Hyper-androgenemia and obesity in early-pubertal girls

From repellent to risk: DEET's adverse effects on hormones and bone health in kids

INTRODUCTION

Early life bone accumulation, which predicts future fragility fracture risk, is intimately associated with sex hormones. N, N-diethyl-3-methylbenzamide (DEET) is the primary and most effective active ingredient widely used globally, especially among children and adolescents. However, the effects of DEET on sex hormones and bone mass remain unclear.

OBJECTIVE

We aimed to explore the adverse effects of DEET exposure on bone mass and to elucidate the potential mediating roles of sex hormones in children and adolescents.

METHODS

This cross-sectional study analyzed 864 children and adolescents from NHANES 2013-2016. Urinary 3-diethyl-carbamoyl benzoic acid (DCBA) was employed as a biomarker for DEET exposure. The study examined the relationships between DCBA, sex hormones, and bone mass, with a particular focus on evaluating the independent and serial mediation effects of sex hormones on DEET-bone mass associations.

RESULTS

Increased DCBA was associated with decreased testosterone (TT), estrogen (E2), and free androgen index (FAI), alongside an increase in sex hormone-binding globulin (SHBG) levels, particularly pronounced among subjects < 12 years [β% (95 % CI) = -0.081 (-0.144, -0.017), -0.064 (-0.114, -0.013), -0.101 (-0.177, -0.024), and 0.020 (-0.009, 0.048), respectively] and non-overweight subjects [β% (95 % CI) = -0.160 (-0.234, -0.086), -0.103 (-0.158, -0.048), -0.195 (-0.282, -0.107), and 0.035 (0.012, 0.058), respectively]. Negative dose-response relationships between DCBA and bone mass were observed in non-overweight participants [β% (95 % CI) = -0.011 (-0.018, -0.005) and -0.027 (-0.041, -0.013) for total bone mineral density (BMD) and total bone mineral content (BMC), respectively], and in children < 12 years for total BMC [β% (95 % CI) = -0.012 (-0.024, 0.000)]. Additionally, TT, E2, and SHBG were found to significantly and independently mediate 15.41 % to 79.84 % of the relationship between DCBA and bone mass. Furthermore, serial mediation effects among sex hormones were detected between TT, E2, and SHBG.

CONCLUSIONS

DEET exerts a detrimental effect on bone health by interfering with sex hormones in children and adolescents, warranting heightened public concern.

Relationship of obesity, body fat, benign adrenal tumors and the mediating mechanism: a two-step mendelian randomization study

BACKGROUND

Benign adrenal tumors comprise the majority of asymptomatic adrenal masses and are often associated with cortisol secretion, which increases the risk of obesity and metabolic syndrome. Hormone secretion by these tumors may confound prevailing epidemiologic findings, and the causal relationships among obesity, body fat, and benign adrenal tumors remain uncertain. Mendelian randomization (MR) uses genetic variation as an instrumental variable to simulate randomized controlled trials, thereby reducing confounding and supporting causal relationships. Therefore, we aim to use MR methods to investigate causal relationships between obesity, body fat, and benign adrenal tumors. And use two-step MR to evaluate potential mediating mechanisms and their mediation proportions.

METHOD

Single nucleotide polymorphisms significantly associated with obesity, body fat and possible mediators were selected as instrumental variables from published genome-wide association studies (GWAS). GWAS data for benign adrenal tumor cases (n = 1,790) and controls (n = 390,633) were obtained from the Finngen database. Univariable MR analysis was performed to evaluate the causal associations of obesity and body fat with benign adrenal tumors, with obesity and body fat quantified using ten anthropometric indicators. In addition, two-step MR was used to examine four categories of possible mediators (metabolic indicators, hormone indicators, inflammation and oxidation indicators, and diseases) to explore potential mechanisms between obesity, body fat, and benign adrenal tumors and to calculate mediation proportions.

RESULT

Our results show that all anthropometric indicators are risk factors for benign adrenal tumors (OR range from 1.59 to 2.49 with FDR < 0.05). In addition, two-step MR analysis shows that both total and bioavailable testosterone levels significantly mediate body fat percentage, trunk fat percentage, and trunk fat mass on benign adrenal tumors in women (mediation proportion: 4.07%-15.58%). In addition, bioavailable testosterone levels mediate whole body fat mass (10.95%) and body mass index (17.04%), while total testosterone levels mediate hip circumference (7.27%) in women.

