Prevalence and Characteristics of Back Pain in Children and Adolescents from the Region of Murcia (Spain): ISQUIOS Programme

Puberty is a vulnerable period for musculoskeletal disorders due to the existence of a wide inter-individual variation in growth and development. The main objective of the present study was to describe the prevalence of back pain (BP) in the past year and month in school-aged children according to sex, age, maturity status, body mass index (BMI) and pain characteristics. This study involved 513 students aged between 9 and 16 years. Anthropometric measures were recorded to calculate the maturity stage of the students using a regression equation comprising measures for age, body mass, body height, sitting height and leg length. An ad hoc questionnaire composed of eight questions was used to describe BP prevalence in school-aged children. The results showed that the prevalence of BP in school-aged children was observed in 35.1% over the last year (45% boys and 55% girls), and 17.3% (40.4% boys and 59.6% girls, with an association found between female sex and BP) in the last month. The prevalence of back pain in the past year and month was higher the older the students were, or the more pubertal development they had experienced. The prevalence of BP in the last year was also higher in those with overweight or obesity. After adjustment for sex, there was an association between BP and older age and higher BMI in boys and an association between BP and higher pubertal development in girls. In summary, the present study showed that the prevalence of BP was related to the maturity stage and weight of the participants, with different prevalence patterns found according to sex.

Inactivating NHLH2 Variants Cause Idiopathic Hypogonadotropic Hypogonadism and Obesity in Humans

Metabolism has a role in determining the time of pubertal development and fertility. Nonetheless, molecular/cellular pathways linking metabolism/body weight to puberty/reproduction are unknown. The KNDy (Kisspeptin/Neurokinin B/Dynorphin) neurons in the arcuate (ARC) nucleus of the hypothalamus constitute the GnRH (Gonadotrophin-releasing hormone) pulse generator. We previously created a mouse model with a whole-body targeted deletion of nescient helix-loop-helix 2 (Nhlh2; N2KO), a class II member of the basic helix-loop-helix (bHLH) family of transcription factors. As this mouse model features pubertal failure and late-onset obesity, we wanted to study whether NHLH2 represents a candidate molecule to link metabolism and puberty in the hypothalamus. Exome sequencing of a large Idiopathic Hypogonadotropic Hypogonadism (IHH) cohort revealed obese patients with rare sequence variants in NHLH2, which were characterized by in silico protein analysis, chromatin immunoprecipitation, and luciferase reporter assays. In vitro heterologous expression studies demonstrated that the variant p.R79C impairs Nhlh2 binding to the Mc4r promoter. Furthermore, p.R79C and other variants show impaired transactivation of the human KISS1 promoter. These are the first inactivating human variants that support NHLH2’s critical role in human puberty and body weight control. Failure to carry out this function results in the absence of pubertal development and late-onset obesity in humans.

Recent advancement in the treatment of boys and adolescents with hypogonadism

Clinical manifestations and the need for treatment varies according to age in males with hypogonadism. Early foetal-onset hypogonadism results in disorders of sex development (DSD) presenting with undervirilised genitalia whereas hypogonadism established later in foetal life presents with micropenis, cryptorchidism and/or micro-orchidism. After the period of neonatal activation of the gonadal axis has waned, the diagnosis of hypogonadism is challenging because androgen deficiency is not apparent until the age of puberty. Then, the differential diagnosis between constitutional delay of puberty and central hypogonadism may be difficult. During infancy and childhood, treatment is usually sought because of micropenis and/or cryptorchidism, whereas lack of pubertal development and relative short stature are the main complaints in teenagers. Testosterone therapy has been the standard, although off-label, in the vast majority of cases. However, more recently alternative therapies have been tested: aromatase inhibitors to induce the hypothalamic-pituitary-testicular axis in boys with constitutional delay of puberty and replacement with GnRH or gonadotrophins in those with central hypogonadism. Furthermore, follicle-stimulating hormone (FSH) priming prior to hCG or luteinizing hormone (LH) treatment seems effective to induce an enhanced testicular enlargement. Although the rationale for gonadotrophin or GnRH treatment is based on mimicking normal physiology, long-term results are still needed to assess their impact on adult fertility.

