Long-term effects of early kwashiorkor compared with marasmus. II. Intellectual performance

Intellectual performance including IQ (Wechsler Intelligence Scale for Children-Revised) and conservation was measured at ages 11-18 years in a follow-up study of Barbadian girls and boys who had histories of kwashiorkor (n = 53) or marasmus (n = 55) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 58). On both IQ and conservation tests, children with previous kwashiorkor or marasmus had similar scores, which were significantly lower than scores of healthy comparison children. These findings were examined in relationship to current environmental conditions, which were similar in children with histories of kwashiorkor or marasmus and somewhat less advantaged than those of the comparison children. The effect of early malnutrition and related conditions at the time of episode still emerged as significant even when the current environmental factors were controlled for.     

Long-term effects of early kwashiorkor compared with marasmus. III. Fine motor skills

Children with histories of marasmus (n = 53) or kwashiorkor (n = 50) in the first year of life and healthy comparison children (n = 50) were tested for fine motor skills by the Purdue pegboard test at ages 11-18 years. The performance of children with histories of marasmus was impaired on two of the four test measures. However, the performance of children with a history of kwashiorkor was impaired on three measures. The presence of soft neurologic signs measured 6 years earlier in the same children was significantly correlated with current pegboard performance, implying that early malnutrition has effects on nervous system function that are evident at least through 18 years of age.     

Retrospective longitudinal growth study of boys and girls active in sport

Longitudinal records from the Wroclaw Growth Study and the Wroclaw Longitudinal Twin Study were screened for individuals who were active in sport during childhood and adolescence and who were active in sport as young adults. The resulting sample was 25 boys and 13 girls. Heights and weights of the active boys indicated a growth pattern characteristic of early maturers. which was verified in advanced skeletal, sexual and somatic maturation during adolescence. The pubertal progress of active boys suggested no differences in tempo compared to nonathletic boys. In contrast, girls active in sport presented a pattern of growth and maturation characteristic of average maturing individuals, but were taller and heavier than local reference data. Skeletal and chronological ages of active girls did not differ, and the active girls did not differ from local reference data in sexual maturation. PHV, however, was reached later by about one-half of a year. The pubertal progress of girls active in sport did not differ from that of nonathletic girls.     

Growth prognosis and growth after menarche in primary hypothyroidism.

The long term growth of 20 girls and nine boys with juvenile primary hypothyroidism was studied until they reached final height. At diagnosis the girls had a mean age of 8.8 years (range 3.0-13.0); mean bone age was 5.4 years. The mean age of the boys at diagnosis was 9.5 years (range 3.7-14.2); mean bone age was 6.3 years. The patients were treated with thyroxine 100 micrograms/m2/day and serum thyroxine concentrations were maintained in the normal range. During treatment the rate of skeletal maturation exceeded the change in chronological age. Initial mean height SD score for bone age before treatment in the girls was +0.59 and after 11 years of treatment fell to -0.55 Mean height SD score for bone age in the boys decreased from +1.6 to -0.87 during treatment. In the girls the onset of puberty was 1.2 years later than the normal population but the duration of puberty was reduced. Mean age (SD) of menarche was 13.8 (1.7) years. The pattern of growth in girls with treated hypothyroidism was abnormal as growth continued after menarche, at a time when normal girls have almost stopped growing. During the second year after menarche our patients still had a mean growth velocity of 4.1 cm/year. Our data suggest that juvenile primary hypothyroidism results in a permanent height deficit. In addition, there is a loss of the normal harmony between growth and sexual maturation in girls, despite adequate treatment, in that growth continues for much longer after menarche than in normal girls.     

A follow-up study of the effects of early malnutrition on subsequent development. I. Physical growth and sexual maturation during adolescence

A follow-up study of growth and development was conducted on 216 Barbadian children aged 9 to 15 yr, half of whom had histories of moderate to severe protein-energy malnutrition in their 1st yr of life. Although index girls had significant delays in sexual maturation and were reduced relative to comparison girls on measures of weight for height, arm circumference, and skinfold thickness, their rate of growth when compared with values obtained 4 yr earlier was equal to or better than that of the comparison group. In contrast, boys in the index group were slightly reduced in height compared with their matched comparisons and had similar patterns of growth and sexual maturation. This study suggests a relationship between an episode of infantile malnutrition and impaired endocrine functioning among girls in the adolescent years.     

