A Twin-Sibling Study on Early Growth and Hormone Levels in Adolescents

Update on Adrenarche-Still a Mystery

CONTEXT

Adrenarche marks the timepoint of human adrenal development when the cortex starts secreting androgens in increasing amounts, in healthy children at age 8-9 years, with premature adrenarche (PA) earlier. Because the molecular regulation and significance of adrenarche are unknown, this prepubertal event is characterized descriptively, and PA is a diagnosis by exclusion with unclear long-term consequences.

EVIDENCE ACQUISITION

We searched the literature of the past 5 years, including original articles, reviews, and meta-analyses from PubMed, ScienceDirect, Web of Science, Embase, and Scopus, using search terms adrenarche, pubarche, DHEAS, steroidogenesis, adrenal, and zona reticularis.

EVIDENCE SYNTHESIS

Numerous studies addressed different topics of adrenarche and PA. Although basic studies on human adrenal development, zonation, and zona reticularis function enhanced our knowledge, the exact mechanism leading to adrenarche remains unsolved. Many regulators seem involved. A promising marker of adrenarche (11-ketotestosterone) was found in the 11-oxy androgen pathway. By current definition, the prevalence of PA can be as high as 9% to 23% in girls and 2% to 10% in boys, but only a subset of these children might face related adverse health outcomes.

CONCLUSION

New criteria for defining adrenarche and PA are needed to identify children at risk for later disease and to spare children with a normal variation. Further research is therefore required to understand adrenarche. Prospective, long-term studies should characterize prenatal or early postnatal developmental pathways that modulate trajectories of birth size, early postnatal growth, childhood overweight/obesity, adrenarche and puberty onset, and lead to abnormal sexual maturation, fertility, and other adverse outcomes.

Developmental origins of cardiometabolic health outcomes in twins: A systematic review and meta-analysis

BACKGROUND AND AIMS

Studies of twins can reduce confounding and provide additional evidence about the causes of disease, due to within-pair matching for measured and unmeasured factors. Although findings from twin studies are typically applicable to the general population, few studies have taken full advantage of the twin design to explore the developmental origins of cardiometabolic health outcomes. We aimed to systematically review the evidence from twin studies and generate pooled estimates for the effects of early-life risk factors on later-life cardiometabolic health.

METHODS AND RESULTS

An initial search was conducted in March 2018, with 55 studies of twins included in the review. Risk of bias was assessed using the Newcastle-Ottawa Scale, and eligible studies were included in a meta-analysis, where pooled estimates were calculated. Twenty-six studies analysed twins as individuals, and found that higher birthweight was associated with lower SBP (β = -2.02 mmHg, 95%CI: -3.07, -0.97), higher BMI (β = 0.52 kg/m², 95%CI: 0.20, 0.84) and lower total cholesterol (β = -0.07 mmol/L, 95%CI: -0.11, -0.04). However, no associations were reported in studies which adjusted for gestational age. Few of the included studies separated their analyses into within-pair and between-pair associations.

CONCLUSIONS

Early-life risk factors were associated with cardiometabolic health outcomes in twin studies. However, many estimates from studies in this review were likely to have been confounded by gestational age, and few fully exploited the twin design to assess the developmental origins of cardiometabolic health outcomes.

Steroid hormone concentrations in milk predict sex-specific offspring growth in a nonhuman primate

OBJECTIVES

In humans and other mammals, maternal hormones are transferred to offspring during lactation via milk and may regulate postnatal development, including the pace of early growth. Here, we used a nonhuman primate model to test the hypotheses that milk cortisol and dehydroepiandrosterone-sulfate (DHEAS) concentrations reflect maternal characteristics, and that changes in these hormones across lactation are associated with early postnatal growth rates.

METHODS

Demographic information, morphometrics, and milk samples were collected from rhesus macaque mothers and their infants at the California National Primate Research Center in Davis, California. Using linear models, we examined the relationship between maternal traits and milk hormone concentrations (N = 104 females) and explored the effect of milk hormones on the rate of offspring growth (N = 72 mother-infant dyads), controlling for available milk energy.

RESULTS

Contrary to previous studies, we found that milk cortisol concentrations were categorically higher in multiparous females than in primiparous females. However, milk DHEAS concentrations decreased with maternal parity. Neither milk cortisol nor DHEAS were related to maternal rank. Finally, changes in milk hormones predicted offspring growth in a sex-specific and temporal manner: increases in cortisol from peak to late lactation predicted faster female growth, and increases in DHEAS concentrations from early to peak and peak to late lactation predicted faster male growth.

CONCLUSIONS

Our findings shed light on how hormonal components of milk have sex-specific effects on offspring growth during early postnatal life with varying temporal windows of sensitivity.

Natural variation in fetal cortisol exposure is associated with neonatal body mass in captive vervet monkeys (Chlorocebus aethiops)

Poor maternal condition during gestation is commonly associated with impaired fetal growth in humans and other animals. Although elevated maternal glucocorticoids (GCs) are often implicated as the mechanism of intrauterine growth stunting, the direct contribution of maternal GCs remains unclear because enzymatic conversion of GCs at the placenta may limit the ability of maternal hormones to reach the fetus. Further, because previous studies on gestational stress have often employed synthetic GCs, which cross the placenta unobstructed, it remains unknown whether naturalistic endogenous GC elevations will have similar effects. Here, we use an unmanipulated colony of captive vervet monkeys (N = 18 mother-offspring dyads) to examine how maternal condition predicts maternal gestational hormones, and how these in turn predict neonatal body mass, especially in comparison with total prenatal hormone exposure as measured from neonatal hair. We focused on GCs and dehydroepiandrosterone-sulfate (DHEAS), an additional steroid suspected to influence growth. We found that measures of poor maternal condition (low body mass and low parity) were not associated with elevations in maternal GCs or DHEAS. Furthermore, only fetal GC exposure predicted neonatal body mass, while neither maternal GCs, nor maternal or fetal DHEAS, had any effect. Surprisingly, neonates exposed to higher gestational GCs were larger, rather than smaller at birth. Taken together, these results suggest that GC concentrations within a more naturalistic range may be positively rather than negatively associated with neonatal body mass. Further, the effect of maternal gestational GCs on neonatal mass may be modulated by placental control of GC exposure.

Long-term metabolic risk among children born premature or small for gestational age

Accumulating evidence suggests that both the intrauterine environment and growth during early life can influence the development of chronic noncommunicable diseases, such as type 2 diabetes mellitus and cardiovascular disease, in adulthood. Here, we review the available human data supporting increased metabolic risk among children born premature or small for gestational age; the adrenal and pubertal modifications that contribute to this risk; metabolic changes that occur during adolescence and early adulthood; and approaches to potentially modify or decrease risk of metabolic disease. The risks associated with delivery at term or preterm are compared for each period of life. Knowledge of these associations is fundamental for the paediatric community to develop preventive strategies early during postnatal life.