Childhood obesity and central precocious puberty

Risk factors for precocious puberty: A systematic review and meta‑analysis

PURPOSE

Precocious puberty (PP) typically refers to the initiation of puberty prior to the age of eight in females and before the age of nine in males. The objective of this systematic review and meta-analysis is to pinpoint the risk factors linked to PP, thereby facilitating early diagnosis and timely intervention for individuals at high risk.

METHODS

A thorough search was carried out in the Cochrane Library, PubMed, and Embase databases up to November 10, 2024. The eligible studies comprised participants diagnosed with PP in the exposure group and participants without PP in the control group. The odds ratio (OR) and weighted mean difference (WMD) with 95 % confidence interval (CI) were computed using a random-effects model.

RESULTS

Out of 653 initially identified papers, 13 studies involving 15 cohorts were ultimately included. The mate-analysis findings indicated significant associations between several factors and the incidence of PP: BMI, maternal menarche age, and duration of breastfeeding. These three factors are significantly associated with the presence of pp: estrogen (E2) levels, follicle-stimulating hormone (FSH) levels, luteinizing hormone (LH) levels.

CONCLUSION

The occurrence of PP is strongly associated with several factors including BMI, maternal menarche age, and breastfeeding duration. The presence of PP is associated with three factors including E2, LH, FSH.

Differentiating true precocious puberty and puberty variants in consecutive 275 girls: a single center experience

OBJECTIVES

This study aimed to identify clinical features of girls referred to a pediatric endocrinology clinic for suspected precocious puberty, differentiate true precocious puberty from other variants, evaluate treatment status, and identify distinguishing factors between patient groups.

METHODS

We retrospectively evaluated the records of 275 consecutive girls aged 0-10 years referred for suspected precocious puberty.

RESULTS

Among the patients, 30 (10.9 %) were diagnosed with precocious puberty, 35 (12.7 %) with premature adrenarche, 22 (8 %) with premature thelarche, 33 (12 %) with rapidly progressing early puberty, 108 (39.3 %) with early puberty, and 47 (17.1 %) had a normal diagnosis. Precocious puberty was associated with higher rates of overweight/obesity (p=0.002), advanced bone age (p<0.001), height SD, and mid-parental height SD difference (p<0.001), as well as a history of preterm birth (p=0.041). Patients with rapidly progressing early puberty had mothers with a lower age at menarche (p=0.040). No significant differences were found for being born small for gestational age, maternal polycystic ovary syndrome, screen time, and junk food consumption (p>0.05). Treatment was recommended for 32 patients (11.6 %), including 11 with precocious puberty and 21 with rapidly progressing early puberty.

CONCLUSIONS

Most patients referred for early pubertal development are diagnosed with normal puberty or its variants. Assessing preterm birth, early maternal menarche age, and advanced bone age helps identify true precocious puberty and rapidly progressing early puberty, aiding timely treatment.

[Association between insulin resistance and uterine volume in girls with idiopathic central precocious puberty]

OBJECTIVES

To investigate the association between insulin resistance and uterine volume in girls with idiopathic central precocious puberty (ICPP).

METHODS

A retrospective study was conducted involving 61 girls diagnosed with ICPP who visited the pediatric growth and development clinic of the Third Affiliated Hospital of Zhengzhou University between January 2022 and September 2024, designated as the ICPP group, and 61 normally developing girls as the control group. The differences in insulin resistance index (homeostasis model assessment of insulin resistance, HOMA-IR), uterine volume, and other indicators between the two groups were compared, and the relationship between insulin resistance and uterine volume in these girls was analyzed.

RESULTS

The uterine volume and HOMA-IR level in the ICPP group were significantly higher than those in the control group (P<0.05). Correlation analysis revealed that there was a positive correlation between HOMA-IR level and uterine volume in the ICPP group (rs=0.643, P<0.001). Multiple linear regression analysis indicated that as HOMA-IR increased,uterine volume in the girls tended to increase (P<0.05).

CONCLUSIONS

There is an association between insulin resistance and uterine volume in girls with ICPP, and as HOMA-IR increases, uterine volume in the girls also increases.

The effect of obesity on the GnRH stimulation test in girls with idiopathic central precocious puberty

The gonadotropin-releasing hormone (GnRH) stimulation test is essential for diagnosing idiopathic central precocious puberty (ICPP). Research provided that luteinizing hormone (LH) levels during the test are lower in overweight and obese girls. This study aims to establish diagnostic cut-off values in the GnRH stimulation test specifically for overweight and obese girls with ICPP. Retrospective data from 925 girls diagnosed with ICPP or premature thelarche (PT) who underwent GnRH testing were analyzed. Patients were categorized into normal weight (NW) and overweight/obese (OW) groups based on Body Mass Index Standard Deviation Score (BMI-SDS), with BMI-SDS ≥ 1 indicating OW. Only patients with Tanner stage 2 or 3 breast development were included. The mean age at diagnosis was 7.9 ± 1.1 years in ICPP and 6.4 ± 1.4 years in PT. Among the patients, 455 (49.2%) were OW. In the OW-ICPP group, the peak LH cut-off was 3.56 IU/L (AUC:0.733; sensitivity:69.2%, specificity:64%), and the peak LH/FSH ratio was 0.29 (AUC:0.828; sensitivity:77.1%, specificity:76.3%). For NW patients, the peak LH cut-off was 4.75 IU/L (AUC:0.809; sensitivity:77.1%, specificity:70.7%), and the peak LH/FSH ratio was 0.3 (AUC:0.926; sensitivity: 86.3%, specificity: 86%). In the peak LH cut-off model, the multivariate analysis identified BMI-SDS as a significant negative predictor (OR:0.585, 95%CI: 0.477-0.717, p < 0.001), showing a strong inverse relationship. Similarly, in the peak LH/FSH ratio model, BMI-SDS remained a significant negative predictor (OR: 0.744, 95% CI: 0.614-0.902, p < 0.001).

CONCLUSION

In this study, gonadotropin responses during the GnRH stimulation test were lower in overweight and obese girls with Tanner stage 2 and 3 ICPP compared to standard thresholds. It is important to utilize the GnRH test alongside clinical findings when diagnosing these patients, as responses below standard values do not rule out precocious puberty. This highlights the need for tailored diagnostic criteria to ensure timely and accurate diagnosis in this population.

WHAT IS KNOWN

• Obesity is a risk factor for early puberty.

WHAT IS NEW

• In girls with idiopathic central precocious puberty, obesity leads to lower values in the GnRH stimulation test compared to normal ranges. This may result in missed diagnoses, emphasizing the need to evaluate cases thoroughly with clinical data.

Research on Body Composition and Lifestyle Behaviors During Pubertal Development in 6-12-Year-Old Children with Obesity

Objective: The objective of this study was to investigate the pubertal development in school-age children with obesity and to explore the body composition and lifestyle behaviors influencing its onset. Method: We enrolled 217 children, aged 6-12 years, who visited the Pediatrics Department at Beijing Jishuitan Hospital, Capital Medical University. All participants underwent a series of examinations. These assessments included body composition analysis, measurement of blood glucose and fasting insulin levels, and evaluation of secondary sexual characteristics. Statistical analysis was conducted using R4.0.3 software. Results: Of the 152 male participants, 83 (54.6%) were in the adolescent-undeveloped group, and 69 (45.4%) were in the adolescent-developed group. Of the 119 female students, 30 (25.2%) were in the adolescent-undeveloped group, and 89 (74.8%) were in the adolescent-developed group. In a comparative analysis of children, those in the adolescent development group exhibited significantly higher values for age, height, weight, body mass index (BMI), BMI-z score, body fat, muscle mass, fat-free weight, fat-free body mass index, and waist/hip ratio compared to the adolescent-undeveloped group (p < 0.05). Additionally, fasting insulin and insulin resistance index were also higher in the development group, with statistical significance observed. BMI emerged as an independent factor affecting the adolescent development of school-age girls with obesity (p < 0.05). Among boys in the adolescent development group, the consumption of sugary drinks and fried food was higher than in the undeveloped group, and moderate-intensity exercise was significantly lower, with statistical significance (p < 0.05). In girls, the adolescent development group reported longer daily sitting times and higher intakes of sugary drinks and fried foods compared to the undeveloped group, with these differences being statistically significant (p < 0.05). The consumption of fried food was positively correlated with adolescent development in children with obesity and was identified as an independent influencing factor of adolescent development (p < 0.05). Conclusions: A high body mass index (BMI) in girls with obesity and high intake of fried foods in both genders are strong predictors of early puberty in school-age children.