Secular trend of puberty

The aim of our study was to evaluate the age of the onset of pubertal characteristics in a population of Northern Italy and to compare our data with the pubertal staging scale defined by Tanner in 1976. These observations may help us to verify if even in Italy there is a positive secular change in sexual maturation, as has been observed in many European countries. We studied 3510 children (1868 males and 1642 females) aged 6-15 years, born between 1983 and 1996. In every subject sexual maturity was evaluated according to Tanner stages. We calculated the percentile distribution for ages of attainment of B2 and PH2 stages for females and G2, PH2 and testicular volume = or >4 ml (VT4) for males. In females the percentile values for B2 were: 3rd=8.1, 50th=10.5, and 97th=12.6 years. In males the percentile values for G2 and VT4 were: 3rd=8.8 and 9.1 years respectively, 50th=11 years, and 97th=13.4 and 13.3 years respectively. 3rd, 50th, and 97th centiles for pubic hair stage 2 were 8.1, 10.6 and 12.6 years for females and 8.8, 11.2 and 13.4 years for males. For all stages an earlier pubertal development was seen in comparison with Tanner data. One hundred-twenty-five girls had already reached menarche. Median (interquartile range) age at menarche was 11.9 (11.4-12.4) years showing a decrease compared with Tanner values. Our data clearly demonstrate a positive secular trend in pubertal development and point out the need of having updated references values of the timing of sexual maturation for the whole Italian population.     

北京市儿童青少年女性青春期性征发育流行病学研究

摘要 目的：了解北京市6~18岁学龄女生青春期第二性征发育现状,以及人群性早熟发生率。方法：利用2004年北京市儿童代谢综合征调查（BCAMS）总样本中9 778名6~18岁中小学女生的青春期发育数据，用概率单位回归法计算月经初潮、乳房、阴毛不同发育时期的中位年龄。8岁前乳房或阴毛发育达Tanner II 期（B2,P2），或10岁前月经初潮者被定义为性早熟。结果：9 778名6~18岁中小学女生中城市人口5 040人，占总样本51.5%。北京市学龄女生月经初潮年龄平均为 （12.1±1.1）岁，城市女生（11.9±1.1）岁，农村女生（12.5±1.1）岁；女性第二性征开始发育年龄（总体/城市/农村）分别为，乳房：（9.5±1.2）岁/（9.3±1.1）岁/(9.6±1.2）岁；阴毛:(11.1±1.1）岁/(10.8±1.1）岁/(11.4±1.1）岁。城市女生月经初潮、乳房和阴毛发育均显著早于农村女生。月经初潮早发生率为0.79%，城市高于农村（1.03%：0.55%；x2=6.93，P<0.01）；乳房、阴毛早发育率分别为2.91%和0.22%。1962~1982年期间，北京女生月经初潮年龄平均每10年提前0.7岁（8.4个月）；近10年平均提前0.43岁（5.2个月）。结论：北京市城区女生青春期第二性征发育明显早于郊区县女生。月经初潮年龄提前的长期变化趋势依然存在，但近10年这一趋势趋于减缓。     

Pubertal correlates in black and white girls

OBJECTIVES: Since pubertal maturation is an important covariate in studies that evaluate physical and social changes that occur during the teen years, we examined pubertal parameters in a group of US girls. STUDY DESIGN: Black and white girls recruited at age 9 were followed annually for 10 years. Preece-Baines model 1 was used to estimate tempo and growth parameters. The temporal trend between age of menarche and onset of puberty was calculated. RESULTS: The study included 615 (77.2% prepubertal) white and 541 (49.4% prepubertal) black participants. Mean onset of puberty was 10.2 and 9.6 years in white and black girls, respectively, menarche was 12.6 and 12.0, achievement of Tanner growth stage 5 was 14.3 and 13.6, and achievement of adult height was 17.1 and 16.5 years. The Pearson's correlation coefficient between menarche and onset of puberty was .37. CONCLUSIONS: Menarche is often used as a marker for onset of puberty and for timing of puberty. Data gathered over the past 20 years suggest only moderate correlation between menarche and onset of puberty (.37-.38), which has decreased significantly during the last 50 years. This suggests the existence of both similar and unique factors that impact the age at onset of puberty and age at menarche.     

