Gonadotropin releasing hormone analogue therapy in girls with idiopathic precocious puberty/early-fast puberty: dynamics in adiposity indices, eating habits and quality of life.

BACKGROUND: The impact of gonadotropin-releasing-hormone-analogue (GnRHa) treatment on weight and body composition is controversial. Exploring the nutritional, psychological patterns of this population may aid to clarify this propensity to gain weight. This prospective observational study aimed to evaluate longitudinal changes in adiposity, nutrition and quality of life in girls with central precocious/early-fast puberty (CPP/EFP) during GnRHa treatment. METHODS: Thirty-two GnRHa-treated girls with CPP/EFP and 27 prepubertal girls (7-10 years) were included in the analysis. Outcome measures assessed at baseline for CPP/EFP and the control groups and during up to two years of GnRHa treatment for the CPP/EFP group, included anthropometrics, body-composition, basal-metabolic-rate (BMR), 3-day food-diaries, child eating-behavior questionnaire, and pediatric quality-of-life questionnaire (PedsQL). RESULTS: Girls with CPP/EFP had higher pretreatment BMI-SDS, fat percentages, waist circumference and waist-per-height (p<0.01 for all), and lower psychosocial functioning than controls (p<0.05). Changes in anthropometric and body composition measurements indicated a gradual increase in adiposity and a decrease in muscle mass (p<0.001 for all). Dynamics in body composition could not be explained by the participants' self-reported dietary patterns and physical activity levels or by the measured BMR, which revealed an adequate and relatively low energy intake as compared to energy requirements. A gradual decline in physical functioning (PedsQL) after one and two years of GnRHa treatment was observed (p<0.001). CONCLUSIONS: Our findings highlight the need for comprehensive surveillance in girls with CPP/EFP. Dynamics in weight status and body composition during GnRHa treatment indicate the need for tailored nutritional and physical activity counseling aimed at preventing obesity.

Growth hormone therapy and short stature-related distress: A randomized placebo-controlled trial.

CONTEXT: Growth hormone (GH) treatment of short healthy children is based on the belief that short stature is associated with psychosocial problems and a diminished quality of life. OBJECTIVE: To determine the impact of GH therapy on psychosocial well-being and the ability of psychological metrics to define short stature-related distress. METHODS: Sixty prepubertal boys with idiopathic short stature (age: 10.0 ± 1.4 years, height-SDS: -2.38 ± 0.3) were enrolled in this 4-year intervention study (1-year double-blinded, randomized, placebo-controlled [GH/placebo-2:1] and 3-year open-labelled GH therapy). Explicit (conscious/voluntary) psychological metrics (Pediatric Quality of Life Inventory [PedsQL], Silhouette Apperception Test [SAT], Rosenberg Self-Esteem Scale [RSES], Child Behavior Checklist [CBCL]) and implicit (unconscious/involuntary) psychological metrics (Single-Category Implicit Association Test for height [SC-IAT-H], Height Perception Picture Test [HPPT]). Psychosocial evaluations were performed at study entry, after 1 and 4 years. RESULTS: At study entry, PedsQL of boys with idiopathic short stature was lower than Israeli norms (P = 0.001). After 1-year blinded intervention, only the GH-treated boys improved their actual and anticipated adult height perception (SAT, P < 0.001 and P = 0.022) with reduced short stature-related distress (SC-IAT-H, P < 0.001). At study end, RSES and SC-IAT-H improved significantly (P < 0.001), with no change in PedsQL and CBCL. CONCLUSIONS: Our finding of improved psychosocial functioning only in the GH-treated boys after 1-year blinded intervention suggests that it was the GH therapy, rather than being enrolled in a clinical trial, which contributed to the outcome. Long-term open-labelled GH treatment significantly improved height perception and self-esteem. Future studies are needed to fully assess the relevance of complementing the routinely used explicit self-report measures with the implicit measures.

The Natural History of Metabolic Comorbidities in Turner Syndrome from Childhood to Early Adulthood: Comparison between 45,X Monosomy and Other Karyotypes.

OBJECTIVE: Patients with Turner syndrome (TS) are at increased risk for metabolic disorders. We aimed to delineate the occurrence and evolution of metabolic comorbidities in TS patients and to determine whether these differ in 45,X monosomy and other karyotypes. METHODS: A longitudinal and cross-sectional retrospective cohort study was conducted in a tertiary pediatric endocrine unit during 1980-2016. Ninety-eight TS patients, 30 with 45,X monosomy were followed from childhood to early adulthood. Outcome measures included weight status, blood pressure (BP), glucose metabolism, and lipid profile. RESULTS: Longitudinal analysis showed a significant change in body mass index (BMI) percentiles over time [F(3,115) = 4.8, P = 0.003]. Age was associated with evolution of elevated BP [systolic BP: odds ratio (OR) = 0.91, P = 0.003; diastolic BP: OR = 0.93, P = 0.023], impaired glucose metabolism (HbA1c: OR = 1.08, P = 0.029; impaired glucose tolerance: OR = 1.12, P = 0.029), and abnormal lipid profile (cholesterol: OR = 1.06, P = 0.01; low-density lipoprotein cholesterol: OR = 1.07, P = 0.041; high-density lipoprotein cholesterol: OR = 1.07, P = 0.033). The occurrence of metabolic comorbidities was similar in 45,X monosomy and other karyotypes. Coexistence of multiple metabolic comorbidities was significantly higher in 45,X monosomy [F(1,72) = 4.81, P = 0.032]. BMI percentiles were positively correlated with metabolic comorbidities (occurrence and number) in each patient (r = 0.35, P = 0.002 and r = 0.383, P = 0.001, respectively). CONCLUSION: Our longitudinal study provides unique insights into the evolution of weight gain and metabolic disorders from childhood to early adulthood in TS patients. Since overweight and increasing age aggravate the risk for metabolic comorbidities, careful surveillance is warranted to prevent and control obesity already from childhood. The more prominent clustering of metabolic comorbidities in 45,X monosomy underscores the importance of a more vigorous intervention in this group.