β-Elemene inhibits adipogenesis in 3T3-L1 cells by regulating AMPK pathway

The prevalence of childhood obesity in global is quickly augmented, resulting into grievous public health problems and influencing adolescent development. β-Elemene is a sesquiterpene, and can extracted from traditional Chinese medicine-Curcuma longa L. β-Elemene has been discovered to display regulatory functions in multiple diseases, but it's roles in obesity need further investigations. The purpose of this work is to investigate the regulatory impacts of β-elemene on obesity progression and associated pathways. In this study, it was revealed that the heightened lipid accumulation in 3T3-L1 cells triggered by 3-isobutyl-1-methylxanthine + dexamethazone + insulin (MDI) can be restrained by β-elemene. Furthermore, β-elemene can modulate lipid metabolism in 3T3-L1 cells mediated by MDI. The glucose consumption was descended after insulin resistance treatment, but this impact was reversed after β-elemene treatment. At last, it was illustrated that the AMPK pathway was retarded after β-elemene induction, but this change was offset after β-elemene treatment. To sum up, our results manifested that β-elemene inhibited adipogenesis in 3T3-L1 cells, and evoked the AMPK pathway. This project may supply serviceable insights of β-elemene in the progression of obesity.

Efficacy of Triptorelin Combined with Recombinant Human Growth Hormone (rhGH) on Serum Sex Hormones, Bone Age, and Clinical Outcomes in Girls with Precocious Puberty

Aims/Background Triptorelin effectively delays bone age progression in children with precocious puberty but may suppress pituitary growth hormone response, affecting growth hormone-binding protein secretion and overall growth rate. This study aimed to evaluate the efficacy and safety of triptorelin alone versus in combination with recombinant human growth hormone (rhGH) in treating girls with precocious puberty. Methods This retrospective study examined 82 girls with precocious puberty treated at The First People's Hospital of Tongxiang from January 2021 to June 2023. Patients treated with triptorelin alone were assigned to the control group (n = 42), while those treated with triptorelin combined with rhGH formed the study group (n = 40). Both groups received continuous treatment for one year. Outcomes, including efficacy and safety, were compared between the groups. Results Following treatment, height and body mass in the study group were significantly higher than those in the control group (t = 2.126, p = 0.037; t = 2.419, p = 0.018). The bone age/chronological age (BA/CA) ratio in the study group was significantly lower than that in the control group (t = 2.185, p = 0.032). Levels of estradiol (E2), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the study group were also significantly reduced compared to the control group (t = 2.208, p = 0.030; t = 4.492, p < 0.001; t = 2.952, p = 0.004). Furthermore, left and right ovarian volumes and uterine volume were significantly lower in the study group than those in the control group (t = 2.740, p = 0.008; t = 2.936, p = 0.004; t = 2.520, p = 0.014). After one year, the effective treatment rate in the study group was higher than that in the control group (97.50% vs 80.95%, p < 0.05). No serious adverse reactions were observed in either group during the treatment period. Conclusion The combination of triptorelin and rhGH demonstrates a clear therapeutic in girls with precocious puberty, which effectively delays bone age growth, regulates sex hormone levels, and reduces ovarian and uterine volumes without severe adverse effects.

Long-Term Exposure to Fine Particulate Matter (PM2.5) Components and Precocious Puberty Among School-Aged Children: Cross-Sectional Study

Background

The increasing incidence of precocious puberty is a major health challenge for Chinese children, while related risk factors remain less well explored. Exposure to ambient fine particulate matter (PM2.5) is a leading environmental hazard in China. Although certain components of PM2.5 have been reported to be endocrine disruptors for sex hormones, population-based evidence is still lacking on the association between PM2.5 exposure and precocious puberty in China.

Objective

Based on a cross-sectional survey covering 30 cities in 2017 to 2019, this study was designed to explore the association between long-term exposure to PM2.5 and its 5 major components with precocious puberty in China and to check the potential modifying effects of family-related and personal factors.

Methods

We included 34,105 children aged 6 to 9 years. We collected the 5-year average concentrations of PM2.5 and its 5 major components (sulfate, nitrate, ammonium, organic matter, and black carbon) in the area (at a spatial resolution of 0.1° × 0.1°) where each school was located. We used mixed effect logistic regression to estimate the effect sizes of the total mass of PM2.5 and each of its components on precocious puberty, and we examined the modifying effects of family-related and personal factors using an additional interactive term. A weighted quantile sum (WQS) regression model was applied to identify the weights of each component in explaining the effect size of the total mass of PM2.5.

Results

We found that the odds ratio (OR) for precocious puberty per IQR increase in the concentration of total PM2.5 mass was 1.27 (95% CI 0.92-1.75) for the whole population, 2.12 (95% CI 1.27-3.55) for girls, and 0.90 (95% CI 0.62-1.30) for boys. Similarly, the effect sizes of the 5 major components were all substantial for girls but minimal for boys. Results of the WQS analysis showed that organic matter could explain the highest proportion of the effect of PM2.5, with the weight of its contribution being 0.71. Modification effects of family income and dietary habits were only observed in certain population subgroups.

Conclusions

Long-term exposure to total PM2.5 mass was significantly associated with precocious puberty in girls, with organic matter identified as the major effect contributor. The results add evidence on the detrimental effects of PM2.5 on children's development and growth.

Clinical and epidemiological insights into early puberty in Thai girls: a 5-year study

PURPOSE

There is growing global concern about the shift to earlier onset of puberty among girls; however, the prevalences of precocious and normal variant puberty among Thai girls are uncertain. We conducted a study at King Chulalongkorn Memorial Hospital in Bangkok from 2018 to 2022 (amid the coronavirus disease 2019 pandemic) to investigate the prevalence, characteristics, and treatment of early puberty in a large cohort of Thai girls.

METHODS

The medical records of 583 girls who had been evaluated for early puberty were reviewed. Demographic and clinical characteristics, and treatment approaches were analyzed.

RESULTS

The analyses found a significant annual increase in evaluations for early signs of puberty (P-value for trend 0.04). The majority (71.2%) of cases were categorized as gonadotropin-releasing-hormone (GnRH)-dependent or central precocious puberty (CPP), with 16 cases showing abnormal brain magnetic resonance imaging findings. Among girls with normal variant puberty, early normal puberty was the most common category (10.5%), followed by premature thelarche (9.5%), slow-progressive precocious puberty (6.6%), and premature adrenarche (2.2%). Median age at presentation, basal luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and bone age differed significantly among groups. Importantly, 97% of girls with CPP received GnRH agonists. Girls with CPP exhibited higher body mass index z-scores and basal LH and FSH compared with those with slow-progressive precocious puberty.

CONCLUSION

Our analyses of the prevalence, characteristics, and treatment of early puberty in Thai girls highlighted the impact of obesity on pubertal timing. The findings underscore the need for preventive weight management and country-specific guideline updates to enhance healthcare strategies for young girls.

Investigation of vitamin D deficiency in girls with growth and development variations-a single center study

Purpose

To understand the status of vitamin D deficiency in girls with growth and developmental variations, as well as the impact of COVID-19 on their vitamin D levels, and to provide reference for the prevention and treatment of vitamin D deficiency in children.

Methods

A retrospective analysis was conducted on 1,345 instances of girls with growth and developmental variations who visited our pediatric endocrinology department and completed vitamin D detection. A total of 279 girls with complete data were included in this study. Among them, 246 girls were classified into four groups based on different growth and developmental variations: early puberty group, menarche group, obesity group, short stature group, and 33 healthy girls served as the control group. Besides, the girls were divided into pre-epidemic and post-epidemic groups by the occurrence of the COVID-19 epidemic. Vitamin D were measured in all girls. The 25(OH)D <20 ng/ml was used as the standard for vitamin D deficiency.

Results

The levels of vitamin D in the early puberty group, menarche group, obesity group, short stature group, and control group were as follows: 20.23 ± 5.90 ng/ml, 17.85 ± 5.69 ng/ml, 21.31 ± 8.99 ng/ml, 27.90 ± 12.27 ng/ml, and 29.42 ± 12.65 ng/ml, respectively. The levels of vitamin D in the early puberty group, menarche group, and obesity group were significantly lower than those in the control group (P < 0.05). The individual vitamin D deficiency rates in the aforementioned groups were 52.07%, 73.91%, 59.46%, 30.95%, and 30.30%, respectively. The vitamin D levels in the pre-epidemic and post-epidemic groups were 20.48 ± 6.22 ng/ml and 22.50 ± 9.74 ng/ml, respectively (P > 0.05).

Conclusion

Girls with early puberty, menarche, and obesity have a certain deficiency of vitamin D levels, and appropriate vitamin D treatment should be provided clinically. Girls with short stature and healthy girls also have certain levels of vitamin D deficiency, and awareness of prevention should be strengthened.

