Valoración de la tendencia secular de la pubertad en niños y niñas

Adult Height in Girls With Idiopathic Premature Adrenarche: A Cohort Study and Design of a Predictive Model

Introduction

Idiopathic premature adrenarche (IPA) is considered a normal variant of puberty, presenting more commonly in female patients. There are concerns as to whether IPA alters the final height of these girls. Our main objectives were to (a) compare the adult height of girls with IPA against their target height and (b) design a mathematical model to predict adult height at diagnosis in female patients with IPA.

Materials and Methods

A cohort study of girls with IPA was conducted from the time of IPA diagnosis until adult height. The following data were collected: target height, perinatal history, anthropometric and biochemical variables and bone age at diagnosis, age at Tanner stage 2 and menarcheal age, and adult height. First, we performed a univariate statistical analysis after which we carried out a multiple linear regression analysis using adult height as the dependent variable.

Results

We obtained data from 79 female patients diagnosed with IPA with a mean adult height of 164.6 cm (95% CI: 163.36-165.85 cm). The mean follow-up time was 6.60 years. Average age at Tanner stage 2 was 9.71 years. Mean menarcheal age was 11.64 years. There were no significant differences between target height and adult height. Of the several predictive models designed for these patients, one of them, which included bone age, obtained an R2 value of 71%.

Conclusions

Although slightly advanced puberty was observed among the girls with IPA, their adult height was preserved. The use of predictive models of adult height on diagnosis of IPA could facilitate closer follow-up of girls at risk of reduced adult height.

Early and precocious puberty during the COVID-19 pandemic

During the year 2020, the COVID-19 pandemic rapidly became a severe health emergency worldwide. In order to contrast the spread of the novel SARS-CoV-2, many countries implemented extraordinary restrictive measures, such as a strict lockdown and school closures. The pandemic had a great impact on children and adolescents' daily life, leading to a much more sedentary lifestyle, to larger use of electronic devices and to an increase in stress-related symptoms. These conspicuous changes acted as disruptors of children's normal development. Since the beginning of the pandemic, many studies reported an increase in the number of precocious puberty cases as well as a faster progression rate of puberty itself, if compared to the pre-pandemic years. In this review, our aim was to evaluate the incidence of new cases of early and precocious puberty during the COVID-19 pandemic, analyzing variations in the timing of puberty and in pubertal progression rate, and to investigate the role of environmental and lifestyle factors during the pandemic in modulating the physiopathology of pubertal development. While a direct effect of SARS-CoV-2 infection remains, at the moment, a remote hypothesis, both physical and psychological factors related to the pandemic seem to have a role in triggering GnRH pulsatile secretion leading to earlier pubertal onset. It is indeed important to stress the need to clarify the exact role of COVID-19 in early pubertal onset comparing data from all over the world; long-term comprehensive studies are also pivotal to explain whether this phenomenon will continue while we resume pre-pandemic habits.

[Growth hormone deficit: Influence of puberty on the response to treatment]

INTRODUCTION

Short stature is the most frequent reason for consultation in Pediatric Endocrinology consultations and sometimes requires treatment with growth hormone. The aim of the study was to analyze the response to treatment based on its onset in pubertal or prepubertal stages and to analyze the possible benefit of an early onset.

PATIENTS AND METHODS

Longitudinal, retrospective and observational study in 139 patients treated for idiopathic growth hormone deficiency up to adult height.

MAIN VARIABLES STUDIED

(a) genetic background: maternal, paternal and genetic height; (b) perinatal history; (c) anthropometry during follow-up and at pubertal onset: weight, height, body mass index; (d) variables during follow-up and at pubertal onset: growth rate, bone age and growth prognosis. Final response variables: adult height, adult height with respect to target height, adult height with respect to initial growth prediction, adult height with respect to initial height at the start of treatment and adult height with respect to height at pubertal onset.

RESULTS

Total pubertal gain was 0.84±0.6 SD. 61.9% of the patients started treatment with rhGH in prepuberty. The initiation of treatment in the prepubertal stage and a higher total pubertal gain are correlated with a better final height (P=.001 and r=0.507, P=.00, respectively). Furthermore, a longer duration of treatment in pre-puberty is correlated with a better final response (r=0.328, P=.00).

