Stages Of Pubertal Development Research Articles

Assessment of mean testicular volume in adolescent school boys of Udaipur district (10–18 years) at different stages of pubertal development

Background: The most important changes during puberty are secondary sexual characters. Objective: The objective of this study was to find out the mean testicular volume (MTV) by Prader orchidometer at different stages of pubertal development. Materials and Methods: Children between 10 and 18 years of age (sample size 525) from schools of Udaipur city were included in the study. Children, who underwent major surgery or having any systemic disorders, were excluded from the study. TV assessment was done by Prader’s orchidometer with Tanner staging and correlation was statistically analyzed. Results: The maximum boys belonged to 15–16 years of age group (14.7%), and 9.3% of boys were in 10–11 years of age group. The secondary sexual characters were observed to increase with the increase in MTV. The MTV for P1 was 4.46 ml, for P5 was 22.68 ml, and for G1 and G5, it was 4.69 ml and 23.27 ml, respectively (p<0.05). Conclusion: TV adds more objectivity in the detection of sexual maturation and helps to differentiate early genital maturation than pubic hair. The study population had an early rise of TV before pubic hairs were clinically visible which showed that it was the first to increase with the onset of puberty.

Association of Serum Total Osteocalcin Concentrations With Endogenous Glucocorticoids and Insulin Sensitivity Markers in 12-Year-Old Children: A Cross-Sectional Study.

Background: Osteocalcin (OC) is an osteoblast-derived marker of bone turnover that has recently been linked to glucose metabolism, glucocorticoid action, and cardiovascular risk.Objective: We determined whether serum total OC (tOC) is associated with cardiometabolic factors, such as insulin sensitivity (IS) markers and endogenous glucocorticoids in 12-year-old children. In addition, we assessed whether low birth weight or exposure to maternal preeclampsia affect tOC concentrations.Methods: In this cross-sectional study, 192 children (109 girls) were studied at 12 years of age. Seventy of them had been born small (SGA), 78 appropriate for gestational age (AGA), and 44 from preeclamptic pregnancies (PRE) as AGA. Blood pressure was measured, and fasting blood samples were collected for markers of glucose metabolism, osteoblast, adipocyte, and adrenocortical function. IS was estimated by Quantitative Insulin Sensitivity Check Index (QUICKI). Free cortisol index (FCI) was calculated as serum cortisol/corticosteroid binding globulin.Results: The highest tOC concentrations were detected in midpubertal children (Tanner B/G stage 3). The children in the highest tOC quartile (n = 48) had lower body mass index (BMI), waist-to-height ratio, diastolic blood pressure, leptin, cortisol/cortisone ratio and FCI, and higher insulin-like growth factor I (IGF-I), IGF-binding protein-1 (IGFBP-1), IGFBP-3, and alkaline phosphatase (ALP) than those in the lower tOC quartiles (p < 0.02 for all). QUICKI was similar in these subgroups. In logistic regression analysis, pubertal developmental stages 2 and 3, high ALP, IGF-I, and low FCI and BMI (p < 0.02 for all) were associated independently with higher tOC. The means of serum tOC and IS markers were similar in the SGA, AGA, and PRE subgroups.Conclusions: In both sexes, the highest tOC levels were detected in midpubertal children reflecting the fast pubertal growth phase. Higher tOC levels were associated with lower BMI and FCI, whereas no association was found with IS. Birth weight or exposure to preeclampsia had no effect on tOC concentrations.

