Self-assessment of sexual maturation in adolescent females with anorexia nervosa

Adolescents and Eating Disorders:

Little is known about the incidence and prevalence of eating disorders among adolescents of color who are poor or identify themselves as gay or lesbian. Among American women, eating disturbances are equally as common among Native, Asian, or Hispanic Americans as they are among Caucasians. African Americans were at higher risk of developing eating disorders than were Hispanic and Asian Americans. Media and gender-role body stereotype and body dissatisfaction are strongly linked and have been shown to be the strongest predictors of disordered eating. As these youth adopt Western values about beauty, they may be at increased risk for developing eating disorders.

Body image in adolescents with disorders of steroidogenesis

AIM

Little is known about body image in children with endocrine conditions. We evaluated body image in children with congenital adrenal hyperplasia (CAH), familial male precocious puberty (FMPP), and Cushing's syndrome (CS).

STUDY DESIGN

We compared 67 patients (41 CAH, 12 FMPP, 14 CS) age 8-18 years with 55 age-matched controls.

RESULTS

Patients expressed more weight unhappiness than controls (females: p < 0.001; males: p = 0.01). This difference remained for females after adjusting for body mass index (BMI) (p = 0.03), but not for males (p = 0.12). Unhappiness with height and age of appearance was similar between groups. In female patients, higher BMI was a significant predictor of weight unhappiness (p = 0.01).

CONCLUSION

Adolescents with CAH, FMPP, and CS are at risk for negative body image regarding weight, but not height or age of appearance. Weight unhappiness is partially related to greater weight, but factors unrelated to physical findings seem to contribute to negative body image in female patients.

Public health implications of altered puberty timing

Changes in puberty timing have implications for the treatment of individual children, for the risk of later adult disease, and for chemical testing and risk assessment for the population. Children with early puberty are at a risk for accelerated skeletal maturation and short adult height, early sexual debut, potential sexual abuse, and psychosocial difficulties. Altered puberty timing is also of concern for the development of reproductive tract cancers later in life. For example, an early age of menarche is a risk factor for breast cancer. A low age at male puberty is associated with an increased risk for testicular cancer according to several, but not all, epidemiologic studies. Girls and, possibly, boys who exhibit premature adrenarche are at a higher risk for developing features of metabolic syndrome, including obesity, type 2 diabetes, and cardiovascular disease later in adulthood. Altered timing of puberty also has implications for behavioral disorders. For example, an early maturation is associated with a greater incidence of conduct and behavior disorders during adolescence. Finally, altered puberty timing is considered an adverse effect in reproductive toxicity risk assessment for chemicals. Recent US legislation has mandated improved chemical testing approaches for protecting children's health and screening for endocrine-disrupting agents, which has led to changes in the US Environmental Protection Agency's risk assessment and toxicity testing guidelines to include puberty-related assessments and to the validation of pubertal male and female rat assays for endocrine screening.

Assessment of growth

The assessment of growth is an important part of paediatrics and community child health. Poor growth is a common side-effect of many local and systemic conditions and its identification acts as a useful early warning of a possible problem. In addition, disorders directly affecting growth, for example, growth hormone deficiency, can be diagnosed only through growth monitoring. The process of growth assessment involves single or multiple measurements of height and/or weight, and sometimes more specialized measurements, plotted on suitable reference charts and interpreted appropriately. Poor growth is reflected by an extreme measurement centile on a single occasion, or evidence of marked centile crossing over time. Careful attention needs to be given to the processes of measurement, recording and interpretation.

Self-assessment of sexual maturity status in children with Crohn's disease

OBJECTIVE

To evaluate the validity of self-assessment of sexual maturity status (SMS) in children with Crohn's disease (CD), a pediatric chronic disease that often affects growth and development.

STUDY DESIGN

Self-assessment of SMS in 100 children (34 girls) ages 8 to 18 years with CD from the Children's Hospital of Philadelphia was compared with an independent assessment by one well trained pediatrician, using drawings and written descriptions of Tanner stages of breast, genital, and pubic hair development.

RESULTS

Overall, subjects with CD (age, 14.3 +/- 2.8 years) had delayed growth status based on height-for-age (HAZ) and weight-for-age Z scores (WAZ). Boys were more growth delayed (HAZ, -0.90 +/- 1.1; WAZ, -0.75 +/- 1.3) than girls (HAZ, -0.45 +/- 1.3; WAZ, -0.20 +/- 1.1). Kappa coefficients (kappa) showed excellent agreement between child and physician assessment of SMS, ranging from kappa = 0.74 to 0.85, depending on sex and SMS component, corresponding to a 79% to 88% agreement. When not in agreement, children tended to overestimate their SMS. Boys who overestimated (n = 8) had significantly higher weight and BMI status than boys who assessed accurately.

CONCLUSIONS

Self-assessment of SMS was a reliable and valid method in children with CD and is useful in screening for maturational delay in children with chronic disease.