Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.
JAMA Netw Open. 2022 Feb 1;5(2):e2146873. doi: 10.1001/jamanetworkopen.2021.46873.
Earlier pubertal onset may be associated with an increased risk of chronic diseases. However, the extent to which growth in the first 5 years of life-an important developmental life stage that lays the foundation for later health outcomes-is associated with pubertal onset remains understudied.
To assess whether changes in weight, length or height, and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) during the first 5 years of life are associated with earlier pubertal onset.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 36 cohorts participating in the Environmental Influences on Child Health Outcomes program from January 1, 1986, to December 31, 2015. Participant inclusion required at least 1 anthropometric measure in the first 5 years of life and at least 1 measure of pubertal onset. Data were analyzed from January 1 to June 30, 2021.
Standardized velocities of weight, length or height, and BMI gain in early infancy (0-0.5 years), late infancy (0.5-2 years), and early childhood (2-5 years).
Markers of pubertal onset for boys and girls, including age at peak height velocity (APHV), time to puberty score greater than 1, time to Tanner pubic hair stage greater than 1, and time to menarche. Multivariable regression models were used to estimate mean differences in APHV by growth periods.
Of 7495 children included in the study, 3772 (50.3%) were girls, 4505 (60.1%) were White individuals, and 6307 (84.1%) were born during or after the year 2000. Girls had a younger APHV (10.8 vs 12.9 years) than boys. In boys, faster weight gain (per 1-SD increase) in early infancy (β, -0.08 years; 95% CI, -0.10 to -0.06), late infancy (β, -0.10 years; 95% CI, -0.12 to -0.08), and early childhood (β, -0.07 years; 95% CI, -0.08 to -0.05) was associated with younger APHV after adjusting for the child's birth year, race, and Hispanic ethnicity as well as maternal age at delivery; educational level during pregnancy; annual household income during pregnancy; prenatal cigarette smoking; whether the mother was nulliparous; whether the mother had gestational diabetes, hypertension, or preeclampsia; mode of delivery; prepregnancy BMI; gestational weight gain; and gestational age at delivery. Similar associations were observed for length or height and BMI gains during the same age periods. In girls, faster gains (per 1-SD increase) in weight (β, -0.03 years; 95% CI, -0.05 to -0.01) and height (β, -0.02 years; 95% CI, -0.04 to 0.00) in early childhood were associated with younger APHV. Faster BMI gain in late infancy was associated with earlier time to menarche, whereas faster BMI gain in early childhood was associated with earlier time to Tanner pubic hair stage greater than 1.
This cohort study found that faster gains in weight, length or height, or BMI in early life were associated with earlier pubertal onset. The results suggest that children who experience faster early growth should be monitored closely for earlier onset of puberty and referred as appropriate for supportive services.
青春期提前可能与慢性病风险增加有关。然而，生命最初 5 年的生长程度——为后来的健康结果奠定基础的重要发育生命阶段——与青春期开始的关系仍研究不足。
评估生命最初 5 年内体重、身高或长度以及体重指数（BMI，体重公斤数除以身高米数的平方）的变化是否与青春期提前有关。
设计、地点和参与者：本队列研究使用了环境影响儿童健康结果计划（1986 年 1 月 1 日至 2015 年 12 月 31 日）中 36 个队列的数据。参与者的纳入标准是生命最初 5 年内至少有 1 项人体测量指标和至少有 1 项青春期开始的指标。数据分析于 2021 年 1 月 1 日至 6 月 30 日进行。
婴儿早期（0-0.5 岁）、婴儿晚期（0.5-2 岁）和幼儿期（2-5 岁）体重、身高或长度以及 BMI 增长的标准化速度。
男孩和女孩青春期开始的标志，包括峰值身高速度（APHV）年龄、青春期评分大于 1 的时间、Tanner 阴毛阶段大于 1 的时间和月经初潮时间。多变量回归模型用于估计生长期间 APHV 的平均差异。
在纳入的 7495 名儿童中，3772 名（50.3%）为女孩，4505 名（60.1%）为白人，6307 名（84.1%）出生于 2000 年或之后。女孩的 APHV 年龄比男孩小（10.8 岁比 12.9 岁）。在男孩中，婴儿早期（β，-0.08 岁；95%CI，-0.10 至-0.06）、婴儿晚期（β，-0.10 岁；95%CI，-0.12 至-0.08）和幼儿期（β，-0.07 岁；95%CI，-0.08 至-0.05）体重增长较快与 APHV 年龄较小有关，调整了孩子的出生年份、种族和西班牙裔民族、母亲分娩年龄、怀孕期间的教育水平、怀孕期间的家庭年收入、产前吸烟、母亲是否初产妇、母亲是否患有妊娠糖尿病、高血压或先兆子痫、分娩方式、孕前 BMI、孕期体重增加和分娩时的胎龄。在女孩中，在同一时期，体重（β，-0.03 岁；95%CI，-0.05 至-0.01）和身高（β，-0.02 岁；95%CI，-0.04 至 0.00）的生长较快与 APHV 年龄较小有关。婴儿晚期 BMI 增长较快与初潮时间较早有关，而幼儿期 BMI 增长较快与 Tanner 阴毛阶段大于 1 的时间较早有关。
本队列研究发现，生命早期体重、身高或长度或 BMI 较快增长与青春期提前有关。结果表明，生长较快的儿童应密切监测青春期提前，并酌情提供支持性服务。