Puberty Status Modifies the Effects of Genetic Variants, Lifestyle Factors and Their Interactions on Adiponectin: The BCAMS Study

BackgroundHypoadiponectinemia has been associated with various cardiometabolic disease states. Previous studies in adults have shown that adiponectin levels were regulated by specific genetic and behavioral or lifestyle factors. However, little is known about the influence of these factors on adiponectin levels in children, particularly as mitigated by pubertal development.MethodsWe performed a cross-sectional analysis of data from 3,402 children aged 6-18 years from the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study. Pubertal progress was classified as prepubertal, midpuberty, and postpuberty. Six relevant single nucleotide polymorphisms (SNPs) were selected from previous genome-wide association studies of adiponectin in East Asians. Individual SNPs and two weighted genetic predisposition scores, as well as their interactions with 14 lifestyle factors, were analyzed to investigate their influence on adiponectin levels across puberty. The effect of these factors on adiponectin was analyzed using general linear models adjusted for age, sex, and BMI.ResultsAfter adjustment for age, sex, and BMI, the associations between adiponectin levels and diet items, and diet score were significant at prepuberty or postpuberty, while the effect of exercise on adiponectin levels was more prominent at mid- and postpuberty. Walking to school was found to be associated with increased adiponectin levels throughout puberty. Meanwhile, the effect of WDR11-FGFR2-rs3943077 was stronger at midpuberty (P = 0.002), and ADIPOQ-rs6773957 was more effective at postpuberty (P = 0.005), while CDH13-rs4783244 showed the strongest association with adiponectin levels at all pubertal stages (all P < 3.24 × 10-15). We further found that effects of diet score (Pinteraction = 0.022) and exercise (Pinteraction = 0.049) were stronger in children with higher genetic risk of hypoadiponectinemia, while higher diet score and exercise frequency attenuated the differences in adiponectin levels among children with different genetic risks.ConclusionsOur study confirmed puberty modulates the associations between adiponectin, and genetic variants, lifestyle factors, and gene-by-lifestyle interactions. These findings provide new insight into puberty-specific lifestyle suggestions, especially in genetically susceptible individuals.

The Association Between Sports, Body Image, and Eating Disorders of Males Teens at Eastside Catholic

In the past 25 years, the number of males who are dissatisfied with their bodies increased threefold. This is prevalent especially in the athletic field, where different physique expectations are closely associated with performance. Heightened focus on dietary rules and fitness level cause males to struggle with body dissatisfaction and shame and increase the risk of them developing eating disorders (ED), some of which are the most fatal mental illnesses. Many disordered eating behaviors stem from negative self-perceptions, which start to develop as early as the beginning of grade school and intensifies during pubertal development. However, most studies that examine this issue either looks at female college athletes who have a heavy exercise load and pressure from society on their physiques or focuses on social factors of peer pressure, family influence, and beauty standard. Therefore, it is imperative to determine whether sports participation is positively correlated with the rapidly growing rate of body image issues and ED symptoms in adolescent boys to help address them promptly and prevent severe and lasting damages. This quantitative case study conducted on male teens at Eastside Catholic High School (ECHS) found positive correlations between aesthetic/strength sports, body image issues, and higher ED risks, suggesting that athletic involvement plays a greater role in a person’s physical perception and mental health than body weight does. The conclusions inform education institutions and guardians of the more effective way to detect male adolescents’ body image issues and eating disorder symptoms, helping to prevent or alleviate mental illnesses.

Association Between Paternal Separation During Early Childhood and Pubertal Timing Among Girls Using Longitudinal Birth Cohort in Japan

IntroductionPrevious studies have shown that paternal absence leads to earlier pubertal timing among girls in high-income countries. Despite the low divorce rate in Japan, paternal separation is commonly seen due to a unique corporation system, tanshin funin, where employees relocate with their spouses and children. We examined paternal separation, including paternal absence (due to divorce or paternal death) and paternal tanshin funin, during early childhood as a predictor of earlier girl’s pubertal development, assessed as age at peak height velocity (PHV).MethodsThis study examined 15 214 girls from a longitudinal survey conducted in Japan from 2001 to 2016 by the Ministry of Health, Labor and Welfare. Paternal separation was determined by the occurrence through annual surveys conducted at ages 0.5 to 4.5 years. Outcome was defined as age at PHV between ages 6 to 15 years. We conducted linear regression, adjusted for potential confounders and other covariates.ResultsContinuous father cohabitation was seen in 88.7% of households, while paternal separation was experienced 1-2, 3-4 and 5 times (always) among 7.4%, 2.8% and 1.1% of households, respectively. Girls who confronted continuous paternal separation (5 times) experienced 0.42 years earlier [95% confidence interval (CI): -0.75, -0.10] age at PHV compared to their peers who always lived with their fathers.ConclusionGirls who experienced paternal separation throughout ages 0.5 to 4.5 years experienced PHV earlier.