CONCLUSION

Our study demonstrates that obesity and elevated body fat may serve as risk factors for benign adrenal tumors. Furthermore, we identify the mediating role of total/bioavailable testosterone levels in women, suggesting its potential target for prevention and intervention of benign adrenal tumors in individuals with obesity or high body fat.

Analysis of the Relationship Between Body Mass Index (BMI) and Dento-Skeletal Maturation: A Cross-Sectional Case-Control Study

Background/Objectives: The aim of this cross-sectional study was to establish if there is a relationship between body mass index (BMI) and skeletodental development in young obese patients in comparison with normal-weight patients. Methods: The sample consisted of 178 individuals (115 normal weight, 37 overweight and 26 obese), aged 6 to 16 years, with a mean biological age of 11.96 ± 2.44 years. Dental maturation (dental age) was determined by using Demerjian's method; craniofacial growth pattern, skeletal and dental class were determined by using cephalometric measurements; skeletal maturation was determined by using Baccetti's method. Data were statistically analyzed. Results: According to Demirjian's method, the mean dental age of the overweight and obese subjects was significantly higher than that of the normal-weight subjects (p = 0.001 and p = 0.02, respectively). A higher rate of dental class III was detected in the overweight group (p = 0.002). Concerning cephalometric records, statistically significant differences (p = 0.018) were observed in the distribution of SNA and SNB values, higher values being found in obese subjects. No difference was detected in the distribution of the ANB angle between the groups. As regards craniofacial growth pattern, no significant differences were found between the groups. Children with obesity presented more advanced skeletal maturation, reaching statistically significant differences (p = 0.02), in comparison with the normal-weight subjects. Conclusions: In conclusion, obese children showed increased tooth and skeletal development in comparison to the normal-weight subjects. These findings may be of interest for orthodontists, who should consider weight status when performing orthodontic treatment in children and adolescents.

Potential Role of Sleep Disturbance in the Development of Early Puberty: Past Clinical Evidence for Future Management

The incidence of early puberty in children has been increasing. It has been suspected that both genetic and various environmental factors such as nutrition and hormonal exposure could influence the mechanisms underlying the earlier onset of puberty. Interestingly, several previous studies have reported a strong connection between sleep and puberty. Specifically, it was discovered that luteinizing hormone (LH), a potential marker for the onset of puberty, was increased during the deep sleep period. Furthermore, a high prevalence of early puberty was observed in patients with sleep disorders, especially in those experiencing narcolepsy. In this review article, findings related to the association between sleep disturbance and early puberty have been comprehensively summarized. Any contrary findings are also included and discussed. Advances in the knowledge surrounding sleep disturbance have led to a greater understanding of a correlation between early puberty and sleep disorder and provide alternative therapeutic options for the treatment of central precocious puberty in the future.

Alterations in the gut microbiota community are associated with childhood obesity and precocious puberty

OBJECTIVE

To explore the distribution and differences in the intestinal microbiota in girls with obesity-related precocious puberty and the relationship between intestinal microbiota and obesity-related precocious puberty.

METHODS

16 S rRNA gene amplicons from fecal samples from girls with precocious puberty and obesity-complicated precocious puberty and healthy children were sequenced to define microbial taxa.

RESULTS

The α- and β-diversity indices of the microbiome significantly differed among the three groups. At the phylum level, the proportions of Firmicutes, Actinobacteriota, Bacteroidota, Bacteria, Campylobacterota, and Acidobacteriota were different. At the genus level, there were differences in Bifidobacterium, Bacteroides, Anaerostipes, Fusicatenibacter, Klebsiella, Lachnospiraceae, ErysipelotrichaceaeUCG-003, Prevotella9, Ruminococcus gnavus group, and Lachnoclostridium. Additionally, Bifidobacterium, Anaerostipes, Bacteroides, Candidatus Microthrix, Eubacterium hallii group, Klebsiella, and Erysipelotrichaceae UCG-003 were identified as bacterial biomarkers by LEfSe. Furthermore, Sellimonas, Intestinibacter, Anaerostipes, Ruminococcus gnavus group, and Oscillibacter were identified as the differential biomarkers by random forest. A receiver operating characteristic (ROC) curve was used to evaluate the biomarkers with high predictive value for obesity-related precocious puberty. Spearman correlation analysis confirmed that Anaerostipes levels were negatively correlated with body weight, body mass index (BMI), bone age, luteinizing hormone, follicle-stimulating hormone, and estradiol.

