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Adiposity rebound of middle childhood ages: Children grow and horses race: is the adiposity rebound a critical period for later obesity?

Introduction Childhood obesity is an epidemic problem worldwide, often leading to adult obesity and early occurrence of several obesity-related conditions such as type 2 diabetes and metabolic syndrome [ 1 ]. In multivariable analysis, female sex, limited maternal education, increased maternal BMI, and increased caloric intake were significant predictors of early rebound.

David Stewart
Thursday, December 7, 2017
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  • Using the racing analogy again, the leading horses at any point in the race have run the fastest to that point and are likely to continue running fast.

  • The study flow chart is presented in Supplementary Figure 1.

  • Such children are likely to have a raised body mass index later. Allison D.

  • Lower body weight and BMI at birth were associated with early adiposity rebound in hydroxylase deficiency patients. Koivuaho View author publications.

Introduction

Therefore the variables have been log-transformed. Early adiposity rebound and middls risk of adult obesity. Previous studies lacked the repeated BMI measures in infancy and childhood required to assess both BMI peak and rebound concurrently, 5—79 nor have the relationships of BMI peak and rebound with later cardiometabolic health outcomes been well characterized. Download: PPT.

Eur Chilldhood Clin Nutr. We generated 50 imputed datasets for all Project Viva participants with live births. The timing of adiposity rebound has shifted not only among overweight and obese children, but also among children at the 10th percentile of BMI for age. The Korean National Growth Charts for children and adolescents: development, improvement, and prospects.

Correspondence to TJ Cole. Few studies have examined the independent and combined relationships of body mass index BMI peak and rebound with adiposity, insulin resistance and metabolic risk later in life. Parental covariates included educational attainment, obesity status, total gestational weight gain, maternal smoking history never, smoked before pregnancy or smoked during pregnancyprenatal glucose tolerance status normoglycaemia, isolated hyperglycaemia, impaired glucose tolerance or GDM and gestational hypertensive disorders normal blood pressure, chronic hypertension, gestational hypertension and pre-eclampsia. Magnitude of BMI at both peak and especially rebound was positively associated with lean mass and total and central adiposity Figure 2. Article Contents Abstract. We assessed associations between the BMI trajectory milestones and cardiometabolic outcomes using multivariable linear regression.

MeSH terms

DohertyHelena J. Adjustment models shown in Supplementary Figure 3. The fact that gestational ages were not determined by means of ultrasonography may have had some effect on the detection of subtle differences between the study groups. Finnish general population-based birth cohort study. Supplementary Figure 2.

What is the relation between early AR and obesity? References 1. Table 1. Acknowledgments The authors thank all the participants who engaged in this study. Interestingly, serum testosterone levels at age 31 or 46 were not associated with timing of AR, even though hyperandrogenism has been associated with a more severe BMI outcomes in women with PCOS. Children grow and horses race: is the adiposity rebound a critical period for later obesity? The key question for future work on the precursors of child obesity is: what mechanism drives upward BMI centile crossing?

Data on birth weight was collected prospectively by local midwives in the antenatal clinics and the data were available for all the cohort members. Given that birth weight is sensitive to several pregnancy-related genetic and environmental factors, recent study have also suggested that it may not share the same programming with postnatal growth, especially the growth in childhood [ 23 ]. Koivuaho View author publications. N Engl J Med. However, we have previously shown the validity of self-reported symptoms as reliable indications of PCOS [ 91016 ]. Issue Date : July

The age at AR did not associate with T levels at ages 31 or 46 years. Neueste erkenntnisse hashimoto s hypothyroidism the present study, women with PCOS had a lower birth weight compared with controls, and the results of several [ 1519 ] but not all [ 2021 ] studies are in line with our findings. BMC Endocrine Disorders The AR occurred earlier 5. Given that hyperandrogenic women with PCOS commonly present with the highest BMI [ 27 ], we assessed the association between serum testosterone concentrations at ages 31 and 46, and AR timing. It is associated with high-level morbidity and is an economic burden to society [ 7 ]. Interestingly, serum testosterone levels at age 31 or 46 were not associated with timing of AR, even though hyperandrogenism has been associated with a more severe BMI outcomes in women with PCOS.

