Supplemental materials for: Current pubertal development in Chinese children and the impact of overnutrition, lifestyle and perinatal factors
Creators
- Xinyi Liang1
- Ke Huang1
- Guanping Dong1
- Ruimin Chen2
- Shaoke Chen3
- Rongxiu Zheng4
- Chunlin Wang5
- Haiyan Wei6
- Bingyan Cao7
- Yan Liang8
- Hui Yao9
- Zhe Su10
- Mireguli. Maimaiti11
- Feihong Luo12
- Pin Li13
- Min Zhu14
- Hongwei Du15
- Yu Yang16
- Lanwei Cui17
- Shuting Si18
- Guannan Bai1
- YunxianYu18
- Er-Gang Wang19
- Paul L Hofman20
- JunfenFu1
- 1. Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
- 2. Department of Endocrinology, Children's Hospital of Fuzhou, Fujian Province, Fuzhou, China
- 3. Department of Pediatric, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
- 4. Department of Pediatric, Tianjin Medical University Central Hospital, Tianjin, China
- 5. Department of Pediatric, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
- 6. Department of Endocrinology, Zhengzhou Children's Hospital, Zhenzhou
- 7. Department of Endocrinology, Beijing Children's Hospital, Capital Medical University,National Medical Center for Children's health, Beijing, China.
- 8. Department of Pediatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- 9. Department of Pediatric, Wuhan Children's Hospital, Tongji Medical College,Huazhong University of Science & Technology. Wuhan, China.
- 10. Department of Endocrinology, Shenzhen Children's Hospital, Shenzhen, China
- 11. Department of Pediatric, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- 12. Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China.
- 13. Department of Endocrinology, Children's Hospital of Shanghai Jiaotong University, Shanghai, China.
- 14. Department of Endocrinology, Children's Hospital of Chongqing Medical University, Chongqing, China
- 15. Department of Pediatric Endocrinology, The First Bethune Hospital of Jilin University, Changchun, China.
- 16. Department of Endocrinology, Jiangxi Provincial Children's Hospital, Nanchang, China
- 17. Department of Pediatric, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
- 18. Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
- 19. Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- 20. Liggins Institute, University of Auckland, Auckland, New Zealand
Description
Context: Pubertal onset has been decreasing in many countries but there has been no data on pubertal development in Chinese children over the last decade.
Objective: The primary objective of the study was to evaluate the current status of sexual maturation in Chinese children and adolescents. Secondary objectives were to examine socio-economic, lifestyle and auxological associations with pubertal onset.
Design: A national, cross-sectional health survey.
Setting: The community-based setting.
Participants: A multistage, stratified cluster random sampling method was used to select a nationally representative sample, consisting of 231,575 children and adolescents(123,232 boys and 108,343 girls) between 2017 and 2019.
Main Outcome Measure: Growth parameters and pubertal staging were assessed by physical examination.
Results: Compared to 10 years previously the median age of Tanner 2 breast development and menarche were similar at 9.65 years and 12.39 years respectively. However, male puberty occurred earlier with a median age of testicular volume ≥4 ml of 10.65 years. Pubertal onset did occur earlier at the extremes with 3.3% of the girls with breast development between 6.5-6.99 years old increasing to 5.8% by 7.5-7.99 years old. Early pubertal onset was also noted in boys, with a testicular volume ≥ 4 ml noted in 1.5% between 7.5-7.99 years increasing to 3.5% between 8.5-8.99 years old. Obesity and overweight increased the risk of developing earlier puberty compared to the normal weight in both boys and girls.
Conclusions: Over the past decade, pubertal development is occurring earlier in Chinese children. While the cause is multifactorial, overweight and obesity are associated with earlier puberty onset. The currently-used normative pubertal data of precocious puberty may not be applicable to diagnose precocious puberty.