Early Maturity as the New Normal: A Century-long Study of Bone Age

Boeyer, Melanie E; Sherwood, Richard J.; Deroche, Chelsea B; Duren, Dana L.

doi:10.1097/corr.0000000000000446

Cited by 37 publications

(23 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, 64.7% (515/796) of children with normal-weight had a SA lower than CA (Fig. 4 b) in this study, which disagrees with a previous study that encouraged a general advancement with an improvement in the nutritional level of modern people [ 29 ]. Third, no statistical difference was observed in relative SA between males and females among children aged 3–6 years (Table 3 ); this result was inconsistent with a previous conclusion that the development of SA occurs earlier in females than in males from birth to early adolescence [ 30 ].…”

Section: Discussioncontrasting

confidence: 99%

“…Another consideration was that nutritional status was an important factor influencing both accelerated skeletal maturation and overweight/obesity. Several studies indicated that the secular trend of earlier maturation could be caused by improved nutrition and socioeconomic environments [ 29 , 38 – 40 ], which is the same reason for the increasing prevalence of childhood overweight and obesity worldwide [ 2 , 41 ]. Conversely, as shown in the results, 69.6 and 64.7% of children with thin and normal-weight had lower SA than CA, respectively (Fig.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Cai

et al. 2020

BMC Pediatr

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Cai

et al. 2020

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…These results supported the findings of previous research on children and adolescents [10,11,13]. Second, 64.7% (515/796) of children with normal-weight had a SA lower than CA (Figure 2b) in this study, which disagrees with a previous study that encouraged a general advancement with an improvement in the nutritional level of modern people [17]. Third, no statistical difference was observed in relative SA between males and females among children aged 3-6 years (Table 10 2); this result was inconsistent with a previous conclusion that the development of SA occurs earlier in females than males from birth to early adolescence [18].…”

Section: Discussionsupporting

confidence: 78%

“…The occurrence of a secular trend was noted in skeletal maturation in South African children (both white and black) [30]. Boeyer indicated that the initiation and completion of epiphyseal fusion occur at substantially younger ages in normally developing children born in 1995 than those born in 1935 (both male and female) [17]. These studies indicated that the secular trend of earlier maturation is attributed to the removal of growth constraints through improved nutrition, healthcare, and socioeconomic environments [26,31].…”

Section: Discussionmentioning

confidence: 97%

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

Cai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Body mass index and skeletal age are important indicators of individual growth and maturation. The recognition of their association could contribute to the prevention of childhood obesity and accelerated skeletal maturation. This study aimed to examine the effects of overweight and obesity on accelerated skeletal maturation in preschool children. Methods: Participants included 1330 children aged 3.1-6.6 years. The main outcomes were skeletal age assessed by left hand-wrist radiograph, and body mass index classified as thinness, normal weight, overweight and obesity. Results: The percentage of accelerated skeletal maturation increased with body mass index ( x 2 = 89.442, df = 3, P <0.01) and age group ( x 2 = 43.417, df = 5, P <0.01). Logistic regression analysis showed a higher risk of accelerated skeletal maturation in children with overweight and obesity than children with normal weight after adjusting for gender and age (Overweight, OR = 3.27, 95% CI : 2.20-4.87; Obese, OR = 4.73, 95% CI : 2.99-7.48). Conclusions: Accelerated skeletal maturation was associated with overweight and obesity in preschool children, and its prevalence increased with age. These findings suggest that parents and child-health managers should be aware of an existing risk of accelerated skeletal maturation in preschool children with overweight and obesity.

show abstract

“…However, children with considerably advanced BA (BA-CA ≥ 2 years) have been observed in different populations: approximately 10% of healthy prepubescent Chinese children (unpublished observations by our research team); up to 21% of healthy children in the United States 3 ; and 48.7% of girls with isolated premature thelarche, who should not have significantly advanced BA 4 , 5 . Moreover, a long-term trend of overall accelerated bone maturation in children has been observed in many countries 3 , 6 – 10 . Unfortunately, existing research results cannot fully explain the acceleration of bone maturation in children.…”

Section: Introductionmentioning

confidence: 99%

Association between phthalate exposure and accelerated bone maturation in Chinese girls with early puberty onset: a propensity score-matched case–control analysis

Huang

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Estrogen can promote the acceleration of bone maturation and phthalate esters (PAEs) have estrogen-mimicking effects. We investigated whether PAEs are associated with the acceleration of bone age (BA) in girls with early onset of puberty (EOP). This case–control study enrolled 254 girls with EOP from the Endocrinology Department at Shenzhen Children’s Hospital between December 2018 and August 2019. Ultra-performance liquid chromatography and tandem mass spectrometry were used to analyze the 10 metabolites of PAEs (mPAEs) in urine samples. BA was measured using an artificial intelligence system. BA exceeding the chronological age (CA) by > 2 years (BA-CA ≥ 2 years) was referred to as significant BA advancement. Participants were divided into groups A (BA-CA ≥ 2 years; case group) and B (BA-CA < 2 years; control group). Propensity score matching (PSM) was performed for both groups in a 1:2 ratio with a caliper of 0.25. To identify potential dose–response relationships between PAEs exposure and BA advancement, we grouped the participants after PSM according to the tertiles of the mPAE concentrations. After PSM, 31 and 62 girls in groups A and B were selected. The concentration of Mono-ethyl phthalate (MEP) in group A was significantly higher than in group B (11.83 μg/g vs. 7.11 μg/g, P < 0.05); there was no significant difference in the levels of other mPAEs between the groups. The degree of BA advancement and proportion of significantly advanced BA in the lowest, middle, and highest tertiles of the MEP sequentially increased, as well as in the lowest, middle, and highest tertiles of Mono-(2-ethyl-5-carboxypentyl) phthalate; however, these were only statistically different between the highest and lowest MEP tertiles (both P < 0.05). For the remaining mPAEs, differences in the degree of BA advancement among the lowest, middle, and highest tertiles, as well as differences in the proportion of significantly advanced BA among the lowest, middle, and highest tertiles, were not significant (all P > 0.05). Our findings suggested that MEP was positively associated with BA advancement in girls with EOP. Exposure to PAEs may promote accelerated bone maturation.

show abstract

Early Maturity as the New Normal: A Century-long Study of Bone Age

Abstract: Level II, prognostic study.

Cited by 37 publications

References 34 publications

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

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

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

Association between phthalate exposure and accelerated bone maturation in Chinese girls with early puberty onset: a propensity score-matched case–control analysis

Contact Info

Product

Resources

About