Publication types

We have performed direct measurements of fat mass using DXA and our results indicate that subjects with early age at AR have higher fat mass. Google Scholar PubMed. Body mass and stature were measured as anthropometric indicators. This is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. View Article Google Scholar 9.

Reprints and Permissions. Therefore, targeting modifiable factors in very early life to delay the timing of adiposity rebound is important. Healthy Weight Gain. In a cohort including subjects from Finland born between —44, age at AR before 5 years of age was associated with an incidence of 8. Sign In or Create an Account. Their hypothetical data are selected to cover the range of BMI and age at rebound.

  • However, catch-up growth depends not only on birth weight but also on gestational age. This is owing to the trend of a steeper increase of height as compared to weight in the first years of life.

  • Kettunen, M.

  • Correlation analyses between serum leptin levels and body composition variables are shown in Table S2.

  • MoranArul EarnestDorota A. Age at adiposity rebound: determinants and association with nutritional status and the metabolic syndrome at adulthood.

  • Pediatric Research

Significance assessed by using the Kruskal—Wallis test with multiple comparisons. In the clinical examinations during cohort data collection, weight was measured using cildhood neueste erkenntnisse hashimoto s hypothyroidism scale and height was measured twice using a standard calibrated stadiometer. These observations are shown below. Public Health Nutr ; 18 : — These findings suggest that age at AR might be useful to identify boys at risk of future obesity. View Article Google Scholar 3.

The AR occurred earlier 5. According to the literature, early timing of AR is defined as that occurring before the age of 5 years adiposity rebound of middle childhood ages 5 ]. More studies are needed to shed light on the prenatal triggering mechanisms behind PCOS in humans. Because of a level difference in the assays used at different time points, values at age 31 were amended as follows: 0. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In our study population, an AR drop of 1 year was associated with a 1. The data on gestational age were collected as described above.

Background

Am J Prev Med. Mo-Suwan et al. Obes Rev ; 9 : —

  • Rights and permissions Reprints and Permissions.

  • The age at AR did not associate with T levels at ages 31 or 46 years. Results: A total of children demonstrated early rebound, 59 children were nonrebounders, and a further 35 had inconclusive data.

  • BMC Medicine Br J Radiol —

  • Determinants of blood glucose and insulin in healthy 9-month-old term Danish infants; the SKOT cohort.

BMC Med. Clin Obstet Gynaecol. For covariate analysis, maternal pre-pregnancy BMI, maternal smoking, and gestational age at birth were utilized. Birthweight and mortality in adulthood: a systematic review and meta—analysis.

Obesity Silver Spring ; 21 : — We derived sex-specific trajectories by including interactions of child sex with spline terms as fixed parameters in the model. Public Health Nutr. Do we fatten our children at the television set?

MeSH terms

Similarly, gestational age was defined from the last menstrual period and the data were collected by the middle childhood. Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: prospective cohort study. Moreover, even though some investigators have reported a higher rate of prematurity in the offspring of women with PCOS [ 22 ], in the present data there was no difference in gestational ages. Information on maternal age, education, pre-pregnancy BMI, and smoking status during pregnancy was self-reported and data were collected by local midwives in the antenatal clinics using a questionnaire that was designed for NFBC data collection.

Early adiposity rebound is associated with metabolic rebkund in 7-year-old children. Clin Obstet Gynaecol. The participation rate has been high throughout all data collection points and the early BMI growth data were obtained from the health register of a child health program that is available and free for all families. Fertil Steril. You are using a browser version with limited support for CSS.

Identification of women with PCOS The year follow-up questionnaire included two questions screening for PCOS symptoms: i is your adiposity rebound of middle childhood ages cycle longer than 35 days more than adi;osity a year oligomenorrhea, OA ; and ii do you have bothersome, excessive body hair hirsutism, H? Psychological distress is more prevalent in fertile age and premenopausal women with PCOS symptoms: year follow-up. Moreover, even though some investigators have reported a higher rate of prematurity in the offspring of women with PCOS [ 22 ], in the present data there was no difference in gestational ages. Download citation. Study design: A total of children, ages 2. Body mass index centile crossing is more direct than the timing of adiposity rebound for predicting later fatness. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis.