Mindfulness-based interventions for improvement of lifestyle behaviors and body mass index in children with overweight or obesity: a systematic review and meta-analysis

This study aimed to synthesize evidence from primary studies on the acceptability and effectiveness of mindfulness-based interventions (MBIs) for improving lifestyle behaviors and body mass index (BMI) in children with overweight or obesity. We conducted a meta-analysis or followed the Synthesis Without Meta-analysis (SWiM) guidelines to synthesize study findings. The analysis included both mindfulness-only interventions and comprehensive behavioral interventions incorporating mindfulness components. Participants were overweight or obese children, with a mean age below 18 years. A total of 11 studies were included: 7 randomized controlled trials (RCTs), 1 non-randomized parallel-controlled study, and 3 single-group studies. Retention rates for MBIs ranged from 62 to 100%, and participants generally expressed positive attitudes toward the interventions. Regarding effectiveness, no significant improvement in BMI was observed overall (pooled mean difference 0.12 kg/m2 (95% CI - 0.38 to 0.62); I2 = 44%). Subgroup analysis revealed that comprehensive behavioral interventions integrating mindfulness were effective in influencing BMI, while only 11% of mindfulness-only interventions showed similar results. Moreover, 71% of the included studies reported improvements in diet or physical activity behaviors following MBIs.

CONCLUSION

Mindfulness-based interventions are generally acceptable and show potential for improving lifestyle behaviors. However, their impact on BMI remains inconsistent in children with overweight or obesity. Comprehensive behavioral interventions that combine mindfulness practices with conventional approaches may enhance effectiveness. Given the limited evidence, these findings should be interpreted with caution.PROSPERO registration number: CRD42023411790.

WHAT IS KNOWN

• Childhood obesity is a significant public health concern, and conventional interventions have achieved limited success. • Mindfulness-based interventions offer a promising alternative to conventional approaches. A systematic review is urgently needed to evaluate their acceptability and effectiveness in improving lifestyle behaviors and body mass index (BMI) in children with overweight or obesity.

WHAT IS NEW

• Mindfulness-based interventions are generally acceptable to children with overweight or obesity. • Mindfulness-based interventions show potential for improving lifestyle behaviors, but their effectiveness in reducing BMI remains inconsistent.

Changes in blood glucose and lipid metabolism levels in children with central precocious puberty and its correlation with obesity

Objective

This study analyzed the changes in blood glucose and lipid metabolism levels in children with central precocious puberty (CPP) and the correlation between CPP and obesity.

Methods

In total, 88 children with CPP aged 6-10 years who were admitted to our hospital between January 2023 and June 2024 (the CPP group), and 88 children without CPP in the same age group who received health check-ups (the non-CPP group) were retrospectively enrolled in this study. General data [gender, age, bone age, and body mass index (BMI)] were collected. Levels of blood glucose metabolism indicators [fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), and hemoglobin A1c (HbA1c)] and blood lipid metabolism indicators [triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] were compared. The incidence of obesity was calculated, and the Tanner stages of the obese group and the non-obese group were compared. The correlation between CPP degree (measured by Tanner staging) and obesity degree (measured by BMI) was analyzed using Spearman's correlation analysis.

Results

The differences in gender and age between the CPP and non-CPP groups were insignificant (P > 0.05). Bone age and BMI in the CPP group were higher than in the non-CPP group (P < 0.05). The CPP group had higher serum FPG, 2hPG, HbA1c, TG, TC, and LDL-C levels and lower serum HDL-C levels than the non-CPP group. The incidence of obesity was higher in the CPP group (21.59%, 19/88) than in the non-CPP group (6.82%, 6/88). The Tanner staging scores in the obese group for the boys (testes and pubic hair), girls (breasts and pubic hair), and as a whole (testes/breasts and pubic hair) were elevated compared to those in the non-obese group (P < 0.05). Spearman's correlation showed that the CPP degree (measured by Tanner staging) was positively correlated with the obesity degree (measured by BMI) in boys, girls, and the study sample as a whole (P < 0.001).

Conclusion

Children with CPP had abnormal levels of blood glucose and lipid metabolism, and the CPP degree in these children was positively correlated with the degree of obesity.

Family Shopping Basket Intervention: A Strategy to Reduce Obesity in Prepubertal Children

Background/Objectives: The goal of childhood obesity treatment is to benefit the physical and mental health of children who suffer from it and to prevent complications, improving their quality of life and ensuring adequate development. Family-based interventions are demonstrating positive results, especially in prepubertal children. The aim of our study was to evaluate the effectiveness of a family grocery basket intervention for the treatment of childhood obesity in a Spanish primary care office. Methods: A randomized controlled trial comparing a family grocery basket intervention through the analysis of unhealthy products included in the grocery receipts that families bring to the primary care office, in comparison with the usual interventions. Results: Ninety-one children participated in the study (intervention group: n = 60, control group: n = 31). After one year of follow-up, a relevant weight loss with a decrease of ≥0.5 SDS in the z-IMC was obtained in 60.6% of the total sample. In the intervention group, there was a significant decrease in the number of unhealthy products in the family grocery basket and a lower percentage of hypertension and severe obesity than in the control group. In families in which there was a significant decrease in the consumption of unhealthy products, a higher percentage of weight loss was observed. Conclusions: Intervention in the family grocery basket through receipts is an original, simple and effective tool for family-based treatment in childhood obesity.

Association Between Exposure to Particulate Matter Air Pollution with Risk of Obesity Among Children and Adolescents in Northern and Central Taiwan

INTRODUCTION

The present study investigated the relationship between air pollution, specifically PM2.5 and PM10, and childhood and adolescent obesity in northern and central Taiwan. Previous research has shown a positive correlation between air pollution and pediatric obesity, but no study has been conducted in Taiwan. We used data from the K-12 Education Administration, Ministry of Education, and the Taiwan Air Quality Monitoring Network to analyze the association between PM2.5 and PM10 exposures and obesity rates among elementary and junior high school students.

METHODS

Data on students' height and weight were combined with air pollution data obtained from monitoring stations to assess exposure. A multivariable model estimated the relative risk and 95% confidence intervals of obesity linked to PM2.5 and PM10 exposures. Cities were categorized into quartiles (Q1-Q4) based on pollutant accumulation to compare the obesity rates.

RESULTS

Students living in areas with higher PM2.5 and PM10 exposures (Q4) had a significantly higher risk of obesity than those living in areas with lower exposures (Q1). The effect was more pronounced in girls and older students, with PM2.5 exhibiting a stronger relationship than PM10.

CONCLUSIONS

PM2.5 and PM10 exposures are significantly associated with an increased obesity risk in children and adolescents, particularly in girls and older students. Further research is needed to explore the underlying mechanisms and to control for socioeconomic and demographic factors.

Obesity prevention across the lifespan: assessing the efficacy of intervention studies and discussing future challenges

INTRODUCTION

Obesity is intricately linked with metabolic conditions that disrupt hormones and metabolism, often resulting in weight-related challenges. Given the heightened mortality rates associated with cardiovascular and metabolic disorders linked to obesity, there is a pressing call to mobilize medical professionals, researchers, and policymakers towards advocating for healthy lifestyles and preventing obesity. Traditionally, obesity prevention and treatment have been viewed as separate endeavors, with prevention primarily falling under public health initiatives and treatment within the purview of clinicians. However, this division has led to significant healthcare costs without a substantial reduction in obesity rates.

EVIDENCE ACQUISITION

Our search encompassed published articles focused on prevention, excluding any mention of "treatment". Data was gathered from diverse sources including academic databases, government health agency websites like the CDC, research organizations, clinical trials registries, and public health campaigns.

EVIDENCE SYNTHESIS

Due to the diverse range of interventions (encompassing dietary modifications, physical activity promotion, policy initiatives, education, and community-based programs, either independently or in combination), and the variability in study design and population demographics, we conducted a narrative review to systematically present and critically analyze evidence on preventing overweight and obesity across different age groups.

CONCLUSIONS

Effectively addressing obesity prevention necessitates a comprehensive, multidisciplinary approach that establishes an environment where healthier choices are accessible and viable for all. This requires collaborative efforts between individuals, communities, healthcare providers, policymakers, and industries to institute enduring change. Furthermore, there remains a critical need for national and international guidelines tailored to age-related risk factors, paving the way for innovative precision medicine approaches centered on salutogenesis rather than pathogenesis.

The Role of DLK1 Deficiency in Central Precocious Puberty and Association with Metabolic Dysregulation

INTRODUCTION

Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. Central precocious puberty (CPP) is a rare condition that is diagnosed when premature activation of the hypothalamic-pituitary-gonadal axis is detected, in association with precocious breast development or testicular growth. Idiopathic CPP is historically considered to be the most common form, but in recent years defects in a small but growing number of genes regulating the timing of puberty have been identified in an increasing proportion of cases of CPP. Delta-like non-canonical Notch ligand 1 (DLK1) is understood to be one of the key genes involved in the etiology of CPP, although its mechanistic role is not yet fully understood.

