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BMC Pediatrics Jan 2018An estimated 11% of births occur preterm, and survival is improving. Early studies suggested an association between preterm birth and earlier puberty. Given the adverse... (Review)
Review
BACKGROUND
An estimated 11% of births occur preterm, and survival is improving. Early studies suggested an association between preterm birth and earlier puberty. Given the adverse outcomes associated with early puberty this could have significant public health implications. The objective of this review was to assess the timing of puberty after preterm birth.
METHODS
Pubmed, Embase, Popline, Global Health and Global Health Library were searched using terms relating to "premature birth", "menarche", "puberty" and "follow up studies". Inclusion criteria were a population consisting of pubertal or post-pubertal adolescents and adults; studies which defined preterm delivery in participants and compared outcomes to those after term delivery; and a quantitative assessment of pubertal onset. Assessment of risk of bias was conducted using principles from the Critical Appraisal Study Process.
RESULTS
Our search identified 1051 studies, of which 16 met the inclusion criteria. In females, 8 studies found no association between preterm birth and the timing of menarche. Five studies found earlier onset in preterm infants, 1 found later onset, and 1 showed both earlier and later menarche, depending on birth weight. The range of effect of studies showing earlier menarche was - 0.94 to -0.07 years in the preterm group, with a median of - 0.3 years. In males, 2 studies showed earlier onset of puberty in the preterm group, 5 showed no difference, and 1 showed later onset. Most studies did not present outcomes in the form of a mean with standard deviation, precluding a meta-analysis. There was insufficient data to address potential confounding factors.
CONCLUSIONS
The published evidence does not suggest that being born preterm leads to a significant acceleration in the onset of puberty. This should prove reassuring for public health purposes, and for clinicians counseling parents of infants born preterm.
Topics: Confounding Factors, Epidemiologic; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Menarche; Premature Birth; Sample Size; Selection Bias; Time Factors
PubMed: 29310614
DOI: 10.1186/s12887-017-0976-8 -
Frontiers in Pediatrics 2023The aim of this study was to evaluate the potential association between early onset puberty and the risk of different forms of obesity in children. (Review)
Review
OBJECTIVES
The aim of this study was to evaluate the potential association between early onset puberty and the risk of different forms of obesity in children.
METHODS
The databases PubMed, EMBASE, Web of Science and Cochrane Library were systematically searched for relevant studies. The odds ratio (OR) and 95% confidence interval (CI) of obesity in precocious puberty were calculated using Stata software 14.0. A fixed-effects model was used if > 0.1 and ≤ 50%. Otherwise, a random-effects model was used. Publication bias was assessed using funnel plots and Egger's test.
RESULT
The pooling analysis showed that precocious puberty in girls was associated with a higher risk of obesity (OR = 1.98; 95% CI: 1.76-2.24; = 0.00%, < 0.001). Girls with a history of precocious puberty were found to have an increased risk of general obesity (OR = 2.03; 95% CI: 1.62-2.55; = 22.2%, < 0.001), central obesity (OR = 1.96; 95% CI: 1.70-2.26; = 0.00%, < 0.001), and overweight (OR = 2.03; 95% CI: 1.68-2.46; = 5.1%, < 0.001). The pooled analysis showed that precocious puberty in boys was not associated with an increased risk of obesity (OR = 1.14; 95% CI: 0.86-1.51; = 50.6%, = 0.369). In boys, the occurrence of precocious puberty was not associated with an elevated risk of general obesity (OR = 0.96; 95% CI: 0.40-2.27; = 79.6%, = 0.922), central obesity (OR = 1.17; 95% CI: 0.96-1.43; = 0.00%, = 0.125), or overweight (OR = 1.03; 95% CI: 0.56-1.88; = 74.4%, = 0.930).
CONCLUSION
This meta-analysis suggests that the onset of puberty at an early age in girls is associated with an increased risk of obesity, however precocious puberty in boy was not associated with an increased risk of obesity. These findings highlight that precocious puberty should be considered an independent risk factor for obesity in girls.
SYSTEMATIC REVIEW REGISTRATION
CRD42023404479.