Hypogonadism in male infants and adolescents: new androgen formulations

Background Male hypogonadism may be associated with micropenis and cryptorchidism in newborn, absent or incomplete pubertal development when it occurs during childhood. During puberty, androgen replacement therapy plays a pivotal role in subjects with hypogonadism to induce sexual maturation, growth acceleration, anabolic effects on fat-free mass growth increasing muscle strength, directly and indirectly on the attainment of peak bone mass in young men. Moreover, in newborns with congenital hypogonadism, androgen therapy could be effective to increase genital size. Summary Testosterone replacement therapy (TRT) represents the cornerstone of the management of hypogonadism in boys. During puberty, replacement therapy needs to be modulated with gradual dosing increase to better mimic the physiologic pubertal development. Currently, intramuscular testosterone esters (in particular testosterone enanthate, TE) and subcutaneous testosterone pellets are the only formulations approved by the US Food and Drug Administration (FDA) for delayed puberty, while no preparation is approved for long-term use in the adolescent age. Several new testosterone (T) formulations (as transdermal, nasal, subcutaneous, and oral formulation) are recently developed to improve the pharmacokinetic profile and to ease the administration route increasing patient compliance in adult males with hypogonadism. All these formulations are not approved for pediatric age, although some of them are used as “off-label” regimens. This special issue is aimed to illustrate new T formulations and their potential role as replacement therapy in the pediatric population, as well as to highlight investigational areas to contribute to health care improvement in these patients. Key Messages. Despite the lack of evidence-based guidelines regarding the choice of T formulation in the pediatric population, new formulations appear to have a potential role for TRT in adolescent age. They have been designed for adult age with a little flexibility of dosage, although a few formulations may be attractive for pubertal induction and penile enlargement thanks to their greater flexibility and easing of administration. On the other hand, long-acting and stable formulations could meet post-pubertal needs, increasing TRT compliance in a critical phase as the adolescent age. Further controlled, long-term safety, and efficacy studies for all these new T formulations within the pediatric population are needed.

Misreporting of Energy Intake From Food Records Completed by Adolescents: Associations With Sex, Body Image, Nutrient, and Food Group Intake

Background and Objectives: A healthy diet during adolescence is important for growth and pubertal development. Assessing the diet of adolescents may be challenging as the behavioural factors and food habits which impact on what they eat may also affect how they report dietary intake. This study assesses factors associated with the misreporting of dietary intake.Methods: Adolescents (n = 4,844; average age 13.8 years) from the Avon Longitudinal Study of Parents and Children (ALSPAC) completed a 3-day diet record. Misreporting was estimated using an individualised method, and adolescents were categorised by reporting status. Foods were categorised as core and noncore foods to evaluate diet quality. Body composition measurements were recorded at a research clinic. Information on dieting, weight concern, family socioeconomic status, and parental BMI were collected via questionnaires. Binary logistic regression was performed, in boys and girls separately, to investigate factors associated with underreporting of dietary intake.Results: Girls were much more likely than boys to be dissatisfied with their weight and to diet, but showed similar levels of underreporting (~67%). In adjusted regression analysis underreporters (UR) were more likely to be overweight or obese: OR in boys 2.8 (95% CI 1.7–4.8) and in girls 2.2 (95% CI 1.5–3.2). Dissatisfaction with weight and dieting were positively associated, and perception of being underweight negatively associated with underreporting in boys. Perception of being overweight, dieting, and exact age were positively associated with underreporting in girls. UR obtained a greater percentage of energy from protein and a smaller percentage of energy from fat; they reported greater intake of core foods and lower intakes of non-core foods than plausible reporters.Conclusion: A large proportion of adolescents underreported their dietary energy intake. This was associated with their body weight status and body image and had a differential effect on their estimated food and macronutrient intakes. Assessment of misreporting status is essential when collecting and interpreting dietary information from adolescents.

The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty

Puberty is a critical phase of growth and development characterized by a complex process regulated by the neuroendocrine system. Precocious puberty (PP) is defined as the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. The timing of puberty has important public health, clinical, and social implications. In fact, it is crucial in psychological and physical development and can impact future health. Nutritional status is considered as one of the most important factors modulating pubertal development. This narrative review presents an overview on the role of nutritional factors as determinants of the timing of sexual maturation, focusing on early-life and childhood nutrition. As reported, breast milk seems to have an important protective role against early puberty onset, mainly due to its positive influence on infant growth rate and childhood overweight prevention. The energy imbalance, macro/micronutrient food content, and dietary patterns may modulate the premature activation of the hypothalamic–pituitary–gonadal axis, inducing precocious activation of puberty. An increase in knowledge on the mechanism whereby nutrients may influence puberty will be useful in providing adequate nutritional recommendations to prevent PP and related complications.