Height, weight, body mass index and pubertal development references for children of Moroccan origin in The Netherlands

AIM: To provide growth and sexual maturation reference data for Moroccan children living in The Netherlands and to compare them with the reference data of children of Dutch origin. METHODS: Cross-sectional growth and demographic data were collected from 2880 children of Moroccan origin and 14,500 children of Dutch origin living in The Netherlands in the age range 0-20 y. Growth references for length, height, weight, weight-for-height, body mass index (BMI) and head circumference were constructed with the LMS method. Predictive variables for height and BMI were assessed by regression analyses. Reference curves for sexual maturation were estimated by a generalized additive model. RESULTS: Moroccan young adults were on average 9 cm shorter than their Dutch contemporaries. Mean final height was 174.7 cm for males and 161.3 cm for females. Height differences in comparison with Dutch children increase from 2 y onwards. Height SDS was predominantly associated with target height. Compared to Dutch children, maturation started 0.2 and 0.9 y later for girls and boys, respectively. Median age at menarche was 12.9 y, 3.6 mo earlier than in Dutch girls (p = 0.001). BMI of Moroccan children was above that of Dutch children, especially for girls. BMI SDS was associated with birthweight in the age group 0 - < or = 5 y. CONCLUSION: Moroccan children living in The Netherlands are substantially shorter than Dutch children. Girls have higher weight-for-height and BMI for age. Median age at menarche occurs earlier. Given these differences, separate growth charts for the Moroccan children are useful.     

Serum and red cell folates,and serum vitamin B12 in protein calorie malnutrition

In 22 cases of kwashiorkor, 19 cases of marasmus, and 16 normal controls, red cell folate, serum folate, and serum vitamin B₁₂ were estimated, and the bone marrow and peripheral blood examined. Erythrocyte folate deficiency was shown in 9 cases of kwashiorkor and 7 cases of marasmus. Serum folate deficiency was present in 14 cases of kwashiorkor and 7 cases of marasmus. Megaloblastosis was found in 45% of cases of kwashiorkor and 37% of cases of marasmus. Megaloblastosis and macrocytosis correlated more with erythrocyte than with serum folate deficiency. Serum vitamin B₁₂ levels in children with kwashiorkor or marasmus did not differ from those of normal controls. The role of folate deficiency in the pathogenesis of megaloblastosis in protein calorie malnutrition was confirmed.     

Accuracy of pubertal Tanner staging self-reporting

OBJECTIVES: Previous studies examining the reliability of self-reported Tanner stages have given conflicting results. We report on the reliability of self-reported Tanner stages in lean healthy children. METHODS: Self-reported Tanner staging of 240 children (130 girls, 110 boys) were compared to the ratings of a pediatric endocrinologist who was unaware of the children's self-assessments. The correlation between the two approaches was analyzed using kappa statistics. RESULTS: 40% (kappa coeffcient = 0.49, p <0.001) and 23% (kappa coefficient = 0.68, p <0.001) of the girls rated their breast and pubic Tanner stage incorrectly, respectively; 39% of the boys (kappa coefficient = 0.49, p <0.001) rated their pubic stage incorrectly. The age of the children who self-rated correctly and incorrectly was not different; no independent predictors for correct Tanner staging self-assessment were found. CONCLUSIONS: The results of this analysis suggest that self-rated Tanner pubertal staging is not influenced by age and is not a reliable method of assessing Tanner stage.     

Stunting,recovery from stunting and puberty development in the MINIMat cohort,Bangladesh

Aim

This paper aimed to analyse the association between small for size at birth, stunting, recovery from stunting and pubertal development in a rural Bangladeshi cohort.

