Reinehr Thomas, Bosse Christina, Lass Nina, Rothermel Juliane, Knop Caroline, Roth Christian Ludwig
Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten, Germany.
Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten, Germany.
J Pediatr. 2017 May;184:143-150.e1. doi: 10.1016/j.jpeds.2017.01.066. Epub 2017 Feb 24.
To assess the impact of weight changes on the onset of puberty in overweight children.
We evaluated the timing of puberty onset in 160 prepubertal overweight children (aged 11.2 ± 1.0 years) depending on the changes of their weight status in a 1-year lifestyle intervention. We determined body mass index (BMI), pubertal stage, luteinizing hormone (LH), follicle-stimulating hormone, insulin-like growth factor (IGF)-1, insulin-like growth factor binding protein-3, insulin resistance index homeostatic model assessment, and serum gonadotropins at baseline and 1 year later.
Puberty onset during the 1-year follow-up was significantly (P = .014) more frequent in girls without BMI-SDS reduction (75.0%) compared with girls with BMI-SDS reduction (45.7%). The start of puberty was significantly (P = .024) more frequent in boys with BMI-SDS reduction (76.9%) compared with boys without BMI-SDS reduction (53.6%). In logistic regression analyses adjusted for baseline age and BMI-SDS, BMI-SDS reduction was associated with a decreased likelihood for puberty onset in girls (OR 0.24; 95% CI 0.07-0.85) and an increased likelihood in boys (OR 3.77; 95% CI 1.34-10.52). Central onset of puberty was confirmed by an increase of LH concentration and LH/follicle-stimulating hormone ratio in both boys and girls. Homeostatic model assessment, IGF-1, and IGF-1/insulin-like growth factor binding protein-3 ratio as marker for free IGF-1 at baseline or their changes were not associated with the onset of puberty.
BMI-SDS reduction in overweight children was associated with earlier gonadotropin-dependent onset of puberty in boys and later onset of puberty in girls, suggesting earlier puberty in obese girls and later puberty in obese boys. We found no evidence that insulin resistance or IGF-1 have an impact on the start of puberty in obese children.
ClinicalTrials.gov: NCT00435734.
评估体重变化对超重儿童青春期启动的影响。
我们在一项为期1年的生活方式干预中，根据160名青春期前超重儿童（年龄11.2±1.0岁）体重状况的变化，评估其青春期启动的时间。我们测定了基线时以及1年后的体重指数（BMI）、青春期阶段、促黄体生成素（LH）、促卵泡生成素、胰岛素样生长因子（IGF）-1、胰岛素样生长因子结合蛋白-3、胰岛素抵抗指数稳态模型评估以及血清促性腺激素。
在1年的随访期间，与BMI-SDS降低的女孩（45.7%）相比，BMI-SDS未降低的女孩青春期启动更为频繁（75.0%），差异有统计学意义（P = 0.014）。与BMI-SDS未降低的男孩（53.6%）相比，BMI-SDS降低的男孩青春期启动更为频繁（76.9%），差异有统计学意义（P = 0.024）。在对基线年龄和BMI-SDS进行校正的逻辑回归分析中，BMI-SDS降低与女孩青春期启动可能性降低相关（比值比[OR]0.24；95%置信区间[CI]0.07 - 0.85），而与男孩青春期启动可能性增加相关（OR 3.77；95% CI 1.34 - 10.52）。男孩和女孩体内LH浓度及LH/促卵泡生成素比值升高证实了青春期的中枢性启动。稳态模型评估、IGF-1以及作为游离IGF-1标志物的IGF-1/胰岛素样生长因子结合蛋白-3比值在基线时或其变化与青春期启动无关。
超重儿童BMI-SDS降低与男孩促性腺激素依赖性青春期较早启动以及女孩青春期较晚启动相关，提示肥胖女孩青春期较早而肥胖男孩青春期较晚。我们没有发现胰岛素抵抗或IGF-1对肥胖儿童青春期启动有影响的证据。
ClinicalTrials.gov：NCT00435734。
