During puberty, boys and girls develop their secondary sexual characteristics and their reproductive competence, which is triggered by the secretion of the gonadotropin-releasing hormone (GnRH) [1
]. Among other factors, a good nutritional status seems to be a prerequisite for a typical pubertal development [2
]. Therefore, excess of adiposity can accelerate the onset of puberty and contribute to its precocious development [3
]. Recent research suggests that precocious puberty is associated with immediate and long-term health risks [4
Evidence has shown that precocious puberty is associated with a higher adult body mass index (BMI), fasting insulin, diastolic blood pressure (DBP), and decreased High-density lipoprotein (HDL) cholesterol in both sexes, as well as with higher total serum cholesterol, Low-density lipoprotein (LDL) cholesterol, and triglycerides in males [7
]. Conversely, in a longitudinal study of an adolescent population, Remsberg et al. [8
] found that early menarche was associated with greater cardiovascular risk as reflected in high blood pressure, glucose intolerance (regardless of age), fat-free mass, and body fat percentage.
Other studies found that excess fat (BMI and skinfold thickness) was associated with pubertal stage and with early maturation in boys and girls, though the associations were in opposite directions. Compared with their counterparts, early maturing boys had thinner skinfolds, whereas early maturing girls had thicker ones [9
]. These results seem to indicate that the pubertal stage could act as a modulating factor in the development of cardiometabolic risk in young people.
The objective of this study was to explore the association between pubertal stage and biochemical and anthropometric factors in Colombian children and adolescents.
This study explored the association between pubertal stage and anthropometric and cardiometabolic risk factors in 2877 Colombian children and adolescents (9–17.9 years old). Our findings show significant gender-based differences in the nutritional status of the participants with a higher prevalence of overweight among the girls (23%). This finding agrees with Briceño et al. [22
], who studied a population of children and adolescents in Bogotá and found that there were 18.2% more overweight girls than boys.
Previous studies have shown that the timing of pubertal development affects body composition in girls [22
] and in boys [6
]. In line with the findings of Caicedo-Álvarez et al. [11
], who studied a population of Colombian children living in the city of Bogotá, we also found (as expected) that mean WC values increased with age. Moreover, studies have shown that the distribution pattern of fat varies with age [2
], with a tendency for fat to be deposited in the central area of the body instead of in peripheral areas, which heightens the risk of cardiovascular disease [7
]. In same line, we have found a higher rate of increased overweight/obese among pre-pubertal boys with a decreasing trend towards pubertal/post-pubertal boys. However, prevalence of overweight/obese among the girls was greater than that among boys as compared to pubertal stage. These results also coincide with those obtained by Freedman et al. [23
], who conducted a prospective study of 6866 boys and girls, 5–17 years of age, in Louisiana (USA). In that study, the author found that the BMI values of girls were considerably higher than those of boys. Furthermore, the tendencies regarding obesity status reported in our study are also in consonance with the general statistics of Colombia’s 2016 Report Card on physical activity for children and youth [24
]. These research results justify the need to implement programs that foment healthy life styles from an early age. Moreover, the analysis of body composition in our study found significant differences in the body fat percentages in both sexes with a higher prevalence in girls (24.9%) in comparison to boys (16.6%).
According to Prenkert and Ehnfors [25
], these differences in body fat percentage could be due to differences in physical and sexual development, which generally occur earlier girls. Therefore, before puberty, from five up to the age of ten, both sexes have similar amounts of body fat. However, during puberty, girls usually experience an increase in body fat whereas in boys, there is a decrease [26
]. For this reason, scientific evidence suggests that pubertal development affects body composition in both sexes [27
In regard to pubertal stage and cardiovascular risk factors, puberty was significantly associated with some cardiovascular risk factors, such as high systolic blood pressure, overweight/obesity, and obesity. This suggests that the simple and inexpensive measure of BMI can be as clinically important or even more important than total adiposity measures assessed by accurate, complex, and expensive methods [30
]. Nonetheless, the results showed that the most significant variable in the prognosis of cardiometabolic risk was BMI. In addition, the Tanner pubertal development stages seem to be a predictor of cardiometabolic risk [6
One of the major issues at puberty is the difference in the percentage of body fat between sexes. Consequently, for girls, the physiological pattern of body fat, running parallel to age and pubertal development (especially late/post-pubertal development), could be associated with increased early cardiovascular risk [6
]. As for the boys, in addition to the previously mentioned factors, puberty was significantly associated with low HDL-C and CMRI. Therefore, our findings indicate that pubertal development (i.e., late/post-pubertal) can be a determining factor in the predisposition to cardiometabolic risk, especially in girls, which coincides with the results of previous studies [31
]. Nonetheless, the findings obtained in other studies [31
] were somewhat less conclusive regarding the association of pubertal development stages and cardiometabolic risk in boys, but still agree with the results of our study.
We explored the association between pubertal stages and individual cardiometabolic risk factors to examine whether pubertal stage was associated with CMRI, whereas the other studies looked into the changes of metabolic profile that occur in different pubertal stages by sex. Additionally, the association of CMRI is statistically more demanding than CMRI, as it removes the WC component from the risk score. The results of our study as well as those of other studies suggest that it would be appropriate to include the evaluation of pubertal development stage in clinical screening, given its association with cardiovascular risk. However, similar to the findings of the Chan et al. [6
] in Hong Kong Chinese children, the increases in the variance explained by the pubertal stage (i.e., interaction-term) was negligible (1%–2%), so these data should be cautiously interpreted. Therefore, further research is necessary to identify and monitor the factors that lead to higher adiposity levels in children and adolescents in Bogotá. In fact, these results should be a wake-up call for the Colombian government since they are a clear justification of the need to implement policies that foment healthy lifestyles in young people. This includes regular physical exercise, as well as a balanced diet in early childhood. Schools may be an ideal setting to monitor cardiometabolic risk factors [24
] and to formulate and apply specific strategies to promote young people’s health.
This study had some limitations. First, all participants were from the same region in Colombia. Consequently, any inferences for all Colombian children and adolescents should be made with caution. Second, this research did not consider the potential impact of determinants such as socioeconomic, dietary and physical activity patterns, and ethnic factors, all of which can modulate growth and levels of adiposity. However, such limitations do not compromise the interest of the results obtained. One of the strong points of the study is its large sample size. Another positive aspect is that the children and adolescents in the sample attended public schools, which were located in different districts of Bogotá, therefore including a mix of locally-born residents and those arriving from other regions, and so it is racially and culturally diverse.