Levels In Girls Research Articles

Effects of low-level mercury exposure on brain-derived neurotrophic factor in preschool children

ObjectivesMercury (Hg), a ubiquitous heavy metal, could affect the neurodevelopment of the children, however, these associations are still equivocal. Brain derived neurotrophic factor (BDNF) plays an essential role in the central nervous system development in children. This study aimed to investigate the effects of low-level mercury exposure on serum BDNF levels and the influence of sex and dietary intake on these relationships in children. MethodsIn this cross-sectional study, a total of 541 pre-school children were recruited, the blood mercury concentrations and serum BDNF levels were measured. The background information on demographic characteristics and dietary habits of the children was collected through questionnaires. Multivariable linear models after adjustment for potential confounders were used to evaluate the associations between mercury exposure and levels of BDNF in children. ResultsThe GMs of blood mercury concentrations and serum BDNF levels were 1.06 μg/L, 20.4 ng/mL, respectively. A significant positive association between blood mercury concentrations and serum BDNF levels was found. After stratification by sex, the blood mercury concentrations in children were positive associated with serum BDNF levels in girls but not in boys. However, these associations were attenuated when we further adjusted the children’s dietary intake variables. ConclusionsOur findings suggest that low-levels of mercury exposure may have sex-specific effects on BDNF levels in young children and that dietary intake may be potential confounders in these relationships. However, further studies are warranted to investigate the role of BDNF in the effects of mercury on neurodevelopment.

Serum Irisin Levels in Central Precocious Puberty and Its Variants.

The exact mechanisms that trigger the onset of puberty are not well known. Adipomyokines are postulated to stimulate the central neural network. In the present study, we investigated irisin levels in girls with central precocious puberty (CPP), slowly progressing precocious puberty (SPPP), or premature thelarche (PT); we also studied prepubertal girls and to determine if this adipomyokine could be used as a marker in this context. A total of 94 girls including 33 with CPP, 31 with precocious puberty (PP) variants (SPPP or PT), and 30 healthy controls were enrolled to the study. The mean irisin levels were compared between groups. The bivariate correlations of irisin levels with clinical and laboratory parameters were assessed. Multivariate linear regression analysis was performed to determine independent predictive factors of irisin levels. Irisin levels were higher in the CPP group compared with the other groups (CPP group: 723.25 ± 62.35 ng/mL; PP variants group: 529.60 ± 39.66 ng/mL; and control group: 325.03 ± 27.53 ng/mL) (P < 0.001). Irisin levels were positively correlated with body mass index standard deviation scores (BMI-SDS), height-SDS, weight-SDS, bone age, uterus long axis, ovary size, baseline FSH and LH, and peak LH levels. Multivariate linear regression analysis revealed that irisin levels had the strongest correlation with peak LH. The other independent predictive factor of irisin levels was BMI-SDS. The mean irisin levels were higher in patients with CPP compared with other groups. The results of this study imply that increased irisin levels may be used as a marker of CPP provided that these findings are confirmed in larger prospective studies.

Physical Activity Level among School Going Children in Surat City, Gujarat: A Cross Sectional Survey

Background: Physical inactivity in children and adolescents is a major issue in public health. Physical activity (PA) is a best predictor of cardiovascular, skeletal, and mental health in children and adolescents, yet contemporary youth, and especially girls, are often insufficiently active. However, PA levels in children of Surat city, Gujarat has been less explored. So present study was undertaken. Methodology: A Cross sectional survey was conducted on 82 children from 3 different schools of Surat city using self -reported PAQ-C (Physical Activity Questionnaire -Children) in last seven days to measure PA after obtaining permission from school authorities. Anthropometric measures and self-reported socio-demographic data were also recorded. Descriptive statistics were used to depict the characteristics of the study population and PA levels. Results: Mean PA level amongst children was 2.55 (SD=0.60). PA level in girls (2.24, SD=0.73) was significantly lower than in males (2.67, SD=0.67), (p<0.05). 82% (n=66) of students fell in low PA group (PA score <3). PA declined with increasing age (r= -0.17, p<0.05).Conclusion: Inadequate PA was reported among children. The present study even suggested that children should be engaged in more amount of PA which will help in reducing the health risks.

