Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study

Body Composition, Body Mass, and Cardiovascular Health in Mid-Childhood and Midlife: A Compositional Data Analysis

Background: We aimed to quantify associations of cardiovascular (CV) large and small artery measures with body composition and body mass (1) separately and (2) in combination in 11- to 12-year-old children and their parents. Methods: In the population-based cross-sectional Child Health CheckPoint study (1495 children, mean 12 ± 0.4 years, 49.3% girls; 1496 parents, mean 44.3 ± 5.0 years, 86.7% mothers), we measured weight, height, body composition [truncal fat, non-truncal fat, fat-free mass (FFM)], and CV functional (blood pressure, pulse wave velocity, arterial elasticity) and structural (carotid intima-media thickness, retinal arteriolar/venular caliber) outcomes. Using compositional data analyses, we examined associations of body composition (expressed as log ratios) and body mass (multiplicative total) with CV measures in separate and combined models. Results: Mean BMI z-score was 0.3 in children [standard deviation (SD) 1.0, 4.5% obese], and mean BMI was 27.9 in parents (SD 6.1, 28.8% obese). In both children and adults, more adverse CV measurements were associated with higher %truncal fat, %non-truncal fat, and body mass and lower %FFM. Compared with normal-weight children, children with obesity had poorer CV measures (e.g., 1 SD faster pulse wave velocity, 0.5 SD lower arterial elasticity), with higher body mass and lower %FFM mainly accounting for these relationships. All relationships were similar, albeit larger, for parents. Conclusion: Poorer CV health in both generations was associated with higher body mass, lower %FFM, and, to a lesser extent, higher %truncal and non-truncal fat. Trials could test whether weight reduction interventions with vs. without FFM preservation differentially improve CV functional and structural precursors.

Maternal asthma in pregnancy and pubertal timing in daughters and sons: A population-based cohort study

PURPOSE

We investigated the impact of maternal asthma on children's pubertal timing as it remains underexplored.

METHODS

The Danish National Birth Cohort (DNBC) provided information on maternal asthma during pregnancy, supplemented with diagnosis codes from the Danish National Patient Register. The DNBC sub-cohort the Puberty Cohort gave half-yearly information on pubertal timing from 11 years. We estimated adjusted mean age differences in months for reaching Tanner Stages 1-5 for breast, genital and pubic hair development, axillary hair, acne, and voice break, and menarche for daughters, and first ejaculation for sons. Further, a negative control analysis explored confounding, and two mediation analyses explored mediation through birthweight and childhood asthma.

RESULTS

In total, 15,819 children and their mothers participated and 6.6 % of the children had mothers with asthma. Results indicated slightly later pubertal development in sons of mothers with asthma (average difference: 1.0 months (95 % confidence intervals -0.4, 2.4)). This association was not mediated by birthweight or childhood asthma. We did not observe any associations among daughters. The negative control analysis suggested some confounding towards the null.

CONCLUSION

Sons of mothers with asthma during pregnancy had slightly later pubertal timing, though the result could also indicate no association.

Associations between structural stigma and earlier pubertal timing persist for 1 year among Black girls and Latinx youth

Black and Latinx youth experience earlier pubertal timing relative to their non-stigmatized peers. Research on determinants of this increased risk has largely focused on aspects of individuals (e.g., body mass index) or their proximal environment (e.g., socioeconomic status), to the exclusion of broader macro-social factors. Using 2 years of Adolescent Brain Cognitive Development Study® data, we examined whether structural stigma (e.g., state-level policies, aggregated prejudicial attitudes) was associated with hormonal and physical markers of pubertal development. Baseline results documented earlier pubertal timing among Black girls (hormones) and Latinx girls and boys (youth and/or caregiver report) in states with higher (vs. lower) levels of structural racism and xenophobia, respectively. Observed associations were comparable in effect size to a well-established correlate of pubertal development, body mass index, and remained 1 year later among these stigmatized (vs. non-stigmatized) groups. Findings suggest the need to broaden the study of determinants of pubertal development to include macro-social factors.

Explainable predictive models of short stature and exploration of related environmental growth factors: a case-control study

BACKGROUND

Short stature is a prevalent pediatric endocrine disorder for which early detection and prediction are pivotal for improving treatment outcomes. However, existing diagnostic criteria often lack the necessary sensitivity and specificity because of the complex etiology of the disorder. Hence, this study aims to employ machine learning techniques to develop an interpretable predictive model for normal-variant short stature and to explore how growth environments influence its development.

METHODS

We conducted a case‒control study including 100 patients with normal-variant short stature who were age-matched with 200 normal controls from the Endocrinology Department of Nanjing Children's Hospital from April to September 2021. Parental surveys were conducted to gather information on the children involved. We assessed 33 readily accessible medical characteristics and utilized conditional logistic regression to explore how growth environments influence the onset of normal-variant short stature. Additionally, we evaluated the performance of the nine machine learning algorithms to determine the optimal model. The Shapley additive explanation (SHAP) method was subsequently employed to prioritize factor importance and refine the final model.

RESULTS

In the multivariate logistic regression analysis, children's weight (OR = 0.92, 95% CI: 0.86, 0.99), maternal height (OR = 0.79, 95% CI: 0.72, 0.87), paternal height (OR = 0.83, 95% CI: 0.75, 0.91), sufficient nighttime sleep duration (OR = 0.48, 95% CI: 0.26, 0.89), and outdoor activity time exceeding three hours (OR = 0.02, 95% CI: 0.00, 0.66) were identified as protective factors for normal-variant short stature. This study revealed that parental height, caregiver education, and children's weight significantly influenced the prediction of normal-variant short stature risk, and both the random forest model and gradient boosting machine model exhibited the best discriminatory ability among the 9 machine learning models.

CONCLUSIONS

This study revealed a close correlation between environmental growth factors and the occurrence of normal-variant short stature, particularly anthropometric characteristics. The random forest model and gradient boosting machine model performed exceptionally well, demonstrating their potential for clinical applications. These findings provide theoretical support for clinical identification and preventive measures for short stature.

Pubertal timing as a predictor of epigenetic aging and mortality risk in young adulthood

Early pubertal timing is associated with adverse health in adulthood. These effects may be mediated by DNA methylation changes associated with accelerated cellular aging and mortality risk, but few studies tested associations between pubertal timing and epigenetic markers in adulthood. Additionally, pubertal timing effects often vary by sex and are understudied in diverse youth. Thus, this longitudinal study examined links between pubertal timing and later epigenetic aging and mortality risk together with sex differences in predominantly Black youth. Participants included 350 individuals (58% female, 42% male; 80% Black, 19% non-Hispanic White). Perceived pubertal timing relative to peers and self-reported phenotypic pubertal timing based on age-adjusted Tanner scores were assessed during early adolescence (Mage = 13) whereas epigenetic aging (GrimAge, DunedinPace of Aging Calculated from the Epigenome, and PhenoAge) and mortality risk were measured during young adulthood (Mage = 27). After adjusting for covariates (smoking, body mass index, family income, early-life stress, race/ethnicity, sex, parenthood), early pubertal timing (both perceived and phenotypic) predicted higher epigenetic mortality risk, and early phenotypic pubertal timing predicted accelerated DunedinPace of Aging Calculated from the Epigenome. Both perceived and phenotypic early pubertal timing were correlated with accelerated GrimAge. Off-time phenotypic pubertal timing (i.e., early and late) was associated with accelerated PhenoAge in males only whereas perceived off-time pubertal timing was unexpectedly linked with lower PhenoAge acceleration. These findings extend prior research by linking two dimensions of early pubertal timing with epigenetic mortality risk and accelerated aging in racially diverse young adults and showing nonlinear effects on PhenoAge acceleration that differ across pubertal timing measures and show some sex differences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Particularities of Arterial Hypertension in Female Sex: From Pathophysiology to Therapeutic Management

Arterial hypertension is the most important modifiable cardiovascular risk factor and a major cause of cardiovascular mortality worldwide. In daily clinical practice, the hypertensive patient is often treated in a uniform way, thus ignoring the significant effects of sex on several aspects of hypertension, including its prevalence, pathophysiology, response to antihypertensive treatment, and outcomes. Along with the immune response and several cardiometabolic risk factors that frequently coexist, the substantial hormonal changes during a woman's life cycle are among the main pathophysiological mechanisms driving hypertension in women. Concurrently, women exhibit increased cardiovascular risk at lower blood pressure (BP) levels compared to age-matched men and present certain disparities in the incidence of cardiovascular events and subsequent hypertension-related cardiovascular prognosis. In addition, women respond differently to antihypertensive treatment, experience more drug-related side effects, and exhibit lower rates of BP control compared to men. Currently, international guidelines propose the same targets and the same therapeutic algorithms for the treatment of hypertension in both sexes without taking into account the sex differences that exist. In this review, we aim to describe certain particularities of arterial hypertension in the female sex, moving from pathophysiological aspects to clinical and therapeutical management.

The Metabolic Programming of Pubertal Onset

BACKGROUND

There is increasing evidence that maternal factors such as nutritional status (both under and over-nutrition) and diabetes, alongside prenatal exposure to endocrine disrupting chemicals (EDCs), are associated with early pubertal onset in offspring. Such children are also at increased risk of the metabolic syndrome during adolescence and young adulthood.

AIM

This literature review focuses on the role of the prenatal environment in programming pubertal onset, and the impact of prenatal metabolic stressors on the declining average age of puberty.

METHOD

A review of all relevant literature was conducted in PubMed by the authors.

