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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 961-970. doi: 10.19723/j.issn.1671-167X.2022.05.025

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Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study

Tao MA1,Yan-hui LI1,Man-man CHEN1,Ying MA1,Di GAO1,Li CHEN1,Qi MA1,Yi ZHANG1,Jie-yu LIU1,Xin-xin WANG2,Yan-hui DONG1,Jun MA1,*()   

  1. 1. Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
    2. School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
  • Received:2022-06-13 Online:2022-10-18 Published:2022-10-14
  • Contact: Jun MA E-mail:majunt@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(81673192);the Research Special Fund for Public Welfare Industry of Health of the Ministry of Health of China(201202010)

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Abstract:

Objective: To explore and analyze the relationship between early onset of puberty and different types of obesity in children, by combining large sample cross-sectional survey data with long-term longitudinal cohort data, so as to provide clues for further clarifying the health hazards of early onset of puberty and obesity prevention and control. Methods: The research data were from the cross-sectional survey data of seven provinces(autonomous regions, municipalities) in China and the cohort data of adolescent development in Xiamen. The study first found the association between early onset of puberty and obesity by Logistic regression on the cross-sectional data, and then used Poisson regression to analyze the association between early puberty initiation and various types of obesity risk. Results: In the study, 43 137 and 1 266 children were included in the cross-sectional survey and cohort survey respectively. The cross-sectional study found that among the girls aged 10-13 years, compared with the girls of the same age who did not start puberty, the body mass index (BMI)-Z score of the girls in the puberty start group was 0.5-0.8 higher, and the waist circumference Z score was 0.4-0.7 higher, and the risk of various types of obesity was higher. At the same time, the early onset of puberty was positively correlated with simple obesity, central obesity and compound obesity, the OR (95%CI) were 1.86 (1.42-2.44), 1.95 (1.65-2.32) and 1.86 (1.41-2.45), respectively. No significant association was found in boys. According to the cohort data, in girls, the risk of simple obesity was 6.00 times [RR (95%CI): 6.00 (1.07-33.60)], the risk of central obesity was 3.30 times [RR (95%CI): 3.30 (1.22-8.92)], and the risk of compound obesity was 5.76 times [RR (95%CI): 5.76 (1.03-32.30)], compared with the group without early puberty initiation, while no association between early puberty initiation and obesity was found in boys. Conclusion: Based on the cross-sectional survey and longitudinal cohort survey, it is confirmed that the early onset of puberty in girls may increase the risk of simple obesity, central obesity and compound obesity, while there is no significant correlation between puberty onset and obesity in boys.

Key words: Pediatric obesity, Puberty, Children, Cross-sectional studies, Cohort studies

CLC Number: 

  • R723.14

Figure 1

Technical roadmap of this study"

Table 1

Basic information of participants"

Subjects Cross-sectional data of seven provinces (autonomous regions, municipalities) in China Last follow-up data of Xiamen cohort
Boys Girls P value Boys Girls P value
Sample size, n (%) 21 094 (48.9) 22 043 (51.1) 613 (48.4) 653 (51.6)
Age group, n (%) < 0.001 < 0.001
  6-12 years 13 206 (62.6) 12 710 (57.7) 456 (74.4) 651 (99.7)
  13-15 years 5 093 (24.1) 5 965 (27.1) 157 (25.6) 2 (0.3)
  16-18 years 2 795 (13.3) 3 368 (15.3)
Residence area, n (%) < 0.001
  Urban 11 446 (54.3) 12 935 (58.7) 613 (48.4) 653 (51.6)
  Rural 9 648 (45.7) 9 108 (41.3)
Simple obesity, n (%) < 0.001 126 (20.5) 27 (4.1) < 0.001
  Yes 16 064 (76.6) 16 719 (76.3) 487 (79.4) 626 (95.9)
  No 3 370 (16.0) 1 910 (8.7)
Central obesity, n (%) 0.369 < 0.001
  Yes 17 971 (85.3) 20 210 (91.8) 173 (28.2) 54 (8.3)
  No 4 896 (23.4) 5 201 (23.7) 440 (71.8) 599 (91.7)
Compound obesity, n (%) < 0.001 < 0.001
  Yes 0 (0) 10 908 (49.5) 120 (19.6) 26 (4.0)
  No 3 094 (14.7) 1 816 (8.2) 493 (80.4) 627 (96.0)
Puberty onset, n (%) < 0.001 0.011
  Yes 5 605 (26.6) 10 908 (49.5) 531 (86.6) 595 (91.1)
  No 15 489 (73.4) 11 135 (50.5) 82 (13.4) 58 (8.9)
Breast-feeding, n (%) 0.016 0.470
  Yes 5 241 (32.9) 5 247 (31.6) 189 (34.9) 75 (32.2)
  No 0 (0) 0 (0) 353 (65.1) 158 (67.8)
BMI, ${\bar x}$±s 19.29±4.10 18.63±3.62 < 0.001 20.44±3.78 16.91±2.64 < 0.001
WC, ${\bar x}$±s 67.56±11.70 65.12±9.64 < 0.001 70.11±10.71 58.91±6.78 < 0.001
BMI-Z, ${\bar x}$±s 0.42±1.42 0.00±1.14 < 0.001 0.79±1.33 -0.44±1.18 < 0.001
WC-Z, ${\bar x}$±s 0.32±1.03 0.20±1.01 < 0.001 0.42±0.99 -0.44±0.79 < 0.001
Fruit and vegetable intake/(portions/day), ${\bar x}$±s 3.17±2.19 3.17±2.06 0.994 3.23±2.34 3.42±2.34 0.155
Meat intake/(portions/day), ${\bar x}$±s 1.36±1.38 1.05±1.10 < 0.001 1.12±0.89 1.05±0.74 0.177
Moderate and high intensity exercise/(h/d), ${\bar x}$±s 1.20±1.48 0.94±1.22 < 0.001 1.04±0.99 0.88±0.92 0.005
Puberty onset age/years, M (P25, P75) 13.08 (12.33, 13.92) 12.25 (11.58, 12.92) < 0.001 11.10 (10.41, 11.58) 9.65 [8.95, 10.38] < 0.001