Dioxin exposure and sexual dimorphism of gaze behavior in prepubertal Vietnamese children living in Da Nang, a hot spot for dioxin contamination

Previous studies have reported that dioxin exposure alters sexual dimorphism of play behavior in pre-pubertal children. We aimed to investigate the effects of perinatal dioxin exposure, indicated by dioxins in breast milk, on sexual dimorphism of gaze behavior after adjusting for salivary testosterone (T). Participants were pre-pubertal children in a hot spot for dioxin contamination originating from herbicide spraying in Vietnam.We used eye tracking to assess gaze behavior in 172 children (100 boys and 72 girls) aged 8–9 years. Two sets of 15 pairs of pictures, one oriented towards boys and one oriented towards girls, containing 5 pairs of toy photos (non-biological stimuli) and 10 pairs of human line drawings (biological stimuli) were shown to all children. The total fixation duration for each picture was extracted using Tobii studio software and a feminine index of gaze behavior was defined as the ratio of the summed fixation duration for the girl- vs boy-oriented versions of each stimuli.When viewing non-biological stimuli, feminine index scores significantly increased with TCDD (β = 0.294) in girls only. For biological stimuli, however, feminine index scores significantly increased with TEQ-PCDD/Fs (β = 0.269) in boys and with TCDD in girls (β = 0.286). These associations were significant even after adjusting for salivary T levels, which were inversely associated with some dioxin congeners in girls. In addition, increased feminine index scores for biological stimuli were associated with lower cognitive scores for hand-movement and word-order tests in boys and for face-recognition tests in girls examined at 5 years of age.In conclusion, these results suggest that perinatal dioxin exposure may increase visual interest in girl-oriented objects through impairment of cognitive abilities in pre-pubertal Vietnamese children. PCDD congeners were associated with gaze behavior independently of T levels in boys, while this was only the case for TCDD levels in girls.

Risk Factors for Physical Inactivity Among Children With and Without Asthma Living in Peri-Urban Communities of Lima, Peru.

The authors sought to examine physical activity patterns among children with and without asthma in 2 peri-urban communities in Lima, Peru, to identify socioeconomic and demographic risk factors for physical inactivity and examine the relationship between asthma and physical activity. The authors measured mean steps per day in 114 children (49 with asthma and 65 without) using pedometers worn over a 1-week period. They also used the 3-day physical activity recall to determine the most common activities carried out by children. The authors found that 84.2% of the children did not meet the daily international physical activity recommendations. Girls took significantly fewer mean steps per day as compared with boys (2258 fewer steps, 95% confidence interval, 1042-3474), but no other factors, including asthma status, showed significant differences in the mean daily steps. Mean daily steps were positively associated with higher socioeconomic status among girls, and current asthma had a larger inverse effect on daily steps in boys when compared with girls. Physical activity levels were below recommended guidelines in all children. There is a need for policy and neighborhood-level interventions to address low physical activity levels among Peruvian youth. Special focus should be given to increasing the physical activity levels in girls.

Relationship Between Muscle Strength And Body Composition In Young Athletes

INTRODUCTION: A lower cardiometabolic risk in adulthood has been suggested when a better development of the cardiopulmonary and strength condition is reached at an early age. It is important to be able to assess the cardiometabolic risk against variables such as strength in the upper and lower limbs. PURPOSE: To explore the correlation between anthropometric and strength condition variables in upper and lower limbs in boys and girls assigned to sports training schools (soccer, volleyball, skating) in the municipality of Madrid (Colombia). METHOD: A total of 110 children and adolescents were evaluated using long jump test and handgrip strength (HS). The anthropometrics characteristics are, for boys and girls, respectively: weight (kg): 50,5 ±12,9 and 49,2 ±11,9; height (m): 158,3 ±11,8 and 152,6 ±9,2; age (years): 13,7 ±13,8 and 12,9 ±2,2. The Pearson’s correlation coefficient (r) was used to calculate the correlations regardless of gender and divided by boys and girls. The correlations studied were between the anthropometric variables (weight, height, body mass index (BMI), waist circumference and fat%), compared to long jump test (LJT), right HS (RHS) and left HS (LHS). The results of r are indicated with a statistical level of significance of p <0.001. RESULTS: In the general analysis, r = 0.81 was obtained for height versus RHS and LHS and, for weight, r = 0.68 and 0.67 was found in RHS and LHS, respectively. When correcting by gender, the height in girls shows r = 0.7 and 0.65 in RHS and LHS; while, in children, it was 0.61, 0.85 and 0.89 for SL, RHS and LHS, respectively. The weight in girls showed r = 0.6 for RHS and, in boys, 0.8 and 0.84 for RHS and LHS, in whom r = 0.6 and 0.63 for RHS and LHS were also found when compared were made in front of BMI. No associations were found with LJT. CONCLUSIONS: The results indicated that the strength in the upper limbs (measured through the determination of handgrip strength) is a strong and moderate association in relation to height and weight respectively and regardless of gender. When comparing by gender, this relation is maintained in boys but the association in height went to a moderate level in girls. Thus, the results suggest that the development of strength measured through HS is closely related to the anthropometric characteristics of young athletes, especially height and weight.

