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Burns JS, Bather JR, Sergeyev O, Lee MM, Korrick SA, Sokolov S, Kovalev S, Koch HM, Lebedev AT, Mínguez-Alarcón L, Hauser R, Williams PL. Longitudinal association of prepubertal urinary phthalate metabolite concentrations with pubertal progression among a cohort of boys. Environ Res 2023; 233:116330. [PMID: 37348639 PMCID: PMC10575624 DOI: 10.1016/j.envres.2023.116330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/19/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Epidemiological studies have reported associations of anti-androgenic phthalate metabolite concentrations with later onset of male puberty, but few have assessed associations with progression. OBJECTIVES We examined the association of prepubertal urinary phthalate metabolite concentrations with trajectories of pubertal progression among Russian boys. METHODS At enrollment (ages 8-9 years), medical history, dietary, and demographic information were collected. At entry and annually to age 19 years, physical examinations including testicular volume (TV) were performed and spot urines collected. Each boy's prepubertal urine samples were pooled, and 15 phthalate metabolites were quantified by isotope dilution LC-MS/MS at Moscow State University. Metabolites of anti-androgenic parent phthalates were included: butylbenzyl (BBzP), di-n-butyl (DnBP), diisobutyl (DiBP), di(2-ethylhexyl) (DEHP) and diisononyl (DiNP) phthalates. We calculated the molar sums of DEHP, DiNP, and all AAP metabolites. We used group-based trajectory models (GBTMs) to identify subgroups of boys who followed similar pubertal trajectories from ages 8-19 years based on annual TV. We used multinomial and ordinal regression models to evaluate whether prepubertal log-transformed phthalate metabolite concentrations were associated with slower or faster pubertal progression trajectories, adjusting for covariates. RESULTS 304 boys contributed a total of 752 prepubertal urine samples (median 2, range: 1-6) for creation of individual pools. The median length of follow-up was 10.0 years; 79% of boys were followed beyond age 15. We identified three pubertal progression groups: slower (34%), moderate (43%), and faster (23%) progression. A standard deviation increase in urinary log-monobenzyl phthalate (MBzP) concentrations was associated with higher adjusted odds of being in the slow versus faster pubertal progression trajectory (aOR 1.47, 95% CI 1.06-2.04). None of the other phthalate metabolites were associated with pubertal progression. CONCLUSIONS On average, boys with higher concentrations of prepubertal urinary MBzP had a slower tempo of pubertal progression, perhaps attributable to the disruption of androgen-dependent biological pathways.
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Affiliation(s)
- J S Burns
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, 14th Floor, Boston, MA, 02115, USA.
| | - J R Bather
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 4th Floor, Boston, MA, 02115, USA
| | - O Sergeyev
- Group of Epigenetic Epidemiology, Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Leninskye Gory, House 1, Building 40, Room 322, 119992, Moscow, Russia
| | - M M Lee
- Nemours Children's Health/Sidney Kimmel Medical School, Jefferson University, 1600 Rockland Road, Wilmington, DE, USA
| | - S A Korrick
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, 14th Floor, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| | - S Sokolov
- Chemistry Department, Lomonosov Moscow State University, Moscow, 119991, Leninskie Gory 1/3, Russia
| | - S Kovalev
- Chemistry Department, Lomonosov Moscow State University, Moscow, 119991, Leninskie Gory 1/3, Russia
| | - H M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - A T Lebedev
- Chemistry Department, Lomonosov Moscow State University, Moscow, 119991, Leninskie Gory 1/3, Russia
| | - L Mínguez-Alarcón
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, 14th Floor, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| | - R Hauser
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, 14th Floor, Boston, MA, 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health Kresge Building, 9th Floor, Boston, MA, 02115, USA
| | - P L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 2, 4th Floor, Boston, MA, 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health Kresge Building, 9th Floor, Boston, MA, 02115, USA
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Lee YC, Huang CY, Lin CH, Cheng BW, Huang SK, Yeh SN, Lee YJ, Ting WH. The effects of estrogen induction therapy on pubertal presentations in turner syndrome patients. Taiwan J Obstet Gynecol 2022; 61:788-793. [PMID: 36088045 DOI: 10.1016/j.tjog.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In this study, we investigated various pubertal presentations and progressions before and after estrogen induction therapy and the correlations with Turner syndrome karyotypes. MATERIALS AND METHODS We reviewed the medical records of patients with Turner syndrome diagnosed before the age of 18 years between 2000 and 2019. Sixty-six patients were enrolled and distributed into 45,X monosomy group, X chromosome structural abnormalities group and X mosaicism group. The pubertal presentations were classified into spontaneous puberty, arrested puberty and no spontaneous puberty. All patients' karyotypes, pubertal progressions and laboratory data were collected and analyzed. RESULTS The karyotypes were highly correlated with pubertal presentations. No spontaneous puberty was noticed in 58.3% 45,X monosomy patients, 50% patients with X chromosome structural abnormalities had arrested puberty, whereas 70% patients with X mosaicism had spontaneous puberty. Estrogen induction therapy in patients with no spontaneous puberty could induce puberty and the tempo of puberty may approximate to the spontaneous puberty group (median, 2.3 vs. 2.2 years, P = 0.95). In both interventional groups, the FSH level was distinguishable before treatment (median, 65.1 vs. 100.4 mIU/mL, P = 0.02). After long term estrogen therapy, the FSH could be suppressed to similar level in both interventional groups (median, 37.5 vs 34.5 mIU/mL, P = 0.84). Neither LH nor E2 level provided valuable information before and after treatment. CONCLUSION The karyotypes were highly correlated with pubertal presentations at Turner syndrome patients. The integrity of 2nd X chromosome plays an important role. Low dose estrogen could mimic the tempo of puberty even delay induction age at Taiwan. The FSH data could provide predictive information of pubertal induction for both interventional groups.