CONCLUSIONS

The start of treatment in the prepubertal stage and its longer duration during this period are determining factors to achieve a good long-term response. Total pubertal gain was greater in patients who started treatment in the pubertal stage.

Pubertal mammary gland development is a key determinant of adult mammographic density

Mammographic density refers to the radiological appearance of fibroglandular and adipose tissue on a mammogram of the breast. Women with relatively high mammographic density for their age and body mass index are at significantly higher risk for breast cancer. The association between mammographic density and breast cancer risk is well-established, however the molecular and cellular events that lead to the development of high mammographic density are yet to be elucidated. Puberty is a critical time for breast development, where endocrine and paracrine signalling drive development of the mammary gland epithelium, stroma, and adipose tissue. As the relative abundance of these cell types determines the radiological appearance of the adult breast, puberty should be considered as a key developmental stage in the establishment of mammographic density. Epidemiological studies have pointed to the significance of pubertal adipose tissue deposition, as well as timing of menarche and thelarche, on adult mammographic density and breast cancer risk. Activation of hypothalamic-pituitary axes during puberty combined with genetic and epigenetic molecular determinants, together with stromal fibroblasts, extracellular matrix, and immune signalling factors in the mammary gland, act in concert to drive breast development and the relative abundance of different cell types in the adult breast. Here, we discuss the key cellular and molecular mechanisms through which pubertal mammary gland development may affect adult mammographic density and cancer risk.

Menstrual characteristics and its association with socio-demographic factors and nutritional status: a study among the urban slum adolescent girls of West Bengal, India

Menstrual health is one of the major areas of concern in reproductive health, and affects a large number of women throughout their reproductive life from adolescence. Menstruation is a biological phenomenon imbued with social-cultural, nutritional and personal significance. The present study aims to focus on the menstrual characteristics and its association with socio-demographic factors and nutritional status among the urban slum adolescent girls of North 24 Parganas district, West Bengal. This community-based study was conducted among a group of 90 Bengali speaking Hindu adolescent girls aged between 16 to 18 years. A pre-tested structured schedule was used to collect detailed information about the socio-economic conditions and menstrual characteristics. All anthropometric measurements were taken using the standard procedures. Results of the study revealed that underweight girls attained menarche comparatively in later age (12.67±1.23) than that of healthy and overweight girls. Mean length of the menstrual cycle, mean duration of menstrual bleeding and mean number of days of peak discharge were maximum among the girls whose BMI was below 5th percentile, i.e. underweight. Majority of the underweight (75%) and healthy (50%) girls experienced heavy discharge during their menstrual days. Disorders like premenstrual syndrome (PMS) (78.8%) and dysmenorrhea (85.5%) were the major prevalent menstrual problems among these girls and occurrence of the symptoms of these disorders significantly varied based on their BMI. A highly significant difference (p<0.01) was found among underweight, healthy and overweight girls in terms of duration of menstrual bleeding, mean number of days of peak discharge and occurrences of PMS. Result of linear regression and step wise logistic regression (backward elimination) shows that various socio-economic and anthropometric variables are the influential predictors of menstrual characteristics like duration of menstrual discharge, cycle length, days of peak discharge as well as menstrual problems like cycle irregularity and heavy flow (p<0.05). Therefore, the present study unwraps a podium to focus on the menstrual health issues of the adolescent girls and enforce health education as well as instigates nutritional intervention programme to fortify the existing menstrual health status.

The prevalence of premature thelarche in girls and gynecomastia in boys and the associated factors in children in Southern China

Background

To investigate the prevalence and risk factors of premature thelarche (PT) in girls and gynecomastia (GM) in boys in Southern China.

Methods

We conducted a cross-sectional study of preschool children across 9 cities in Zhejiang province. A total of 6273 children in the age-group of 2–7 years were recruited from January 2014 to March 2015. Relevant information was collected from mothers through face-to-face interviews. Logistic regression models were used to examine the correlates of PT and GM. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

Results

The prevalence of PT among girls was 4.8% and that of GM among boys was 0.8%. One hundred girls were diagnosed with PT before the age of 2 years; 69 (69.0%) of these girls experienced spontaneous resolution of PT. Twenty-four boys were diagnosed with GM before the age of 2 years; 10 (41.7%) of these experienced spontaneous resolution of GM. Children borne of mothers with early onset of menarche and those belonging to high-income families were at a higher risk of premature breast development. Greater consumption of eggs was associated with premature breast development in early childhood.