PubMed: 37635793
DOI: 10.3389/fped.2023.1226933 -
BMC Endocrine Disorders Oct 2023Many studies have investigated the impact of precocious puberty on cardiovascular disease (CVD) outcomes and the association between lipid profile levels and precocious... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Many studies have investigated the impact of precocious puberty on cardiovascular disease (CVD) outcomes and the association between lipid profile levels and precocious puberty. However, the results have been inconsistent. The aim of this meta-analysis was to evaluate whether triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL)and low density lipoprotein (LDL) levels were altered in girls with precocious puberty compared with healthy controls.
METHODS
References published before June 2022 in the EMBASE, Cochrane Library, PubMed and Web of Science databases were searched to identify eligible studies. A DerSimonian-Laird random-effects model was used to evaluate the overall standard mean difference (SMD) between precocious puberty and healthy controls. Subgroup analyses and sensitivity analyses were preformed, and publication bias was assessed.
RESULTS
A total of 14 studies featuring 1023 girls with precocious puberty and 806 healthy girls were selected for analysis. The meta-analysis showed that TG (SMD: 0.28; 95% CI: 0.01 to 0.55; P = 0.04), TC (SMD: 0.30; 95% CI: 0.01 to 0.59; P = 0.04), LDL (SMD: 0.45; 95% CI: 0.07 to 0.84; P = 0.02)levels were significantly elevated in girls with precocious puberty. HDL levels did not change significantly (SMD: -0.06; 95% CI: -0.12 to 0.61; P = 0.62). Subgroup analyses revealed that the heterogeneity in the association between lipid profile and precocious puberty in this meta-analysis may arise from disease type, region, sample size, chronological age, body mass index difference and drug usage.
CONCLUSION
Lipid profile levels altered in girls with precocious puberty compared with healthy controls. In order to minimize the risk of CVD morbidity and mortality, early interventions were needed to prevent obesity in children and adolescents, especially those with precocious puberty.
Topics: Female; Child; Adolescent; Humans; Lipids; Pediatric Obesity; Puberty, Precocious; Cholesterol, HDL; Cholesterol, LDL; Triglycerides; Cardiovascular Diseases
PubMed: 37848909
DOI: 10.1186/s12902-023-01470-8 -
International Journal of Environmental... Oct 2017This systematic review and meta-analysis examined the associations between obesity and puberty timing based on scientific evidence. Eight electronic databases were... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis examined the associations between obesity and puberty timing based on scientific evidence. Eight electronic databases were searched up to February 2017 for eligible studies, and two reviewers screened the articles and extracted the data independently. A total of 11 cohort studies with 4841 subjects met the inclusion criteria. Compared with the group of normal-weight girls, the obese group had more girls with menarche (RR: 1.87, 95% CI: 1.59-2.19, 2 studies). The number of girls with early puberty was significantly higher in the obese group than the normal weight group (RR: 2.44, 95% CI: 1.32-4.52, 5 studies). However, no differences were detected between girls who were obese or normal weight at age of menarche (WMD: -0.53 years, 95% CI: -1.24-0.19, 2 studies). There is no consistent result in the relationship between obesity and timing of pubertal onset in boys. Obesity may contribute to early onset of puberty in girls, while in boys, there is insufficient data. Given the limited number of cohort studies included in this meta-analysis, high-quality studies with strong markers of puberty onset, as well as standardized criteria for defining obesity are needed.
Topics: Cohort Studies; Humans; Obesity; Puberty; Sexual Maturation
PubMed: 29064384
DOI: 10.3390/ijerph14101266 -
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 -
The South African Journal of... 2019Adolescent idiopathic scoliosis (AIS) is one of the most common structural spinal deformities in adolescents, becoming apparent around the time of puberty. Schroth...
BACKGROUND
Adolescent idiopathic scoliosis (AIS) is one of the most common structural spinal deformities in adolescents, becoming apparent around the time of puberty. Schroth scoliosis-specific exercises have demonstrated promising results in reducing the progression of AIS.
OBJECTIVES
The aim of this study was to identify, critically appraise and establish the best available evidence for the effectiveness of Schroth exercises in comparison to non-surgical management to reduce the progression of AIS.