Accepted : 12 March Moreover, there are three critical periods for the development of childhood neueste erkenntnisse hashimoto s hypothyroidism adolescent obesity [ 13 midd,e the prenatal period, which refers to early development during gestation and is commonly represented by birth weight; the adiposity rebound, adiosity begins at the moment the body mass index BMI increases after the lowest point during infancy, which can occur at after 7 years old [ 1415 ]; and biological maturation, which is related to development of adiposity during adolescence [ 1316 ]. The data were analyzed using SPSS software version J Pediatr ; : 69 — Differences in continuous variables anthropometric parameters, AR timing, and hormonal outcomes were analyzed by using the independent samples t -test, the Mann—Whitney U test, one-way analysis of variance or the Kruskal—Wallis test, as appropriate, and for differences in categorical parameters, the Chi-square test was utilized.

Given that hyperandrogenic women with PCOS commonly present with the highest BMI [ 27 ], we assessed the association between serum testosterone concentrations at ages 31 and 46, and AR timing. However, we have previously shown the validity of self-reported symptoms as reliable indications of PCOS [ 91016 ]. Two aspects of the body mass index curve, the body mass index centile and the rate of body mass index centile crossing, determine a child's age at rebound. Birth weight and AR Data on birth weight was collected prospectively by local midwives in the antenatal clinics and the data were available for all the cohort members. The participants were asked questions on lifestyle, occupation and working history, living environment, and health. Clin Obstet Gynaecol.

Pediatric adiposity rebound of middle childhood ages abes with longitudinal measurements of height and weight were collected retrospectively for the subjects of the GOOD study. The best hope for influencing these family patterns is that the educational efforts of health professionals will take effect in the next generation when these parents, as grandparents, repeat the advice that they were given. Archives of Disease in Childhood. BMC Medicine Int J Obes Lond ; 36 : —

The study flow chart is presented in Supplementary Figure 1. Lower body weight and BMI at birth were associated with early adiposity rebound in hydroxylase deficiency patients. Indeed, early timing of adiposity rebound ARthe midddle rise in BMI following a nadir occurring in early childhood, has been associated with increased risks of obesity and metabolic derangements both in adolescence and in adulthood [ 56 ]. Here we report lower birth weight and a differential growth pattern during childhood in women with PCOS. Data on birth weight was collected prospectively by local midwives in the antenatal clinics and the data were available for all the cohort members.

Chidhood studies are needed to shed light on the prenatal triggering mechanisms behind PCOS in humans. BMC Endocrine Disorders Koivuaho View author publications. Age at adiposity rebound: determinants and association with nutritional status and the metabolic syndrome at adulthood. These findings further strengthen the hypothesis that early childhood is a sensitive period for not only early metabolic risks but also for PCOS [ 11122526 ]. The participation rate has been high throughout all data collection points and the early BMI growth data were obtained from the health register of a child health program that is available and free for all families. Similarly, PCOS has been associated with many of these metabolic abnormalities, with some studies showing weight gain from adolescence to adulthood being a risk factor for PCOS [ 9 ].

The stability of weight status through the early to middle childhood years adiposity rebound of middle childhood ages Australia: a longitudinal study. Many risk factors related to early adiposity rebound have been studied; however, for some of them, the evidence is not yet conclusive. Fourth, we investigated multiple cardiometabolic outcomes, therefore increasing the risk of false-positive results. The reason is readily apparent — for A and B the background centile curves are falling with time, for D and E they are rising, and for C they are effectively flat. In addition we made the novel observation that early age at AR was associated with an early puberty in men. Figure 2 emphasises that their wide spectrum of centile crossing patterns is obscured at rebound by the falling then rising centile curves, and are much more obvious later in childhood. Changes in BMI were calculated from age 14 to age 31, from age 31 to age 46, and from age 14 to age

Age at adiposity rebound is associated with fat mass in young adult males - the GOOD study. Infancy and childhood growth measurements weight and height from early infancy to adolescence were gathered from the welfare clinic records. Periods of risk in childhood for the development of adult obesity—what do we need to learn?

According to the literature, early timing of AR is defined as that occurring before the age of 5 years [ 5 ]. Advanced search. Full size image. References 1.

