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Environmental Research Nov 2020To identify the association between phenolic chemicals and the risk of earlier puberty based on the available evidence by systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify the association between phenolic chemicals and the risk of earlier puberty based on the available evidence by systematic review and meta-analysis.
METHODS
Databases PubMed, Web of Science, and Cochrane Library were searched and retrieved appropriate journal articles on the association between phenols exposure and earlier puberty in children published before February 14, 2020. Stata software version 12.0 and Excel were used for statistical analysis.
RESULTS
Nine studies were included in the meta-analysis with total subjects of 4737. All the subjects included in our studies were girls. The pooled estimate has shown the association between 2, 5- dichrolophenol exposure, and earlier puberty in children with effect size (ES) 1.13 (95% CI: 1.06, 1.20). Exposed to other types of phenolic chemicals such as bisphenol A, Triclosan, Benzophenone-3 were not statistically significant associated with the risk of earlier puberty in children with the overall pooled estimates of ES of 1.09 (95%CI: 0.88, 1.35), ES 1.05(95% CI: 0.96, 1.15), and ES 0.98 (95% CI: 0.88, 1.10) respectively.
CONCLUSION
Our results portray that phenols particularly 2, 5- dichlorophenol exposure might be associated with the risk of earlier puberty in children. Also, caution should be taken to other type of phenolic chemicals since in subgroup analysis some individual studies have shown a positive relationship between bisphenol A, Triclosan and Benzophenone-3 exposures, and the risk of earlier puberty in children. Future cohort studies should be conducted with more sample sizes to determine the relationship between 2, 5- dichlorophenol, and the risk of earlier puberty in children of all gender.
Topics: Child; Cohort Studies; Female; Humans; Phenols; Puberty; Puberty, Precocious; Triclosan
PubMed: 32805251
DOI: 10.1016/j.envres.2020.110056 -
Journal of Alternative and... Nov 2020Herbal medicine (HM) is widely used in East Asia to treat idiopathic central precocious puberty (ICPP). However, no systematic reviews of the efficacy and safety of HM... (Meta-Analysis)
Meta-Analysis
Herbal medicine (HM) is widely used in East Asia to treat idiopathic central precocious puberty (ICPP). However, no systematic reviews of the efficacy and safety of HM for treatment of ICPP have been reported. Thus, this systematic review assessed the efficacy and safety of HM for ICPP. Most available clinical trials that investigated HM for ICPP were included in this review. Eleven databases, including Asian databases, were searched from the date of inception until June 2018. We included randomized controlled trials (RCTs) that assessed HM for ICPP. Nine RCTs including 650 participants with ICPP, were included in this review. As a result of meta-analysis, response rate of HM group was 1.14 times higher compared with control group, with moderate level of evidence. Also, serum estradiol (E2) level was significantly lower in HM group compared to control group with moderate level of evidence. Notably, serum luteinizing hormone (LH) level (IU/L) and E2 level were significantly lower in HM group than triptorelin injection group with moderate level of evidence. Bone age index and uterine volume were also significantly lower in HM group than control group with very low level of evidence. The incidence of adverse events was lower in the HM group than control group, but it was not statistically significant. According to the results of the meta-analysis, it seems that HM treatment has a significant effect on the treatment of ICPP and can effectively reduce serum LH, E2 level, and bone age. In particular, as gonadotropin-releasing hormone analog therapy has a negative effect on the growth rate and final height if bone age ≥13 years, this study suggests that HM treatment may be helpful. Additional higher quality RCTs are needed to demonstrate the efficacy and safety of HM for treatment of ICPP.
Topics: Child; Drugs, Chinese Herbal; Female; Herbal Medicine; Human Growth Hormone; Humans; Phytotherapy; Plant Preparations; Plants, Medicinal; Puberty, Precocious; Randomized Controlled Trials as Topic; Research Design
PubMed: 32654496
DOI: 10.1089/acm.2019.0312 -
Environmental Science. Processes &... Apr 2020Exposure to phthalate derivatives has adverse effects on the health and development of humans, especially for children. A growing body of evidence supports the idea that... (Meta-Analysis)
Meta-Analysis
Exposure to phthalate derivatives has adverse effects on the health and development of humans, especially for children. A growing body of evidence supports the idea that exposure to phthalates can change an individual's physiological set point and the time of puberty in both genders. In this systematic review and meta-analysis, recent studies were evaluated to obtain systematic and regulation results in relation to puberty status and phthalate exposure in girls and boys. We searched English-language papers using Scopus, ISI, and PubMed databases as search engines, with no restriction of time, until the end of July 2019. A comprehensive literature search for an association between phthalate exposure and signs of puberty as well as levels of different types of hormones was carefully performed. Of the 67 studies retained for full-text screening, 39 studies were eligible for data management and extraction. For conducting a meta-analysis, four studies had appropriate effect size and metrics for pooling in the meta-analysis. Our findings revealed that low and high exposure to phthalates could alter pubertal development in both genders; the effects were either early or delayed puberty such as changes in the pubarche, thelarche, and menarche time, as well as in testicular volume. We statistically analyzed the association of pubic-hair development, breast development, and menarche time with exposure to phthalates in girls. For example, the pooled odds ratios of mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) in relation to breast development were (OR: 1.48, 95% CI: 1.11-1.85) and (OR: 1.52, 95% CI: 1.15-1.58) (P-value < 0.001), respectively. In addition, we analyzed the correlation between pubic-hair development and testicular volume with exposure to phthalates in boys. To the best of our knowledge, this is the first systematic review and meta-analysis of its kind for girls and boys. In conclusion, we found that a positive association exists between phthalate exposure and pubertal timing in the pediatric age group. Therefore, prevention of exposure to phthalates and reduction of their use should be underscored in the strategies for primordial prevention of pubertal timing and related consequences.