Sex-specific associations between person and environment-related childhood adverse events and levels of cortisol and DHEA in adolescence.

Person and environment-related childhood adverse events have been demonstrated to increase the risk of impaired mental health in later life differently for boys and girls. Altered hypothalamic pituitary adrenal (HPA)-axis functioning has been suggested as a key mechanism underlying this association. Cortisol and dehydroepiandrosterone (DHEA) are both output hormones of the HPA-axis. DHEA may have a protective function against long-term exposure to increased levels of cortisol, but has been little investigated in relation to childhood adversity. We aimed to test the associations between person-, and environment-related childhood adversity and levels of cortisol, DHEA and cortisol/DHEA ratio in adolescent boys and girls. A total of 215 Dutch adolescents participated in the study and filled out the 27-item Adverse Life Events Questionnaire for the assessment of childhood adversity, which was split up in separate scores for person-related and environment-related events. Cortisol and DHEA concentrations and cortisol/DHEA ratio were determined in proximal 3 cm long hair segments. Additionally, saliva samples were collected immediately and 30 minutes after waking up, at noon and at 8 pm. Multiple linear regression analyses were used to test associations between childhood adversity and cortisol and DHEA concentrations, for boys and girls separately, with age, BMI and pubertal development as covariates. Data were available for 74 boys and 116 girls with a mean age of 15.7 years (SD = 2.0). Higher levels of person-related childhood adversity were associated with higher hair DHEA levels in girls and with higher hair cortisol levels in boys. A trend towards a significant association was observed between higher levels of environment-related childhood adversity and higher DHEA levels in boys. Neither person- nor environment related childhood adversity was associated with cortisol/DHEA ratio. A trend was observed for environment-related childhood adversity and lower daily cortisol output in boys. We found differential associations between childhood adversity and cortisol and DHEA levels in girls and boys, for respectively person-related and environment-related childhood adversity. Our findings suggest that different types of childhood adversity are not only linked to levels of cortisol, but also to DHEA concentrations, in a sex-specific manner, with possible future implications for mental health.

SUN-097 Gonadotropins Levels Measurement in First Morning Voided Urine as a Diagnostic Tool for Central Precocious Puberty

Background: GnRH stimulation test is the gold standard for the diagnosis of central precocious puberty (CPP). However, it is invasive and costly. Previous studies showed that increased urinary gonadotropins (Gn) level in first morning voided (FMV) urine reflected the integration of elevated nocturnal Gn secretions. Therefore, it could be used to diagnose CPP. Nevertheless, its cutoff value for diagnosis of CPP is limited. Objective: To determine the association of Gn levels in FMV urine and serum during pubertal development and establish cutoff value of FMV urinary Gn as an alternative noninvasive method for diagnosis of CPP in girls. Methods: Sixty-one girls who had breast development before 8 years of age with sign of rapid pubertal progression (advanced bone age and/or increased height velocity) underwent subcutaneous GnRH agonist test. FMV urinary Gn were also collected on the same day. Both serum and urinary Gn levels were measured using electrochemiluminescence immunoassay (ECLIA) technique. The definite diagnosis of CPP is based on stimulated serum LH > 5 IU/L. FMV urinary Gn were compared between CPP and premature thelarche (PT) groups. The correlation between serum and urinary Gn were assessed and the cutoff value of urinary Gn to diagnose CPP was established. FMV urinary Gn of 480 Thai school girls (control) were also collected to determine the reference values according to their breast Tanner (BT) stages. Results: FMV ULH level in girls with CPP was significantly higher than that of PT (2.46 VS 0.8 IU/L; median, P <0.001). However, the level of ULH in PT group was not different from control group with BT1. FMV ULH and ULH: UFSH were well correlated with basal serum LH (r=0.63 and 0.73, respectively, Ps<0.001) and peak serum LH (r=0.44 and 0.54, respectively, Ps<0.001). Base on receiver operating characteristics analysis, basal serum LH was the best parameter to differentiate CPP from PT (area under the curve 0.797–0.926). ULH levels at ≥ 1.13 IU/L and ≥ 1.52 provide optimal sensitivity (72.3 and 68.1 %, respectively) and specificity (85.7 and 100 %, respectively). Combined ULH level ≥ 1.13 IU/L with ULH: UFSH ≥ 0.17 increased specificity from 85.7 to 92.9 % for predicting a positive GnRH agonist test. (peak LH ≥ 5 IU/L) Conclusions: First morning voided urinary Gn levels measurement is a highly potential method for the diagnosis of CPP in girls due to its good correlation with GnRH agonist test. Further study in a larger number of patients with close monitoring of clinical outcome is required before recommending as a standard investigation in CPP.