CONCLUSIONS

There was a significant correlation between obesity-associated precocious puberty and gut microbiota, especially the functional characteristics of the microbiome and its interactions, which can provide a theoretical basis for the clinical intervention of obesity and precocious puberty through the microbiome.

Peak serum luteinising hormone cut-off during gonadotropin-releasing hormone analogue test for diagnosing central precocious puberty was lower in girls with obesity as compared with girls with normal weight

OBJECTIVE

Serum luteinising hormone (LH) concentration has been reported to be lower in girls with overweight and obesity (OW/OB) as compared with girls with normal weight (NW). This study aimed to evaluate peak serum LH concentration during gonadotropin-releasing hormone analogue (GnRHa) test in girls with OW/OB and NW who had central precocious puberty (CPP) and to determine peak serum LH cut-off for diagnosing CPP in girls with OW/OB.

DESIGN, PATIENTS AND MEASUREMENTS

Medical records of 971 girls with premature breast development who underwent subcutaneous GnRHa (100 µg of triptorelin acetate) test were reviewed. All girls were classified as either CPP or premature thelarche. All of them were further classified into two groups according to their body mass index as NW and OW/OB groups for each Tanner stage.

RESULTS

There were 634 and 337 girls in NW and OW/OB groups, respectively. CPP was diagnosed in 600 girls (249 had Tanner stage II and 351 had Tanner stage III). There were no differences in peak serum LH concentrations between CPP girls with NW and OW/OB. Peak serum LH cut-off of 5 IU/L (the current widely used cut-off) had a sensitivity and a specificity of 75% and 90%, respectively in NW group. Peak serum LH cut-off for CPP diagnosis was lower at 4 IU/L in the OW/OB group with greater sensitivity and specificity of 86% and 93%, respectively. The results were reproducible for each Tanner stage of breasts.

CONCLUSION

Lower peak serum LH cut-off to 4 IU/L for diagnosing CPP in girls with OW/OB should be considered to avoid underdiagnosis of the condition.

Not Only Metabolic Complications of Childhood Obesity

The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

Serum cortisol and insulin-like growth factor 1 levels in major depressive disorder and schizophrenia

The pathophysiology underlying major depressive disorder (MDD) and schizophrenia is related to endocrine system functions and includes changes in the blood levels of cortisol and insulin-like growth factor 1 (IGF-1). However, these hormones have not been investigated simultaneously in patients with MDD and schizophrenia. We investigated the differences in serum cortisol and IGF-1 levels among patients with MDD and schizophrenia and controls. We included 129 patients with MDD, 71 patients with schizophrenia, and 71 healthy volunteers. Blood tests were performed between 6:00 am and 11:00 am after fasting. Serum cortisol levels were significantly higher in patients with schizophrenia than in patients with MDD and controls. Serum cortisol levels were significantly higher in patients with MDD than in controls. Serum IGF-1 levels were higher in both patient groups than in controls, whereas there was no significant difference between patients with MDD and schizophrenia. Both cortisol and IGF-1 levels were positively correlated with the Hamilton Rating Scale for Depression score in patients with MDD, whereas cortisol level was positively correlated and IGF-1 level was negatively correlated with the Brief Psychiatric Rating Scale score in patients with schizophrenia. The differences in the level of these hormones suggest pathophysiological differences between these disorders.

Childhood obesity and central precocious puberty

Childhood obesity is a major public health problem worldwide, and the relationship between obesity and central precocious puberty has long been confirmed, however, the mechanisms underlying this association remain elusive. This review provides an overview of the recent progress regarding how childhood obesity impacts on hypothalamic-pituitary-gonadal axis and pubertal onset, focusing on adipokines (leptin and ghrelin), hormone (insulin), and lipid (ceramide), as well as critical signaling pathways (AMPK/SIRT, mTOR) that integrate the peripheral metabolism and central circuits. Notably, prevention of obesity and CPP is beneficial for the adult life of the children, thus we further summarize the potential strategies in treating and preventing childhood obesity and CPP. The updated understanding of metabolic stress and pediatric endocrine disease will arise the attention of society, and also contribute to preventing more serious comorbidities in the later period of life in children.