OUTCOME

The mechanism for this appears to be mediated through metabolic signals, such as leptin and insulin, on the kisspeptin-neuronal nitric oxide-gonadotropin releasing hormone (KiNG) axis. Exposed children have an elevated risk of childhood obesity and display a phenotype of hyperinsunlinaemia and hyperleptinaemia. These metabolic changes permit an earlier attainment of the nutritional "threshold" for puberty. Unfortunately, this cycle may be amplified across subsequent generations, however early intervention may help "rescue" progression of this programming.

Central lipid sensing pathways contribute to the control of puberty and its alterations in conditions of obesity

Childhood obesity, especially in girls, often correlates with advanced puberty and long-term comorbidities. Among the central circuits controlling energy homeostasis, hypothalamic lipid sensing pathways, involving free fatty-acid receptors (FFARs), peroxisome proliferator-activated receptors (PPARs), and the bile-acid (BA) receptor, Takeda G protein-coupled receptor 5 (TGR5), have been recognized as major players, with putative pathogenic roles in obesity and its complications. However, their contribution to pubertal regulation and obesity-induced pubertal alterations remains largely unexplored. We describe herein changes in the hypothalamic profiles of specific lipid species, including certain fatty-acyls, BA derivatives, and several glycerolphospholipids, during the juvenile-pubertal transition and conditions of overweight linked to precocious puberty in female rats. Hypothalamic expression of the FFAR, Gpr84, as well as Ppar-γ and Tgr5 gradually increased during the infantile-prepubertal transition, whereas early overfeeding increased hypothalamic mRNA levels of the FFARs, Gpr43, and Gpr84. Expression of Gpr84, Ppar-α, and Tgr5 was documented in FACS-isolated Kiss1 neurons from juvenile and pubertal female mice. Central pharmacological gain- and loss-of-function manipulations of GPR84-, PPAR-, or TGR5-signaling in prepubertal lean and early overfed female rats resulted in specific changes in pubertal timing. In lean rats, central blockade of PPAR-γ/α delayed puberty onset, whereas in early overfed rats, central stimulation of TGR5 signaling partially prevented obesity-induced advanced puberty; effects that were also marginally observed after GPR84 inhibition. Our results disclose the role of brain lipid-sensing pathways in the control of puberty, with a variable contribution of central FFAR-, PPAR-, and TGR5-signaling depending on the maturational and nutritional status.NEW & NOTEWORTHY Puberty is highly sensitive to body energy status, and child obesity is often linked to perturbed puberty. However, whether this comes from excessive energy stores or specific nutrient signals altered in obesity remains largely unexplored. Using suitable preclinical models of early obesity and accelerated puberty, we disclose herein conclusive evidence for altered hypothalamic lipid profiles and the roles of specific lipid-sensing pathways in pubertal control, with a variable contribution depending on the maturational and nutritional status.

Male sex hormone concentrations, puberty timing, baldness patterns, and risk of cardiovascular disease

PURPOSE

Studies exploring the relationship between male-specific factors and risks of cardiovascular disease (CVD) are limited and inconsistent. We aimed to examine the association of male hormone levels and sexual factors (e.g., onset of puberty and baldness pattern) with CVD events.

METHODS

This study included 154,970 men from the UK Biobank for prospective analyses. Cox proportional hazards regression was performed, with outcomes of CVD, coronary heart disease (CHD), stroke, and heart failure (HF), and adjusted for sociodemographics, lifestyle, and medical factors. Restricted cubic spline models assessed nonlinear associations between sex hormone levels and CVD risks.

RESULTS

Over a median follow-up of 13.0 years, 20,216 men (13.0%) experienced a CVD event. Men in the highest quintile of total testosterone had increased stroke risk (HR 1.13, 95% CI: 1.04-1.23). A J-shaped relationship was found between sex hormone-binding globulin (SHBG) levels and CVD risk, with the highest risk in Q5 (1.08, 1.03-1.13). A U-shaped association was noted for free testosterone (FT), where Q3 had lower CVD risk (0.94, 0.90-0.98). Earlier onset of facial hair or voice breaking (< 13 years) correlated with higher CVD risks (HR 1.10, 95% CI: 1.04-1.16 and HR 1.14, 95% CI: 1.06-1.22, respectively). Vertex baldness was linked to increased CVD risk (1.05, 1.01-1.09) and CHD risk (1.06, 1.02-1.11).

CONCLUSIONS

Elevated SHBG levels, earlier puberty onset, and vertex baldness were associated with increased CVD risks in men, highlighting the need for targeted prevention strategies.

A systematic review and meta-analysis of the self-reported pubertal development scale's applicability to children

INTRODUCTION

Assessing pubertal stage can be challenging, particularly in large-scale settings, due to the sensitive nature of Tanner staging by healthcare providers (HCP) or self-reported Tanner stage through photographs or line drawings. The self-reported Pubertal Development Scale (PDS) avoids sensitive issues like genitalia or nudity, is adaptable to various settings, reduces time and cost burdens on researchers. This study aimed to explore the agreement between self-reported PDS and HCP-assessed Tanner staging.

CONTENT

Papers for the meta review were retrieved from Pubmed, Embase, Fang Wan, CNKI, and Cochrane Library before January 15, 2025. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates and 95 % confidence intervals (CI) were calculated using random-effects models.

SUMMARY AND OUTLOOK

Five studies with 6024 participants met inclusion criteria. Among stage 1-5, substantial agreement was found among girls (Wk: 0.63[0.62-0.65]) and overall participants (Wk: 0.68[0.67-0.69]), while moderate agreement was observed in boys (Wk: 0.58[0.56-0.61]). Broadening puberty criteria to stages I-III showed substantial agreement for girls (Wk: 0.66[0.64-0.68]), boys (Wk: 0.64[0.61-0.67]), and overall participants (Wk: 0.69[0.67-0.70]). For pubertal onset, using Tanner stage as the gold standard, girls showed that the area under the receiver operating characteristic curve (AUC) was 0.86(0.85-0.87), the sensitivity and positive predictive value (PPV) of self-reported PDS were 0.85 and 84.2 % respectively. Similarly, among boys, the AUC was 0.89 (95 % CI: 0.87-0.92), the sensitivity and PPV were 0.91 and 97.8 % respectively. Our findings indicate moderate to substantial agreement between the two methods, with high sensitivity and PPV for self-reported PDS in assessing puberty onset, PDS may be a reliable and cost-effective method for large-scale epidemiological studies.

Ramadan During Pregnancy and Offspring Age at Menarche in Indonesia: A Quasi-Experimental Study

Background/Objectives: Animal models have suggested a link between maternal nutrition and offspring pubertal onset. Due to ethical and practical concerns, human studies on this topic remained scarce and focused on extreme nutritional shocks in high-income settings, such as Dutch famine. This paper expands on these findings by investigating the effects of a milder form of nutritional alteration during pregnancy-Ramadan fasting-in a middle-income context, Indonesia. We use offspring age at menarche (AAM) as an indicator of pubertal timing and female reproductive health. Our research has broader implications beyond the Muslim community, as intermittent fasting during pregnancy is also widely practiced by non-Muslims, e.g., meal-skipping. Methods: We used data from the Indonesian Family Life Survey (1993-2014, n = 8081) and Indonesian Demographic and Health Surveys (2002-2007, n = 13,241). OLS and Cox regressions were applied to compare the AAM of female Muslims who were prenatally exposed to Ramadan and those of female Muslims who were not. Exposure was determined based on the overlap between pregnancy and a Ramadan. We further subdivided this overlap into trimester-specific categories, adjusting for urban-rural residence, birth month, birth year, birth year squared, and survey wave. Results: No associations between Ramadan during pregnancy and AAM were found, irrespective of the pregnancy trimester overlapping with Ramadan. These results were stable when we restricted the sample to women with shorter recall periods and younger women at the time of survey. Conclusions: While subtle restrictions in maternal nutrition during pregnancy are critical for offspring health, the impact on menarcheal onset might be limited.

Association of age at menarche with type 2 diabetes mellitus among urban Indian women: results from the CARRS study

BACKGROUND

Early onset of menarche is associated with hormonal alterations that may predispose women to diabetes. We investigated the association between age at menarche and incident diabetes in India, a setting with declining menarche age and increasing burden of diabetes.

METHODS

Data were from the Cardiometabolic Risk Reduction in South Asia study. Women free of diabetes at baseline (2010-12) were followed until 2021 for incident diabetes, defined as prior medical diagnosis or fasting plasma glucose ≥126 mg/dl or HbA1c ≥6.5%. Age at menarche, in years was collected through self-report. Multivariable Cox proportional hazards regression models, controlling for socio-demographic factors and potentially confounding clinical parameters, estimated the association [hazard ratio (HR)] of menarche age with incident diabetes. Effect modification by obesity status was also assessed.

RESULTS

Of 3654 women at risk of diabetes at baseline, mean age was 37.7 [Standard Deviation (SD) = 10.4] years and mean age of menarche was 13.9 (SD = 1.3) years. Younger women (age 20-39 years) had an earlier onset of menarche compared to older women. Over 11 years of follow-up (median: 9.2 years), we observed 390 cases of diabetes [cumulative incidence (CI): 10.7%, 95% CI 9.32-12.33; incidence rate: 12.4 per 1000 person-years (95% CI 11.23-13.69)]. There was no association between age at menarche and incident diabetes, HR = 1.04 (95% CI 0.95-1.14). The null association was consistent in models stratified by obesity status.

CONCLUSION

We did not find evidence of an association between age at menarche and incident diabetes in this large cohort of Indian women.