Physiology of pubertal development in females

Puberty is the critical time when children develop into sexually mature adults. The span of time over which puberty occurs is often referred to interchangeably as adolescence. Adolescence can be an emotionally and physically challenging time for not only the adolescent, but also for their family. The onset and tempo of puberty is controlled by many factors, and the step-wise progression through pubertal milestones in females is best described as the Tanner stages of pubertal development. Puberty in females normally begins with breast development (thelarche) and then progresses to pubarche (onset of pubic hair), peak growth velocity (also known as the growth spurt), and menarche. The onset of puberty is controlled by the hypothalamic-pituitary-gonadal (HPG) axis. Another hormonal cascade, known as the hypothalamic-pituitary-adrenal (HPA) axis, is responsible for stimulating other supporting (secondary) sexual characteristics. An understanding of normal physiology of puberty is essential in order to recognize deviations from the norm and the disorders associated with pubertal development. This article reviews various aspects of the physiology of pubertal development in females.

A preliminary study of association between adolescent estradiol level and dorsolateral prefrontal cortex activity during emotion regulation

Non-human primate models have been useful in clarifying estradiol’s role in cognitive processing. These animal studies indicate estradiol impacts cognitive processes supported by regions within dorsolateral prefrontal cortex (DLPFC). Although human functional neuroimaging studies have begun to find similar relationships between estradiol in women for some forms of ‘cold’ cognitive control, to date no studies have examined the relationship between estradiol and DLPFC function in the context of active attempts to regulate one’s emotions. Here, we asked whether peripheral 17-beta estradiol levels in adolescent girls in different pubertal developmental stages (age = 14.9 years ± 1.74) were related to engagement of DLPFC regions during the use of a cognitive strategy for regulating emotion known as reappraisal using functional Magnetic Resonance Imaging. Findings indicated that higher estradiol levels predicted greater DLPFC activity during the down-regulation of negative emotion using reappraisal. This is the first report of an association between estradiol level and DLPFC activity during cognitive reappraisal of negative emotion. The study suggests a possibility that estradiol might positively contribute to regulatory function of a cortical system important for emotional experiences.

Development and body mass inversely affect children’s brain activation in dorsolateral prefrontal cortex during food choice

Childhood obesity is a rising problem caused in part by unhealthy food choices. Food choices are based on a neural value signal encoded in the ventromedial prefrontal cortex, and self-control involves modulation of this signal by the dorsolateral prefrontal cortex (dlPFC). We determined the effects of development, body mass (BMI Cole score) and body mass history on the neural correlates of healthy food choice in children. 141 children (aged 10-17y) from Germany, Hungary and Sweden were scanned with fMRI while performing a food choice task. Afterwards health and taste ratings of the foods were collected. In the food choice task children were asked to consider the healthiness or tastiness of the food or to choose naturally. Overall, children made healthier choices when asked to consider healthiness. However, children who had a higher weight gain per year chose less healthy foods when considering healthiness but not when choosing naturally. Pubertal development stage correlated positively while current body mass correlated negatively with dlPFC activation when accepting foods. Pubertal development negatively and current body mass positively influenced the effect of considering healthiness on activation of brain areas involved in salience and motivation. In conclusion, children in earlier stages of pubertal development and children with a higher body weight exhibited less activation in the dlPFC, which has been implicated in self-control during food choice. Furthermore, pubertal development and body mass influenced neural responses to a health cue in areas involved in salience and motivation. Thus, these findings suggest that children in earlier stages of pubertal development, children with a higher body mass gain and children with overweight may possibly be less susceptible to healthy eating interventions that rely on self-control or that highlight health aspects of food.

The Mouse Mammary Gland: a Tool to Inform Adolescents About Environmental Causes of Breast Cancer.

Adolescence is a vulnerable period of breast development, and environmental chemical exposures that occur during this period can increase the risk of breast cancer in adulthood. Discussing breast health with adolescent girls can be difficult for several reasons. In this project, we worked to not only inform adolescent researchers about environmental risks for breast cancer but to also involve them in research studies. We taught adolescents about the stages of mammary gland development using samples collected from mice, with a specific focus on pre-pubertal and pubertal stages of development. Our analysis shows that adolescent researchers, with relatively modest training, can collect reliable and reproducible data on aspects of mammary gland biology that are known to be disrupted by environmental chemicals, with coefficients of variation < 2.5% for basic mammary gland parameters and 5-7% for more complex measures. Finally, we provided these adolescents with information about environmental risk factors for breast cancer that they could share with their peers and community and action items to potentially modify their individual risk. We hope that researchers working in this field will engage adolescent researchers in projects to evaluate chemicals that influence breast cancer risk. Summer research programs that inform young adolescents about breast cancer risk factors not only benefit these novice researchers individually but also benefit their communities when they are encouraged to talk about the value of basic science studies, discuss vulnerable periods of mammary gland development, and share what they have learned about cancer and the environment.