To our knowledge, this is the first study carried out to investigate BMI trajectories in women with PCOS from early infancy to premenopausal age in a population-based setting, with the additional benefit of having the possibility to adjust the data for several confounding factors. Identification of women with PCOS The year follow-up questionnaire included two questions screening for PCOS symptoms: i is your menstrual cycle longer than 35 days more than twice a year oligomenorrhea, OA ; and ii do you have bothersome, excessive body hair hirsutism, H? In fact, in the current literature, childhood obesity and the risk of PCOS has received little interest so far. Changes in BMI were calculated from age 14 to age 31, from age 31 to age 46, and from age 14 to age In this prospective population-based cohort study we investigated for the first time the associations between birth weight, early growth, and AR timing vs.

Introduction

Google Scholar 5. Associations between timing of Ages peak-rebound patterns and cardiometabolic outcomes at early adolescence. Age at BMI peak was positively associated, and age at rebound was strongly inversely associated, with lean mass and total and central adiposity in early adolescence. Adiposity rebound has been criticized for the lack of physiological mechanisms and a possible statistical origin of this marker [ 17 ], but posteriorly studies have shown that even subjects that present a low BMI during childhood, suffering an early rebound, they are more likely to present higher obesity and consequently, cardiovascular risk during adulthood, than their peers [ 1415 ].

Int J Epidemiol. Key Messages Few studies have examined adpiosity relationships of body mass index BMI peak in infancy and rebound later in childhood, with later cardiometabolic risk. Many risk factors related to early adiposity rebound have been studied; however, for some of them, the evidence is not yet conclusive. Mediation models are described in Fig 2. In this sense, our study found that the mediation effects of BMI at childhood were significant in the three variables of body adiposity in both sexes. In line with these findings, the timing of adiposity rebound is expected to be different in the 21st century compared with that in the past. Adiposity rebound and the development of metabolic syndrome.

Obesity Silver Spring. Int J Epidemiol. Birth weight and polycystic ovary syndrome in adult life: a register-based study onDanish women born Tapanainen, L. Endocr J.

Later outcomes in children with early adiposity rebound 1. The limitations also include self-reported PCOS symptoms and diagnoses. Then, BMI decreased to the nadir value. Inapproximately 6.

Such children are likely to have a raised body mass index later. Koivuaho View author publications. Both symptoms were reported in 4. Show results from All journals This journal.

Information on maternal age, education, pre-pregnancy BMI, and smoking status during pregnancy was self-reported and data were adiposity rebound of middle childhood ages by local midwives in the antenatal clinics using a questionnaire that was designed for NFBC data collection. Obesity and the polycystic ovary syndrome. Weight gain and dyslipidemia in early adulthood associate with polycystic ovary syndrome: prospective cohort study. Results: A total of children demonstrated early rebound, 59 children were nonrebounders, and a further 35 had inconclusive data. CTRLs:

PLoS Genet. Discussion In this prospective agds cohort study we investigated for the first time the associations between birth weight, early growth, and AR timing vs. BMC Med. HartMartha HickeyLisa J. Show results from All journals This journal. Weight and height data from birth to age 13 years, at age at menarche, and at ages 31 and 46 years were analyzed. Laboratory methods Blood samples were drawn at ages 31 and

Introduction

Each subject's outer two BMI values are the same yet their centiles differ. Furthermore, the observation that lean mass changes rather than fat mass changes show a more similar pattern to body mass index trajectories is interesting. A follow-up chest X-ray showed Mrs. Diabet Med. In a study including longitudinally followed subjects from New Zealand, subjects with early age at AR had larger waist circumference at adult age [9] than subjects with middle or late age at AR, and in the Bogalusa Heart study age at AR was inversely associated with subscapular skinfold thickness [4].

Fourth, we investigated multiple cardiometabolic outcomes, therefore increasing the risk of false-positive results. Weight and height data from birth to age rebpund years, at age at menarche, and at ages 31 and 46 years were analyzed. Total body fat mass, percentage body fat, total body lean mass and fat mass of the trunk, leg and arm were assessed for all subjects using the Lunar Prodigy DXA GE Lunar Corp. All statistical calculations were performed using age-adjusted body composition variables.

Nature Publishing Group; ; 1— These childhoid demonstrate clear practical implications. Timing of adiposity rebound and adiposity in adolescence. One theory for the occurrence of an AR is that the body is being prepared for the adolescent growth spurt. We also observed that children with a normal peak-early rebound pattern had a poorer cardiometabolic profile, exemplified by associations with higher total and central adiposity, insulin resistance and global metabolic risk score, than children with the normal peak-normal rebound.

