Puberty is a major developmental period characterised by the height growth spurt, appearance of secondary sex characteristics, body composition alterations and increasing circulating hormone levels. 1,2 Variability exists in how early (timing of onset) and rapidly (tempo of puberty) individuals commence and progress through these changes.Such variability is known to have immediate and lifelong impacts on health and well-being which, in turn, has clear implications to practice in terms of identifying and delivering timely supportive therapies to those exhibiting "at risk" developmental trajectories.The clinical and hormonal markers of pubertal onset, together with the age range at which onset occurs, are well recognised. The first signs of puberty are measured by the attainment of Tanner stage (TS) 2 for breast (B2) or genital (G2) development, or a rise in gonadal hormones above the childhood range. 3 The typical age of onset ranges from 8 to Cheng and Harris contributed equally to this work.Abbreviations: ATO, age at height take-off; APHV, age at peak height velocity; B2/5, Tanner breast development stage 2/5; BMI, body mass index; G2/5, Tanner genital development stage 2/5; TS Tanner stage; zBMI, age-and sex-adjusted body mass index z-score Abstract Aim: Emerging evidence suggests that pubertal tempo, that is rate of passage through puberty, has relevance to adolescent mood and behaviour. However, its wider health and developmental significance remain unclear. This systematic review sought to clarify the relationship of pubertal tempo to indicators of health and development, and to document tempo definitions and pubertal durations reported in the literature. Methods: Eight electronic databases were searched from earliest record to July 2018. Study eligibility: healthy participants; age 8-21 years; ≥2 longitudinal measures of puberty; analysis of tempo against a health or developmental indicator. Results: Thirty-eight studies met eligibility, and these reported on diverse tempo definitions and seven health-and development-related domains. Data sets with varying tempo definitions converged on an association of rapid pubertal progression to: (a) higher adiposity during childhood and adolescence in both sexes; and (b) lower psychosocial well-being in adolescent males. Later thelarche unanimously predicted faster progression to menarche in females, but this compensation was largely undetected when alternate definitions of pubertal timing and/or tempo were used. Duration of puberty ranged from 2.5-4.1 years. Conclusion: Pubertal tempo may be clinically relevant when considering trajectories of adiposity and psychosocial well-being among adolescents, especially males. Consensus on the definition of tempo would facilitate between-study comparisons. K E Y W O R D S adiposity, adolescence, behaviour problems, depression, pubertal pattern | 901 CHENG Et al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Cheng HL, Ha...

Adolescents showed a U-shaped change in ghrelin corresponding to physical and biochemical markers of growth, and no change in PYY. The overweight and obesity subgroup exhibited an apparent loss of the U-shaped ghrelin trend, but this finding may be attributed to greater maturity and its clinical significance is unclear. Further research on weight-related ghrelin and PYY trends at puberty is needed to understand how these peptides influence growth and long-term metabolic risk.

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