High DHEAS Level in Girls Is Associated with Earlier Pubertal Maturation and Mild Increase in Androgens throughout Puberty without Affecting Postmenarche Ovarian Morphology

Objective: To assess whether the presence of high DHEAS (HD) at 7 years determines different timing, sequence, and rate of pubertal events, and whether it is associated with adrenal and/or ovarian hyperandrogenism and changes in ovarian morphology throughout puberty. Methods: In a longitudinal study of 504 girls, clinical evaluation was performed every 6 months after 7 years of age to detect Tanner stages; hormonal and anthropometric measurements were conducted at thelarche (B2), breast Tanner 4 (B4), and 1 year after menarche; ultrasonographic evaluation was also performed after menarche. The girls were classified as HD if their DHEAS level was >42.1 µg/dL (>75th percentile) around 7 years. Results: HD around 7 years is associated with a younger age at thelarche, pubarche, and menarche. Girls with HD had higher androstenedione and total testosterone levels, and a higher free androgen index (FAI), and lower levels of antimüllerian hormone (AMH) at B2, and higher levels of androstenedione and FAI at B4 and after menarche. All these results were significant even after adjusting for body mass index, age at first DHEAS determination, and birth weight. One year after menarche, polycystic ovarian morphology was detected in 7.6 and 7.3% of the HD and the normal DHEAS group, respectively. Ovarian volume was correlated with AMH, testosterone, androstenedione, and LH but not with DHEAS around 7 years. Conclusion: Prepubertal HD in normal girls was associated with earlier thelarche, pubarche, and menarche, and a mild androgen increase throughout puberty. We believe continuous follow-up of this cohort is important to prospectively address the interrelationships between biochemical adrenarche and early growth as determinants of ovarian function.

The relationship between size and number of over follicles and anti-Müllerian hormone (AMH) levels in girls with precocious puberty

Amaç: Yetişkinlerde AMH ile antral folikül sayısı arasında pozitif korelasyon vardır. Peripubertal sağlıklı kızlarda da AMH ile toplam folikül sayısı ve folikül büyüklüğü arasında ilişki saptanmıştır. Çalışmamızda; santral puberte prekoks (SPP) tanısı almış kızlarda AMH düzeyi ile folikül sayı ve büyüklüğünün ilişkisi araştırıldı.Gereç Ve Yöntemler: Santral puberte prekoks tanılı 32 kız olgu çalışmaya alındı. Hastalardan AMH için kan örneği alınarak pelvik ultrasonografi ile overde folikül sayımı yapıldı. Foliküller büyüklüklerine göre; küçük (1-4,4 mm), orta (4,5-9,4 mm) ve büyük (≥9,5mm) olarak sınıflandırıldı. Hastalar puberte evrelerine ve antral folikül sayısına göre gruplandırıldı.Bulgular: Hastaların AMH düzeyi ile küçük, orta, büyük folikül sayısı, küçük/orta folikül oranı, en büyük folikül boyutu ve toplam folikül sayısı arasında anlamlı bir ilişki saptanmadı (p &amp;gt; 0,05). Hastalar meme evrelerine göre sınıflandırıldığında da grupların AMH düzeyleri, küçük, orta ve büyük folikül sayısı, küçük/orta folikül oranı, en büyük folikül boyutu ve toplam folikül sayısı farklı değildi (p&amp;gt;0,05). Birden fazla antral folikülü olanların AMH düzeyi [median:0,23 ng/ml, (0,06-0,56)], en fazla bir antral folikülü olanların AMH düzeyinden [median:0,17ng/ml (0,05-0,48)] anlamlı olarak daha yüksekti (p:0,035).Sonuç: Puberte prekokslu kızlarda AMH düzeyi ile folikül sayı ve boyutu arasındaki ilişkinin ilk defa incelendiği çalışmamızda; AMH düzeyi ile over hacmi, folikül sayı ve büyüklüğü arasında anlamlı bir ilişki saptanamamış olması hastalarımızın erken pubertal evrede olmasından kaynaklanıyor olabilir. Bununla birlikte; puberte prekoksta folikül gelişim paterninin normal puberteden farklı olabileceği ya da folikül sayısı dışında AMH’ya etkili başka faktörlerin de olabileceği ihtimali de dışlanamaz.