Family Functioning and Pubertal Maturation in Hispanic/Latino Children from the HCHS/SOL Youth

Previous studies have examined the association between family dysfunction and pubertal timing in adolescent girls. However, the evidence is lacking on the role of family dysfunction during sensitive developmental periods in both boys and girls from racial and ethnic minority groups. This study aimed to determine the effect of family dysfunction on the timing of pubertal maturation among US Hispanic/Latino children and adolescents. Participants were 1466 youths (50% female; ages 8-16 years) from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). Pubertal maturation was measured using self-administered Pubertal Development Scale (PDS) items for boys and girls. Family dysfunction included measures of single-parent family structure, unhealthy family functioning, low parental closeness, and neglectful parenting style. We used multivariable ordinal logistic and linear regression analyses to examine the associations between family dysfunction and pubertal maturation (individual and cumulative measures), with adjustment for childhood BMI and socioeconomic factors, design effects (strata and clustering), and sample weights. Multivariable models of individual PDS items showed that family dysfunction was negatively associated with growth in height (OR = 0.66, 95% CI: 0.44, 0.99) in girls; no associations were found in boys. In the assessment of cumulative PDS scores, family dysfunction was associated with a lower average pubertal maturation score (b = -0.63, 95% CI: -1.21, -0.05) in boys, while no associations were found in girls. Pubertal timing lies at the intersection of associations between childhood adversity and adult health and warrants further investigation to understand the factors affecting timing and differences across sex and sociocultural background.

Dietary availability acutely influences puberty onset via a hypothalamic neural circuit

Reproduction poses a substantial burden, especially for mammalian females. Puberty onset serves as a vital checkpoint, regulated based on the body's energy state, to prevent inappropriate reproductive activity under malnutrition. However, the neural basis of this puberty checkpoint remains poorly understood. Here, we demonstrate that peripubertal malnutrition in female mice reduces the synchronous activity episodes of arcuate kisspeptin neurons, which are critical regulators of the gonadotropin axis. Improved dietary availability increased the frequency of this pulsatile activity, facilitating puberty onset. Using a viral-genetic approach, we show that the activity of agouti-related protein neurons in the arcuate nucleus, a hunger center, can bidirectionally regulate the pulsatile activity of kisspeptin neurons and follicular maturation in the ovaries. Collectively, a neural circuit connecting feeding to reproductive centers acts as an adjuster of the frequency of pulsatile kisspeptin neuron activity based on dietary availability, contributing to the neural basis of the puberty checkpoint.

Atopic dermatitis in childhood and pubertal development: A nationwide cohort study

Background

Atopic dermatitis (AD) might delay puberty, but research is lacking.

Objective

To investigate the association between AD and puberty.

Methods

A subcohort within the Danish National Birth Cohort includes children born between 2000 and 2003, with mothers reporting doctor-diagnosed AD at 6 months, 18 months, and 7 years old. The National Patient Registry identified hospital-diagnosed AD. From 11 years, the children give half-yearly information on pubertal development. We estimated the mean age difference in months at attaining Tanner stages 1 to 5 and the development of axillary hair, acne, first ejaculation, voice break, and age at menarche, using an interval-censored regression model.

Results

In total, 15,534 children participated, 21.5% had self-reported doctor-diagnosed AD and 0.7% had hospital-diagnosed AD. For girls with self-reported doctor-diagnosed AD, the average age difference at reaching all pubertal milestones was 0.0 months (95% confidence interval [CI]: -0.8; 0.8), and for hospital-diagnosed AD, it was -0.3 months (95% CI: -5.4; 4.8). For boys, the average age difference was 0.1 months (95% CI: -0.6; 0.9) and -0.3 months (95% CI: -3.6; 3.0), respectively.

Limitations

No information on treatment was available. Missing data on covariates (<5%) were not addressed.

Conclusion

No association was found between AD and puberty in either girls or boys.

Association between pubertal timing and bone and body composition in young adult men

Bone and muscle development are important processes in pubertal maturation. The aim of this study was to investigate associations between pubertal timing and bone density and body composition in young adult men. In this observational study, bone and body composition was cross-sectionally assessed by dual-energy X-ray absorptiometry in 2056 healthy young men with median age 19, who retrospectively self-reported if they experienced pubertal changes at an earlier, similar or later age than their peers. Associations between voice break timing and bone and body composition were analyzed by linear regression. Men reporting earlier voice break than their peers (n = 417, 20%) had higher lumbar bone mineral density (BMD) and higher total body BMD. Apart from higher BMI, there were no differences in body composition. Men who reported later voice break (n = 353, 17%) had lower lumbar bone mineral content, bone area and volume, but similar BMD. They had lower BMI, lean mass and fat mass, resulting in a lower fat-to-muscle ratio. In conclusion, even after adult height has been reached, physiological variations in pubertal timing were associated with differences in bone and body composition in young adult men.

Early-Life Risks of Central Precocious Puberty

OBJECTIVES

To investigate the factors in early life that may contribute to central precocious puberty (CPP).

METHODS

The study utilized data from the Taiwan Puberty Longitudinal Study, including 2241 children under pubertal assessment and a questionnaire of risk factors. We analyzed associations using the Fitting Generalized Linear Models in R (R Core Team, 2023), with R studio (Posit, 2023) version 4.3.1.

RESULTS

Among the 2241 children examined, 745 had CPP. Overall, higher gestational weight gain (GWG) increased the risk of CPP (odds ratio [OR]: 1.03, 95% CI: 1.01-1.05); while higher GWG served as a protective factor in females (OR: 0.97, 95% CI: 0.95-0.99). Maternal gestational diabetes mellitus (GDM) also increased the CPP risk, particularly in males (OR: 2.66, 95% CI: 1.00-7.25). Longer exclusive breastfeeding was linked to lower CPP risk overall (OR: 0.96, 95% CI: 0.93-1.00) but was not significant when analyzed by gender.

CONCLUSIONS

Higher maternal GWG was associated with an increased risk of CPP overall, while GWG became negatively associated with CPP, only in females. Maternal GDM was linked to a higher risk of CPP, particularly in males. The duration of exclusive breastfeeding was inversely correlated with CPP risk, but this effect was not significant when analyzed by gender.

Shared Pathophysiological Mechanisms and Genetic Factors in Early Menarche and Polycystic Ovary Syndrome

Early age at menarche (early AAM) and polycystic ovary syndrome (PCOS) are reproductive and metabolic disorders with overlapping pathophysiological and genetic features. Epidemiological studies suggest a link between these two conditions, both of which are characterized by dysregulation of the neuroendocrine pathways that control pulsatile gonadotropin-releasing hormone secretion, thus affecting gonadotropin release, particularly luteinizing hormone secretion. A common pathophysiology involving positive energy balance and abnormal metabolic status is evident in both disorders. Genetic and epigenetic factors influence the onset of puberty and reproductive outcomes. Genome-wide association studies have identified common genetic variants associated with AAM and PCOS, particularly in genes related to the neuroendocrine axis (e.g., FSHB) and obesity (e.g., FTO). In addition, high-throughput sequencing has revealed rare loss-of-function variants in the DLK1 gene in women with central precocious puberty (CPP), early menarche, and PCOS, who experienced adverse metabolic outcomes in adulthood. This review explores the shared pathophysiological mechanisms between CPP/early AAM and PCOS, examines potential genetic and epigenetic factors that may link these neuroendocrine reproductive conditions, and offers insights into future research and treatment strategies. Understanding these connections may provide new targets for therapeutic interventions and improve outcomes for individuals with these reproductive disorders.

Cardiometabolic Risk Clusters and Their Reproductive Correlates: A Latent Class Analysis of Indian Women

Background

Cardiometabolic conditions are rising among women in low- and middle-income countries and appearing at younger ages. The role of female reproductive characteristics in cardiometabolic risk is not well understood.

Methods

We analyzed seven reproductive characteristics and seven cardiometabolic indicators obtained from 644,191 non-pregnant women aged 15-49 years in the 2019-2021 India National Family and Health Survey (NFHS-5). We conducted a latent class analysis of cardiometabolic indicators (systolic and diastolic blood pressure, random blood glucose, body mass index, waist circumference, and use of anti-hyperglycemic and antihypertensive pharmacotherapy) to identify risk clusters. Multinomial logistic regression models accounting for age and sociodemographic characteristics assessed associations between reproductive characteristics (age at menarche, age at first birth, natural or surgical menopause, parity, time since last birth, experience of pregnancy loss, current contraceptive use) and cluster membership.

Results

Women had a median age of 29.4 (IQR: 21.5-38.4) years, were mostly married (71%), and resided in rural areas (68%). Five cardiometabolic clusters emerged: normal (36%), high-normal (46%), isolated-overweight (12%), hypertension-overweight (6%), and glucose dysregulation-overweight (1%). Early menarche (<13 years), early age at first birth (<20 years), and natural or surgical menopause were positively associated with two or more high-risk clusters (ORs: 1.13-1.62). Higher parity was associated with higher relative odds of isolated-overweight (ORs: 1.31-1.39), while longer time since last birth (≥ 8 years) was associated with hypertension-overweight (OR: 1.25 95% CI: 1.18-1.31) and glucose dysregulation-overweight (OR: 1.21, 95% CI: 1.07-1.37). Pregnancy loss increased the odds of all high-risk clusters (ORs: 1.21-1.42), while contraceptive use decreased the odds (ORs: 0.88-0.93).

Conclusions

Five cardiometabolic risk clusters were identified in Indian women, with cluster membership linked to reproductive characteristics. The timing of fertility milestones and reproductive history appear relevant for early risk stratification among women in early to middle adulthood.

Key Messages

Indian women aged 15-49 years exhibited 5 distinct patterns of cardiometabolic risk clustering: normal, high-normal, isolated-overweight, hypertension-overweight, and glucose dysregulation-overweight clusters.Early age at menarche (<13 years), early age at first birth (<20 years), natural or surgical menopause, higher parity, longer time since last birth, and pregnancy losses were associated with at least one of the high-risk cardiometabolic clusters.Reproductive history and the timing of reproductive milestones may improve early disease risk stratification in Indian women.