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Affiliation(s)
- Yi-Chen Lee
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan; Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Mackay Memorial Hospital, Taitung, Taiwan.
| | - Chi-Yu Huang
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
| | - Bi-Wen Cheng
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Shih-Kang Huang
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Mackay Memorial Hospital, Taitung, Taiwan; Department of Pediatrics, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Nin Yeh
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Saint Paul's Hospital, Taoyuan City, Taiwan
| | - Yann-Jinn Lee
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Medical Research, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan; Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Hsin Ting
- Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior college of Medicine Nursing and Management, New Taipei City, Taiwan.
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Williams PL, Bellavia A, Korrick SA, Burns JS, Lee MM, Sergeyev O, Hauser R. Blood lead levels and timing of male sexual maturity: A longitudinal study of Russian boys. Environ Int 2019; 125:470-477. [PMID: 30769180 PMCID: PMC6388626 DOI: 10.1016/j.envint.2019.01.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/22/2018] [Accepted: 01/28/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Higher blood lead levels (BLLs) have been linked to neurologic deficits and impaired growth, but few studies have evaluated their association with timing of sexual maturity or pubertal progression in boys. METHODS In a longitudinal cohort of Russian boys enrolled at age 8-9 and followed to adulthood, BLLs were measured at study entry, and pubertal staging (genitalia and pubic hair) and testicular volume (TV) measurements were obtained annually. We used interval-censored regression models to estimate differences between boys with higher BLL (≥5 μg/dL) and lower BLL in mean ages at sexual maturity (genitalia stage 5, pubic hair stage 5, or TV ≥ 20 mL) and duration of pubertal progression (onset to maturity), adjusting for potential confounders. Mediation analyses were conducted to quantify the percent of lead's effect attributable to its association with reduced somatic growth. RESULTS Among 481 evaluable boys, 28% had BLL ≥ 5 μg/dL. Adjusted mean ages at sexual maturity were 14.7 years for genitalia, 16.1 for pubic hair, and 13.9 for TV. In adjusted models, boys with BLLs ≥5 μg/dL had later maturity than those with lower levels by 4-5 months depending on pubertal indicator. In mediation analyses, height and body mass index at age 11 accounted for 40-71% of the shift in age at maturity for boys with higher compared to lower BLLs. Higher BLLs were not associated with pace of pubertal progression. CONCLUSIONS Higher lead levels were associated with later attainment of sexual maturity in males, but not with the duration of pubertal progression. A high proportion of the delay in sexual maturity for boys with higher as compared to lower BLL was shown to be attributable to mediating effects of BLL on reduced growth.
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Affiliation(s)
- Paige L Williams
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, United States of America; Department of Epidemiology, Harvard T. H. Chan School of Public Health, United States of America.
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, United States of America
| | - Susan A Korrick
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, United States of America; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, United States of America
| | - Jane S Burns
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, United States of America
| | - Mary M Lee
- Department of Pediatrics, Nemours AI duPont Children's Hospital/Sidney Kimmel Medical School, Jefferson University, United States of America
| | - Oleg Sergeyev
- Chapaevsk Medical Association, Chapaevsk, Samara Region, Russia; A.N. Belozersky Research Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia
| | - Russ Hauser
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, United States of America; Department of Environmental Health, Harvard T. H. Chan School of Public Health, United States of America
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