Observational study of clinical outcomes for testosterone treatment of pubertal delay in Duchenne muscular dystrophy

BackgroundAdolescents with DMD treated with chronic high dose GC therapy typically have profound pubertal delay. Testosterone, the main circulating androgen in men, promotes virilisation and growth with associated accrual of fat-free muscle mass and bone mineral content. Testosterone therapy is routinely used to mimic the normal stages of pubertal development in patients with hypogonadotrophic hypogonadism, androgen deficiency secondary to testicular disease and in constitutional delay of growth and puberty (CDGP). Improved life expectancy in DMD has meant that more adolescents are eligible for testosterone supplementation but there is little objective data regarding the impact of this treatment on muscle structure and function, bone integrity and overall well-being.MethodsThis is a single centre observational clinical trial (NCT02571205) that aims to follow the progress of 15 adolescents with Duchenne muscular dystrophy and delayed puberty as they are managed with incremental testosterone therapy to induce puberty. Subjects will all be treated with a steadily increasing dose of testosterone administered by injection every 4 weeks and data will be collected to help us determine the effectiveness and tolerability of the described treatment regimen. We will use the data to explore the effects of testosterone on pubertal development, growth, muscle strength and function, bone mineral density, body composition with a detailed record of any adverse events. We will also carry out interviews to explore the boys’ views on the tolerability of the regimen. The study will last for 27 months in total for each participant.DiscussionOur experience has indicated that testosterone treatment in adolescents with DMD is liked and well tolerated but we have not collected objective data on a specific treatment regimen and there is no current consensus. Testosterone supplementation is not part of the standard of care of pubertal delay in DMD but inclusion in future protocols may be appropriate depending on the results of this trial.Trial registrationEudraCT Number: 2015–003195-68. Research Registry &

Evaluating the four most important salivary sex steroids during male puberty: testosterone best characterizes pubertal development.

Background During pubertal development in healthy boys, increased levels of different sex steroids occur which are responsible for sexual maturation and physical changes. However, relationships between various sex hormones and pubertal development stages have not been sufficiently studied. Methods The investigation included 165 normal boys (mean age 12.7±2.8 years, mean body mass index [BMI] 19.6±4.2 kg/m2). Pubic hair (PH) stages were stratified by Tanner and testicular volume (TV) by means of the Prader orchidometer and assigned to the prepubertal, pubertal and postpubertal development phase. Four different sex steroids (testosterone [TE], dehydroepiandrosterone [DHEA]/dehydroepiandrosterone-sulfate [DHEAS], androstenedione (AE), 17-hydroxyprogesterone [17-OHP]) were measured in saliva by enzyme-linked immunosorbent assay (ELISA) and as serum total steroids by different assays (radioimmunoassay [RIA], chemiluminescence immunoassay [CLIA], electrochemiluminescence immunoassay [ECLIA]). Validation of saliva-based ELISA tests included data related to inter- and intra-assay coefficients of variation (CVs), recovery and linearity. Results Using Spearman rank correlation, salivary steroids significantly correlated (p<0.001) with pubertal development: TE (TV r=0.74 and PH stages r=0.72), DHEA (r=0.58 and 0.62), AE (r=0.38 and 0.45) and 17-OHP (r=0.42 and 0.43). Correlations between salivary and serum concentrations of steroids were also statistically significant (p<0.001). Binomial logistic regression analysis revealed significant correlations between salivary TE and pubertal maturation during the development phases of prepuberty-puberty and puberty-postpuberty. Inclusion of further salivary steroids did not improve analysis results. Conclusions Salivary TE permits a good non-invasive characterization of pubertal maturation stages. The consideration of further salivary sex steroids did not improve diagnostic accuracy.