Association of childhood obesity with pubertal development in boys: A systematic review and meta-analysis

Childhood obesity leads to early puberty development in girls, but its effect in boys remains unclear. We conducted a systematic review and meta-analysis to study the association between childhood obesity and puberty development in boys. We included 14 cohort studies with 114,822 boys. Meta-analysis showed that childhood overweight (RR, 1.44; 95%CI, 1.08-1.93; the number of studies [N] = 4) and obesity (RR, 1.35; 95%CI, 1.11-1.64; N = 5) were associated with the earlier occurrence of testicular volume ≥4 mL (Tanner stage 2). Age reaching Tanner stage 2 in overweight boys was earlier than normal-weight boys (mean difference: -0.23 years, 95% CI: -0.37 to -0.08; N = 2); a similar trend was observed in obese boys, but the effect estimate did not reach significance level (mean difference: -0.27 years, 95% CI: -0.59 to 0.05; N = 3). Similarly, the age at pubarche in boys with overweight/obesity was earlier than those with normal weight. Qualitative analysis shows first nocturnal emission; change in voice and peak height velocity in boys with overweight/obesity appeared to develop earlier than those with normal weight. These findings suggest overweight/obesity is associated with earlier pubertal development in boys. Due to the limited number of studies identified in this review, further studies are warranted to confirm these associations.

The study of pubertal stage and age of menarche in girls in Isfahan province, Iran

BACKGROUND

The onset age of pubertal changes varies widely among girls and has undergone changes over time around the world. This study aimed to determine the age of onset of puberty in healthy Iranian girls living in Isfahan province.

METHODS

This cross- sectional study was conducted among 13,886 students aged 6-18 years. They were selected by multistage random cluster sampling from urban and rural areas of Isfahan province of Iran. Pubertal stage was determined according the 5-level Tanner stages proposed by Marshall and Tanner. Trained physicians determined the breast development through both visual inspection and palpation, in addition, mothers assessed their daughter's pubic hair growth using Tanner's Sexual Maturation Scale (SMS) by comparison to standard pictures. The data were analyzed by the status quo method. Probit regression analysis was used to evaluate the median age of onset for each characteristic including menarche, breast and pubic hair.

RESULTS

A total of 13,886 healthy girls with mean age (SD) of 11.97 (2.9) were studied. Overall 6968 (50.2%) girls experienced menstruation with a median (95%CI) age of 12.05(11.88-12.21) years at its onset. The median age for onset of breast development was 9.89 (95% CI: 9.77 - 10.02) years and for onset of pubic hair development was 10.14 (95% CI: 9.88- 10.39) years. The 3rd percentile for breast stage 2 (B2) and pubic hair stage 2 (PH2) was 6.85 and 6.75 years, respectively, and the 97th percentile for B2 and PH2 was 12.94and 13.54 years, respectively.

CONCLUSION

According to our findings, the onset of puberty before 6.85 years should be considered as precocious puberty for Iranian girls. Our study indicated the secular trend toward earlier menarche in girls. Nationally representative surveys and longitudinal studies are necessary to determine the exact age of puberty for future international comparisons.

The association between age at menarche (AAM) and cardiovascular disease (CVD) risk factors in the MASHAD cohort study

Age at menarche may be associated with cardiovascular disease risk factors in different ethnic groups. The purpose of this study was to identify the association of cardiovascular disease (CVD) risk factors with age at menarche (AAM) in Mashhad, the second biggest city in Iran. This was a cross- sectional study based on cohort data of 2353 women (35-65 years) from Mashhad, Iran for whom the age at menarche was reported. Baseline demographic, anthropometric data, and biochemical profiles were also collected. The levels of depression and anxiety were evaluated using a validated Persian version of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Multiple logistic regression models were used to examine the association between age at menarche with CVD risk factors. Anthropometric parameters, short stature, prevalence of diabetes, and CVD risk were significantly higher in women who were younger at menarche (AAM) in comparison to women with an older AAM. Women with a menstruating age of 11 years had a significantly higher weight (P < 0.001), higher BMI (P < 0.001), lower waist circumference (WC) (P = 0.004), higher hip circumference (HC) (P < 0.001) and higher waist-to-thigh ratio (WTR) (P < 0.001) than women with an AAM of ≥ 15 years. University-educated women and employed women were most likely to have menarche at ≥ 15 years (P < 0.001 and P = 0.012 respectively. In girls who menstruated at age ≤ 11 years old, the odds of having a BMI > 28.7 kg/m2, WC > 96 cm, HC > 105 cm and WTR > 61.96 were higher than girls who menstruated at 13 years old. The odds of height > 155 cm was higher in girls with menarche age of ≥ 15 than 13 years and the odds of having depression scores greater than 12 was lower in menarche age group of ≥ 15 years. The girls with menstruation age of 12 years had higher odds of having diabetes mellitus and HC > 105 cm than girls with menstruation age of 13 years. The odds of demi span exceeded 74 cm and height > 155 cm were higher in girls with menarche age of 14 than 13 years. AAM may be a useful factor to identify women at greater risk of CVD to implement appropriate preventive measures.

Assessing the stability of psychobiological stress reactivity during adolescence: mixed-effect modelling of cortisol responses to laboratory stressors

Background

Puberty has been historically considered as a time of risk and vulnerability for young people. It is associated with rapid development in the hypothalamus, which is central in the production of both stress and sex steroids. While patterns of stress reactivity are calibrated in early life, this time of rapid development may provide a means for these patterns to change. This purpose of this study was to examine whether patterns of cortisol reactivity remained stable across one year of pubertal development, and whether variations in pubertal development impacted on this stability.

Methods

This study used a secondary dataset comprised of 102 adolescent-aged children and adolescents. Children and adolescents took part in the Trier Social Stress Test to elicit a physiological stress response. Cortisol reactivity was measured as the increase in salivary cortisol concentration taken at five time points throughout the session. Pubertal stage was measured by nurse report where possible, and parent/self-report otherwise and was used to calculate pubertal timing and tempo relative to peers. Measures of anxiety, BMI, and socio-economic status were taken and included in analysis.

Results

Results of a linear mixed-effect model found there to be a significant difference in cortisol reactivity over time, indicating that cortisol stress reactivity did not remain stable during this time (Estimate= 3.39, t=3.67, p<.001, CI[1.56, 5.22]). Additionally, results show children and adolescents who developed slower/quicker than peers displayed decreased stress reactivity (Estimate= -3.59, t=-2.13. p=.03, CI[-6.92, -0.25]).

Conclusions

This research contributes to a relatively small but consistent body of research noting pattern of increased cortisol reactivity during pubertal development. While a significant effect was found for pubertal tempo, this finding should not be considered indicative of any true effect.

Cross-trait multivariate GWAS confirms health implications of pubertal timing

Pubertal timing is highly variable and is associated with long-term health outcomes. Phenotypes associated with pubertal timing include age at menarche, age at voice break, age at first facial hair and growth spurt, and pubertal timing seems to have a shared genetic architecture between the sexes. However, puberty phenotypes have primarily been assessed separately, failing to account for shared genetics, which limits the reliability of the purported health implications. Here, we model the common genetic architecture for puberty timing using a multivariate GWAS, with an effective population of 514,750 European participants. We find 266 independent variants in 197 loci, including 18 novel variants. Transcriptomic, proteome imputation and fine-mapping analyses reveal genes causal for pubertal timing, including KDM4C, LEPR, CCNC, ACP1, and PCSK1. Linkage disequilibrium score regression and Mendelian randomisation analysis establish causal associations between earlier puberty and both accelerated ageing and the risk of developing cardiovascular disease and osteoporosis. We find that alanine aminotransferase, glycated haemoglobin, high-density lipoprotein cholesterol and Parabacteroides levels are mediators of these relationships, and establish that controlling oily fish and retinol intake may be beneficial for promoting healthy pubertal development.

Lifelong impacts of puberty timing on human plasma metabolic profiles: A metabolome-wide Mendelian randomization study

AIM

The aim was to investigate the causal relationship between puberty timing and plasma metabolites, accounting for birth weight, childhood and adulthood adiposity.

MATERIALS AND METHODS

The meta-analysis of genome-wide association studies (GWAS) for puberty timing was extracted from the ReproGen Consortium, involving 329 345 women of European ancestry. Summary data for 174 plasma metabolites were retrieved from a recently conducted cross-platform GWAS that involved a meta-analysis of three cohort studies (i.e. the Fenland, European Prospective Investigation into Cancer-Norfolk and INTERVAL studies) and three publicly available studies and included up to 86 507 participants. We conducted a two-sample Mendelian randomization (MR) analysis to infer the causal relationship of puberty timing on 174 plasma metabolites, complemented by a two-step and multivariable Mendelian randomization (MVMR) analysis to assess direct and indirect effects. Additionally, summary-level data from the UK Biobank were used for our replication analysis.

RESULTS

The results of the two-sample MR provide moderate evidence supporting a causal relationship between puberty timing and 23 of 174 plasma metabolites (i.e. 7 acylcarnitines, 8 amino acids, 2 biogenic amines and 6 lysophosphatidylcholines). Even after single-nucleotide polymorphisms associated with birth weight and childhood adiposity were excluded, causal effects persisted for 16 metabolites (i.e. 8 acylcarnitines, 4 amino acids, 2 biogenic amines and 2 lysophosphatidylcholines). The two-step MR analysis provided evidence that the relationship between puberty timing and plasma metabolites was mediated by adulthood adiposity. Additionally, moderate evidence emerged for an independent causal effect of puberty timing on 10 metabolites through an MVMR analysis (i.e. 5 acylcarnitines, 2 amino acids, 1 biogenic amine, 1 lysophosphatidylcholine and 1 phosphatidylcholine). Furthermore, the replication analysis suggested the robustness of our results.