Topics: Adolescent; Child; Environmental Pollutants; Female; Humans; Male; Phthalic Acids; Puberty, Delayed; Sexual Maturation
PubMed: 32091510
DOI: 10.1039/c9em00512a -
Journal of Pediatric Endocrinology &... Mar 2020The objective of this short communication was the relationship between vitamin D and precocious puberty (PP). In this study, a comprehensive search of multiple databases... (Meta-Analysis)
Meta-Analysis
The objective of this short communication was the relationship between vitamin D and precocious puberty (PP). In this study, a comprehensive search of multiple databases was performed to identify studies focused on the association between vitamin D deficiency and PP. Studies that compared serum vitamin D levels between patients with PP and controls were selected for the systematic meta-analysis. The main outcome was the mean difference in serum vitamin D levels between PP and controls. Vitamin D-deficient subjects were more likely to develop PP. Our findings suggest that PP may be linked to vitamin D deficiency. Thus, providing supplements of vitamin D to PP patients may improve their nutritional status and prevent diseases. But, the amount of vitamin D required is uncertain, so it is important to be careful when taking vitamin D supplements.
Topics: Child; Female; Humans; Male; Nutritional Status; Puberty, Precocious; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 32069239
DOI: 10.1515/jpem-2019-0388 -
JAMA Pediatrics Apr 2020The initial clinical sign of pubertal onset in girls is breast gland development (thelarche). Although numerous studies have used recalled age at menarche (first... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The initial clinical sign of pubertal onset in girls is breast gland development (thelarche). Although numerous studies have used recalled age at menarche (first menstruation) to assess secular trends of pubertal timing, no systematic review has been conducted of secular trends of thelarche.
OBJECTIVES
To systematically evaluate published data on pubertal timing based on age at thelarche and evaluate the change in pubertal onset in healthy girls around the world.
DATA SOURCES
A systematic literature search was performed in PubMed and Embase of all original peer-reviewed articles published in English before June 20, 2019.
STUDY SELECTION
Included studies used clinical assessment of breast development in healthy girls and used adequate statistical methods, including the reporting of SEs or CIs. The quality of the articles was evaluated by assessing study design, potential sources of bias, main characteristics of the study population, and methods of statistical analysis.
DATA EXTRACTION AND SYNTHESIS
In accordance with PRISMA guidelines, all articles were assessed for eligibility independently by 2 authors. Weighted regression analysis was performed using a random-effects model.
MAIN OUTCOMES AND MEASURES
Studies examining age at thelarche (development of Tanner breast stage 2) in healthy girls.
RESULTS
The literature search resulted in a total of 3602 studies, of which 30 studies fulfilled the eligibility criteria. There was a secular trend in ages at thelarche according to race/ethnicity and geography. Overall, the age at thelarche decreased 0.24 years (95% CI, -0.44 to -0.04) (almost 3 months) per decade from 1977 to 2013 (P = .02).
CONCLUSIONS AND RELEVANCE
The age at thelarche has decreased a mean of almost 3 months per decade from 1977 to 2013. A younger age at pubertal onset may change current diagnostic decision-making. The medical community needs current and relevant data to redefine "precocious puberty," because the traditional definition may be outdated, at least in some regions of the world.
