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

2. DP Williams 2007 Prevalence Overweight

3. DP Williams 2007 Tanner Stage Girls Tanner Stage Stage DevelopmentPubic HairBreasts 1Early Adolescence (10-13) Preadolescent 2Sparse, straightSmall mound 3Middle Adolescence (12-14) Dark, curlBigger, no contour separation 4Course, curly, abundant Secondary mound of areola 5Late Adolescence (14-17) Triangle, medial thigh Nipple projects, areola part of breast

4. DP Williams 2007 Tanner Stage Boys Tanner Stage Stage DevelopmentPubic HairPenis/Testes 1Early Adolescence (10.5-14) NonePreadolescent 2ScantySlight increase/ Larger 3Middle Adolescence (12.5-15) Darker, curlLonger/ Larger 4Adult, course, curlyLarger/ Scrotum dark 5Late Adolescence (14-16) Adult, thighsAdult/ Adult

5. DP Williams 2007 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

6. DP Williams 2007 Reported Maturation 1974 Frisch hypothesized “critical body weight” necessary for onset of puberty YearAge Tanner 2Age Menarche 194011.0 196911.1-11.913.5 20029.5 African American 10.3 White 12.0 African American 12.5 White

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

8. DP Williams 2007 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

9. DP Williams 2007 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

10. DP Williams 2007 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

11. DP Williams 2007 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

12. DP Williams 2007 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

13. DP Williams 2007 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)

14. DP Williams 2007 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)

15. DP Williams 2007 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

16. DP Williams 2007 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

17. DP Williams 2007 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

18. DP Williams 2007 Questions

19. DP Williams 2007 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.