CONCLUSIONS

In summary, our study provides compelling evidence that puberty timing has a causal influence on certain plasma metabolites, although this influence is largely mediated by adulthood adiposity.

Earlier pubertal timing, not tempo, links time-limited early adversity with psychopathology

Evolutionary-developmental theories propose that early adverse experiences adaptively shift the timing (i.e., onset) and tempo (i.e., rate) of pubertal maturation. Empirical evidence of links between early life adversity and pubertal maturation is mixed, potentially in part because isolating the unique impacts of early environments is challenging. The current accelerated longitudinal study used a quasi-experimental design to examine pubertal maturation among 132 previously-institutionalized (PI), internationally adopted children who experienced a time-limited form of severe early life adversity, compared to 169 non-adopted (NA) children. Based on prior literature, we also assessed whether pubertal timing and/or tempo are pathways by which early adversity relates to later symptoms of psychopathology. At each of three annual sessions, Tanner pubertal staging was determined by nurse exam, and symptoms of psychopathology were captured in a composite of child self-reported internalizing and parent-reported externalizing symptoms. Findings revealed that, only among children at Tanner pubertal stages 3 or below, PI children were more likely to have reached stage 3 compared to NA children, reflective of earlier pubertal timing. No group differences were found for pubertal tempo. In the subsample of children at Tanner stage 3 or lower, earlier pubertal timing was an indirect pathway by which early adversity related to both higher levels and greater longitudinal declines in internalizing and externalizing symptoms of psychopathology, accounting for a small proportion of the total effect of early adversity on psychopathology. Results from this quasi-experimental study add to existing research on associations between early adversity, early pubertal timing, and psychopathology, further suggesting that links may be specific to timing but not tempo. While findings broadly align with recent calls to consider early pubertal maturation as a transdiagnostic risk marker with utility for identifying children who could benefit from early mental health intervention, they also suggest that pubertal timing is unlikely to be a robust target for reducing psychopathology risk in these children.

Age at Menarche and Coronary Artery Disease Risk: Divergent Associations with Different Sources of Variation

Background

In women, both earlier and later age at menarche (AAM) are associated with increased risk of coronary artery disease (CAD). This study sought to determine if the relationship of AAM with CAD and CAD risk factors differs for different underlying sources of variation in AAM - specifically, variation attributable to common genetic variants as represented by a polygenic score (PGS) vs. variation in AAM adjusted for the PGS.

Methods

Primary analyses were conducted on data from 201,037 women in the UK Biobank and validation studies on data from 23,268 women in the Women's Genome Health Study (WGHS). For each individual, a PGS for AAM was calculated, then two variables were estimated from linear regression models: the genetically predicted AAM (the estimated AAM for each woman solely due to the effects of common genetic variants) and the PGS-adjusted AAM (estimated AAM for each woman solely due to factors other than the PGS). Logistic regression and linear splines were then used to study the relationships of these variables with CAD and CAD risk factors.

Results

Genetically predicted AAM demonstrated a linear relationship with CAD and linear or roughly linear relationships with CAD risk factors. In contrast, PGS-adjusted AAM demonstrated a U-shaped relationship with CAD and with hemoglobin A1c, triglycerides, HDL-C, and waist-hip ratio. Validation studies using WGHS data produced similar results.

Conclusions

These results suggest that later AAM itself does not cause increased risk of CAD; rather, upstream sources of variation other than common genetic variants can cause both later AAM and increased risk of CAD. Dysglycemia, dyslipidemia, and central adiposity are candidate mediators of the association of later AAM with increased risk of CAD.

Interaction between Vitamin D homeostasis, gut microbiota, and central precocious puberty

Central precocious puberty (CPP) is an endocrine disease in children, characterized by rapid genital development and secondary sexual characteristics before the age of eight in girls and nine in boys. The premature activation of the hypothalamic-pituitary-gonadal axis (HPGA) limits the height of patients in adulthood and is associated with a higher risk of breast cancer. How to prevent and improve the prognosis of CPP is an important problem. Vitamin D receptor (VDR) is widely expressed in the reproductive system, participates in the synthesis and function of regulatory sex hormones, and affects the development and function of gonads. In addition, gut microbiota plays an important role in human health by mainly regulating metabolites, energy homeostasis, and hormone regulation. This review aims to clarify the effect of vitamin D deficiency on the occurrence and development of CPP and explore the role of gut microbiota in it. Although evidence on the interaction between vitamin D deficiency, gut microbiota, and sexual development remains limited, vitamin D supplementation and gut microbiota interventions offer a promising, non-invasive strategy for managing CPP.

Genetics of female and male reproductive traits and their relationship with health, longevity and consequences for offspring

Substantial shifts in reproductive behaviors have recently taken place in many high-income countries including earlier age at menarche, advanced age at childbearing, rising childlessness and a lower number of children. As reproduction shifts to later ages, genetic factors may become increasingly important. Although monogenic genetic effects are known, the genetics underlying human reproductive traits are complex, with both causal effects and statistical bias often confounded by socioeconomic factors. Here, we review genome-wide association studies (GWASs) of 44 reproductive traits of both female and male individuals from 2007 to early 2024, examining reproductive behavior, reproductive lifespan and aging, infertility and hormonal concentration. Using the GWAS Catalog as a basis, from 159 relevant studies, we isolate 37 genes that harbor association signals for four or more reproductive traits, more than half of which are linked to rare Mendelian disorders, including ten genes linked to reproductive-related disorders: FSHB, MCM8, DNAH2, WNT4, ESR1, IGSF1, THRB, BRWD1, CYP19A1 and PTPRF. We also review the relationship of reproductive genetics to related health and behavioral traits, aging and longevity and the effect of parental age on offspring outcomes as well as reflecting on limitations, open questions and challenges in this fast-moving field.

Reliability of self-reported pubertal development scale for girls in early adolescent: a school population-based study

OBJECTIVES

The study aimed to evaluate the correlation between self-reported pubertal developmental scale (PDS) and physically assessed Tanner staging by an experienced pediatrician among girls.

METHODS

In a school population-based study in Zhongshan, China, we recruited 1,722 girls in grades 1-3 by a multistage stratified cluster random sampling method. Participants completed self-reported PDS questionnaire prior to physical examination. Breast development was evaluated by a female pediatrician combined with ultrasound examination for overweight/obese girls; pubic hair development was evaluated. Otherwise, we tested follicle-stimulating hormone (FSH) and luteinizing hormone (LH) for some participants.

RESULTS

We observed a weak association between Tanner-derived composite stage (TDCS) and puberty category scores (PCS) (τ=0.288, p<0.001) among all girls. There was correlation (τ=0.314, p=0.001) between ultrasound-derived composite stage (UDCS) and PCS among overweight/obese girls. Moreover, among overweight/obese girls, PCS was positively correlated with LH (r=0.265, p=0.008), but not FSH (r=0.155, p=0.123), and when the basal LH value was greater than 0.3 mIU/mL, the proportion of PCS stage ≥2 (9/18) was higher than the proportion of TDCS ≥2 (5/18). As for the determination of pubertal onset, when UDCS was used as the gold standard, the specificity of PCS was 0.86 and positive predictive value was 90.00 %.

CONCLUSIONS

There was a weak correlation between PCS and TDCS among girls early adolescence. Moreover, among overweight/obese girls, combining hormone values, ultrasonographic stage of breast, and the positive predictive value of PCS, we posit that self-reported PDS might be a more reliable method than TDCS to evaluate pubertal development among overweight/obese girls.

Age, sex, and cell type-resolved hypothalamic gene expression across the pubertal transition in mice

BACKGROUND

The hypothalamus plays a central role in regulating puberty. However, our knowledge of the postnatal gene regulatory networks that control the pubertal transition in males and females is incomplete. Here, we investigate the age-, sex- and cell-type-specific gene regulation in the hypothalamus across the pubertal transition.

METHODS

We used RNA-seq to profile hypothalamic gene expression in male and female mice at five time points spanning the onset of puberty (postnatal days (PD) 12, 22, 27, 32, and 37). By combining this data with hypothalamic single nuclei RNA-seq data from pre- and postpubertal mice, we assigned gene expression changes to their most likely cell types of origin. In our colony, pubertal onset occurs earlier in male mice, allowing us to focus on genes whose expression is dynamic across ages and offset between sexes, and to explore the bases of sex effects.

RESULTS

Our age-by-sex pattern of expression enriched for biological pathways involved hormone production, neuronal activation, and glial maturation. Additionally, we inferred a robust expansion of oligodendrocytes precursor cells into mature oligodendrocytes spanning the prepubertal (PD12) to peri-pubertal (PD27) timepoints. Using spatial transcriptomic data from postpubertal mice, we observed the lateral hypothalamic area and zona incerta were the most oligodendrocyte-rich regions and that these cells expressed genes known to be involved in pubertal regulation.

CONCLUSION

Together, by incorporating multiple biological timepoints and using sex as a variable, we identified gene and cell-type changes that may participate in orchestrating the pubertal transition and provided a resource for future studies of postnatal hypothalamic gene regulation.

Alternate-day fasting delays pubertal development in normal-weight mice but prevents high-fat diet-induced obesity and precocious puberty

BACKGROUND/OBJECTIVES

Childhood obesity, particularly in girls, is linked to early puberty onset, heightening risks for adult-onset diseases. Addressing childhood obesity and precocious puberty is vital to mitigate societal burdens. Despite existing costly and invasive medical interventions, introducing lifestyle-based alternatives is essential. Our study investigates alternate-day fasting's (ADF) impact on pubertal development in normal-weight and high-fat diet (HFD)-induced obese female mice.