METHODOLOGY
Seven databases were searched in April 2018. Main key search terms included and . The quality of the trials was critically appraised according to the PEDro scale. Revman© Review Manager Software was used to pool the quality of life (QOL) results.
RESULTS
Four randomised control trials with an average PEDro score of 6.75/10 were included in this study. Results indicated that Schroth exercises had a significant effect in decreasing the Cobb angle ( < 0.05) in comparison to non-surgical management. The pooled effect on QOL showed a significant result in favour of Schroth exercises at 12 weeks ( < 0.002) and at 24 weeks ( < 0.0004).
CONCLUSION
Level II evidence suggests that Schroth exercises have a significant effect on reducing the Cobb angle and improving QOL in adolescents with idiopathic scoliosis.
CLINICAL IMPLICATIONS
This review's findings should be considered with caution for physiotherapy practice because of the limited number of identified articles and their methodologic limitations. Based on the current available and limited evidence, clinicians could combine supervised Schroth exercises with conventional physiotherapy care (observation, exercise, bracing and manual therapy) when treating adolescents with idiopathic scoliosis.
PubMed: 31206094
DOI: 10.4102/sajp.v75i1.904 -
BMJ Clinical Evidence Apr 2010Prevalence of childhood constipation has been estimated at 0.7% to 29.6% in the general population worldwide; most children have no obvious aetiological factors. One... (Review)
Review
INTRODUCTION
Prevalence of childhood constipation has been estimated at 0.7% to 29.6% in the general population worldwide; most children have no obvious aetiological factors. One third of children with chronic constipation continue to have problems beyond puberty. Half of children with chronic faecal impaction and faecal incontinence have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for children with chronic constipation? What are the effects of treatments for clearing the bowel in children with faecal impaction? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 14 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: anal dilatation, behavioural treatments (biofeedback, diaries, or toilet training), bulk-forming laxatives, enemas, faecal softeners, fibre, macrogols, oral fluids, osmotic laxatives, prebiotics, probiotics, stimulant laxatives, and surgical disimpaction.
Topics: Administration, Oral; Child; Constipation; Fecal Incontinence; Humans; Laxatives; Polyethylene Glycols; Sexual Maturation
PubMed: 21718570
DOI: No ID Found -
The American Journal of Clinical... Oct 2016Puberty is a time of rapid growth and changing energy requirements and is a risk period for obesity. There is little high-quality evidence on the pubertal alterations of... (Review)
Review
BACKGROUND
Puberty is a time of rapid growth and changing energy requirements and is a risk period for obesity. There is little high-quality evidence on the pubertal alterations of energy expenditure and intake, and this has limited our understanding of energy balance during this important life stage.
OBJECTIVE
The purpose of this study was to summarize existing evidence on pubertal energy expenditure and intake in healthy nonobese adolescents.
DESIGN
Studies were identified through CINAHL, the Cochrane Library, Embase, MEDLINE, and Web of Science databases up to August 2015. Articles presenting objectively measured data for basal or resting metabolic rate (BMR/RMR), total daily energy expenditure (TDEE), and/or energy intake (EI) for ≥2 categories of puberty were included. Relevant data adjusted for fat-free mass (FFM) also were extracted. Data were dichotomized into prepubertal and pubertal groups and compared through the use of standardized mean differences (SMDs). Heterogeneous study methodologies precluded meta-analysis.
RESULTS
The search netted 6770 articles, with 12 included for review. From these, 6 of 9 studies supported significantly higher absolute BMR/RMR during puberty (SMD: 1.10-5.93), and all of the studies favored significantly higher absolute TDEE during puberty (SMD: 0.46-9.55). These corresponded to a 12% difference and an 18% difference in absolute BMR/RMR and TDEE, respectively. Results adjusted for FFM were equivocal, with 3 studies favoring higher (1 significantly) and 3 favoring significantly lower adjusted BMR/RMR during puberty. Only 1 study reported EI, showing 41% and 25% greater absolute intakes in pubertal males and females, respectively. These differences were not significant after adjustment for FFM.
CONCLUSIONS
Reasonably consistent evidence exists to support higher absolute BMR/RMR and TDEE in pubertal than in prepubertal adolescents. Differences are largely accounted for by FFM, among other potential factors such as growth- and puberty-related hormones. This review argues for further research into hormonal influences on pubertal energy balance and subsequent effects on obesity risk.
