lesser effect in girls.

Maternal pre-pregnancy BMI, gestational weight gain, and age at menarche in daughters

Life course theory suggests that early life experiences can shape health over a lifetime and across generations. Associations between maternal pregnancy experience and daughters' age at menarche are not well understood. We examined whether maternal pre-pregnancy BMI and gestational weight gain (GWG) were independently related to daughters' age at menarche. Consistent with a life course perspective, we also examined whether maternal GWG, birth weight, and prepubertal BMI mediated the relationship between pre-pregnancy BMI and daughter's menarcheal age. We examined 2,497 mother-daughter pairs from the 1979 National Longitudinal Survey of Youth. Survival analysis with Cox proportional hazards was used to estimate whether maternal pre-pregnancy overweight/obesity (BMI ≥ 25.0 kg/m(2)) and GWG adequacy (inadequate, recommended, and excessive) were associated with risk for earlier menarche among girls, controlling for important covariates. Analyses were conducted to examine the mediating roles of GWG adequacy, child birth weight and prepubertal BMI. Adjusting for covariates, pre-pregnancy overweight/obesity (HR = 1.20, 95 % CI 1.06, 1.36) and excess GWG (HR = 1.13, 95 % CI 1.01, 1.27) were associated with daughters' earlier menarche, while inadequate GWG was not. The association between maternal pre-pregnancy weight and daughters' menarcheal timing was not mediated by daughter's birth weight, prepubertal BMI or maternal GWG. Maternal factors, before and during pregnancy, are potentially important determinants of daughters' menarcheal timing and are amenable to intervention. Further research is needed to better understand pathways through which these factors operate.

Trends and clustering of cardiometabolic risk factors in American adolescents from 1999 to 2008

AIM

To characterize trends and clustering of cardiometabolic risk factors in 12-17-year-old non-Hispanic white, non-Hispanic black (NHB), Mexican-American (MA), and multiracial American (MRA) adolescents.

METHODS

Data from the 1999-2000 to 2007-2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Clustering of cardiometabolic risk factors was determined using cardiometabolic risk factor clustering score (cMetS) computed by aggregating z scores of mean arterial blood pressure, triglycerides, fasting blood glucose, waist circumference, and high-density lipoprotein cholesterol.

RESULTS

There were significant increases in waist circumference and high-density lipoprotein cholesterol, and decreases in low density lipoprotein cholesterol, triglycerides, and mean arterial blood pressure in the 10-year period between 1999-2000 and 2007-2008. There were gender and racial/ethnic differences in cMetS, with NHB having a more favorable cMetS for each studied time point. Overall, cMetS decreased by 93% in the 10-year period between 1999-2000 and 2007-2008. cMetS decreased by 98% and 77.3% for male and female adolescents, respectively, in the period between 1999-2000 and 2007-2008. With the exception of Mexican-American and multiracial American female adolescents, all racial/ethnic groups had improved cMetS values on comparing mean cMetS values of 1999-2000 with mean values of 2007-2008. Compared with other racial/ethnic groups, NHB male and female adolescents had the most improved cMetS.

CONCLUSION

Because clustering of cardiometabolic risk factors is predictive of adult health status, early lifestyle intervention in adolescence may help slow down the progress and delay or prevent the onset of cardiovascular diseases in adulthood.

Contributors to Pediatric Obesity in Adolescence: More than just Energy Imbalance

Disentangling the etiology of pediatric obesity continues to challenge researchers. Due to rapid growth and development, changes in the hormonal milieu, increased autonomy in feeding practices and greater interactions with environmental factors, adolescence is a particularly important period for the determination of body composition trajectories and the relationship to current and future obesity outcomes. A plethora of studies have focused on excess energy consumption and physical inactivity as they relate to weight and fat gain in adolescence. Although these "Big Two" have an impact, the increasing trends in pediatric obesity are not accounted for solely by increased energy intake and decreased physical activity. Indeed, under similar conditions of energy balance, inter-individual variation in fat accumulation has been consistently noted. It is becoming more evident that additional factors may contribute independently and/or synergistically to the increase in obesity. Such factors include (but are not limited to) metabolic programming in utero and in early childhood, the hormonal environment, endocrine disruptors, parental feeding practices, and the built environment. Our objective, therefore, is to investigate possible factors, particularly in adolescence that contributes to the increase in pediatric obesity beyond "The Big Two".

Enhanced post-natal growth is associated with elevated blood pressure in young Senegalese adults

BACKGROUND

Evidence suggests that intrauterine growth restriction followed by rapid post-natal growth is associated with high blood pressure. We assessed the effect of early size and post-natal growth on blood pressure in a population from West Africa, where fetal growth retardation and childhood malnutrition are common.

METHODS

A total of 1288 Senegalese subjects were followed from infancy to young adulthood (mean age 17.9 years). Adult systolic blood pressure (SBP) was regressed on infant and adult anthropometric characteristics.

RESULTS

In unadjusted analyses, infant size was positively associated with adult SBP (1.1 +/- 0.3; P = 0.001 for weight; 0.7 +/- 0.3; P = 0.04 for length). With adjustment for current size, the regression coefficients for infant size were reversed (-0.2 +/- 0.3; P = 0.51 for weight; -0.3 +/- 0.3; P = 0.35 for length). SBP increased by 4.1 and 2.9 mmHg for 1 standard deviation (SD) increase in current weight or height, respectively. No interaction between infant size and current size was found in the overall models (P = 0.11 for weight, P = 0.95 for height), but this term interacted with sex for weight effect. A negative interaction was found in males (-0.9 +/- 0.4; P = 0.02) but not in females (0.3 +/- 0.4; P = 0.46). The association of current weight with SBP was stronger in lighter weight male infants.

CONCLUSIONS

These findings support the hypothesis that subjects who were small in early life and experienced enhanced post-natal growth have higher levels of SBP, even in low-income settings.