METHODS

Four groups of female mice were utilized, with dams initially fed control chow during and before pregnancy. Post-parturition, two groups continued on control chow, while two switched to an HFD. Offspring diets mirrored maternal exposure. One control and one HFD group were subjected to ADF. Morphometry and hormone analyses at various time points were performed.

RESULTS

Our findings demonstrate that ADF in normal-weight mice led to reduced body length, weight, uterine, and ovarian weights, accompanied by delayed puberty and lower levels of sex hormones and growth hormone (GH). Remarkably, GH treatment effectively prevented ADF-induced growth reduction but did not prevent delayed puberty. Conversely, an HFD increased body length, induced obesity and precocious puberty, and altered sex hormones and leptin levels, which were counteracted by ADF regimen. Our data indicate ADF's potential in managing childhood obesity and precocious puberty.

CONCLUSIONS

ADF reduced GH and sex hormone levels, contributing to reduced growth and delayed puberty, respectively. Therefore, parents of normal-weight children should be cautious about prolonged overnight fasting. ADF prevented HFD-induced obesity and precocious puberty, offering an alternative to medical approaches; nevertheless, further studies are needed for translation into clinical practice.

Maternal stress in pregnancy and pubertal timing in girls and boys: a cohort study

OBJECTIVE

To investigate whether maternal stress in pregnancy is associated with pubertal timing in girls and boys and to explore potential mediation by childhood body mass index (BMI) and childhood psychosocial stress.

DESIGN

Cohort study.

SETTING

Not applicable.

PATIENTS

In total, 14,702 girls and boys from the Puberty Cohort, nested within the Danish National Birth Cohort.

INTERVENTION

Maternal stress was obtained from a computer-assisted telephone interview in gestational weeks 30-32 as maternal life stress and emotional distress in pregnancy using questions on the basis of validated screening tools. Maternal life stress and emotional distress in pregnancy were analyzed separately and in an interaction analysis.

MAIN OUTCOME MEASURES

Pubertal timing was measured half-yearly from age 11 years and throughout pubertal development and assessed as Tanner stages 1-5 (breast and pubic hair development in girls and genital and pubic hair development in boys), menarche in girls, voice break and first ejaculation in boys, and occurrence of acne and axillary hair in both girls and boys. A combined estimate for overall pubertal timing was derived using Huber-White robust variance estimation. Mean differences in age at attaining the pubertal milestones according to prenatal exposure to no (reference), low-, moderate-, or high-maternal stress in pregnancy were estimated using a multivariable censored regression model. Potential mediation by childhood BMI and childhood psychosocial stress was investigated in separate models.

RESULTS

After adjustment for potential confounding factors, prenatal exposure to high-maternal life stress (combined estimate: -1.8 months [95% CI, -2.7 to -0.8] and -0.9 months [95% CI, -1.8 to 0.0]), high maternal emotional distress (combined estimate: -1.5 months [95% CI, -2.5 to -0.5] and -1.7 months [95% CI, -2.8 to -0.7]), and both high-maternal life stress and emotional distress (combined estimate: -2.8 months [95% CI, -4.2, to -1.4] and -1.7 months [95% CI, -3.1 to -0.2]) were associated with earlier pubertal timing in girls and boys, respectively. The associations were not mediated by childhood BMI or childhood psychosocial stress.

CONCLUSIONS

Prenatal exposure to maternal stress in pregnancy was associated with earlier pubertal timing in girls and boys in a dose-dependent manner. The associations were not mediated by childhood BMI or childhood psychosocial stress.

High Carbohydrate, Fat, and Protein Diets Have a Critical Role in Folliculogenesis and Oocyte Development in Rats

To date, there is no comparative data on the effects of carbohydrates, fat, and proteins, which are macronutrients, on female reproductive functions. Therefore, in this study, we investigated the effects of diets enriched with carbohydrates, fats, and proteins on folliculogenesis and oocyte development in female rats. 21-day-old rats that were just weaned were divided into 4 groups: control, carbohydrate, fat, and protein. The control group was fed with standard chow and the carbohydrate, fat, and protein groups were fed diets enriched with 75% carbohydrate, 60% fat, and 50% protein for 11 weeks, respectively. It was found that high-fat and high-protein diets caused an increase in the estrous cycle length compared to carbohydrate group (p < 0.05). Graafian follicle number decreased in the protein group compared to the control (p < 0.05). However, the atretic follicle number was higher in the fat group compared to the control group (p < 0.05). In the carbohydrate group, Zp1 was found to be lower than the control and protein groups, Zp2 was found to be lower than the control, and Zp3 was found to be lower than the fat group (p < 0.05). While BMP15 was similar between groups (p > 0.05), GDF9 was lower in all diet groups compared to the control (p < 0.05). Foxo3a was lower in the protein group compared to carbohydrate and control (p < 0.05). GAS2 was found to be higher in the control group than the fat group, and higher in the carbohydrate group than the fat and protein groups (p < 0.05). FSH, LH, Progesterone, and E2 levels were higher in all three diet groups than in the control (p < 0.05). Also, significant differences were observed between the groups regarding adiponectin, resistin, and leptin levels. Taken together, high carbohydrate, fat, and protein intake are associated with impairment of the menstrual cycle, depletion of the developing follicle types, and altered expression of folliculogenesis-specific genes and hormones. Therefore, long-term macronutrient diets may result in shortened reproductive periods and reduced fertilization potential in females in the long run.

Joint models reveal genetic architecture of pubertal stage transitions and their association with BMI in admixed Chilean population

Early or late pubertal onset can lead to disease in adulthood, including cancer, obesity, type 2 diabetes, metabolic disorders, bone fractures, and psychopathologies. Thus, knowing the age at which puberty is attained is crucial as it can serve as a risk factor for future diseases. Pubertal development is divided into five stages of sexual maturation in boys and girls according to the standardized Tanner scale. We performed genome-wide association studies (GWAS) on the "Growth and Obesity Chilean Cohort Study" cohort composed of admixed children with mainly European and Native American ancestry. Using joint models that integrate time-to-event data with longitudinal trajectories of body mass index (BMI), we identified genetic variants associated with phenotypic transitions between pairs of Tanner stages. We identified $42$ novel significant associations, most of them in boys. The GWAS on Tanner $3\rightarrow 4$ transition in boys captured an association peak around the growth-related genes LARS2 and LIMD1 genes, the former of which causes ovarian dysfunction when mutated. The associated variants are expression and splicing Quantitative Trait Loci regulating gene expression and alternative splicing in multiple tissues. Further, higher individual Native American genetic ancestry proportions predicted a significantly earlier puberty onset in boys but not in girls. Finally, the joint models identified a longitudinal BMI parameter significantly associated with several Tanner stages' transitions, confirming the association of BMI with pubertal timing.

Geneenvironment interaction between phthalate exposure and pubertal genetic polymorphisms on blood pressure variability in children: Exploring the moderating effects of lifestyle behaviours

Phthalates (PAEs) are synthetic compounds extensively employed in consumer products. Blood pressure (BP) in children can vary, the degree of visit-to-visit BP variability (VVV) is at least partially independent of BP. The interactions between PAEs exposure, pubertal-related genetic susceptibility and lifestyles on childhood VVV are not investigated. This study utilized data from a cohort collected from Oct 2017-2020 in Xiamen, China. Seven urine PAE metabolites were measured. The long-term VVV was characterized employing the standard deviation (SD) and average real variability. We constructed a genetic risk score (GRS) of pubertal-related genes and healthy lifestyle scores. Exposed to high levels of mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) (OR=1.43, 95 %CI=1.07, 1.92) and mono-2-ethyl-5-oxohexyl phthalate (OR=1.36, 95 % CI=1.01, 1.83) was related to increased SBP-SD, and the OR for high SBP-SD related to high GRS was 1.38 (95 % CI=1.02, 1.85). Compared to participants who had low GRS and low MEHHP exposure, participants exhibiting high GRS and MEHHP levels were more likely to experience high SBP-SD (OR=2.00, P<0.05). Individuals exhibiting low GRS, low MEHHP levels, and adhering to healthy lifestyles were associated with the least probability of experiencing high SBP-SD (OR=0.31, P<0.05). Increased PAEs exposure could elevate childhood systolic VVV, and exacerbated the adverse impact of pubertal-related genetic susceptibility on the high VVV of SBP; however, healthy lifestyles might alleviate these adverse effects. Promoting healthy lifestyles and reducing PAEs exposure for preventing elevated BP variability among children is important, especially for individuals with greater genetic susceptibility to early pubertal onset. ENVIRONMENTAL IMPLICATION: Blood pressure (BP) in children can vary, as a noninvasive, inexpensive and applicable method, the extent of visit-to-visit variability (VVV) is at least partially independent of BP. The interactions between phthalates (PAEs) exposure, variants of puberty-related genes and lifestyles on VVV are not investigated. Increased childhood systolic VVV might be associated with PAEs exposure, with the associations more pronounced combined with pubertal genetic susceptibility. Yet, healthy habits could partly eliminate such adverse effects. Our study underscores the importance of advocating for healthy lifestyles and reducing exposure to PAEs, especially among individuals with high genetic susceptibility to early puberty onset.