Evaluation of serum makorin ring finger protein 3 (MKRN3) levels in girls with idiopathic central precocious puberty and premature thelarche.

This study aims to investigate serum makorin ring finger protein 3 (MKRN3) levels in girls with idiopathic central precocious puberty (ICPP) and premature thelarche (PT), in order to determine whether circulating MKRN3 level is associated with ICPP and PT. A total of 90 girls were enrolled in the stud. 30 age-matched girls were allocated for each group (ICPP, PT and healthy controls [HC], respectively). The base LH (B-LH) and E2 levels were higher in ICPP girls than those in HC and PT girls. The peak LH (P-LH) levels and P-LH/P-FSH values were obviously higher in ICPP girls than those in PT girls, while higher peak FSH (P-FSH) levels were detected in PT girls when compared to those in ICPP girls. Kisspeptin levels were lower in HC girls than those in ICPP and PT girls. MKRN3 levels were the highest in HC girls among the three groups. There were relatively strong negative correlations among MKRN3, kisspeptin and P-LH/P-FSH. Circulating MKRN3 can have an important role in the onset of ICPP and PT. However, this should not be used as an independent diagnostic criterion for diagnosing ICPP or differentiating ICPP from PT, but should be used only as an adjunctive diagnostic biomarker.

Physical activity, sedentary time and cardiometabolic health indicators among Mexican children.

We examined the independent associations of moderate to vigorous physical activity (MVPA) and sedentary time (ST) with cardiometabolic indicators in Mexican children (4-6 years of age). We conducted a cross-sectional study (n = 400) using the measures of MVPA and ST (7-day accelerometry) and the following indicators: % body fat, waist circumference, body mass index (BMI) z-score, glycated haemoglobin, blood glucose, triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, leptin, adiponectin and resting blood pressure. We examined the independent associations of MVPA and ST with cardiometabolic indicators through confounder-adjusted and mutually adjusted (including both MVPA and ST) linear regression models. Confounder-adjusted models showed that MVPA was associated with higher BMI z-scores and lower adiponectin levels in girls and lower body fat among boys. ST was associated with higher body fat, in the full sample, and lower LDL cholesterol among boys. After mutually adjusting for MVPA and ST, MVPA (10-minute increase) remained significantly associated with BMI z-score in girls (β = 0.187, 95% CI: 0.019, 0.356) and ST (60-minute increase) remained significantly associated with higher body fat (β = 1.11%, 95% CI: 0.019, 2.203) among boys and higher glycated haemoglobin (β = 0.047% points, 95% CI: 0.000, 0.094) in the full sample. In preschool-aged children, the objective measures of ST and MVPA were associated with small differences in cardiometabolic health indicators. ST was unfavourably associated with some cardiometabolic indicators even after adjusting for MVPA, and thus appeared to have a more significant role than MVPA, especially in boys. Future longitudinal studies should confirm these results.

Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol.

Background The aim of this study was to investigate the effect of 12 weeks of aerobic training, 4 weeks of detraining and use gonadotropin-releasing hormone agonist (GnRHa) on serum C-reactive protein (CRP) and cortisol levels in girls with central precocious puberty (CPP). Methods Forty-five girls (aged 6-8 years) with precocious puberty were randomly divided into three groups (medication, training and medicine + training groups). Fifteen healthy girls (without precocious puberty) were also included as the control group. Serum CRP and cortisol levels were measured at baseline by the enzyme-linked immunosorbent assay (ELISA) technique. Then, the experimental groups performed an aerobic training program for 3 days/week 20-75 min per day at 45-75% maximum heart rate for 12 weeks. The medication groups also received GnRHa during the study, once a month (1 mL every 4 weeks) by intramuscular injection. Serum CRP and cortisol levels were measured again 48 h after the last training session and also after 4 weeks of detraining. Results Analysis of variance (ANOVA) with repeated measures showed a significant decrease in CRP (p = 0.02) and cortisol levels (p = 0.01) in the training group and the medicine + training group. Detraining led to return of CRP and cortisol levels to the pre-training levels (p = 0.001). No significant difference in serum CRP (p = 0.43) and cortisol levels (p = 0.06) was observed in the medication group. Further, no significant difference was observed between groups in CRP and cortisol. Conclusions Long-term regular moderate training decreases inflammation indices, and detraining eliminates the benefits of training in girls with precocious puberty.