Topics: Adolescent; Age Factors; Breast; Child; Female; Humans; Puberty
PubMed: 32040143
DOI: 10.1001/jamapediatrics.2019.5881 -
Journal of the Endocrine Society May 2019mutations represent the most common genetic cause of central precocious puberty (CPP) but associations between genotype and clinical features have not been extensively...
mutations represent the most common genetic cause of central precocious puberty (CPP) but associations between genotype and clinical features have not been extensively explored. This systematic review and meta-analysis investigated genotype-phenotype associations and prevalence of mutations in CPP. The search was conducted in seven electronic databases (Cochrane, EMBASE, LILACS, LIVIVO, PubMed, Scopus, and Web of Science) for articles published until 4 September 2018. Studies evaluating mutations in patients with CPP were considered eligible. A total of 22 studies, studying 880 subjects with CPP, fulfilled the inclusion criteria. Eighty-nine subjects (76 girls) were identified as harboring mutations. Girls, compared with boys, exhibited earlier age at pubertal onset (median, 6.0 years; range, 3.0 to 7.0 8.5 years; range, 5.9 to 9.0; < 0.001), and higher basal FSH levels (median, 4.3 IU/L; range, 0.7 to 13.94 IU/L 2.45 IU/L; range, 0.8 to 13.70 IU/L; = 0.003), and bone age advancement (BA; median, 2.3 years; range, -0.9 to 5.2 1.2 years; range, 0.0 to 2.3; = 0.01). Additional dysmorphisms were uncommon. A total of 14 studies evaluating 857 patients were included for quantitative analysis, with a pooled overall mutation prevalence of 9.0% (95% CI, 0.04 to 0.15). Subgroup analysis showed that prevalence estimates were higher in males, familial cases, and in non-Asian countries. In conclusion, mutations are associated with nonsyndromic CPP and manifest in a sex-dimorphic manner, with girls being affected earlier. They represent a common cause of CPP in western countries, especially in boys and familial cases.
PubMed: 31041429
DOI: 10.1210/js.2019-00041 -
Developmental Medicine and Child... Dec 2019To evaluate neuropsychiatric comorbidities in children and adolescents with hypothalamic hamartoma.
AIM
To evaluate neuropsychiatric comorbidities in children and adolescents with hypothalamic hamartoma.
METHOD
We retrospectively analysed case notes for all individuals with hypothalamic hamartoma referred to Great Ormond Street Hospital, London, between 2000 and 2016. In addition, a systematic review aiming to identify all previous paediatric case series was performed. Psychiatric symptoms, demographics, physical comorbidities, and cognitive functioning were recorded for all cases where possible. Analyses were performed to determine which factors were associated with psychopathology and potential mechanisms investigated.
RESULTS
Forty-six cases were included in the case series (28 males, 18 females; mean age at assessment 11y 8mo [1y 11mo-16y 11mo, SD 4y 0mo]). Twenty-nine papers representing data from 264 cases met inclusion criteria for the systematic review. Overall, at least 50% of cases presented with psychopathology. Epilepsy, intellectual disability, and male sex were associated with externalizing disorders (attention-deficit/hyperactivity disorder, conduct and oppositional defiance disorders, and rage attacks). Intellectual disability mediated the effects of epilepsy on externalizing psychopathology. No factors were associated with internalizing disorders (anxiety and depressive disorders), although these were not well reported.
INTERPRETATION
Psychiatric comorbidities are highly prevalent in the presentation of paediatric hypothalamic hamartoma. The aetiology of psychopathology comprises a range of interacting biological and psychosocial factors with particular influence from epilepsy. Further research is required to achieve an evidence base for treatment.
WHAT THIS PAPER ADDS
Over half of children with hypothalamic hamartoma present with psychiatric comorbidity. Externalizing and internalizing disorders are present in approximately 60% and 30% of children with hypothalamic hamartomas respectively. Epilepsy and male sex are associated with externalizing psychopathology. Intellectual disability mediates the association between epilepsy and externalizing symptoms. No clear associations are evident for internalizing disorders or precocious puberty.
Topics: Adolescent; Child; Child, Preschool; Comorbidity; Epilepsy; Female; Hamartoma; Humans; Hypothalamic Diseases; Infant; Male; Mental Disorders; Sex Factors
PubMed: 30977116
DOI: 10.1111/dmcn.14241 -
Journal of Pediatric Endocrinology &... Jul 2018Background Some pediatric endocrinologists recommend that girls with central precocious puberty (CPP) have cranial magnetic resonance imaging (MRI) performed only if... (Meta-Analysis)
Meta-Analysis Review
Background Some pediatric endocrinologists recommend that girls with central precocious puberty (CPP) have cranial magnetic resonance imaging (MRI) performed only if they are younger than 6 years of age. However, no practice guidelines exist. The objective of this review was to assess the frequency of intracranial lesions in girls with CPP. Content We searched six electronic databases (PubMed, Cochrane, Web of Science, SCOPUS, ProQuest, and Dissertation & Theses) from 1990 through December 2015. We included studies on girls with CPP and MRI data. Case reports, case series, studies from the same author/group with the same patient population, and studies with conditions predisposing to CPP were excluded. Two physicians independently reviewed the search results and extracted data. A random-effects model was used to obtain pooled prevalence of positive MRI's across studies. Heterogeneity among studies was evaluated with the Q-statistic. Publication bias was assessed with funnel plots and Egger's test. Pooled prevalence was computed by age group. A linear regression assessed the relationship between intracranial lesion prevalence and healthcare availability. We included 15 studies with a total of 1853 girls <8 year old evaluated for CPP. Summary The pooled prevalence from all studies was 0.09 [95% confidence interval (CI) 0.06-0.12]. There was a significant heterogeneity, indicating the appropriateness of a random effects model in computing pooled prevalence. In the few studies stratified by age group, pooled prevalence was 25% in girls <6 years vs. 3% in girls 6-8 of age. Outlook Our results support that the benefit of routine MRIs in girls with CPP older than 6 years of age without any neurological concerns is not clear-cut.