CASE PRESENTATION

We identified a novel de novo variant of DLK1 (c.835C>T; p.Gln279*) in an 8-year-old girl of Bangladeshi origin. She presented with an advanced Tanner staging of B4P4A2, significantly advanced bone age (BA, 13 years), a near-adult proportioned uterus, with a history of menarche at the age of 7.4 years. Diagnosis was confirmed by raised basal luteinizing hormone concentration. She was found to have truncal obesity associated with abnormal fasting insulin levels and mildly elevated cholesterol levels. These findings are consistent with previous literature describing an association between patients with DLK1 deficiency and an impaired metabolic profile. The patient was treated for 2 years with GnRH agonists with ongoing biochemical follow-up into adolescence.

CONCLUSION

This case illustrates the susceptibility to metabolic derangement for patients with mutations in DLK1 and the need for ongoing monitoring after puberty. Our summary of previously identified DLK1 variants and their metabolic consequences demonstrates the frequency of obesity, lipid abnormalities, and insulin dysregulation in this patient cohort in childhood and beyond. This knowledge can guide future clinical practice for patients with CPP patients due to DLK1 deficiency.

The fetal origins of metabolic health: exploring the association between newborn biological age and metabolism hormones in childhood

BACKGROUND

Telomere length (TL), mitochondrial DNA copy number (mtDNAcn), and DNA methylation age (DNAmAge) are common aging biomarkers. However, research on the associations between these three markers at birth and subsequent metabolic status was limited. This study aimed to evaluate the association between TL, mtDNAcn, and DNAmAge in newborns and the variation in metabolic hormones of children at 3 years old.

METHODS

This research involved 895 mother-child pairs from a birth cohort in China, with TL and mtDNAcn measured using quantitative real-time PCR, DNA methylation (DNAm) assessed using Infinium MethylationEPIC Beadchip, and DNAm age (DNAmAge) determined using Horvath's epigenetic clock. Insulin and leptin levels were measured via electrochemiluminescence assay. Multivariable adjusted linear regression and restricted cubic spline (RCS) analysis were utilized to examine the association between aging markers and metabolic hormones.

RESULTS

The linear regression analysis indicated the percentage change of metabolism hormones for per doubling of aging biomarkers alterations and found significant associations between DNAmAge and insulin levels (adjusted percent change (95% CI), - 13.22 (- 23.21 to - 1.94)), TL and leptin levels (adjusted percent change (95% CI), 15.32 (1.32 to 31.24)), and mtDNAcn and leptin levels (adjusted percent change (95% CI), - 14.13 (- 21.59 to - 5.95)). The RCS analysis revealed significant non-linear associations between TL (Ln transformed) and insulin (Ln transformed) (P = 0.024 for nonlinearity), as well as DNAmAge (Ln transformed) and leptin (Ln transformed) (P = 0.043 for nonlinearity). Specifically, for TL and insulin, a positive association was observed when TL (Ln transformed) was less than - 0.05, which transitioned to an inverse association when TL (Ln transformed) was greater than - 0.05. Regarding DNAmAge and leptin, there was a sharp decline when DNAmAge (Ln transformed) was less than - 1.35, followed by a plateau between - 1.35 and - 0.67 and then a further decline when DNAmAge (Ln transformed) was greater than - 0.67.

CONCLUSIONS

In this prospective birth cohort study, variation in metabolic hormones of children at 3 years old was associated with TL, mtDNAcn, and DNAmAge at birth. These findings suggested that TL, mtDNAcn, and DNAmAge might play a role in the biological programming of metabolic health from birth.

Overview of Pediatric Obesity as a Disease

The authors highlight well-known and hypothesized pathophysiologic mechanistic links underlying obesity and the various pediatric disorders across multiple organ systems with which it is associated. Obesity is attributed to an imbalance in energy intake versus expenditure; there is growing knowledge regarding its multifactorial origins, dysfunctional physiologic processes, and adverse health consequences. Individuals with obesity exhibit variations in metabolic rate, genetic predisposition, and hormonal regulation, influencing diverse responses in regulating energy balance. Understanding the complex mechanistic relationships surrounding the pathophysiology of obesity assists in its consideration as a disease process, allowing pediatric health practitioners to manage its sequelae more effectively.

Association Between the Serum Copper Levels and Environmental Tobacco Exposure on the Risk of Overweight and Obesity in Children: a Study Based on the National Health and Nutrition Examination Survey

This study was to assess the individual effects of serum copper levels and environmental tobacco exposure and their joint effects on the risk of overweight and obesity among children and adolescents of 6 to 19 year olds. We analyzed cross-sectional data from 1849 children and adolescents participating in the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2016. Environmental tobacco exposure was determined by cotinine levels. The serum copper level was divided into < median group and ≥ median groups according to the median of 109.81 µg/dL. The outcome was overweight/obese in children and adolescents. Weighted multinomial multivariate logistic regression models were used to assess the association of serum copper and cotinine levels, with the risk of overweight/obesity, and the joint effects on the risk of overweight and obesity among children and adolescents. The subgroup analyses based on age, gender, and household smoking status were conducted. Among 1849 children and adolescents, 332 children and adolescents had overweight BMI, and 450 children and adolescents had obese BMI. Higher serum copper levels were associated with the risk of obesity in children and adolescents (odds ratio (OR) 2.96, 95% confidence interval (CI) 1.39-6.31, P = 0.006). A positive association between increasing levels of cotinine levels and the risk of overweight (OR 1.83, 95% CI 1.16-2.87, P = 0.010) and obesity (OR 2.56, 95% CI 1.03-6.40, P = 0.044) in children and adolescents was observed. A remarkable association was found between higher serum copper in combination with higher cotinine levels and the risk of overweight (OR 3.23, 95% CI 1.19-8.83, P = 0.023) and obesity (OR 8.76, 95% CI 2.14-35.87, P = 0.003) in children and adolescents. The subgroup analyses revealed positive associations between high serum copper levels in combination with high cotinine levels and overweight and obesity in children and adolescents aged ≥ 12 years, of female sex, and without smoking family members. There may exist a joint effect of serum copper levels and environmental tobacco exposure on overweight/obesity among children and adolescents. These findings offer an insight that early weight control and reduction of tobacco exposure and the detection of serum copper levels may be important in reducing the risk of obesity in children.

Growth pattern, growth deceleration, and relevant predictors in girls treated with GnRHa: a retrospective longitudinal study

OBJECTIVES

This study aimed to analyze the height growth pattern and the incidence of significant growth deceleration in girls with CPP and EFP on GnRHa treatment, and thereby identify relevant predictors of growth deceleration.

METHODS

The data of 99 girls diagnosed with CPP and 47 girls with EFP were included in this retrospective analysis. The incidence of growth deceleration was calculated in both the first and second years. Multivariate logistic regression analysis was used to identify predictors indicative of growth deceleration.

RESULTS

Growth velocity (GV) trajectories showed gradual decreases to the nadir at 18 months of treatment, and then they recovered till the 24th month of treatment, especially in girls with CPP. Nevertheless, the recovery was significantly greater in the CPP group than EFP. In the first year, no significant difference in the incidence of growth deceleration was found between the CPP group and the EFP group [17.35 vs. 25.53 %, p=0.249]; in the second year, the CPP group had a lower incidence than the EFP group [42.86 vs. 76.92 %, p=0.027]. The multivariate logistic regression analysis suggested that bone age (BA) was an independent predictor of growth deceleration (OR=2.264, 95 % CI: 1.268-4.042, p=0.006). The result of ROC curves showed the cut-off value of BA was 11.05 years.

CONCLUSIONS

GV varies at different periods during GnRHa treatment. GnRHa should be used with more caution for EFP treatment than for CPP. BA can be used to predict the occurrence of growth deceleration during GnRHa treatment.

The Validation of the Greulich and Pyle Atlas for Radiological Bone Age Assessments in a Pediatric Population from the Canary Islands

Bone age assessments measure the growth and development of children and adolescents by evaluating their skeletal maturity, which is influenced by various factors like heredity, ethnicity, culture, and nutrition. The clinical standards for this assessment should be up to date and appropriate for the specific population being studied. This study validates the GP-Canary Atlas for accurately predicting bone age by analyzing posteroanterior left hand and wrist radiographs of healthy children (80 females and 134 males) from the Canary Islands across various developmental stages and genders. We found strong intra-rater reliability among all three raters, with Raters 1 and 2 indicating very high consistency (intra-class coefficients = 0.990 to 0.996) and Rater 3 displaying slightly lower but still strong reliability (intra-class coefficients = 0.921 to 0.976). The inter-rater agreement was excellent between Raters 1 and 2 but significantly lower between Rater 3 and the other two raters, with intra-class coefficients of 0.408 and 0.463 for Rater 1 and 0.327 and 0.509 for Rater 2. The accuracy analysis revealed a substantial underestimation of bone age compared to chronological age for preschool- (mean difference = 17.036 months; p < 0.001) and school-age males (mean difference = 13.298 months; p < 0.001). However, this was not observed in females, where the mean difference was minimal (3.949 months; p < 0.239). In contrast, the Atlas showed greater accuracy for teenagers, showing only a slight overestimation (mean difference = 3.159 months; p = 0.823). In conclusion, the GP-Canary Atlas demonstrates overall precision but requires caution as it underestimates the BA in preschool children and overestimates it in school-age girls and adolescents.