Table 2

Correlation between onset of puberty and physical indicators of students aged 10-18 years in the seven provinces (autonomous regions, municipalities) cross-sectional study"

Age group Boys Girls
BMI-Z WC-Z BMI-Z WC-Z
10 years-
  Puberty started 0.7±1.1 0.7±1.0
  Puberty does not start 0.1±1.2 0.2±1.0
  P value < 0.001 < 0.001
11 years-
  Puberty started 0.6±1.0 0.5±0.9
  Puberty does not start -0.1±1.3 0.1±1.0
  P value < 0.001 < 0.001
12 years-
  Puberty started 0.6±1.2 0.4±1.0 0.3±1.1 0.4±1.0
  Puberty does not start 0.5±1.4 0.3±1.0 -0.5±1.2 -0.3±0.9
  P value 0.151 0.446 < 0.001 < 0.001
13 years-
  Puberty started 0.5±1.3 0.4±1.0 0.1±1.1 0.3±1.0
  Puberty does not start 0.4±1.4 0.3±1.0 -0.7±1.2 -0.3±0.9
  P value 0.056 0.014 < 0.001 < 0.001
14 years-
  Puberty started 0.1±1.3 0.4±1.1 -0.1±1.0 0.2±1.0
  Puberty does not start 0.0±1.3 0.2±1.1 -0.6±1.0 -0.3±1.0
  P value 0.368 0.080 < 0.001 0.001
15 years-
  Puberty started 0.0±1.3 0.4±1.1
  Puberty does not start 0.1±1.4 0.3±1.1
  P value 0.732 0.703
16 years-
  Puberty started 0.0±1.3 0.3±1.0
  Puberty does not start 0.0±1.4 0.4±1.1
  P value 0.525 0.323
17 years-
  Puberty started -0.2±1.3 0.3±1.1
  Puberty does not start -0.2±1.3 0.3±1.2
  P value 0.950 0.944

Table 3

Correlation between onset of puberty and obesity types of students aged 10-18 years in the seven provinces (autonomous regions, municipalities) cross-sectional study*"