Topics: Brain Diseases; Child; Female; Humans; Magnetic Resonance Imaging; Prevalence; Prognosis; Puberty, Precocious
PubMed: 29902155
DOI: 10.1515/jpem-2018-0052 -
International Journal of Environmental... Nov 2017: Epidemiological studies reporting the effect of small fetuses (SF) on puberty development have shown inconsistent results. : To examine current study evidence and... (Meta-Analysis)
Meta-Analysis Review
: Epidemiological studies reporting the effect of small fetuses (SF) on puberty development have shown inconsistent results. : To examine current study evidence and determine the strength and direction of the association between SF and puberty timing. : PubMed, OVID, Web of Science, EBSCO, and four Chinese databases were searched from their date of inception to February 2016. All cohort studies that examined the association between SF and puberty timing in children were identified. Two reviewers independently screened the studies, assessed the quality of included studies, and extracted the data. The quality of the included cohort studies was assessed by the Newcastle-Ottawa Scale. Risk ratio (RR), Weighted Mean Difference (WMD), and 95% confidence intervals (CIs) were calculated and pooled by RevMan5.3 (Cochrane Collaboration, London, UK). : A total of 10 cohort studies involving 2366 subjects was included in the final analysis. The pooled estimates showed that SF did not significantly increase the number of pubertal children in boys (RR: 0.97; 95% CI: 0.82 to 1.15), or in girls (RR: 0.91; 95% CI: 0.79 to 1.04). Compared with the control group, the SF group had an earlier onset of puberty in girls (WMD: -0.64; 95% CI: -1.21 to -0.06), and in precocious pubarche (PP) girls (WMD: -0.10; 95% CI: -0.13 to -0.07). There was no difference in the onset of puberty in boys (WMD: -0.48; 95% CI: -1.45 to 0.50) between SF and control groups. The pooled result indicated an earlier age at menarche in girls born small for gestational age (WMD: -0.30; 95% CI: -0.58 to -0.03), but no difference in the age at menarche in the SF group of PP girls. : SF may be associated with an earlier age of onset of puberty, especially among girls, as well as earlier age at menarche for girls. Well-designed studies with larger sample sizes and long-term follow-up among different countries and ethnicities are needed.
Topics: Cohort Studies; Fetal Development; Humans; Infant, Newborn; Infant, Small for Gestational Age; Puberty; Sexual Maturation
PubMed: 29137163
DOI: 10.3390/ijerph14111377 -
Journal of Developmental Origins of... Dec 2016The decline in age of pubertal timing has serious public health implications ranging from psychosocial adjustment problems to a possible increase in reproductive... (Review)
Review
The decline in age of pubertal timing has serious public health implications ranging from psychosocial adjustment problems to a possible increase in reproductive cancers. One biologically plausible explanation for the decline is a decrease in exposures to infections. To systematically review studies that assess the role of infection in pubertal timing, Medline, Web of Science and EMBASE were systematically searched and retrieved studies were reviewed for eligibility. Eligible studies examined the association between infections, including microbial exposures, and physical pubertal characteristics (breast, genitalia and pubic hair development) or age at menarche. We excluded studies that were published in a language other than English, focused on precocious puberty, were case studies, and/or included youth with autoimmune diseases. We report on study design, population characteristics, measurement of infection and puberty and the main effects of infection on pubertal development. Based on our search terms we identified 1372 unique articles, of which only 15 human and five animal studies met our eligibility criteria. Not all studies examined all outcomes. Infection was associated with later breast development (4/4 human studies), with less consistent evidence for genitalia and pubic hair development. Seven studies assessed age at menarche with inconsistent findings (three supporting later, four no association). We conclude that a small but consistent literature supports that infection is associated with later breast development; the evidence for other pubertal events and age at menarche is less clear. Where fewer childhood infections coincide with the rise in incidence of hormone-related cancers.
Topics: Age Factors; Age of Onset; Female; Humans; Infections; Puberty; Sexual Maturation
PubMed: 27827292
DOI: 10.1017/S2040174416000313