Comparison of antibody response between boys and girls after infant and childhood vaccinations in the Netherlands

BackgroundInfectious diseases can differ by sex in their incidence, prevalence, or severity of disease. These differences may be induced by sex-dependent immune responses and resulting protection, for example after vaccination. Therefore, this study aims to assess possible sex-differences in immunoglobulin levels (IgG) after infant and childhood vaccination. MethodsData from a national cross-sectional serosurvey conducted in 2006/2007 were used (Pienter 2). We compared IgG levels against measles, mumps, rubella, diphtheria, tetanus, poliomyelitis, pertussis, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup C (MenC) between girls and boys both short term (1 month to 1 year) and long term (1–3 year) after infant and childhood vaccinations, using linear regression analysis. Proportions of boys and girls reaching a protective IgG level were compared using Fishers exact test. ResultsDifferences in IgG were found at specific time points after vaccination against measles, mumps, rubella, MenC, and polio. The geometric mean concentration or titer (GMC/T) girls:boys ratios ranged between 1.10 for polio type 1 <1 year after the first childhood booster to 1.90 for MenC <1 year after infant vaccination, indicating higher antibody levels in girls. No significant differences were found between boys and girls for diphtheria, tetanus, pertussis, and Hib at either time point. Proportions with protective levels differed only at 1–3 years after infant vaccination for mumps (82.5% boys vs. 91.9% girls, p = 0.046), and at the same time point for MenC (7.0% boys vs. 18.2% girls, p = 0.015), and polio type 1 (87.8% boys vs. 95.9% girls, p = 0.047). ConclusionDifferences in IgG between boys and girls were generally small and not consistent, neither between pathogens nor within pathogens. If differences were observed, girls were favored over boys. On the whole, the results suggest that there are no major sex differences in protection from the studied pathogens in the Netherlands.

A school-based intervention based on self-determination theory to promote girls' physical activity: study protocol of the CReActivity cluster randomised controlled trial

BackgroundPhysical inactivity is deemed to be the fourth leading cause for premature death. Nevertheless, only a minority of children and adolescents in Germany fulfil the guideline of the World Health Organization of at least 60 min of moderate-to-vigorous physical activity per day. Children and adolescents with a lower socioeconomic background and especially girls are regarded as a high-risk group in terms of physical inactivity. Aim of this study is to examine how a theory-based physical education intervention programme supporting students’ autonomy, competence and relatedness affects physical activity both during these lessons and in leisure time. Based on the self-determination theory and the social cognitive theory, the extent to which autonomy, competence, relatedness, social support and self-efficacy in girls mediate the effect of the intervention programme on their physical activity will be examined. Moreover, the potential moderating role of socioeconomic status, environmental factors, teacher characteristics and BMI will be tested.MethodsCReActivity is a two-arm cluster randomised controlled trial with a follow-up period of three months after the end of the intervention programme. A total of 600 sixth grade girls in lower secondary schools in Bavaria, Germany will be proactively recruited. The intervention is carried out by the physical education teachers of the participating classes for five months. Primary outcome is the girls’ physical activity measured by accelerometers and systematic observations.DiscussionWe expect to provide an intervention programme that can contribute to the increase of physical activity levels in girls and offer insights into the mechanisms of physical activity behaviour change.Trial registrationGerman Clinical Trials Register DRKS00015723 (date of registration: 2018/10/22 retrospectively registered).

Review of Hormone Replacement Therapy in Girls and Adolescents with Hypogonadism.