Age group Obesity type Boys Girls
Adolescent, n (%) Preadolescent, n (%) OR (95%CI) Adolescent, n (%) Preadolescent, n (%) OR (95%CI)
10 years- Non obesity Ref.
Simple obesity 22 (21.8) 209 (10.4) 2.39 (1.46-3.92)
Central obesity 48 (47.5) 522 (26.1) 2.56 (1.71-3.83)
Compound obesity 21 (20.8) 202 (10.1) 2.34 (1.42-3.87)
11 years- Non obesity Ref.
Simple obesity 19 (16.4) 37 (8.1) 2.22 (1.23-4.03)
Central obesity 39 (33.6) 96 (21.1) 1.89 (1.21-2.95)
Compound obesity 17 (14.7) 36 (7.9) 2.01 (1.08-3.72)
12 years- Non obesity Ref. Ref.
Simple obesity 36 (13.2) 287 (15.6) 0.82 (0.57-1.20) 204 (11.6) 39 (4.6) 2.72 (1.91-3.87)
Central obesity 70 (25.8) 497 (27.1) 0.94 (0.70-1.26) 493 (28.1) 96 (11.4) 3.05 (2.41-3.87)
Compound obesity 36 (13.2) 282 (15.3) 0.84 (0.58-1.22) 191 (10.8) 38 (4.5) 2.60 (1.82-3.72)
13 years- Non obesity Ref. Ref.
Simple obesity 123 (14.6) 239 (14.0) 1.04 (0.83-1.32) 196 (7.7) 8 (2.3) 3.63 (1.78-7.43)
Central obesity 212 (25.3) 403 (23.9) 1.08 (0.89-1.31) 658 (26.0) 34 (9.6) 3.30 (2.30-4.76)
Compound obesity 116 (13.8) 226 (13.3) 1.04 (0.82-1.33) 192 (7.6) 8 (2.3) 3.55 (1.74-7.27)
14 years- Non obesity Ref. Ref.
Simple obesity 43 (9.8) 33 (9.2) 1.07 (0.67-1.73) 44 (5.6) 1 (2.1) 2.72 (0.37-20.16)
Central obesity 85 (19.4) 66 (18.5) 1.06 (0.74-1.51) 171 (21.8) 4 (8.5) 2.99 (1.06-8.44)
Compound obesity 42 (9.6) 30 (8.3) 1.16 (0.71-1.90) 43 (5.4) 1 (2.1) 2.65 (0.36-19.69)
15 years- Non obesity Ref.
Simple obesity 150 (10.2) 31 (11.4) 0.88 (0.59-1.33)
Central obesity 326 (22.2) 68 (25.1) 0.85 (0.63-1.15)
Compound obesity 149 (10.1) 31 (11.4) 0.88 (0.58-1.32)
16 years- Non obesity Ref.
Simple obesity 186 (9.9) 27 (13.4) 0.71 (0.46-1.09)
Central obesity 409 (21.9) 48 (24.1) 0.88 (0.63-1.24)
Compound obesity 180 (9.6) 26 (12.9) 0.71 (0.46-1.11)
17 years- Non obesity Ref.
Simple obesity 62 (9.4) 4 (7.0) 1.38 (0.48-3.94)
Central obesity 134 (20.6) 10 (17.5) 1.22 (0.60-2.48)
Compound obesity 59 (9.0) 4 (7.0) 1.31 (0.46-3.75)

Table 4

Relationship between early onset of puberty and obesity type in the seven provinces(autonomous regions, municipalities) cross-sectional study"

Obesity type Early onset of puberty Boys, OR (95%CI) Girls, OR (95%CI)
Unadjusted Adjusted* Unadjusted Adjusted*
Simple obesity No 0 (reference) 0 (reference) 0 (reference) 0 (reference)
Yes 1.41 (1.08-1.83) 1.32 (0.94-1.86) 1.91 (1.56-2.33) 1.86 (1.42-2.44)
Central obesity No 0 (reference) 0 (reference) 0 (reference) 0 (reference)
Yes 1.10 (0.90-1.34) 1.07 (0.83-1.39) 1.91 (1.68-2.17) 1.95 (1.65-2.32)
Compound obesity No 0 (reference) 0 (reference) 0 (reference) 0 (reference)
Yes 1.38 (1.06-1.81) 1.27 (0.90-1.80) 1.87 (1.52-2.29) 1.86 (1.41-2.45)

Table 5

Relationship between early onset of puberty and obesity type in cohort studies"

Obesity type Early onset of puberty n/N Unadjusted relative risk (95%CI) Adjusted relative risk (95%CI)*
Boys Simple obesityNo 26/459 0 (reference) 0 (reference)
Yes 4/38 1.83 (0.65-5.16) 1.82 (0.61-5.49)
Central obesity No 22/401 0 (reference) 0 (reference)
Yes 4/55 1.30 (0.47-3.59) 1.29 (0.45-3.69)
Compound obesity No 28/482 0 (reference) 0 (reference)
Yes 4/33 2.08 (0.73-5.92) 2.38 (0.77-7.38)
Girls Simple obesityNo 113/613 0 (reference) 0 (reference)
Yes 5/8 7.10 (1.70-29.73) 6.00 (1.07-33.60)
Central obesity No 104/587 0 (reference) 0 (reference)
Yes 10/24 3.11 (1.38-7.01) 3.30 (1.22-8.92)
Compound obesity No 118/619 0 (reference) 0 (reference)
Yes 5/8 6.83 (1.63-28.58) 5.76 (1.03-32.30)
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