Fertil Steril. Elsevier Adiposity rebound of middle childhood ages Ltd; ; — Published : 12 March Moreover, there are three critical periods rfbound the development of childhood and adolescent obesity [ 13 ]: the prenatal period, which refers to early development during gestation and is commonly represented by birth weight; the adiposity rebound, which begins at the moment the body mass index BMI increases after the lowest point during infancy, which can occur at after 7 years old [ 1415 ]; and biological maturation, which is related to development of adiposity during adolescence [ 1316 ]. Cardiovasc Diabetol. Therefore, early adiposity rebound indicates faster growth, more advanced development, and earlier puberty.

Individuals with birth weight under the 10th percentile for gestational age were considered as SGA and individuals with birth weight over the 90th percentile for gestational age were considered as LGA. Download references. Regarding hydroxylase deficiency, one study hypothesized that low birth weight with concomitant excess androgen exposure during the fetal and perinatal periods may contribute to timing of AR, whereas in cases of premature adrenarche it is thought that early growth acceleration leads to obesity that may results into premature adrenarche [ 2829 ]. Obesity Silver Spring. Download PDF.

Early timing of AR has been shown to be associated with adverse metabolic adiposity rebound of middle childhood ages, such as obesity, higher triglyceride and low-density lipoprotein-cholesterol levels, insulin resistance, and metabolic syndrome in adulthood but also in children shown as early as at 7 years of age [ 5 adkposity, 62425 ]. Show results from All journals This journal. Children grow and horses race: is the adiposity rebound a critical period for later obesity?. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Acknowledgments The authors thank all the participants who engaged in this study. There are also differences found for children likely to be lean or obese later in life. The middle measurement is smaller in value than the other two, and its age of measurement may be earlier or later than the true unobserved age at rebound.

Introduction During the developmental period, body mass index BMIwhich is used as an index of obesity, shows an interesting growth trajectory. In line with these findings, the timing of adiposity rebound is expected to be different in the 21st century compared with that in the past. Assure the family that Andre is well nourished. While visceral fat is a strong risk factor for cardiovascular disease and the metabolic syndrome, it has recently been shown that expanded subcutaneous adipose tissue as well is associated with increased cardiovascular risk [19]. With permission. The age at rebound depends primarily on the ages of the outer two measurements, and their mean age assuming a symmetric BMI curve [ 12 ] is an unbiased estimate of the age at rebound. Previous studies have indicated an association between waist circumference at adult age and age at AR [9] and an inverse association between age at AR and subscapular skinfold thickness in adult age [4]indicating an association between timing of AR and indirect measurements of fat mass.

Supplementary Figure 2. Briefly, the longitudinal BMI linear mixed-effect model was fitted using logarithmically transformed BMI as the outcome and the predicted timing adiposity rebound of middle childhood ages AP and AR was calculated using estimated fixed and random coefficients [ 19 ]. Koivuaho View author publications. The study population is part of the prospective, longitudinal, population-based, Northern Finland Birth Cohort NFBCrecruited at gestational week 24 from the two northernmost provinces of Finland. Early BMI data weight and height were available for

Obes Res — Tracking of continuous adiposity indicators are presented in Table 2. As the Korean Growth Standard adopted the World Health Organization Child Growth Standards for children aged 0—35 months, there is a transition point at 36 months of age. In addition we made the novel observation that early age at AR was associated with an early puberty in men. It is likely that AR is now occurring earlier among children "at-risk" for obesity. This is an opportunity for resident role-play. The other factors may be also.

Cnildhood, for a child to be too skinny provides a rationale for Mrs. Association between common variation at the FTO locus and changes in body mass index from infancy to late childhood: the complex nature of genetic association through growth and development. Anon: Childhood obesity: an emerging public-health problem. The ages at rebound for A and B are similar Figure 2 yet their centiles and centile rate rises are very different Figure 3. Adverse childhood experiences and trauma informed care: treating the whole patient with a more complete osteopathic approach.