Girls with either hypo- or hypergonadotropic hypogonadism need treatment with estrogens to initiate puberty and maintain a normal hormonal milieu. The focus of this review is hormone replacement treatment in girls with hypogonadism, to initiate and progress through puberty, and to maintain a healthy hormonal milieu in women. It also addresses what is known in the literature regarding estrogen levels in girls and women, instructive cases, practical tables for reference and application, and thoughts on future directions in this area. It represents a thorough literature review with author opinions and recommendations. Girls with normal ovarian function begin puberty on average at 10.5years old, although there is variation according to ethnicity and degree of excess weight gain. The aim of estrogen therapy to initiate puberty is to mimic normal onset and rate of progression. On the basis of the currently available literature, when a diagnosis of hypogonadism is established, we recommend initiating treatment between age 11 and 12years of age, with dose increases approximately every 6months until adult levels are reached. In some situations, treatment may be delayed to allow time for diagnosis or permit more time for linear growth, or address unique risks found in girls treated for various cancers or blood disorders. When adult dosing is reached, progestins are also used to protect uterine health. This can be combined sequentially, allowing regular menstruation, or combined continuously when menstrual bleeding is not preferred. Treatment is continued until the average age of menopause, again with various considerations for longer or shorter duration on the basis of risk-benefit ratios. Transdermal estrogens are considered the most physiologic replacement and theoretically might have fewer associated risks. We review what is known about risks and outcomes and areas for future research.

OR25-6 Higher Ovarian Androgen Responses to Ambient Luteinizing Hormone and to Recombinant Human Chorionic Gonadotropin Stimulation in Late Pubertal Girls with Obesity

Our studies suggest that 60% of obese peripubertal girls have androgen excess, a precursor to polycystic ovary syndrome. Since the ovary is a major source of androgens in women, we studied steroid levels after dexamethasone (DEX) and after recombinant human chorionic gonadotropin (r-hCG) in girls to assess how obesity affects ovarian androgens during puberty. We studied 41 peripubertal girls in the mid-follicular phase (if relevant, 11 were pre-menarcheal): age 13.2 ± 3.0 (7.3-18.8) y (mean ± SD [range]); BMI Z-score 1.2 ± 1.1 (-1.08 to +2.64); Tanner breast 4.0 ± 1.3 (1-5); bone age 14.2 ± 2.9 (7.8-18) y. In early pubertal girls (Tanner 1-3), 5 were normal weight (NW, BMI%-for-age [BMI%] 5-84) and 6 overweight (OW, BMI% ≥ 85). In late pubertal girls (Tanner 4-5), 12 were NW and 18 OW. DEX (1 mg po) was given at 10 pm. At 7 am the next day, progesterone (P4), 17-OH progesterone (OHP), 17-OH pregnenolone, androstenedione (A4), dehydroepiandrosterone (DHEA), testosterone (T), estradiol (E2), and anti-mullerian hormone were measured immediately before r-hCG (25 mcg IV) was given. DEX was again given at 10 pm; hormone levels were repeated 24h after r-hCG. Free T was calculated using SHBG. Forty girls also had frequent (q 10 min) LH sampling from 7 pm-7 am. Comparisons were made using Student’s t-tests. In early pubertal girls, NW girls had higher DHEA levels after r-hCG compared to OW girls (2.46 ± 1.07 vs. 1.23 ± 0.68 ng/dL, p=0.04). In late puberty, OW girls had higher free T after DEX (19.3 ± 15.6 vs. 8.6 ± 4.1 pmol/L, p=0.03) and after r-hCG (27.2 ± 22.3 vs. 10.7 ±4.5 pmol/L, p=0.02) versus NW girls. OW girls also had higher total T levels after DEX (21.7 ± 15.2 vs. 16.7 ± 7.4 ng/dL, p=0.3) and after r-hCG (30.0 ± 20.4 vs. 21.1 ± 10.2 ng/dL, p=0.2), but did not achieve significance. SHBG was lower in OW versus NW girls in late puberty only (20.7 ± 13.4 vs. 48.0 ± 21.8 nmol/L, p=0.0002). No other hormone levels were different. Overnight mean LH was not different for NW and OW groups, for either early or late puberty. However, in late pubertal girls, 33% in OW group had mean LH values ≥ 5 (5.3-9.3) mIU/mL compared to 17% in NW group. Compared to OW girls with mean LH < 5, OW girls with mean LH ≥ 5 had higher OHP, A4, free T, and total T after DEX and after r-hCG (p ≤ 0.05 for all, except A4 after r-hCG [p=0.06]). Results suggest that OW late pubertal girls had higher free T levels after DEX, which may reflect steady-state ovarian androgen production related to ambient LH milieu. OW late pubertal girls had higher free T levels after r-hCG, which may suggest increased capacity to produce ovarian androgens in response to stimulation. In a subgroup of OW girls, obesity during late puberty was associated with higher mean LH values and higher androgen levels after DEX and r-hCG, in keeping with our earlier reports that LH levels predict free T levels in girls with obesity.