Challenges in Pediatric Diabetes Classification: A Case Report

Type 2 diabetes (T2DM) incidence and prevalence are increasing in pediatrics. All children aged > 10 years or postpubertal should be screened in primary care for T2DM if they are overweight with one risk factor or have signs of insulin resistance or associated conditions. Classifying pediatric diabetes is challenging. An accurate, timely diagnosis is critical to optimize care, as children with T2DM are at risk for more severe disease as adults. We describe a 10-year-old female referred to endocrine following abnormal laboratory results in primary care. Despite the initial presentation of diabetic ketoacidosis, the child was diagnosed with T2DM.

Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile.

Methods

The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child.

Conclusions

This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.

Community Awareness and Knowledge About Precocious Puberty in Riyadh City, Saudi Arabia

Background Puberty is the process of physical maturation where an adolescent reaches sexual maturity and becomes capable of reproduction. On average, puberty typically begins between 8 and 13 years old in females and 9 and 14 years old in males. The traditional definition of precocious puberty is the development of secondary sexual characteristics before eight years of age in girls and nine years in boys. In this study, we aimed to assess the knowledge and awareness of Riyadh residents in Saudi Arabia about precocious puberty and its complications. Methodology A cross-sectional study was conducted to estimate the awareness and knowledge among Riyadh residents about precocious puberty and its complications; 426 participants were included in this study. Participants completed a pretested self-administered questionnaire that included sociodemographic data, knowledge about precocious puberty definition, risk factors, complications, and treatment. Results This study enrolled 426 participants. Overall, 10.1% were correct about the precocious puberty age for girls, and 8.5% knew about the precocious puberty age for boys. The overall mean knowledge score among the study sample was 5.56 (SD = 2.79), with poor knowledge being prominent and constituting 68.8%, while fair and good knowledge were 30% and 1.2%, respectively. Working in a non-medical field was the sole independent significant predictor of incorrect answers of knowledge about precocious puberty. Conclusions Awareness strategies are needed to increase awareness among the community to encourage prevention and treatment for precocious puberty as the awareness and knowledge of Riyadh residents in Saudi Arabia about precocious puberty and its complications are low.

Development and application of a nomogram model for predicting the risk of central precocious puberty in obese girls

Objective

The purpose of this study is to develop and assess a nomogram risk prediction model for central precocious puberty (CPP) in obese girls.

Methods

We selected 154 cases of obese girls and 765 cases of non-obese girls with precocious puberty (PP) who underwent the gonadotropin-releasing hormone stimulation test at the Jiangxi Provincial Children's Hospital. Univariate analysis and multivariate analysis were conducted to identify predictors of progression to CPP in girls with PP. A predictive model was developed and its predictive ability was preliminarily evaluated. The nomogram was used to represent the risk prediction model for CPP in girls with obesity. The model was validated internally using the Bootstrap method, and its efficacy was assessed using calibration curves and clinical decision analysis curves.

Results

In obese girls with PP, basal luteinizing hormone (LH) and follicular stimulating hormone (FSH) levels, as well as uterine volume, were identified as independent risk factors for progression to CPP. In non-obese girls, the basal LH level, bone age, and uterine volume were identified as independent risk factors for progression to CPP. With an AUC of 0.896, the risk prediction model for obese girls, was found to be superior to that for non-obese girls, which had an AUC of 0.810. The model displayed strong predictive accuracy. Additionally, a nomogram was used to illustrate the CPP risk prediction model for obese girls. This model performs well in internal validation and is well calibrated, providing a substantial net benefit for clinical use.

Conclusion

A medical nomogram model of CPP risk in obese girls comprised of basal LH value, basal FSH value, and uterine volume, which can be used to identify those at high risk for progression of CPP in obese girls and develop individualized prevention programs.

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.

Childhood obesity and central precocious puberty

Central precocious puberty (CPP) is an endocrine disorder in children caused by the early activation of the hypothalamic-pituitary-gonadal axis (HPGA), leading to elevated gonadotropin-releasing hormone (GnRH), which triggers the development of gonads and the secretion of sex hormones. This eventually results in the development of internal and external genitalia and secondary sexual characteristics. CPP significantly affects the physical and mental health of children and may increase the risk of various adult diseases. The influencing factors and mechanisms of CPP are a central focus of research, and its prevention and treatment remain challenging. Childhood obesity is an important risk factor for CPP, with a complex relationship influenced by endocrine-disrupting chemicals, genetic factors, and epigenetic regulation. The link between the two is primarily related to the regulation of HPGA function by nutritional and metabolic signals. Exploring the relationship between childhood obesity and CPP, along with the potential mechanisms by which obesity induces CPP, can provide theoretical references for identifying new therapeutic targets.

The relationship between sex hormone levels and ocular surface parameters in girls with idiopathic central precocious puberty

Purpose

The study aimed to investigate the correlation between the change of sex hormone levels and ocular surface parameters in girls with idiopathic central precocious puberty(ICPP).

Methods

Eighteen girls with ICPP and 18 age-matched normal girls participated in this study, all of the participants had undergone physical measurements, laboratory tests, imaging examination and ocular surface assessments.

Results

The Objective Scatter Index (OSI) in the ICPP group was significantly higher than in the control group (P = 0.031), girls with ICPP showed slightly lower MNITBUT compared to the normal control group, although this difference was not statistically significant. Bivariate analysis revealed a positive association between estradiol and OSI (r=0.383, P=0.021), Additionally, in the study population, both Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH) were negatively correlated with Mean noninvasive tear breakup time (MNITBUT) (r=-0.359, P=0.031)(r=-0.357, P=0.032).

Conclusion

In comparison with the normal control group, alterations in the OSI were observed in girls with ICPP. This alteration may be associated with an elevation in estrogen levels. Although there was a slight non-significant decrease in NITBUT in ICPP girls, the negative correlation between LH and FSH with MNITBUT suggests new perspective for further investigation.

Obesity and dyslipidemia in early life: Impact on cardiometabolic risk

Childhood obesity with its growing prevalence worldwide presents one of the most important health challenges nowadays. Multiple mechanisms are involved in the development of this condition, as well as in its associations with various cardiometabolic complications, such as insulin resistance, diabetes, metabolic dysfunction-associated steatotic liver disease and cardiovascular diseases. Recent findings suggest that childhood obesity and associated dyslipidemia at least partly originate from epigenetic modifications that take place in the earliest periods of life, namely prenatal and perinatal periods. Hence, alterations of maternal metabolism could be fundamentally responsible for fetal and neonatal metabolic programming and consequently, for metabolic health of offspring in later life. In this paper, we will review recent findings on the associations among intrauterine and early postnatal exposure to undesirable modulators of metabolism, development of childhood obesity and later cardiometabolic complications. Special attention will be given to maternal dyslipidemia as a driven force for undesirable epigenetic modulations in offspring. In addition, newly proposed lipid biomarkers of increased cardiometabolic risk in obese children and adolescents will be analyzed, with respect to their predictive potential and clinical applicability.

Gut microbiota-metabolite interactions meditate the effect of dietary patterns on precocious puberty

Precocious puberty, a pediatric endocrine disorder classified as central precocious puberty (CPP) or peripheral precocious puberty (PPP), is influenced by diet, gut microbiota, and metabolites, but the specific mechanisms remain unclear. Our study found that increased alpha-diversity and abundance of short-chain fatty acid-producing bacteria led to elevated levels of luteinizing hormone and follicle-stimulating hormone, contributing to precocious puberty. The integration of specific microbiota and metabolites has potential diagnostic value for precocious puberty. The Prevotella genus-controlled interaction factor, influenced by complex carbohydrate consumption, mediated a reduction in estradiol levels. Interactions between obesity-related bacteria and metabolites mediated the beneficial effect of seafood in reducing luteinizing hormone levels, reducing the risk of obesity-induced precocious puberty, and preventing progression from PPP to CPP. This study provides valuable insights into the complex interplay between diet, gut microbiota and metabolites in the onset, development and clinical classification of precocious puberty and warrants further investigation.

