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Obesity and Early Puberty

Obesity and Early Puberty. Pauline Williams, MPA, RD, CD. Prevalence Overweight. Tanner Stage Girls. Tanner Stage Boys. Tanner Stage.

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Obesity and Early Puberty

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  1. Obesity and Early Puberty Pauline Williams, MPA, RD, CD

  2. Prevalence Overweight DP Williams 2007

  3. Tanner Stage Girls DP Williams 2007

  4. Tanner Stage Boys DP Williams 2007

  5. Tanner Stage • Middle Adolescence (Stages 3 and 4): acceleration of weight and growth as well as secondary sex characteristics.  Pubic hair first, then axillary, then facial hair. • Female: menarche (average age 12 years) - can occur in Stages 1 and 2; usually 3 and 4 factors affecting: nutrition, genetic - age of mother’s menarche. • Male: gynecomastia also appears during middle adolescence: up to 70% of normal males DP Williams 2007

  6. Reported Maturation • 1974 Frisch hypothesized “critical body weight” necessary for onset of puberty DP Williams 2007

  7. Chicken or Eggwhich came first • Increased obesity is leading to early puberty • Early puberty is leading to increased obesity • Fact: Obesity and early puberty are related DP Williams 2007

  8. Early puberty associations • BMI at 36 months • Rate of change of BMI between 36 months and age 6 • Early age of maternal menarche • Nonwhite race DP Williams 2007

  9. Evidence • Lee, JM, et al. Weight Status in Young Girls and Onset Puberty (2007) • 354 girls • Longitudinal • Ht, wt, assessment of pubertal stage • Measured at • 36 months, 54 months • Grades 1,4,5, and 6 DP Williams 2007

  10. Results • Lee et al (2007) • Higher BMI at 36 months • Higher rate of change of BMI • By grade 4; 30% were at risk or overweight • Both associated with early puberty • Increased body fatness precedes onset of puberty DP Williams 2007

  11. Evidence • Ribeiro, P, et al Association between overweight and early sexual maturation in Portuguese boys and girs (2005) • 382 boys, 437 girls • Cross-sectional • BMI, skinfolds, Tanner stage • Ages 10-15 DP Williams 2007

  12. Results • Ribeiro et al (2005) • Overweight higher in early maturing boys and girls (30.5%, 32.7%) • Lower prevalence overweight in late maturing boys and girls (20.3%, 18.3%) • Association between early sexual maturity and prevalence of overweight in both genders DP Williams 2007

  13. Evidence • McCartney, R, et al Obesity and Sex Steroid Changes across Puberty (2006) • 30 normal weight 74 obese peripubertal girls • Cross-sectional • BMI, Tanner stage, blood tests (testosterone, fasting insulin, progesterone, LH) DP Williams 2007

  14. Results • McCartney et al (2006) • Peripubertal obesity associated with high hormone levels and high insulin levels • Known association between childhood obesity and insulin resistance and hyperinsulinemia • High insulin may lead to adult polycystic ovary syndrome (PCOS) DP Williams 2007

  15. Pubertal Timing Controversy? • Syper Review (2006) • Tanner stage may be overestimated • Adipose tissue can resemble true breast tissue • Evidence not conclusive that early puberty is due to obesity; ? Early puberty leads to obesity? • More longitudinal studies DP Williams 2007

  16. Consequences of Early Puberty • Psychiatric disorders • Deficit in psychosocial functioning • Early initiation of alcohol, sexual intercourse, and teenage pregnancy • Increased rates of adult obesity • Increased rates of reproductive cancers DP Williams 2007

  17. Review • Puberty beginning 6 months to 2 years earlier • Obesity and early puberty are associated • High BMI at 36 months • Rate of change of BMI by first grade • Cause and effect? • Other associations • Early age maternal menarche • Nonwhite race • More longitudinal studies needed DP Williams 2007

  18. Questions DP Williams 2007

  19. References • Lee, JM, Appugliese, D, Kaciroti, N, Corwyn, RF, Bradley, RH, Lumeng, JC (2007) Weight Status in Young girls and the Onset of Puberty. Pediatrics 2007;119;E624-630. • McCartney, CR, et al (2007) Obesity and Sex Steroid Changes across Puberty: Evidence for marked Hyperandrogenemia in Pre-and Early Pubertal Obese Girls. J Clin Endocrin & Metab; 92(2):430-436. • Ribeiro, J, Santos, P, Duarte, J, & Mota, J. (2006) Association between overweight and early sexual maturation in Portuguese boys and girls. Ann Human Biology; 33(1): 55-63. • Slyper, AH. (2006). The pubertal timing controversy in the USA, and a review of possible causative factors for the advance in timing of onset of puberty. Clin Endocrinology; 65:1-8. DP Williams 2007

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