Serum interleukin 15 in anorexia nervosa: Comparison to normal weight and obese girls

Background: Interleukin 15 (IL-15) plays a key role in the muscle-fat interaction, reducing adipose tissue mass without changes in the lean body mass and reduction of food intake. Here we assess serum IL-15 levels in girls with anorexia nervosa (AN) relative to obese and normal weight female adolescents.Methods: Serum IL-15 concentrations were evaluated using a commercially available ELISA kit in 32 Polish girls with restrictive AN, 29 girls with obesity (O), and 21 healthy controls (C). Anthropometric measurements (weight, height, BMI) and laboratory assays (serum fasting glucose, insulin, HOMA-IR, total cholesterol, HDL, LDL, triglycerides, and C-reactive protein (CRP)) were performed.Results: Mean serum IL-15 in the AN group was significantly higher than in C, but lower than in O. In all examined girls, significant positive correlations between IL-15 and body weight, BMI, insulin, HOMA, LDL, triglycerides and CRP were noted. We also observed an inverse relationship between IL-15 and HDL.Conclusions: Our study demonstrated that serum IL-15 concentrations in adolescent girls with AN and obesity are significantly elevated in comparison to normal weight controls. However, the role of IL-15 in the pathogenesis of AN and obesity remains still unclear.

Cardiometabolic risk factors in Turkish children with hepatosteatosis.

Aslan A, Erdemli S, Durukan Günaydın G, Aslan M, Yazar RÖ, Kabaalioğlu A, Ağırbaşlı MA. Cardiometabolic risk factors in Turkish children with hepatosteatosis. Turk J Pediatr 2019; 61: 714-722. We aimed to investigate the prevalence of cardiometabolic (CM) risk factors (impaired fasting glucose ( > 100 mg/dL), high blood pressure, overweight or obesity, high serum triglycerides (TG) and low serum high-density lipoprotein cholesterol levels) in children with hepatosteatosis detected by abdominal ultrasound. Children whom ultrasound examination revealed hepatic steatosis were included in the study. Medical records, anthropometric and biochemical parameters were reviewed for the presence of the CM risk factors. Presence of ≥3 risk factors was defined as metabolic syndrome (MS). One hundred and forty-eight children and adolescents (67 boys, 81girls, and mean age 12.1±2.7 years) with hepatosteatosis were included. Sonographic hepatosteatosis grades of 1, 2 and 3 were observed in 111 (75%), 33 (22.3%), and 4 (2.7%) subjects, respectively. MS was observed in 36 patients (24.3%). The number of CM risk factors and degree of hepatic steatosis were correlated (r=0.183, p=0.026). Serum TG levels in girls and age in boys were significantly associated with the presence of medium to severe hepatosteatosis (grades 2 or 3) (R2=.342, =.040 and R2=.538, p=.001, respectively). CM risk factors and MS are common in children with hepatosteatosis. The presence and grade of hepatosteatosis on ultrasound can be used as surrogate markers of MS and CM risk in children.

Low Serum IGF-1 in Boys with Recent Onset of Juvenile Idiopathic Arthritis.

Background Liver-derived insulin-like growth factor-1 (IGF-1) contributes bone formation. Decreased IGF-1 levels are common in juvenile idiopathic arthritis (JIA), but whether IGF-1 is related to sex and differ during the pathogenic progress of JIA is unknown. Objective The aim of this study was to examine IGF-1 levels in boys and girls with newly diagnosed JIA, with established JIA and in controls. Methods The study group included 131 patients from the Estonian population-based prevalence JIA study. Blood samples were obtained from 27 boys and 38 girls with early JIA (≤1 month from the diagnosis), 29 boys and 36 girls with established JIA (mean disease duration 18 months), and from 47 age- and sex-matched controls. Results IGF-1 levels in boys were significantly decreased in early JIA compared to male controls, while IGF-1 levels in girls were comparable between JIA and controls. In early JIA, IGF-1 levels were 12-fold lower in boys relative to girls. In controls, IGF-1 levels correlated with both age and height, while these correlations were lost in boys with early JIA. Conclusion We report a sex-dependent deficiency in serum IGF-1 in boys with early JIA, which argues for sex-related differences in biological mechanisms involved in the disease pathogenesis.