Accelerated skeletal maturation is associated with overweight and obesity as early as preschool age: a cross-sectional study

Abstract

Background Body mass index (BMI) and skeletal age (SA) are important indicators of individual growth and maturation. Although the results have not been unified, most studies indicated that accelerated skeletal maturation is associated with overweight/obesity. However, there have so far been insufficient studies about the association between accelerated skeletal maturation and overweight/obesity in preschoolers, particularly Asian children. A cross-sectional study was conducted on Chinese children to verify the association between accelerated skeletal maturation and overweight/obesity at preschool age. Methods The study involved 1330 participants aged 3.1–6.6 years old (730 males and 600 females) in Shanghai, China. The skeletal age was determined according to the method of TW3-C RUS. Accelerated skeletal maturation was defined as relative SA (SA minus chronological age [CA]) ≥1.0 years. BMI was classified as thinness, normal weight, overweight, and obesity according to the International Obesity Task Force (IOTF) BMI cut-offs. The Chi-square was performed to determine the statistically significant difference in the frequency of accelerated skeletal maturation in BMI and age categories. The logistic regression model analyzed the association between accelerated skeletal maturation and overweight/obesity. Results The percentage of accelerated skeletal maturation increased with BMI (7.8% of children in thinness group had accelerated skeletal maturation; the percentage increased to 30.8% in obese group. x2 = 89.442, df = 3, P < 0.01) and age group (at age 3.5, 3.5% of participants had accelerated skeletal maturation; at age 6.0 years, this increased to 27.8%. x2 = 43.417, df = 5, P < 0.01). Logistic regression analysis showed that children with overweight and obesity are more likely to have accelerated skeletal maturation than children with normal weight after adjusting for gender and age (Overweight, odds ratio [OR] = 3.27, 95% confidence interval [CI]: 2.20–4.87; Obese, OR = 4.73, 95% CI: 2.99–7.48). Conclusions There is an association between accelerated skeletal maturation and overweight/obesity among preschool children. This study suggests that accelerated skeletal maturation might coexist with overweight/obesity in preschool children, and interventions, such as dietary modifications and increasing levels of physical activity, should be employed to prevent both accelerated skeletal maturation and overweight/obesity as early as preschool age.

An Approach to the Evaluation and Management of the Obese Child With Early Puberty

“…BA was advanced more than 2 years in 33% of obese children compared with only 1% of nonobese children [ 57 ]. Another study also observed the effect of obesity on BA advancement, specifically among preschool children (age 3-6 years) [ 59 ].…”

Bone age in prepubertal children with nonfamilial or familial idiopathic short stature and prepubertal short-stature children born small for gestational age: a longitudinal data analysis

“…Prepubertal BA is accelerated in obese children (2)(3)(4)(5), presumably due to increased insulin secretion (3). In this study, the median BMI SD scores among 6-and 7-yr-olds in the FSS group exceeded 0, unlike in the other two groups.…”

“…The CA with the greatest BA delay was 9 yr, 8 yr, and 7 yr in the ISS, FSS, and SGA groups. Adrenal androgen affects bone maturation in prepubertal children (5)(6)(7). It is well known that adrenarche starts early in children born SGA (18), but there have been no reports concerning the timing of adrenarche in children with ISS or FSS.…”

“…It is unclear why BA is delayed in prepubertal children without endocrine abnormalities. In contrast, BA accelerates in prepubertal obese children (2)(3)(4)(5), and the timing of adrenarche affects bone maturation in prepubertal children with normal stature (6,7).…”

Association between sex hormones and bone age in boys aged 9–18 years from China

“…11,15,16 Conversely, others have shown that the combined effect of multiple hormones influences skeletal maturation. 17,18 The inconsistent findings in existing studies might be attributed to the differences in ethnicity, sample size, nutritional status of the populations, investigations timing and the instruments and methods used to measure hormone levels. 19 To gain comprehensive insights, this study aimed to analyse the association between sex hormones and BA in Chinese boys aged 9-18 years, both individually and interactively, and further to explore the potential effect of nutritional status on this association.…”