Early puberty: a review on its role as a risk factor for metabolic and mental disorders

Accumulating evidence indicates that there is a trend of early puberty onset in humans. The early timing of puberty has raised concerns due to its association with significant negative health outcomes. However, overall impact and potential risk of early puberty remain uncertain. In this study, we conducted a comprehensive review of existing epidemiological studies to gain insights into the long-term adverse health effects associated with early puberty. Our objective was to provide a consolidated summary of these outcomes at a population level by considering studies that encompass various indicators of puberty. In all, early puberty has been identified as a potential risk factor for various metabolic diseases, such as obesity, diabetes, cardiovascular diseases (CVD). Children who experience early puberty are more likely to have a higher body mass index (BMI) during adulthood, increasing their risk of obesity. Early puberty also has been found to be an independent risk factor for diabetes mellitus, including gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM), as earlier onset of menarche in girls and voice breaking in boys is associated with a higher prevalence of T2DM. Furthermore, evidence suggests that early puberty may contribute to an elevated risk of CVD, including conditions like coronary heart disease (CHD), stroke, angina, and hypertension. In addition, adolescents who experience early puberty, particularly girls, are more likely to suffer from mental problems, such as behavioral dysfunction and depression. Notably, early puberty has a more significant impact on girls than boys. Further research should consider the underlying mechanisms and potential preventive measures.

Age at Menarche and Its Association With Adult-Onset Metabolic Syndrome and Related Disorders in Women: A Cross-Sectional Study of a Nationally Representative Sample Over 10 Years

The prevalence of metabolic syndrome (MetS) as well as related social costs and efforts is increasing. The purpose of this study was to investigate the association between age at menarche and the risk of MetS, obesity, diabetes, and cardiovascular disease (CVD) in women over 30 years, using data from the Korean National Health and Nutrition Examination Survey (2010-2020). The analysis of 30 916 participants showed that early menarche (before 11 years) significantly increased the risk of obesity, diabetes, and MetS compared with the median age of 14 years. Late menarche (after 17 years) was also linked to MetS and related disorders. The relationship between age at menarche (at <10 years and >19 years) and the risk of MetS and related disorders exhibited a reversed J-shaped (し) pattern characterized by a pronounced increased risk among those who experience early menarche, whereas the increased risk associated with late menarche was less consistent. These results will help to decrease the risk of MetS and related disorders by enabling early intervention in early and late menarche age groups.

Association of obesity and menarche SNPs and interaction with environmental factors on precocious puberty

BACKGROUND

Obesity is an important cause for the precocious or early puberty. However, the association between obesity-related loci and the risk of precocious puberty as well as the effect of gene-environment interaction are unclear, especially in the Chinese children population.

METHODS

This was a case-control study using baseline data from two cohorts and hospital cases in China. 15 SNPs loci and several environmental factors were included in the analysis of 1201 participants. Chi-square test and logistic regression were used to analyze the association between SNPs and precocious puberty. Additionally, exploratory factor analysis was conducted on 13 environmental variables, and then to explore their interaction with genes on precocious puberty.

RESULTS

The effect allele C of rs571312, and G of rs12970134 MC4R were associated with precocious puberty in girls with obesity. Regarding the gene-environment interaction, we found that when girls were in the high socioeconomic status, the rs571312 (OR: 3.996; 95% CI: 1.694-9.423) and rs12970134 (OR: 3.529; 95% CI: 1.452-8.573) risk genotypes had a greater effect on precocious puberty.

CONCLUSIONS

The obesity risk gene polymorphisms MC4R rs571312 and rs12970134 were associated with precocious puberty in Chinese girls with obesity, and girls with risk genotypes and high socioeconomic status should be given extra attention.

IMPACT

This is the first study that identified the association between rs571312 and rs12970134 of MC4R gene and precocious puberty in Chinese children. We found that when girls were in the high socioeconomic status, the risk genotypes of rs571312 and rs12970134 had a greater effect on precocious puberty. The results of this study have great public health implications. It is recommended that girls who are in high socioeconomic status and have a high genetic risk for early sexual maturity should closely monitor their pubertal development and consider early intervention strategies.

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.

Natural sweetener glycyrrhizin protects against precocious puberty by modulating the gut microbiome

AIMS

Precocious puberty (PP) may lead to many adverse outcomes. Recent evidence suggests that PP is a gut-brain disease. On the other hand, the use of glycyrrhizin, a natural sweetener, has become popular in the past decade. Glycyrrhizin possesses various health benefits, but its impact on PP has yet to be investigated. We aimed to explore the protective effects of glycyrrhizin against PP in both humans (observational) and animals (interventional).

MATERIALS AND METHODS

In the human cohort, we investigated the association between glycyrrhizin consumption and risk of PP. In the animal experiment, we observed puberty onset after feeding danazol-induced PP rats with glycyrrizin. Blood, fecal, and hypothalamic samples were harvested to evaluate potential mechanistic pathways. We also performed a fecal microbiota transplantation to confirm to causal relationship between glycyrrhizin and PP risk.

KEY FINDINGS

Glycyrrhizin exhibited a protective effect against PP in children (OR 0.60, 95%CI: 0.39-0.89, p = 0.013), primarily driven by its significance in girls, while no significant effect was observed in boys. This effect was consistent with findings in rodents. These benefits were achieved through the modulation of the gut microbiome, which functionally suppressed the hypothalamic-pituitary-gonadal axis and prevented PP progression. A fecal microbiota transplantation indicated that the causal correlation between glycyrrhizin intake and PP is mediated by the gut microbiome alterations.

SIGNIFICANCE

Our findings suggest that glycyrrhizin can protect against PP by altering the gut microbiome. Long term use of glycyrrhizin is safe and tolerable. Therefore, glycyrrhizin can serve as a safe and affordable complementary therapy for PP.

Genetic and non-genetic factors in prediction of early pubertal development in Chinese girls

Objective

The objective of this study is to develop a combined predictive model for early pubertal development (EPD) in girls based on both non-genetic and genetic factors.

Methods

The case-control study encompassed 147 girls diagnosed with EPD and 256 girls who exhibited normal pubertal development. The non-genetic risk score (NGRS) was calculated based on 6 independent biochemical predictors screened by multivariate logistic regressions, and the genetic risk score (GRS) was constructed using 28 EPD related single-nucleotide polymorphisms (SNPs). Area under receiver operator characteristic curve (AROC), net reclassification optimization index (NRI) and integration differentiation index (IDI) were used to evaluate the improvement of adding genetic variants to the non-genetic risk model.

Results

Overweight (OR=2.74), longer electronic screen time (OR=1.79) and higher ratio of plastic bottled water (OR=1.01) were potential risk factors, and longer exercise time (OR=0.51) and longer day sleeping time (OR=0.97) were protective factors for EPD, and the AROC of NGRS model was 83.6% (79.3-87.9%). The GRS showed a significant association with EPD (OR=1.90), and the AROC of GRS model was 65.3% (59.7-70.8%). After adding GRS to the NGRS model, the AROC significantly increased to 85.7% (81.7-89.6%) (P=0.020), and the reclassification significantly improved, with NRI of 8.19% (P= 0.023) and IDI of 4.22% (P <0.001).

Conclusions

We established a combined prediction model of EPD in girls. Adding genetic variants to the non-genetic risk model brought modest improvement. However, the non-genetic factors such as overweight and living habits have higher predictive utility.

Girls with idiopathic central precocious puberty did not display substatial changes in body mass index after treatment with gonadotropin-releasing hormone analogues

AIM

To evaluate changes in body mass index (BMI) in girls during and after treatment for idiopathic central precocious puberty (iCPP).

METHODS

We studied 123 girls receiving gonadotropin-releasing hormone analogue (GnRHa)treatment for iCPP from 2009 to 2019. Pubertal and anthropometric measurements were monitored at routine clinical visits. BMI standard deviation scores (SDS) were estimated at baseline and followed in two stages from baseline to end of treatment (median 18.9 months) and from end of treatment to end of follow-up (median 18.2 months). The influence of baseline BMI SDS and the frequency and dose of treatment was evaluated using BMI trajectories and latent class mixed models.

RESULTS

The median age at treatment initiation was 8.5 years. The median BMI SDS at baseline was 0.7, corresponding to a median BMI of 17.4 kg/m2. Overall, no changes in BMI SDS were observed during treatment. According to baseline BMI subgroups, an increasing trend in BMI trajectories during treatment was observed for girls in the lowest BMI group. After treatment, most girls maintained stable BMI levels.

CONCLUSION

Our retrospective study did not provide evidence that GnRHa treatment for iCPP had a significant impact on BMI trajectories in girls.

Menarche-a journey into womanhood: age at menarche and health-related outcomes in East Asians

STUDY QUESTION

Are there associations of age at menarche (AAM) with health-related outcomes in East Asians?

SUMMARY ANSWER

AAM is associated with osteoporosis, Type 2 diabetes (T2D), glaucoma, and uterine fibroids, as demonstrated through observational studies, polygenic risk scores, genetic correlations, and Mendelian randomization (MR), with additional findings indicating a causal effect of BMI and T2D on earlier AAM.

WHAT IS KNOWN ALREADY

Puberty timing is linked to adult disease risk, but research predominantly focuses on European populations, with limited studies in other groups.

STUDY DESIGN, SIZE, DURATION

We performed an AAM genome-wide association study (GWAS) with 57 890 Han Taiwanese females and examined the association between AAM and 154 disease outcomes using the Taiwanese database. Additionally, we examined genetic correlations between AAM and 113 diseases and 67 phenotypes using Japanese GWAS summary statistics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We performed AAM GWAS and gene-based GWAS studies to obtain summary statistics and identify potential AAM-related genes. We applied phenotype, polygenic risk scores, and genetic correlation analyses of AAM to explore health-related outcomes, using multivariate regression and linkage disequilibrium score regression analyses. We also explored potential bidirectional causal relationships between AAM and related outcomes through univariable and multivariable MR analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

Fifteen lead single-nucleotide polymorphisms and 24 distinct genes were associated with AAM in Taiwan. AAM was genetically associated with later menarche and menopause, greater height, increased osteoporosis risk, but lower BMI, and reduced risks of T2D, glaucoma, and uterine fibroids in East Asians. Bidirectional MR analyses indicated that higher BMI/T2D causally leads to earlier AAM.

