Ann Pediatr Endocrinol Metab.  2023 Sep;28(3):178-183. 10.6065/apem.2244062.031.

Slower progression of central puberty in overweight girls presenting with precocious breast development

• Kim MR
• Jung MK
• Yoo EG

• KMID: 2546341
• DOI: http://doi.org/10.6065/apem.2244062.031

Abstract

Purpose
Overweight (OW)/obese girls tend to have an earlier pubertal onset than girls with normal weight. However, only a few studies have reported the progression of puberty in these girls. This study aimed to identify risk factors for rapid pubertal progression in OW/obese girls presenting with precocious breast development.
Methods
This retrospective cohort study reviewed the medical records of 110 OW (body mass index [BMI] ≥85th percentile for age and sex) and 213 nonoverweight (NW, BMI <85th percentile for age and sex) girls who presented with breast budding before 8 years of age. OW girls were divided into 2 subgroups: girls with central puberty progression before 9 years of age (OW-RP) and those without (OW-SP).
Results
Progression to central puberty before the age of 9 was more common in NW girls than in OW girls (83.8 % vs. 65.2 % in NW vs. OW group, p<0.001), and progression-free survival for 1, 2, and 3 years was higher in the OW group (p<0.001). In a subgroup analysis of OW girls, the OW-RP subgroup had more advanced bone age (BA) at the first visit (p=0.047) and higher initial luteinizing hormone (LH, p=0.010) levels than the OW-SP subgroup. Being NW (p=0.001) and having more advanced BA (p=0.023) at the initial workup were the risk factors for pubertal progression before age 9.
Conclusion
Pubertal progression seems to be slower in OW girls than in NW girls presenting with precocious breast development. However, it can progress rapidly in OW girls with particularly pronounced BA advancement and high LH levels at the initial workup.

Keyword

Precocious puberty; Pediatric obesity; Overweight; Luteinizing hormone

Figure

• 

  Fig. 1. Flowchart of pubertal progression in overweight and nonoverweight girls with precocious breast development. LHRH, luteinizing hormone releasing hormone; BMI, body mass index; LH, luteinizing hormone.

• 

  Fig. 2. Kaplan-Meier curve showing slower progression to central puberty in overweight girls (P<0.001). OW, overweight; NW, nonoverweight; F/U, follow-up.

Reference

References

1. Cavarzere P, Mauro M, Gaudino R, Micciolo R, Piacentini G, Antoniazzi F. Role of body weight in the onset and the progression of idiopathic premature pubarche. Horm Res Paediatr. 2020; 93:351–60.

2. Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics. 2002; 110:903–10.

3. Tenedero CB, Oei K, Palmert MR. An approach to the evaluation and management of the obese child with early puberty. J Endocr Soc. 2021; 6:bvab173.

4. Abou El Ella SS, BarseeEm NF, Tawfik MA, Ahmed AF. BMI relationship to the onset of puberty: assessment of growth parameters and sexual maturity changes in Egyptian children and adolescents of both sexes. J Pediatr Endocrinol Metab. 2020; 33:121–8.

5. Biro FM, Greenspan LC, Galvez MP, Pinney SM, Teitelbaum S, Windham GC, et al. Onset of breast development in a longitudinal cohort. Pediatrics. 2013; 132:1019–27.

6. Benedet J, da Silva Lopes A, Adami F, de Fragas Hinnig P, de Vasconcelos Fde A. Association of sexual maturation with excess body weight and height in children and adolescents. BMC Pediatr. 2014; 14:72.

7. Li W, Liu Q, Deng X, Chen Y, Liu S, Story M. Association between obesity and puberty timing: a systematic review and meta-analysis. Int J Environ Res Public Health. 2017; 14:1266.

8. Kim JH, Yun S, Hwang SS, Shim JO, Chae HW, Lee YJ, et al. The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects. Korean J Pediatr. 2018; 61:135–49.

9. Marshall WA, Tanner JM. Variation in pattern of pubertal changes in girls. Arch Dis Child. 1969; 44:291–5.

10. Kang YS, Yoo DY, Chung IH, Yoo EG. Diurnal variation of gonadotropin levels in girls with early stages of puberty. Ann Pediatr Endocrinol Metab. 2017; 22:183–8.

11. McCartney CR, Prendergast KA, Chhabra S, Eagleson CA, Yoo R, Chang RJ, et al. The association of obesity and hyperandrogenemia during the pubertal transition in girls: obesity as a potential factor in the genesis of postpubertal hyperandrogenism. J Clin Endocrinol Metab. 2006; 91:1714–22.

12. Lee DS, Ryoo NY, Lee SH, Kim S, Kim JH. Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls? Ann Pediatr Endocrinol Metab. 2013; 18:196–201.

13. Bizzarri C, Spadoni GL, Bottaro G, Montanari G, Giannone G, Cappa M, et al. The response to gonadotropin releasing hormone (GnRH) stimulation test does not predict the progression to true precocious puberty in girls with onset of premature thelarche in the first three years of life. J Clin Endocrinol Metab. 2014; 99:433–9.

14. Brito VN, Latronico AC, Arnhold IJ, Mendonça BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endocrinol Metabol. 2008; 52:18–31.

15. Brito VN, Batista MC, Borges MF, Latronico AC, Kohek MB, Thirone AC, et al. Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab. 1999; 84:3539–44.

16. Resende EA, Lara BH, Reis JD, Ferreira BP, Pereira GA, Borges MF. Assessment of basal and gonadotropinreleasing hormone-stimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children. J Clin Endocrinol Metab. 2007; 92:1424–9.

17. Harrington J, Palmert MR, Hamilton J. Use of local data to enhance uptake of published recommendations: an example from the diagnostic evaluation of precocious puberty. Arch Dis Child. 2014; 99:15–20.

18. Tomova A. Body weight and puberty. New York: Springer; 2016:95-108.

19. Kim M, Kim J. Cardiometabolic risk factors and metabolic syndrome based on severity of obesity in Korean children and adolescents: data from the Korea National Health and Nutrition Examination Survey 2007–2018. Ann Pediatr Endocrinol Metab. 2022; 27:134–41.

20. Kang S, Seo MY, Kim SH, Park MJ. Changes in lifestyle and obesity during the COVID-19 pandemic in Korean adolescents: based on the Korea Youth Risk Behavior Survey 2019 and 2020. Ann Pediatr Endocrinol Metab. 2022; 27:281–8.

21. Barros BS, Kuschnir MCMC, Bloch KV, Silva TLND. ERICA: age at menarche and its association with nutritional status. J Pediatr (Rio J). 2019; 95:106–11.

22. Shrestha A, Olsen J, Ramlau-Hansen CH, Bech BH, Nohr EA. Obesity and age at menarche. Fertil Steril. 2011; 95:2732–4.

23. Vecek N, Vecek A, Zajc Petranovic M, Tomas Z, Arch-Vecek B, Skaric-Juric T, et al. Secular trend of menarche in Zagreb (Croatia) adolescents. Eur J Obstet Gynecol Reprod Biol. 2012; 160:51–4.

24. Shirtcliff EA, Granger DA, Schwartz EB, Curran MJ, Booth A, Overman WH. Assessing estradiol in biobehavioral studies using saliva and blood spots: simple radioimmunoassay protocols, reliability, and comparative validity. Horm Behav. 2000; 38:137–47.