Topics: Adolescent; Body Fluid Compartments; Body Weight; Energy Intake; Energy Metabolism; Female; Humans; Male; Obesity; Puberty
PubMed: 27629054
DOI: 10.3945/ajcn.115.129205 -
Frontiers in Pediatrics 2022To determine the relationship between childhood overweight/obesity and early puberty in both boys and girls. Specifically, this is the first time to conduct a...
PURPOSE
To determine the relationship between childhood overweight/obesity and early puberty in both boys and girls. Specifically, this is the first time to conduct a meta-analysis of the relationship between childhood overweight/obesity and early puberty in boys.
METHODS
Relevant studies were identified from PubMed, Web of Science, and EMBASE searches. The exposure of interest was overweight/obesity in childhood. Childhood was defined internationally as the age range of 0-18 years. The overall risk estimates were pooled using random effects models. Subgroup and sensitivity analyses were performed to explore possible sources of heterogeneity and to assess the robustness of the results.
RESULTS
A total of 10 studies involving 13,338 girls and 12,796 boys were included. Results showed that childhood overweight/obesity were associated with a significantly higher risk of early puberty in girls [odds ratio (OR): 2.22, 95% CI: 1.65-2.99]. Although without statistical significance, a higher risk of early puberty was also found in boys who were overweight/obese in childhood (OR: 1.29, 95% CI: 0.98-1.70). Heterogeneity in the risk estimates of early puberty was partially explained by study design, sample size, follow-up duration, definitions of early puberty and confounders controlled. Sensitivity analyses validated the robustness of the findings.
CONCLUSIONS
Our findings showed that for girls the associate between overweight/obesity and early puberty is definite or strong whereas for males, such an association is possible, prompting that future studies need to further explore the possible relationship between overweight/obesity and early puberty in boys.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021264649, PROSPERO CRD42021264649.
PubMed: 35722495
DOI: 10.3389/fped.2022.795596 -
Pediatric Rheumatology Online Journal Mar 2021Autoimmune rheumatic diseases (ARDs) are associated with a significant sex-bias, which becomes more evident post-puberty. This systematic review aims to elucidate the...
BACKGROUND
Autoimmune rheumatic diseases (ARDs) are associated with a significant sex-bias, which becomes more evident post-puberty. This systematic review aims to elucidate the bidirectional relationship between puberty and ARD-related outcomes.
METHODS
Studies published in English until October 2019 were identified using a systematic search of endocrinology and rheumatology literature. Information was extracted on study design, sample size, demographics, puberty outcome measures, disease outcome measures, and main findings. The methodological quality of the studies included was analysed using the Newcastle-Ottawa Scale (NOS).
RESULTS
Sixteen non-randomised studies reporting on the impact of puberty on ARD outcomes (n = 7), ARD impact on puberty-related outcomes (n = 8), or both (n = 1) have been identified. The impact of puberty on ARD outcomes were investigated in patients with juvenile idiopathic arthritis (JIA)-associated uveitis (n = 1), juvenile systemic lupus erythematosus (JSLE) (n = 5) or in healthy controls who developed adult-onset SLE (n = 1) or had non-specific symptoms (n = 1). The impact of ARD on puberty outcomes was explored in JIA (n = 4) and JSLE (n = 3). Quality assessment of studies showed a small to moderate risk of bias overall (NOS 4-9/9). Due to large heterogeneity of the studies it was not possible to perform a meta-analysis. Multiple studies reported on delayed puberty in patients with JIA/JSLE, menstrual and hormonal abnormalities, and lower height and weight than controls. Earlier (pre-pubertal) onset of JSLE was correlated with more severe disease and more need for systemic treatment.
CONCLUSION
A bidirectional relationship exists between puberty and ARDs; however, more and better research is required to elucidate the complexity of this relationship. We propose puberty-related clinical assessments in patients with ARDs, which can improve patient outcomes and facilitate future research.
Topics: Autoimmune Diseases; Humans; Puberty; Rheumatic Diseases
PubMed: 33781271
DOI: 10.1186/s12969-021-00528-y