Psychosocial factors associated with depressive mood in Israeli obese adolescents.

This study aimed to compare levels of depressive symptoms between normal-weight and obese Israeli adolescents and to identify sociodemographic factors that may explain differences in depression between these groups. Thirty normal-weight and 49 obese patients aged 12-18 years participated in this study. The obese group had a significantly higher depression score. On linear regression analysis, obesity, lower parental income, and lower self-esteem were significantly associated with a higher depression score. This model explained 32.4 percent of the variance. The results indicate that psychosocial assessment and identification of depressive signs should be considered integral components in the management of adolescent obesity.

Androgen insensitivity syndrome: risk of malignancy and timing of surgery in a paediatric and adolescent population.

BACKGROUND: Management of female phenotype XY disorders poses a series of problems for the treating clinician. Even after a series of investigations and imaging modalities, there are lingering doubts about the exact nature of the disease and the correct management option. Optimal timing and necessity for removal of their testes have been a debated issue by physicians. There is a generally accepted opinion among physicians that the risk of malignancy in androgen insensitivity syndrome (AIS) is considerably lower than with other intersex disorders and occurs at a later age. OBJECTIVE: The highlight of this presentation is to reinforce the value of laparoscopic gonadectomy in management of AIS in correlation with data suggesting higher risk of malignancy. PATIENTS AND METHODS: A retrospective review of 11 phenotypic females with XY karyotype was carried out. The patients were evaluated by a diagnostic protocol which included clinical, hormonal, sonographic and cytogenetic examinations. Patients/parents were counselled by the team concerning the different treatment modalities and contrary to the assigned gender, laparoscopy was offered to them. Uneventful bilateral gonadectomy was performed in all the patients and gonads submitted for histopathological examination. RESULTS: A total of 11 patients (mean age, 10.4 ± 4.1 years), including six with complete AIS and five with partial AIS (PAIS) were reviewed. In two patients with PAIS (18.1%), histopathology revealed malignancy (bilateral seminoma and gonadoblastoma) and in an additional patient, a benign hamartoma was found. Literature evidence suggests that AIS female phenotype patients retaining their testes through puberty have a 5% chance for developing malignant tumours. Reviewing our results in correlation with literature, we found that PAIS patients may harbour a higher risk of malignancy. CONCLUSIONS: In complementation to hormonal tests and cytogenetic techniques, laparoscopic gonadectomy is required to complete the diagnostic work up for AIS as it also adds a final therapeutic approach with low risk and huge benefit. Since laparoscopy is now a well-tolerated and widely accepted gold standard, it should be included in routine management for patients with AIS. Risk of malignancy in PAIS should be investigated in larger cohort of these patients.

The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children.

Recent findings of a direct association of obesity and impaired health-related quality of life (HRQOL) in children suggest a need for early weight-management interventions that address psychosocial issues and lifestyle. Our aim was to compare the effects of exercise, diet, or diet + exercise on HRQOL in obese children. We hypothesized that HRQOL will improve as a result of the weight-loss intervention and will be correlated with the amount of weight loss achieved by each of the intervention groups. A total of 162 children aged 6 to 11 years with a body mass index (BMI) exceeding the 95th percentile were randomly allocated to a 12-week regimens of diet, exercise, or diet + exercise. Weight, height, and percent fat mass were measured, and parents completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 at baseline and at the end of the intervention. The reductions in BMI were significantly greater in the diet and diet + exercise groups than in the exercise group. Pediatric Quality of Life Inventory scores improved significantly, with no differences among the groups. A greater reduction in BMI occurred in children whose parents completed the PedsQL at baseline (n = 105) than in children whose parents did not (n = 15) (-1.8 +/- 1.3 vs -1.0 +/- 1.5; P = .048) and in children whose parents completed the PedsQL at the end of the intervention (n = 73) than in children whose parents did not (n = 47) (-2.0 +/- 1.3 vs -1.3 +/- 1.3; P = .013). Weight-management programs that promote a healthy eating and physical activity can serve as an effective tool to improve the low HRQOL of obese children. Parental compliance is an important factor and may be assessed by the parents' cooperativeness in completing questionnaires.

Influence of weight-loss diets with different macronutrient compositions on health-related quality of life in obese youth.

The aims of this study were to compare the effects of weight-loss diets of different macronutrient compositions on weight and health-related quality of life (HRQOL), and to examine the relationship between changes in HRQOL parameters and weight loss during weight-loss programs in obese adolescents. Seventy one adolescents (12-18 years, BMI>95th percentile) were randomly allocated to one of three 12-week diet regimens: low-carbohydrate low-fat (LCLF), low-carbohydrate high-fat (LCHF) or high-carbohydrate low-fat (HCLF) diets. Weight, height and fat-mass were measured, and the PedsQL 4.0 questionnaires were administered to the participants at baseline and at the end of the intervention. Significant similar reductions in BMI, BMI-SDS, and fat percentage occurred in all groups. A significant improvement in HRQOL was found only in the LCLF and HCLF groups. For the entire sample, positive correlations were found between emotional and psychosocial functioning at baseline and the reduction in BMI, BMI-SDS, and fat percentage. By multiple regression analysis, higher baseline emotional functioning and BMI-SDS were significant predictors to higher reduction in BMI-SDS during the intervention. Our results support the importance of evaluating and improving psychosocial functioning before initiation of a weight-loss intervention program in adolescents, and the importance of low-fat diets in weight-loss interventions for adolescents.