Methods

The participants were 994 girls and 987 boys whose mothers participated in the Maternal and Infant Nutrition Interventions in Matlab trial. The birth cohort was followed from birth to puberty 2001-2017. Pubertal development according to Tanner was self-assessed. Age at menarche was determined and in boys, consecutive height measurements were used to ascertain whether pubertal growth spurt had started. The exposures and outcomes were modelled by Cox’s proportional hazards analyses and logistic regression.

Results

There was no difference in age at menarche between girls that were small or appropriate for gestational age at birth. Boys born small for gestational age entered their pubertal growth spurt later than those with appropriate weight. Children who were stunted had later pubertal development, age at menarche and onset of growth spurt than non-stunted children. Children who recovered from infant or early childhood stunting had similar pubertal development as non-stunted children.

Conclusion

Infant and childhood stunting was associated with a later pubertal development. Recovery from stunting was not associated with earlier puberty in comparison with non-stunted children.

     

Induction of puberty in hypogonadal children

Puberty is the transitional period between childhood and adulthood when physical, sexual, and psychosocial maturation occurs. The onset of puberty is controlled by the gonadotropin-releasing hormone (GnRH) neuron and is triggered when inhibition of the neuron is lifted. Subsequently, GnRH induces secretion of other hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn stimulate the gonads. Concurrently, increases in estrogen levels in both boys and girls stimulate growth hormone (GH) and insulin-like growth factor-I (IGF-I) secretion, which are responsible for the pubertal growth spurt. In hypogonadal children, however, hypothalamic/pituitary defects or gonadal diseases preclude the production of these hormones, preventing the onset of puberty. Hormone replacement therapy with either estrogen or testosterone is a viable treatment option for hypogonadal children. These should be administered with consideration of sexual maturation rates, statural and bone growth rates, and occurrence of adverse effects. The merits and disadvantages of various hormone replacement therapies for girls and for boys are discussed.     

Growth and Sexual Maturation in Paediatric Patients Treated by Dialysis and Following Kidney Transplantation

Linear growth and sexual maturation were assessed in 48 children during dialysis treatment and in 68 children following renal transplantation. Height at the onset of haemodialysis treatment was more than 2 SD below the mean in 33% of prepubertal children. During dialysis treatment most children showed a progressive deterioration in SD score. The onset of puberty and sexual maturation was delayed but was in accordance with bone age. After transplantation 59% of prepubertal children had a normal height increment. Onset of puberty was recorded at a chronological age of 14.6 ± 1.9 years in boys and 13.3 ± 1.9 years in girls. The peak of the pubertal growth spurt was 6.6 ± 1.6 cm/year in boys and 6.5 ± 2.9 cm/year in girls. The duration of pubertal development in transplanted children was within normal limits. In transplanted girls menarche was achieved at a mean chronological age of 15.9 years and bone age of 12.9 years. Adult height was achieved at a mean age of 20.3 years in men and 18.7 years in women. Overall, one third of the children attained an adult height more than 2 SD below the mean. These data indicate that poor growth is achieved in most children on dialysis treatment; following transplantation normal growth may be restored. However, poor growth before kidney transplantation and the loss of growth potential during pubertal development have a great influence on adult height.     

Reliability of pubertal self-assessment in Hong Kong Chinese children

Aim:   To validate a Tanner stages self-assessment questionnaire using gender-specific line drawings and brief explanatory text in Chinese.
Methods:   Design: A cross sectional study design. Setting: One primary and two secondary schools. Participants: 172 boys and 182 girls aged between 8 and 18 years. Main outcome measures: Students' self-assessments of pubertal maturation were compared with assessments made by a same gender rater using visual depiction physical examination. Raters' physical examinations were performed after the children had answered the self-assessment questionnaire individually and in private. Raters were blinded to the self-assessment results. Accuracy rates and weighted kappa statistic were used to evaluate the degree of agreement between children and raters.
Results:   Substantial to almost perfect agreement was found between self- and rater's assessments of breast development and pubic hair growth in girls [weighted kappa 0.72 ( P  < 0.0001, 95% CI 0.66, 0.79) and 0.83 ( P  < 0.0001, 95% CI 0.78, 0.87) respectively]. Moderate to substantial agreement was found between self- and rater's assessments of male genital development and pubic hair growth [weighted kappa 0.58 ( P  < 0.0001, 95% CI 0.48, 0.68) and 0.80 ( P  < 0.0001, 95% CI 0.74, 0.86) respectively]. Most agreements between self- and rater's assessments differed by only one Tanner stage. Agreement was higher for girls than boys. Girls tended to overestimate their breast stages and boys tended to underestimate their genitalia development.
Conclusion:   This study confirms that a Tanner pubertal self-assessment questionnaire with line drawings and explanatory Chinese text can reliably estimate sexual maturation status in Hong Kong Chinese children.     