Conclusions

Socioeconomic status of family, early onset of menarche in mother, and consumption of eggs were strongly associated with premature breast development in early childhood.

Age at spermarche: 15-year trend and its association with body mass index in Chinese school-aged boys

BACKGROUND

Little is known about the secular trends in age at spermarche among boys, and the association between body mass index (BMI) and male puberty is controversial.

OBJECTIVE

This study aimed to estimate the trend in age at spermarche in China and explore the association of spermarche with BMI.

METHODS

We used four cross-sectional Chinese National Surveys on Students' Constitution and Health (CNSSCH; 1995, 2000, 2005 and 2010). Median age at spermarche was determined using probit analysis. Logistic regression was used to assess the association of spermarche with BMI.

RESULTS

Age at spermarche among Chinese boys dropped from 14.57 to 14.03 years from 1995 to 2010 with a decrease of 4.3 months per decade. Boys with BMI-for-age z-score lower than -2 had the latest age at spermarche. A higher BMI or BMI-for-age z-score was associated with an increased likelihood of having reached spermarche, and this association was consistently observed at all survey points.

CONCLUSION

This study provides important evidence of a secular trend of earlier age at spermarche over the past 15 years in China, and this decrease was accompanied by a simultaneous increase in BMI. Strategies and interventions focusing on thinness may promote both their nutritional status and puberty development among Chinese boys.

Ontogeny of the male femur: Geometric morphometric analysis applied to a contemporary Spanish population

OBJECTIVE

To describe the morphological changes of the male femur during the adolescent growth spurt and to compare the pattern obtained with that reported previously for females.

MATERIAL AND METHODS

Two hundred and forty males from a Spanish population aged between 9 and 16 years were analysed, based on telemetries. Size and shape variation of the femur was quantified by 22 2D-landmarks and analysed using geometric morphometric methods. Likewise, the variation of neck-shaft and bicondylar angles were also determined and evaluated by Student's t-test. Sexual differences were analysed by comparing results here obtained on boys with those corresponding to girls reported in a previous study.

RESULTS

In males, both size and shape varied significantly with age, with males having larger dimensions than females. In general terms, these changes are generally characterised by an increase in robustness of the femur and shape modifications in the epiphyses. During growth, the neck-shaft angle decreases and the size of the greater and lesser trochanters increase. A significant increase of distal epiphyseal dimensions was recorded, mainly in the medial condyle. The angular remodeling of both the neck and the bicondylar regions of the male femur continues until 16 and 15 years, respectively. Female and male femur each followed divergent growth trajectories. Males showed a greater variability in neck-shaft and bicondylar angles than females.

DISCUSSION

The timing, morphology and growth trajectories provided on the femur during development can be very helpful in anthropological, paleoanthropological and evolution studies.

Relationship of age at menarche on anthropometric index and menstrual irregularity in late adolescent girls in Seoul

PURPOSE

To examine the relationship between menarcheal age and anthropometric indices and menstrual irregularity in late adolescent girls in Seoul.

METHODS

We surveyed 4,218 fertile adolescent girls between the ages of 16 and 18 years to determine their anthropometric indices and menarcheal age. Measurements were taken from June 2008 to October 2009 at seven girl's high schools in Seoul, Korea. Participants were offered self-report questionnaire as a survey tool that included questions on anthropometric indices (height, weight, waist circumference), menarcheal age, menstrual pattern, frequency of menstruation per year.

RESULTS

THE PARTICIPANTS WERE CATEGORIZED INTO THREE GROUPS BASED ON MENARCHEAL AGE: early menarche group (younger than 2 standard deviations [SD]), mid menarche group (within ±2 SD), late menarche group (older than 2 SD). The mean age of early menarche group was 9.9±0.2 years, mid menarche group 12.5±0.9 years, late menarche group 15.1±0.3 years (P < 0.001). Heights were recorded as 160.4±5.2 cm, 161.8±4.9 cm, 162.3±4.7 cm in early, mid, and late menarche group, respectively (P = 0.001). Body mass index (BMI) and waist circumference significantly were lager in early menarche group than mid and late menarche ones (P < 0.001). The menarcheal age had a positive correlation with height and negative correlations with weight, BMI, waist circumference (P < 0.001). The prevalence of oligomenorrhea was more frequent in late menarche group than early and mid menarche group.