[Value of single-phase gonadotropin-releasing hormone stimulation test in diagnosis of central precocious puberty in girls with different levels of body mass index]

OBJECTIVES

To investigate the value of single-phase gonadotropin releasing hormone (GnRH) stimulation test in the diagnosis of central precocious puberty (CPP) in girls with different levels of body mass index (BMI).

METHODS

A retrospective analysis was performed for the data of 760 girls with breast development before 7.5 years of age who attended the Third Affiliated Hospital of Zhengzhou University from January 2017 to August 2023. According to the results of GnRH stimulation test and clinical manifestations, they were divided into a CPP group (297 girls) and a non-CPP group (463 girls). According to the values of BMI, the girls were divided into a normal weight group (540 girls), an overweight group (116 girls), and an obese group (104 girls). The receiver operating characteristic (ROC) curve was used to investigate the value of single-phase GnRH stimulation test in the diagnosis of CPP in girls with different levels of BMI.

RESULTS

Luteinizing hormone (LH)/follicle-stimulating hormone at 30 minutes after GnRH stimulation had an area under the curve (AUC) of 0.985 in the diagnosis of CPP, which was higher than the AUC at 0, 60, and 90 minutes (P<0.05). LH at 30 minutes had a similar diagnostic value to LH at 60 minutes (P>0.05). LH at 30 minutes was negatively correlated with BMI and BMI-Z value (P<0.05).The AUC for diagnosing CPP in normal weight, overweight, and obese girls at 30 minutes LH was 0.952, 0.965, and 0.954, respectively (P<0.05).

CONCLUSIONS

The 30-minute GnRH stimulation test has a good value in the diagnosis of CPP in girls with different levels of BMI and is expected to replace the traditional GnRH stimulation test, but the influence of BMI on LH level should be taken seriously.

Navigating Pubertal Goldilocks: The Optimal Pace for Hierarchical Brain Organization

Adolescence is a timed process with an onset, tempo, and duration. Nevertheless, the temporal dimension, especially the pace of maturation, remains an insufficiently studied aspect of developmental progression. The primary objective is to estimate the precise influence of pubertal maturational tempo on the configuration of associative brain regions. To this end, the connection between maturational stages and the level of hierarchical organization of large-scale brain networks in 12-13-year-old females is analyzed. Skeletal maturity is used as a proxy for pubertal progress. The degree of maturity is defined by the difference between bone age and chronological age. To assess the level of hierarchical organization in the brain, the temporal dynamic of closed eye resting state high-density electroencephalography (EEG) in the alpha frequency range is analyzed. Different levels of hierarchical order are captured by the measured asymmetry in the directionality of information flow between different regions. The calculated EEG-based entropy production of participant groups is then compared with accelerated, average, and decelerated maturity. Results indicate that an average maturational trajectory optimally aligns with cerebral hierarchical order, and both accelerated and decelerated timelines result in diminished cortical organization. This suggests that a "Goldilocks rule" of brain development is favoring a particular maturational tempo.

Lipid Profile and Triglyceride-Glucose Index (TyG) Alterations in a Single-Center Cohort of Children Diagnosed with Central Precocious Puberty

Background: A correlation between plasma lipids and timing of pubertal development has been hypothesized, though lipid influence remains unclear in central precocious puberty (CPP). Aim: To assess any possible alterations in the lipid profile and triglyceride glucose index (TyG) in children diagnosed with CPP. Patients and Methods: Retrospective single-center study conducted on children (aged 6.3 ± 2.1 years) evaluated for the suspicion of CPP. Results: Based on the results of the gonadotropin releasing hormone (GnRH) test, considering 5 IU/L as cut-off of the luteinizing hormone peak, CPP was confirmed in 43 patients (57.3%). Sixteen (37.2%) had a pathologic body mass index (BMI), with 9 (20.9%) being overweight and 7 (16.27%) obese. High total cholesterol was found in 3 patients with CPP (6.97%), high triglycerides were found in 11 patients with CPP (25.58%), high LDL cholesterol was found in 5 patients with CPP (11.62%), low HDL cholesterol was found in 12/43 patients with CPP (27.9%), a pathologic TyG was found in 13/43 patients with CPP (30.23%). No significant association was observed in the lipid profile for patients with or without CPP, except for HDL cholesterol, which was lower in the CPP group (47.1 ± 10.9; p = 0.033). However, the association between serum HDL cholesterol and CPP was not confirmed at the multivariate logistic regression analysis adjusted for patients' sex and age (p = 0.1; OR: 1.035; 95% CI: 0.993-1.078). Conclusion: The overall lipid profile of our pediatric patients diagnosed with CPP did not differ from patients having idiopathic precocious thelarche or normal variants of puberty development.

Diagnostic Value of Single LH and LH/FSH Ratio at 60-minute after GnRHa Stimulation Test for Central Precocious Puberty

OBJECTIVES

To evaluate the diagnostic value of luteinizing hormone (LH) and LH/follicle stimulating hormone (FSH) ratio at 60 min after gonadotropin-releasing hormone analogs (GnRHa) stimulation test for central precocious puberty (CPP) in girls.

METHODS

Two hundred and fifty-seven girls, aged 3 to 7.5 y, suspected of precocious puberty at authors' hospital from April 2020 through November 2023 were enrolled in the study. The blood was taken at 0, 30, 60 min after GnRHa stimulation test, and LH and LH/FSH were detected by chemiluminescence assay. The diagnostic efficacy was analysed by Mann-Whitney U test, spearman's correlation analysis and receiver operating characteristic (ROC) analysis. The proportion of obesity was analysed by Chi-square test.

RESULTS

LH and LH/FSH at different times were statistically significantly different (P <0.05) between the CPP and non-CPP groups. Spearman's correlation analysis showed that the level of LH and LH/FSH at 60 min had the strongest consistency with the peak of LH (r = 0.9988, P <0.001) and LH/FSH (r = 0.9981, P <0.001). ROC curve analysis showed that the area under the ROC curves at 60 min of LH and LH/FSH were 0.975 and 0.997 with a cut-off value of 5.70 IU/L and 0.609, respectively.

CONCLUSIONS

The peak of LH and LH/FSH in the diagnosis of CPP can be determined by LH and LH/FSH at 60 min after the triptorelin acetate is injected. This will reduce the number of blood draws required compared with the traditional stimulation test, which is more effective and acceptable for children.

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.

Profiling the Gut Microbiota in Obese Children with Formula Feeding in Early Life and Selecting Strains against Obesity

Formula feeding, obesity and the gut microbiota are closely related. The present investigation explored the profiles of the intestinal microbiota in obese children over 5 years old with formula feeding in early life. We identified functional bacteria with anti-obesity potential through in vitro and in vivo experiments, elucidating their mechanisms. The results indicated that, in the group of children over 5 years old who were fed formula in early life, obese children exhibited distinct gut microbiota, which were characterized by diminished species diversity and reduced Bifidobacterium levels compared to normal-weight children. As a result, Lactobacillus acidophilus H-68 (H-68) was isolated from the feces of the N-FF group and recognized as a promising candidate. H-68 demonstrated the ability to stimulate cholecystokinin (CCK) secretion in STC-1 cells and produce bile salt hydrolase. In vivo, H-68 promoted CCK secretion, suppressing food intake, and regulated bile acid enterohepatic circulation, leading to increased deoxycholic acid and lithocholic acid levels in the ileum and liver. This regulation effectively inhibited the diet-induced body weight and body fat gain, along with the liver fat deposition. In conclusion, H-68 was recognized for its prospective anti-obesity impact, signifying an auspicious pathway for forthcoming interventions targeted at averting pediatric obesity in formula-fed children.

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.

The effect of GnRH analog treatment on BMI in children treated for precocious puberty: a systematic review and meta-analysis

INTRODUCTION

The purpose of the present meta-analysis was to systematically evaluate the effect of GnRHa treatment on the BMI of children with precocious puberty after GnRHa treatment as compared to before, and to analyze the effect of GnRHa treatment on the body composition of children with precocious puberty at different BMIs by classifying into normal body mass, overweight, and obese groups according to BMI at the time of initial diagnosis.

CONTENT

A meta-analysis was performed using Stata 12.0 software by searching PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), and Wan fang database for relevant literature on standard deviation score of body mass index (BMI-SDS) after GnRHa treatment as compared to before in children with precocious puberty.

SUMMARY

A total of eight studies were included with a total sample size of 715 cases, and the results of meta-analysis showed that BMI-SDS increased in children with precocious puberty after GnRHa treatment as compared to before starting [(weighted mean difference (WMD)=0.23, 95 % CI: 0.14-0.33, p=0.000)] and also increased in children with normal body mass [(WMD=0.37, 95 % CI: 0.28-0.46, p=0.000)], and there was no significant change in BMI-SDS in children in the overweight or obese group [(WMD=0.01, 95 % CI: -0.08-0.10, p=0.775)].