Age of puberty in a representative sample of Iranian girls

Background  To obtain normal references for growth and pubertal development in a given population, assessment of pubertal stages is of great importance. This study aimed to determine the age of appearance of secondary sexual characteristics in a representative sample of Iranian girls. Methods  This cross-sectional study was conducted during 2005–2006 in 3192 girl students, aged 6–17 years, in Isfahan, Iran. Participants were selected by multistage random cluster sampling from school students. Secondary sexual characteristics were evaluated by inspection and palpation, and were recorded according to Tanner staging. The self-reported date of menarche (if any) was recorded as well. Data were analyzed with Probit analysis based on the status quo method. Results  The median ages (10th–90th percentile) of Tanner stage 2 breast development (B2) and Tanner stage 2 pubic hair growth (PH2) were 10.14 years (8.33–11.95 years) and 10.78 years (9.09–12.48 years), respectively. The ages of the 3rd percentile for B2 and PH2 were 7.48 and 8.29 years, respectively. The median age of menarche among the 3192 girls who had experienced menarche was 12.65 years (11.18–14.11 years). Conclusions  The median age of puberty onset is 10.14 years, and the onset of puberty before 7.5 years is considered as precocious puberty in a representative sample of Iranian girls. The values obtained from the present study can provide baseline data for analysis of time trends, as well as for international comparisons.     

Nipple (papilla) development in puberty: longitudinal observations in girls

The purpose of this study was to determine the manner of breast nipple (papilla) development occurring during puberty in girls on a longitudinal basis and to compare this development to the established criteria of sexual maturation. Forty-six girls (19 white and 27 black) were followed for periods of 2 to 5 years (mean 2.67 years). In each, the nipple diameter was measured and the Tanner stage assessed. Minimal nipple development occurred from stages PH1 to PH3 (3.24 to 4.44 mm) and B1 to B3 (3.00 to 4.72 mm) or more than 1 year prior to menarche (3.75 mm). Significant growth occurred beyond stages PH3 (PH4 6.54 mm, PH5 8.98 mm) and B3 (B4 7.25 mm, B5 9.41 mm) and from less than 1 year prior to menarche to more than 1 year after menarche (5.92 mm for girls less than 1 year premenarche, 7.88 mm for girls in their first year after menarche, and 9.05 mm for girls more than 1 year beyond menarche). A more objective definition for breast stages B4 and B5, based upon nipple diameter, is now feasible. Thus, these data enhance the precision with which physiologic events occurring toward the close of puberty in girls can be studied.     

Pubertal development in The Netherlands 1965-1997

We investigated pubertal development of 4019 boys and 3562 girls >8 y of age participating in a cross-sectional survey in The Netherlands and compared the results with those of two previous surveys. Reference curves for all pubertal stages were constructed. The 50th percentile of Tanner breast stage 2 was 10.7 y, and 50% of the boys had reached a testicular volume of 4 mL at 11.5 y of age. Median age at menarche was 13.15 y. The median age at which the various stages of pubertal development were observed has stabilized since 1980. The increase of the age at stage G2 between 1965 and 1997 is probably owing to different interpretations of its definition. The current age limits for the definition of precocious are close to the third percentile of these references. A high agreement was found between the pubic hair stages and stages of pubertal (genital and breast) development, but slightly more in boys than in girls. Menarcheal age was dependent on height, weight, and body mass index. At a given age tall or heavy girls have a higher probability of having menarche compared with short or thin girls. A body weight exceeding 60 kg (+1 SDS), or a body mass index of >20 (+1 SDS), has no or little effect on the chance of having menarche, whereas for height such a ceiling effect was not observed. In conclusion, in The Netherlands the age at onset of puberty or menarche has stabilized since 1980. Height, weight, and body mass index have a strong influence on the chance of menarche.     