CONCLUSION

The menarcheal age have positive relationship with height and inverse relationship with BMI and waist circumference in late adolescent girls in Seoul. Late menarcheal girls are disposed to have menstrual irregularity compared to early menarcheal girls.

Whether age of menarche is influenced by body mass index and lipoproteins profile? a retrospective study

BACKGROUND

Menarche, a milestone in the reproductive life span of a woman, is influenced by several genetics and environmental factors. There is no consensus regarding the impact of body mass index (BMI) and lipid profiles on the age of menarche, as the results of various studies demonstrate.

OBJECTIVE

To investigate the correlation between age of menarche and BMI/lipoprotein profile in a community sample of Iranian girls.

MATERIALS AND METHODS

In the study, 370 girls, aged 10-16 years, who began their menarche within six months prior to the study, were recruited from the Tehran Lipid and Glucose Study (TLGS) population. Information was documented regarding their body composition, including height, weight, BMI, waist and hip circumference were collected and their lipid profiles were assessed after a 12-hour fast.

RESULTS

In this study, the mean±SD of age of menarche and BMI were 12.6±1.1 years and 21.7±3.9 kg/m(2), respectively. There were statistically significant relationships between age of menarche and height, BMI, waist circumference, and the maternal educational level. The relationship between age of menarche and the weight and lipid profiles of subjects was not statistically significant.

CONCLUSION

Age at menarche is not influenced by lipid profiles but it is influenced by BMI.

The prevalence and risk factors of premature thelarche and pubarche in 4- to 8-year-old girls

AIM

To assess the prevalence of premature thelarche (PT) and pubarche in healthy 4- to 8-year-old girls and to investigate factors associated with early pubertal development.

METHOD

Eight hundred and twenty girls were examined by two paediatric endocrinologists to determine Tanner staging. The effects of body mass index, gestational age, intrauterine growth status, age at the first tooth eruption, socio-economical status, maternal age of menarche and consumption of certain food items on early pubertal development were analysed through parametric and nonparametric tests.

RESULTS

The prevalence of PT and of premature pubarche was 8.9% and 4.3%, respectively. We found a strong association between the prevalence of PT and the body mass index standard deviation scores (BMI SDS). There were more girls with BMI SDS values above 1 in the PT group (56.1%) than among the remaining subjects (22.9%). Premature thelarche was not significantly associated with intrauterine growth, premature birth, socioeconomic status, age of first tooth eruption or maternal age of menarche. Similarly, the amount of milk, eggs, chicken or fish consumed was not associated with PT. None of the investigated factors were associated with premature pubarche.

CONCLUSION

Occurrence of PT is strongly associated with BMI SDS. Studies investigating secular trends in pubertal development must consider a secular change in body mass index.

SECULAR CHANGES IN HEIGHT, BODY WEIGHT, BODY MASS INDEX AND PUBERTAL DEVELOPMENT IN MALE CHILDREN AND ADOLESCENTS IN KRAKOW, POLAND

This study examined the secular changes in height, body weight, body mass index and pubertal development in male children and adolescents in Krakow (Poland) over the past 80 years, with an emphasis on the last decade (2000–2010). The survey of the population of Krakow is a continuation of observations conducted in that area for many years. The analysis aims to determine whether in the last decade Krakow still witnessed the secular trend, and what form the trend took. The body height and weight, and body mass index (BMI), of 1862 boys aged 3.5–18.5 years were analysed, against the background of a survey series from the years 1938 (N=1801), 1971 (N=2045), 1983 (N=3124) and 2000 (N=2328). The mean body height, in almost all age categories, was greater than in the past; however the final height over the last decade remained the same. The mean values of body weight and BMI increased, especially in the last decade. Also, an acceleration of puberty in boys was observed. The last 10 years saw an over 3-month decrease in the age of initial appearance of pubic hair in boys. In conclusion, the last decade saw cessation of the growing taller trend: maximum body height stabilized at approximately 179 cm, but weight and BMI increased. Also, a distinct acceleration of puberty was noticed. Lack of height increase, at the same time as weight gain and puberty acceleration, indicate a progressing developmental disharmony.