OUTLOOK

Overall, there was an observed increase in BMI-SDS at the conclusion of GnRHa treatment in children with precocious puberty. Additionally, it was found that the effect of GnRHa treatment on body composition varied among children with different BMI status. Clinicians should emphasize the promotion of a healthy lifestyle and personalized dietary management for children.

Serum Copper/Zinc Ratio in Overweight and Obese Children: a Cross-Sectional Study

To assess the association between serum copper/zinc ratio (CZR) and overweight/obesity in children. Sociodemographic and clinical data of children aged 8-18 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this cross-sectional study. These associations were explored using weighted univariate and multivariate logistic regression analyses with the odds ratios (ORs) and 95% confidence intervals (CIs). High serum CZR level was related to higher odds of overweight (OR = 1.74), obesity (OR = 5.26), and central obesity (OR = 2.99). Subgroup analyses showed that high serum CZR levels were associated with high odds of overweight in children aged ≥ 12 years old (OR = 2.19) and females (OR = 2.02), while the increased odds of obesity and central obesity were found in children aged ≥ 12 years old and both male and female. Elevated serum CZR level was linked to high odds of childhood overweight, obesity, and central obesity, and this relationship was also found in children with different age and gender.

Causal association between mTOR-dependent circulating protein levels and central precocious puberty: a Mendelian randomization study

Background

The mechanistic target of rapamycin (mTOR) signaling pathway has a significant effect on central precocious puberty (CPP). However, the causality between mTOR-dependent circulating protein levels and CPP is still unclear. Our aim is to assess the effects of seven mTOR-dependent circulating protein levels on CPP using Mendelian randomization (MR).

Methods

Instrumental variables (IVs) for mTOR-dependent circulating protein levels were retrieved from the proteomics-GWAS INTERVAL study and eQTLGen. The summary-level genetic datasets for CPP outcome were obtained from the FinnGen Consortium. Inverse-variance weighted (IVW) was used as the primary method and the pleiotropy, heterogeneity and robustness of the analyses were detected as sensitivity analysis. Positive exposures in the discovery cohort would be revalidated in the validation cohort.

Results

This two-sample MR study revealed a causal association between eIF4G level in plasma and CPP in both discovery cohort (IVW: OR = 0.45, 95% CI = 0.22-0.91, p = 0.026) and validation cohort (IVW: OR = 0.45, 95% CI = 0.24-0.85, p = 0.014).

Conclusions

There was a causal association between eIF4G level in plasma and CPP. Whether eIF4G can be used for the prevention or treatment of CPP needs to be explored in further studies.

Multi-omic analysis of precocious puberty girls: pathway changes and metabolite validation

Objective

Precocious puberty (PP) is a prevalent endocrine disorder affecting the physical and mental wellbeing of children. Identifying the triggering factors of PP has become a central issue. This study seeks to investigate the metabolomic and transcriptomic alterations in PP.

Material and methods

First, 37 school-aged girls diagnosed with PP and 25 age-matched prepubertal control girls were recruited, and the fecal samples were collected for non-targeted metabolomic analysis to screen for differentially expressed metabolites (DEMs). Subsequently, an animal model of PP was constructed by danazol administration to neonatal female rats, and both fecal non-targeted metabolomics and serum next-generation transcriptomic sequencing were performed to screen DEMs and differentially expressed genes (DEGs) in PP. Moreover, the DEM co-existing in clinical and animal models was administrated to PP rats to explore the role of the target metabolite in PP.

Results

A total of 24 DEMs in PP clinical samples and 180 DEMs and 425 DEGs in PP animal samples were identified. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that these DEMs and DEGs were enriched in disease-associated pathways, including fatty acid synthesis, glycerolipid metabolism, pyrimidine metabolism, steroid hormone biosynthesis, progesterone-mediated oocyte maturation, and gonadotropin-releasing hormone (GnRH) signaling pathway, forming a tight DEM-DEG pathway regulatory network. Further DEM validation demonstrated that thymine supplementation delayed the opening of the vagina and development of PP in model rats.

Conclusion

This study reveals that the metabolomic and transcriptomic changes, along with enriched pathways, are implicated in PP based on clinical and animal analyses. The findings may provide new strategies and research avenues for PP treatment.

Correlation between serum vitamin D level and uterine volume in girls with idiopathic central precocious puberty

OBJECTIVES

Investigate serum vitamin D (vit D) levels' relation to uterine volume in idiopathic central precocious puberty (ICPP) girls and compare findings with normal peers.

METHODS

Analyzed 278 ICPP cases from January 2017 to September 2022 alongside 239 normally developing girls. Collected clinical data and lab markers and performed subgroup analysis based on vit D levels. Correlation and regression analyses were conducted.

RESULTS

The ICPP group exhibited elevated uterine volume and lower serum vit D compared to controls (p<0.05). A weak negative correlation was noted between vit D and uterine volume in ICPP (r=-0.193, p=0.004), and no such correlation in controls (r=-0.073, p=0.319). The ICPP vit D deficiency subgroup displayed higher uterine volume than the insufficiency and sufficiency subgroups (p<0.05). Uterine volume in the insufficiency subgroup exceeded the sufficiency subgroup (p<0.05). After adjusting for confounders, lower vit D is linked to increased ICPP uterine volume (non-standardized regression coefficient β=-25.55, 95 % CI= -46.23, -4.87, p=0.016). A Limited correlation between vit D and uterine volume was seen in girls with normal pubertal timing.

CONCLUSIONS

We demonstrated a correlation between vit D and uterine volume in ICPP girls, absent in normal peers. ICPP girls often exhibit lower vit D levels and increased uterine volume. Further research is vital for understanding vit D's role in ICPP pathogenesis and guiding prevention and treatment strategies.

Innovative high fat diet establishes a novel zebrafish model for the study of visceral obesity

Obesity is a complex chronic condition associated with multiple health risks, including visceral obesity, which is particularly detrimental. To gain insight into the mechanisms underlying obesity and its associated pathologies, a novel zebrafish model was established using an innovative high-fat diet (HFD). The primary goal was to induce visceral obesity in zebrafish and study the associated structural changes. To achieve this, a unique HFD consisting of 40% beef fat (HFD40) was developed and supplemented with magnesium aluminometasilicate to improve stability in a high humidity environment. Feeding regimens were initiated for both juvenile (starting at 2 weeks post-fertilization, lasting 18 weeks) and adult zebrafish (3 months post-fertilization, 8 weeks feeding duration). The innovative dietary approach successfully induced visceral obesity in both juvenile and adult zebrafish. This new model provides a valuable tool to study obesity-related pathologies, metabolic syndrome, and potential therapeutic interventions. Most importantly, the low-cost and easy-to-prepare composition of HFD40 was seamlessly incorporated into the water without the need for separation, was readily absorbed by the fish and induced rapid weight gain in the zebrafish population. In conclusion, this study presents a novel HFD40 composition enriched with a high beef fat concentration (40%), which represents a significant advance in the development of an experimental zebrafish model for the study of visceral obesity and associated metabolic changes.

BMI Z-Score (SDS) versus Calculated Body Fat Percentage: Association with Cardiometabolic Risk Factors in Obese Children and Adolescents

INTRODUCTION

BMI or BMI-standardized deviation score (SDS) in children and adolescents is still the standard for weight classification. [BMJ. 2019;366:4293] developed a formula to calculate body fat percentage (%BF) based on age, sex, height, weight, and ethnicity. Using data from the German/Austrian APV registry, we investigated whether the calculated %BF is superior to BMI-SDS in predicting arterial hypertension, dyslipidaemia, and impaired glucose metabolism.

METHODS

94,586 children and adolescents were included (12.5 years, 48.3% male). Parental birth country (BC) was used to depict ethnicity (15.8% migration background); 95.67% were assigned to the ethnicity "white." %BF was calculated based on the Hudda formula. The relationship between BMI-SDS or %BF quartiles and outcome variables was investigated by logistic regression models, adjusted for age, sex, and migration background. Vuong test was applied to analyse predictive power.

RESULTS

58.4% had arterial hypertension, 33.5% had dyslipidaemia, and 11.6% had impaired glucose metabolism. Boys were significantly more often affected, although girls had higher calculated %BF (each p < 0.05). After adjustment, both models revealed significant differences between the quartiles (all p < 0.001). The predictive power of BMI-SDS was superior to %BF for all three comorbidities (all p < 0.05).

DISCUSSION

The prediction of cardiometabolic comorbidities by calculated %BF was not superior to BMI-SDS. This formula developed in a British population may not be suitable for a central European population, which is applicable to this possibly less heterogeneous collective. Additional parameters, especially puberty status, should be taken into account. However, objective determinations such as bioimpedance analysis may possibly be superior to assess fat mass and cardiometabolic risk than calculated %BF.