Body composition, dehydroepiandrosterone sulfate and leptin concentrations in girls approaching menarche

There is strong evidence that the initiation of adrenarche and gonadarche during puberty in girls depends on body mass in general and body fat in particular. The aim of this study was to analyze changes in body composition, i.e. body fat (BF), fat percentage (BF%), and lean tissue mass (LM) in girls during pre-menarcheal stages of development, including the earliest stage lacking clinical manifestations of changes in primary, secondary, and tertiary sexual characteristics. Puberty was assessed according to clinical and ultrasonographic staging of sex features developed by us. Concentrations of leptin and DHEA-S were compared and related to changes in body composition. SUBJECTS AND METHODS: The study was carried out on 65 healthy girls aged 8 years and older who were followed every 3 months over a 5-year period. Age, height, weight, and BMI were recorded. Body composition (BF, BF%, LM) was determined with an infrared method. Tertiary sexual features were staged according to Tanner. Vaginal secretion was assessed according to Peter et al. Transabdominal ultrasound of the uterus and ovaries was performed with the bladder unvoided. Groups were formed according to developmental stage: E0A = pre-estrogenization (no ultrasonographic or clinical evidence of estrogenization); E0B pre-estrogenization with 'luminosity' of mucus in cervical canal; E1 = onset of estrogenization; E = full estrogenization; M = menarche +/- 3 months. Concentrations of DHEA-S and leptin were determined by radioimmunoassay. RESULTS: BF in prepubertal girls averaged 16%. At menarche, BF was 23.9%. Body weight at menarche was 50.6 kg and the LM/BF ratio was 3.0. High leptin concentrations were found in E0B and M groups. Leptin concentrations were lowest during full estrogenization (E). Positive correlations of leptin with BF and LM were found in girls during developmental stages preceding menarche. Mean concentration of DHEA-S started at 1,091.6 microg/l during E0A stage, dropped significantly on passing to E0B (p <0.05), and increased by menarche. DHEA-S levels were found to correlate with BF, LM, and leptin in E0A, E0B, and E1 groups. Correlation coefficients were highest (DHEA-S/BF r = 0.61; DHEA-S/LM r = 0.54; DHEA-S/LEP r = 0.57) in the E0A group, i.e. about 5 months before the appearance of 'luminosity' of cervical mucus, considered to be the first ultrasonographic sign of puberty. Apparently, leptin stimulates somatic maturation during this stage of gonadarche which terminates with menarche. The action of DHEA-S is exerted during the early stages of female puberty.     

Ultrasonographic assessment of the extent of hepatic steatosis in severe malnutrition.

Ultrasonographic, blinded assessment was made of the extent of hepatic steatosis in 55 children with severe malnutrition: undernutrition (n = 6), marasmus (n = 18), marasmickwashiorkor (n = 17), and kwashiorkor (n = 14). The children were examined on admission, in early recovery (considered as baseline), and again at discharge. Eleven healthy control children and eight of the previously malnourished children were studied as comparison groups. Both oedematous and non-oedematous malnourished children had significantly more steatosis than the comparison groups at each time. Children with oedematous malnutrition had significantly greater steatosis than non-oedematous children at admission. Half of the non-oedematous malnourished children had appreciable hepatic steatosis at both admission and at baseline. Hepatic fat was only slowly mobilised. The rate constant was 1.4 +/- 0.3%/day. One quarter of the children did not change steatosis grades during the period they were in hospital. There was no overall correlation between the extent of steatosis and liver size. Hepatic steatosis in childhood malnutrition is not confined to oedematous children: it is frequently present in marasmic and undernourished children. Its extent is not necessarily related to the degree of hepatomegaly and accumulated lipid is only slowly mobilised.