Nutritional and Pubertal Disorders

Abstract

Caloric-protein malnutrition can slow growth and cause pubertal delay. This chapter focuses on endocrine abnormalities and pubertal alterations in patients with eating disorders, childhood obesity, the female athlete triad and children cancer survivors. Patients with anorexia nervosa (AN) exhibit multiple endocrine abnormalities, including isolated hypogonadotropic hypogonadism. The delay in pubertal development and reduction in growth seen in AN patients may be a direct result of malnutrition. Appropriate psychiatric, nutritional and hormonal therapy is necessary. It is suggested that obesity during childhood can accelerate pubertal onset and these children usually exhibit accelerated linear growth during puberty. In girls the relationship between childhood obesity and early pubertal onset could be related to their insulin resistance and/or hyperinsulinemia. The female athlete triad is often observed in physically active girls and women in whom low energy availability with or without disordered eating, menstrual dysfunction and low bone mineral density can be present. In prepubertal girls excess exercise can cause delayed menarche with no effects on adult height, while in postpubertal females it results in menstrual cycle irregularities. The consequences of childhood cancer depend on the type of cancer, its location, the age at which the disease was diagnosed, the dose of radiotherapy, and the type and dose of chemotherapy.

Metabolic regulation of female puberty via hypothalamic AMPK–kisspeptin signaling

“…The timing of puberty is fitted to metabolic and nutritional conditions of the organism. The translational relevance of such metabolic influence on puberty onset is epitomized by the dramatic impact of conditions of metabolic stress, including malnutrition, on the age of puberty in humans (12,13). AMPK is a fundamental cellular energy gauge, which acting on discrete neuronal populations at different hypothalamic nuclei, plays an essential role in whole-body metabolic homeostasis, and its coordination with multiple vital functions and hormonal pathways (17).…”

“…One of the most important determinants of puberty onset is the nutritional and metabolic state (10,11). Conditions of metabolic stress, from cachexia to early-onset obesity, are linked to perturbed pubertal timing (12,13). Indeed, while the higher frequency of child obesity has been related to the trends of earlier puberty (5,6), conditions of persistent energy deficit, ranging from eating disorders to strenuous exercise, are known to severely delay pubertal maturation (13).…”

“…Conditions of metabolic stress, from cachexia to early-onset obesity, are linked to perturbed pubertal timing (12,13). Indeed, while the higher frequency of child obesity has been related to the trends of earlier puberty (5,6), conditions of persistent energy deficit, ranging from eating disorders to strenuous exercise, are known to severely delay pubertal maturation (13). The mechanisms for such a tight metabolic-pubertal connection are yet to fully surface, but appear to be largely brain centered.…”

Morphological and Densitometric Changes in the Temporally Mandibular Joint in Patients with Pulmonary Anomalies

“…Немаловажен и тот факт, что заболевания ВНЧС развиваются до-вольно рано, зачастую в детском возрасте [8,10]. Нужно учитывать, что к нарушениям функции ВНЧС может приводить само ортодонтическое лечение, так как связано с разобщением зубных рядов, изменением привычной окклюзии, переме-щением нижней челюсти [2,3,7].…”

“…Данный факт является подтверждением первично-сти функциональной патологии и перехода ее че-рез изменение качественного состава кости (в дан-ном случае ее плотности) к последующим морфо-анатомическим изменениям головок ВНЧС, что подтверждается данными других авторов [8,9,10].…”