LIMITATIONS, REASONS FOR CAUTION

Our findings were specific to Han Taiwanese individuals, with genetic correlation analyses conducted in East Asians. Further research in other ethnic groups is necessary.

WIDER IMPLICATIONS OF THE FINDINGS

Our study provides insights into the genetic architecture of AAM and its health-related outcomes in East Asians, highlighting causal links between BMI/T2D and earlier AAM, which may suggest potential prevention strategies for early puberty.

STUDY FUNDING/COMPETING INTEREST(S)

The work was supported by China Medical University, Taiwan (CMU110-S-17, CMU110-S-24, CMU110-MF-49, CMU111-SR-158, CMU111-MF-105, CMU111-MF-21, CMU111-S-35, CMU112-SR-30, and CMU112-MF-101), the China Medical University Hospital, Taiwan (DMR-111-062, DMR-111-153, DMR-112-042, DMR-113-038, and DMR-113-103), and the Ministry of Science and Technology, Taiwan (MOST 111-2314-B-039-063-MY3, MOST 111-2314-B-039-064-MY3, MOST 111-2410-H-039-002-MY3, and NSTC 112-2813-C-039-036-B). The funders had no influence on the data collection, analyses, or conclusions of the study. No conflict of interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Metabolome-wide Mendelian randomization for age at menarche and age at natural menopause

BACKGROUND

The role of metabolism in the variation of age at menarche (AAM) and age at natural menopause (ANM) in the female population is not entirely known. We aimed to investigate the causal role of circulating metabolites in AAM and ANM using Mendelian randomization (MR).

METHODS

We combined MR with genetic colocalization to investigate potential causal associations between 658 metabolites and AAM and between 684 metabolites and ANM. We extracted genetic instruments for our exposures from four genome-wide association studies (GWAS) on circulating metabolites and queried the effects of these variants on the outcomes in two large GWAS from the ReproGen consortium. Additionally, we assessed the mediating role of the body mass index (BMI) in these associations, identified metabolic pathways implicated in AAM and ANM, and sought validation for selected metabolites in the Avon Longitudinal Study of Parents and Children (ALSPAC).

RESULTS

Our analysis identified 10 candidate metabolites for AAM, but none of them colocalized with AAM. For ANM, 76 metabolites were prioritized (FDR-adjusted MR P-value ≤ 0.05), with 17 colocalizing, primarily in the glycerophosphocholines class, including the omega-3 fatty acid and phosphatidylcholine (PC) categories. Pathway analyses and validation in ALSPAC mothers also highlighted the role of omega and polyunsaturated fatty acids levels in delaying age at menopause.

CONCLUSIONS

Our study suggests that metabolites from the glycerophosphocholine and fatty acid families play a causal role in the timing of both menarche and menopause. This underscores the significance of specific metabolic pathways in the biology of female reproductive longevity.

Joint association of overweight/obesity, high electronic screen time, and low physical activity time with early pubertal development in girls: a case-control study

To examine the joint association of electronic screen time (EST), moderate-to-vigorous physical activity time (MVPA) and overweight/obesity with early pubertal development (EPD) in girls. A case-control study of 177 EPD girls and 354 girls with normal pubertal development was conducted between October 2019 and August 2022. Overweight/obesity was defined as body mass index ≥ 85th percentiles for age and sex. We found a non-significant increase of EPD risk among girls with high EST alone [OR: 2.75 (0.65-11.58)] or low MVPA alone [OR: 2.54 (0.74-8.69)], but a significant increase of EPD risk among girls with overweight/obesity alone [OR: 4.91 (1.01-23.92)], compared to girls without any of the three risk factors (low MVPA, high EST and overweight/obesity). Girls with any two of the three risk factors faced increased risk of EPD, and girls with all three risk factors faced the highest risk of EPD [OR and 95% CI: 26.10 (6.40-106.45)]. Being overweight/obesity might be more important than having low MVPA or high EST as a correlate of EPD compared to girls without any of the three risk factors, but the co-presence of low MVPA, high EST and overweight/obesity would largely increase the risk of EPD in girls.

Parental age at death is associated with age at first birth in offspring

PURPOSE

People age at different rates and the available evidence suggests that the rate of aging is partly inherited from previous generations. This heterogeneity in aging is evident already in midlife, but to what extent aging is associated with the timing of events earlier in life is not fully known. Here we aim to shed light on this topic by investigating the trade-off between reproduction and aging postulated by evolutionary theories of aging.

METHODS

Drawing on the inheritance of aging we use parental age at death as a proxy for aging-rates in the offspring, and study how age at first birth depends on this variable. We use data from an almost complete Swedish birth cohort comprising 92,359 individuals. Accelerated failure time models are used to estimate the association between parental age at death and age at first birth while adjusting for parental occupational class, educational attainment, and income.

RESULTS

Longer parental lifespans were consistently associated with older age at first births, both in men and women.

CONCLUSION

Our findings suggest that aging-related processes may be interrelated with the processes underlying the timing of reproduction and are in general agreement with evolutionary theories of aging.

Pubertal Timing Across Asian American, Native Hawaiian, and Pacific Islander Subgroups

Importance

Earlier puberty is associated with adverse health outcomes, such as mental health issues in adolescence and cardiometabolic diseases in adulthood. Despite rapid growth of the Asian American, Native Hawaiian, and Pacific Islander populations in the US, limited research exists on their pubertal timing, potentially masking health disparities.

Objective

To examine pubertal timing among Asian American, Native Hawaiian, and Pacific Islander children and adolescents by disaggregating ethnic subgroups.

Design, Setting, and Participants

This retrospective cohort study included Asian American, Native Hawaiian, and Pacific Islander youths aged 5 to 18 years assessed for pubertal development at Kaiser Permanente Northern California, a large, integrated health care delivery system. Follow-up occurred from March 2005, through December 31, 2019. Data were analyzed in October 2023.

Exposure

Race and ethnicity, categorized into 11 ethnic subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian and Pacific Islander, Other South Asian, Other Southeast Asian, Vietnamese, multiethnic, and multiracial.

Main Outcomes and Measures

Pubertal timing was determined using physician-assessed sexual maturity ratings (SMRs). Outcomes included the median age at transition from SMR 1 (prepubertal) to SMR 2 or higher (pubertal) for onset of genital development (gonadarche) in boys, breast development (thelarche) in girls, and pubic hair development (pubarche) in both boys and girls.

Results

In this cohort of 107 325 Asian American, Native Hawaiian, and Pacific Islander children and adolescents (54.61% boys; 12.96% Asian Indian, 22.24% Chinese, 26.46% Filipino, 1.80% Japanese, 1.66% Korean, 1.96% Native Hawaiian and Pacific Islander, 0.86% Other South Asian, 3.26% Other Southeast Asian, 5.99% Vietnamese, 0.74% multiethnic, and 22.05% multiracial), the overall median ages for girls' pubarche and thelarche were 10.98 years (95% CI, 10.96-11.01 years) and 10.13 years (95% CI, 10.11-10.15 years), respectively. For boys' pubarche and gonadarche, median ages were 12.08 years (95% CI, 12.06-12.10 years) and 11.54 years (95% CI, 11.52-11.56 years), respectively. Differences between subgroups with earliest and latest median age at onset were 14 months for girls' pubarche, 8 months for thelarche, 8 months for boys' pubarche, and 4 months for gonadarche. In general, Asian Indian, Native Hawaiian and Pacific Islander, and Other South Asian subgroups had the earliest ages at onset across pubertal markers, while East Asian youths exhibited the latest onset. Restricting to those with healthy body mass index did not substantially change the findings.

Conclusions and Relevance

In this cohort study of Asian American, Native Hawaiian, and Pacific Islander children and adolescents, pubertal timing varied considerably across ethnic subgroups. Further investigation is warranted to assess whether these differences contribute to observed health disparities in adulthood, such as type 2 diabetes and cardiovascular diseases.

Irisin combined index to diagnose central precocious puberty in girls: a cross-sectional study

BACKGROUND

To investigate serum irisin levels in girls at different developmental status and explore the significance of irisin for the diagnosis of central precocious puberty (CPP) in girls.

METHODS

In this cross-sectional study 111 girls were enrolled, including 43 cases of CPP, 44 cases of peripheral precocious puberty (PPP) and 24 cases of girls with normal sexual development as controls. The data on age, weight and height, measured blood levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, and irisin were collected. Pelvic Doppler ultrasound was performed to evaluate uterine length, transverse diameter, anteroposterior diameter. The girls were divided into non-CPP group and CPP group according to gonadotropin-releasing hormone (GnRH) stimulation test.

RESULTS

Serum irisin levels were significantly higher in CPP group than in PPP group and normal control group. Serum irisin level was positively correlated with basal LH level, basal FSH level, peak LH level, peak LH /FSH ratio, uterine volume, bone age, and bone age index. The area under the curve, cut-off value, sensitivity and specificity of serum irisin were 0.958, 219.255 pg/ml, 100% and 80.6%. The combined diagnosis of CPP in girls by serum irisin and serum basal LH combined with uterine volume had an AUC, sensitivity, and specificity of 0.994, 97.6%, and 100%, superior to that of the single index.

CONCLUSIONS

Serum irisin level in girls with CPP is significantly increased. An irisin combined index could help the diagnosis of CPP in girls.