Psychological distress is more prevalent in fertile age and premenopausal women with PCOS symptoms: year follow-up. Moreover, T at age 31 or 46 was not an independent risk factor for timing of AR. Childhood body mass index BMI growth trajectory data have also shown its value as a tool to estimate BMI and metabolic risks in adulthood [ 5 ]. Adiposity rebound and the development of metabolic syndrome. Revised : 21 November Differences in continuous variables anthropometric parameters, AR timing, and hormonal outcomes were analyzed by using the independent samples t -test, the Mann—Whitney U test, one-way analysis of variance or the Kruskal—Wallis test, as appropriate, and for differences in categorical parameters, the Chi-square test was utilized.

Such children are likely to have a raised body mass index later. Supplementary legends. Infancy and childhood rebounv measurements weight and height from early infancy to adolescence were gathered from the welfare clinic records. In addition we did not observed difference between group for clinically defined low birth weight or SGA.

Assure the family that Andre is well nourished. The usual tracking for weight gain relative to length or height would be a childhood ages for the first six or seven months of age followed by a drop in the BMI. Eriksson JG. But she was not reassured. By contrast the rate of centile crossing needs just two BMI measurements a year or two apart to estimate it.

Developmental pathways to adiposity begin before birth and are influenced by genotype, prenatal environment and epigenome. J Clin Endocrinol Metab. Int J Obes 43, — J Pediatr. Keywords: Latino farmworker families; childhood obesity; determinants of adiposity rebound timing; diet; early adiposity rebound; food security; maternal body mass index; physical activity. Sebert Authors E.

This is owing to the trend of a steeper increase of height as compared to weight in the first years of life. Even though physical activity tracking values from childhood to adolescence are moderate to low, previous studies have shown that regular practice of physical activity and sports participation are inversely related to body adiposity indicators [ 36 — 38 ]. Int J Obes. Goossens GH. Adiposity and cardiovascular risk factors in a large contemporary population of pre-pubertal children. Insulin resistance in children: consensus, perspective, and future directions. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood.

Infancy and rebounr growth measurements weight and height from early infancy to adolescence were gathered from the welfare clinic records. In the year postal questionnaire the women reported their age at menarche. The study included only Caucasians; thus, the results may not apply to different ethnicities or populations with higher childhood obesity rates.

As women with PCOS are generally accepted to be at hypothyroidism high risk of obesity and adverse cardio-metabolic profiles, as well as having several other comorbidities, it would be of utmost importance to identify these individuals at risk early on in order to allow possible intervention and support. Reprints and Permissions. In addition, at age 46 calculated free testosterone cFT was assessed by using albumin, SHBG, and testosterone concentrations, according to the method described by Vermeulen et al. DohertyHelena J.

Growth, Maturation, and Physical Activity. Fetal and infant growth and impaired glucose tolerance at age Further studies are needed to identify whether such interventions would be effective in preventing later obesity and its cardiometabolic consequences in children with at-risk BMI peak-rebound patterns. Table 1 Population characteristics Full size table.

Accepted : 20 December Association between birth weight and timing of adiposity rebound AR with polycystic ovary syndrome PCOS diagnosis by age Given that birth weight is sensitive to several pregnancy-related genetic and environmental factors, recent study have also suggested that it may not share the same programming with postnatal growth, especially the growth in childhood [ 23 ]. You can also search for this author in PubMed Google Scholar. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women.

In multivariable analysis, female sex, limited maternal education, increased maternal BMI, and increased caloric intake were significant predictors of early rebound. More than a half of women with PCOS are obese, and later, obesity amplifies the symptoms of PCOS, especially if the weight gain has occurred in early adulthood [ 91314 ]. CTRLs:

Fertil Steril. Simulation of growth trajectories of childhood obesity into adulthood. Despite this finding, androgen levels during childhood have been shown to be associated with the timing of AR, since children with premature adrenarche or hydroxylase deficiency do have early AR [ 2829 ]. Differences in continuous variables anthropometric parameters, AR timing, and hormonal outcomes were analyzed by using the independent samples t -test, the Mann—Whitney U test, one-way analysis of variance or the Kruskal—Wallis test, as appropriate, and for differences in categorical parameters, the Chi-square test was utilized. In our study population, an AR drop of 1 year was associated with a 1. About this article.

Download citation. Insulin resistance in children: consensus, perspective, and future directions. Metabolic risk score and cancer risk: pooled analysis of seven cohorts. This pattern is recorded in children of recent generations as compared to those of previous generations.

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