Early puberty linked to metabolic and mental disorders

Early puberty linked to metabolic and mental disorders | Image Credit: © Halfpoint - © Halfpoint - stock.adobe.com.

Early puberty is a significant risk factor for metabolic and mental disorders, according to a recent study published in Frontiers in Pediatrics.¹

Data has indicated a rising prevalence of early puberty onset, which has been linked to multiple adverse health outcomes. However, there is still little information about overall risks associated with early puberty.

In a recent review, investigators summarized outcomes of early puberty at a population level. Links with metabolic diseases including cardiovascular disease (CVD), as well as hypertensive disorders such as gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM), were discussed.

Puberty onset will often occur in girls aged 8 to 13 years and boys aged 9 to 14 years. However, certain developments have begun to occur earlier over the previous century, such as a 3-month decrease in the onset of breast development. Similarly, the average ages when girls experience pubarche and menarche have decreased.

Early puberty trends have also been reported in boys. These include earlier ages of Tanner stage G2 of genital development and voice breaking.

An increase in early puberty rates was also reported during the COVID-19 pandemic.² One study reported a rapidly progressive idiopathic central precocious puberty rate of 1.44 cases per month from January 2016 to February 2020, vs 3.8 cases per month from March 2020 to June 2021.

The review included studies about pubertal markers to evaluate metabolic and mental impacts^.1 According to investigators, thelarche, defined as breast development, is the gold standard for predicting puberty onset in girls. However, self-reported menarche is the most commonly used marker and is at risk of reporting bias.

Puberty is associated with a rapid increase in insulin resistance, leading to increased risks of developing metabolic disease such as T2DM. Patients with early puberty are at an increased risk of metabolic diseases such as diabetes and CVD.

Hormonal changes during puberty may also lead to weight gain, increasing obesity risk. According to the World Health Organization, approximately 1 in 3 school-aged children in Europe were impacted by overweight or obesity in 2022, highlighting its status as a major public health concern.

The relationship between obesity and early puberty is bidirectional, meaning the onset of one increases the risk of the other. Additionally, the link between early puberty and obesity risk later in life is more pronounced in girls than in boys. One study reported an increased body mass index (BMI) of 0.34 kg/m2 among girls with early menarche.

Diabetes, reported as the ninth leading cause of death worldwide in 2018, is also more likely in patients with early puberty. Data has indicated early puberty as an independent risk factor for GDM and T2DM, with a later age at menarche linked to a relative risk of 0.91 per year.

An increased prevalence of T2DM was also found in girls with an earlier age at menarche vs boys with an earlier age at voice breaking, with an odds ratio of 1.24. Additionally, a negative association has been identified for age at menarche and metabolic markers of T2DM such as insulin, HOMA-IR and HOMA-β.

CVD, the leading cause of death worldwide, is more common in patients with overweight or obesity, diabetes, and high cholesterol levels. Data has indicated an association between early puberty and CVD even after adjusting for age and BMI, with a hazard ratio of 1.22 for stroke and 1.16 for coronary heart disease.

Early puberty has also been linked to mental disorders because of rapid physical maturation alongside gradual phycological development. Hormonal fluctuations, social and emotional maturation, and stressful situations all may contribute to these conditions.

This data highlights significant metabolic and mental health outcomes among patients with early puberty. Investigators recommended establishing a gold standard to enhance the specificity of early puberty research.

References

1. Yukun S, Haiyan L, Chunguang M, Peipei L, Changfu H, Yongjuan X. Early puberty: a review on its role as a risk factor for metabolic and mental disorders. Front. Pediatr. 2024;12. doi:10.3389/fped.2024.1326864
2. Krewson C. Early puberty rates increased during the COVID-19 pandemic. Contemporary OB/GYN. September 14, 2023. Accessed October 2, 2024. https://www.contemporaryobgyn.net/view/early-puberty-rates-increased-during-the-covid-19-pandemic