Analysis of serum insulin-like growth factor-1, fibroblast growth factor 23, and Klotho levels in girls with rapidly progressive central precocious puberty

To study the levels of serum insulin-like growth factor 1 (IGF-1), fibroblast growth factor 23 (FGF23), and Klotho, and to study their relationship with girls with rapidly progressive central precocious puberty (RP-CPP). This is a cross-sectional study on the progression rate of central precocious puberty in girls, who complained of breast development before the age of 8 years and were followed between June 2021 and June 2022. At the same time, 28 healthy girls less than 8 years old who had not started puberty were recruited as the control group. The physical examination and laboratory evaluation of each group was completed. Only patients with CPP received pelvic ultrasound examination and bone age test. Bone age index (BAI), basal LH levels (BLH), basal LH levels/basal FSH levels (BFSH), peak LH (PLH)/peak FSH (PFSH), IGF-1, Klotho, FGF23, and ovarian volume in the RP-CPP group were higher than those in slowly progressive CPP (SP-CPP) group. In the RP-CPP group, IGF-1 was correlated with Klotho, FGF23, and BLH; Klotho was correlated with FGF23 and BLH; FGF23 was correlated with BLH.

CONCLUSION

The BLH, FGF23, Klotho, and IGF-1 have a certain correlation with RP-CPP, which may play an important role in the speed of girls' sexual development.

WHAT IS KNOWN

• The association between IGF-1 and RP-CPP.

WHAT IS NEW

• We found the association between FGF23, Klotho and RP-CPP.

Rapid increases in BMI waist to height ratio during adolescence and subsequent neurobehavioral deficits

OBJECTIVE

The aim of this study was to explore prospective relationships between changing patterns of BMI/waist to height ratio (WHtR) during adolescence and subsequent neurobehavioral development.

METHODS

In this prospective cohort study, randomized stratified sampling was used to recruit six middle schools and 609 students in Shanghai, China. In Grades 6, 7, and 9, the Youth Self Report scale was used to assess student neurobehavioral status and anthropometric measurements were conducted to calculate BMI z scores and WHtRs. Longitudinal data were analyzed using latent class mixture modeling to delineate trajectories of BMI z scores ("stable," "decreasing," "rapidly increasing") and WHtRs ("stable," "rapidly increasing"), and their associations with neurobehavioral status in Grade 9 were assessed.

RESULTS

In Grades 6 through 9 (ages 11-15 years), the prevalence of overall obesity and abdominal obesity ranged from 10.7% to 13.0% and 13.0% to 19.8%, respectively. Compared with the stable BMI z score trajectory, the rapidly increasing BMI z score trajectory was longitudinally associated with delinquent behavior, aggressive behavior, and externalizing problems (incidence rate ratio: 1.564-1.613, adjusted p < 0.05). Compared with the stable WHtR trajectory, the rapidly increasing WHtR trajectory significantly predicted increased risks of social problems and delinquent behavior (incidence rate ratios: 1.776-1.967, adjusted p < 0.05). Significant associations of the rapidly increasing BMI z score/WHtR trajectories with subsequent neurobehavioral deficits were observed among girls (adjusted p < 0.05) but not among boys (adjusted p > 0.05).

CONCLUSIONS

Rapid increases in BMI or WHtR during adolescence could predict subsequent neurobehavioral deficits, especially for externalizing behaviors. Timely intervention for weight control may be considered to promote adolescent mental health.

Association between precocious puberty and obesity risk in children: a systematic review and meta-analysis

Objectives

The aim of this study was to evaluate the potential association between early onset puberty and the risk of different forms of obesity in children.

Methods

The databases PubMed, EMBASE, Web of Science and Cochrane Library were systematically searched for relevant studies. The odds ratio (OR) and 95% confidence interval (CI) of obesity in precocious puberty were calculated using Stata software 14.0. A fixed-effects model was used if P > 0.1 and I2 ≤ 50%. Otherwise, a random-effects model was used. Publication bias was assessed using funnel plots and Egger's test.

Result

The pooling analysis showed that precocious puberty in girls was associated with a higher risk of obesity (OR = 1.98; 95% CI: 1.76-2.24; I2 = 0.00%, P < 0.001). Girls with a history of precocious puberty were found to have an increased risk of general obesity (OR = 2.03; 95% CI: 1.62-2.55; I2 = 22.2%, P < 0.001), central obesity (OR = 1.96; 95% CI: 1.70-2.26; I2 = 0.00%, P < 0.001), and overweight (OR = 2.03; 95% CI: 1.68-2.46; I2 = 5.1%, P < 0.001). The pooled analysis showed that precocious puberty in boys was not associated with an increased risk of obesity (OR = 1.14; 95% CI: 0.86-1.51; I2 = 50.6%, P = 0.369). In boys, the occurrence of precocious puberty was not associated with an elevated risk of general obesity (OR = 0.96; 95% CI: 0.40-2.27; I2 = 79.6%, P = 0.922), central obesity (OR = 1.17; 95% CI: 0.96-1.43; I2 = 0.00%, P = 0.125), or overweight (OR = 1.03; 95% CI: 0.56-1.88; I2 = 74.4%, P = 0.930).

Conclusion

This meta-analysis suggests that the onset of puberty at an early age in girls is associated with an increased risk of obesity, however precocious puberty in boy was not associated with an increased risk of obesity. These findings highlight that precocious puberty should be considered an independent risk factor for obesity in girls.

Systematic Review Registration

CRD42023404479.

Rapid weight gain in early life is associated with central precocious puberty in girls, not in boys - a nationwide population-based study in Korea

Objectives

This study aimed to investigate the effect of rapid weight gain (RWG) on the incidence of central precocious puberty (CPP) using nationwide population-based data.

Methods

A total of 253,967 children (101,841 boys and 152,126 girls) who underwent regular health consultations under the National Health Insurance Service from 2007 to 2010 were followed up until the age of 10 years for boys and 9 years for girls. We calculated differences in the weight Z-scores from 4-6 months to 9-12 months (infancy) and from 9-12 months to 18-24 months or 30-36 months (toddlerhood) using the lambda-mu-sigma method. The population was subdivided into four groups: RWGinf/tod (infancy > + 0.67 standard deviation score [SDS], toddlerhood > 0 SDS), RWGinf (infancy > + 0.67 SDS, toddlerhood < 0 SDS), RWGtod (toddlerhood > + 0.67 SDS), and control (no RWG). The diagnosis of CPP was based on the diagnostic codes of the International Classification of Diseases 10th revision and the prescription of gonadotropin-releasing hormone agonists. The cumulative risk of CPP based on age was analyzed using Kaplan-Meier survival curves, and the association between the RWG groups and CPP was assessed using multivariate logistic regression analysis.

Results

CPP was diagnosed in 268 boys and 9,225 girls. For the girls, the CPP-free probability was the highest in the control group, followed by the RWGtod, RWGinf, and RWGinf/tod groups (log-rank p < 0.001). However, the incidence of CPP did not vary significantly for the boys. Compared to the control group, the other groups had a higher risk of CPP in girls (RWGinf/tod: adjusted odds ratio [aOR] 1.35, 95%, confidence interval [95% CI] 1.13-1.62; RWGinf: aOR 1.25, 95% CI 1.13-1.38; and RWGtod: aOR 1.18, 95% CI 1.09-1.28).

Conclusions

This nationwide population-based study demonstrated that any RWG from birth to 3 years of age contributed to an increased risk of CPP in girls but not in boys. Girls who experienced RWG during both infancy and toddlerhood had the highest risk of developing CPP. These findings suggest that early detection and appropriate management of excessive weight gain in early life may be important for preventing CPP in girls.

Links between Childhood Obesity, High-Fat Diet, and Central Precocious Puberty

In recent years, the existing relationship between excess overweight and central precocious puberty (CPP) has been reported, especially in girls. Different nutritional choices have been associated with different patterns of puberty. In particular, the involvement of altered biochemical and neuroendocrine pathways and a proinflammatory status has been described in connection with a high-fat diet (HFD). In this narrative review, we present an overview on the relationship between obesity and precocious pubertal development, focusing on the role of HFDs as a contributor to activating the hypothalamus-pituitary-gonadal axis. Although evidence is scarce and studies limited, especially in the paediatric field, the harm of HFDs on PP is a relevant problem that cannot be ignored. Increased knowledge about HFD effects will be useful in developing strategies preventing precocious puberty in children with obesity. Promoting HFD-avoiding behavior may be useful in preserving children's physiological development and protecting reproductive health. Controlling HFDs may represent a target for policy action to improve global health.