The intricate relationship between stress and sex - findings from the men stress 40+ study

Non-human primate models have been useful in clarifying estradiol’s role in cognitive processing. These animal studies indicate estradiol impacts cognitive processes supported by regions within dorsolateral prefrontal cortex (DLPFC). Although human functional neuroimaging studies have begun to find similar relationships between estradiol in women for some forms of ‘cold’ cognitive control, to date no studies have examined the relationship between estradiol and DLPFC function in the context of active attempts to regulate one’s emotions. Here, we asked whether peripheral 17-beta estradiol levels in adolescent girls in different pubertal developmental stages (age = 14.9 years ± 1.74) were related to engagement of DLPFC regions during the use of a cognitive strategy for regulating emotion known as reappraisal using functional Magnetic Resonance Imaging. Findings indicated that higher estradiol levels predicted greater DLPFC activity during the down-regulation of negative emotion using reappraisal. This is the first report of an association between estradiol level and DLPFC activity during cognitive reappraisal of negative emotion. The study suggests a possibility that estradiol might positively contribute to regulatory function of a cortical system important for emotional experiences.

Self-assessment of pubertal development in a puberty cohort.

Background We evaluated the inter-rater agreement between self-assessed Tanner staging and clinical examination and the intra-individual agreement of self-assessed information on various puberty markers in late adolescents from the longitudinal nationwide Puberty Cohort, a sub-cohort of the Danish National Birth Cohort (DNBC). Methods We invited 715 children from the ongoing Puberty Cohort between June 2016 and January 2017. In total, 366 children (51%) returned an add-on questionnaire identical to the questionnaire used to collect information on puberty markers, including Tanner staging, in the Puberty Cohort. Of these, 197 (54%) also participated in a clinical examination with Tanner staging. We used percentage agreement and weighted kappa statistics to evaluate the inter-rater and intra-individual agreement. Results Due to late entry, more than 75% of children were Tanner stage 4 or above at clinical examination. In girls, the inter-rater agreement for pubic hair and breast staging was 54% and 52%, respectively, yielding weighted kappas of fair strength. In boys, pubic hair and genital staging agreed in 55% and 33%, respectively, corresponding to weighted kappas of fair to moderate strength. Boys tended to underestimate genitalia staging consistently. The intra-individual agreement on Tanner staging was 75-77% in girls and 69% in boys, whereas the intra-individual agreement on axillary hair and acne was above 92%. Conclusions Self-assessment of late stages of pubertal development may be misclassified, leading to random errors in studies of puberty timing. However, self-assessment continues to serve as an important time- and cost-saving tool in large prospective puberty cohorts.

Cognitive consequences of the timing of puberty

In this paper, we use British cohort data to study the degree to which children at different stages of pubertal development at age 11 and 16 differ in their cognitive and behavioral outcomes at age 16 as well as in their completed educational attainment and adult earnings. Controlling for age 7 cognitive skills, region of birth, father’s socioeconomic status and parents’ education, we show that boys’ late pubertal development is associated with lower levels of cognitive skills at 16, lower final educational attainment, and lower earnings in adulthood. For girls we find a similar negative relationship between late puberty and cognitive skills, but only imprecise relationships between the timing of puberty and adult outcomes. We fail to find evidence of strong associations with either motivation or problem behavior in adolescence for either gender, suggesting a more direct link between pubertal and cognitive development.

Male Central Hypogonadism in Paediatrics - the Relevance of Follicle-stimulating Hormone and Sertoli Cell Markers.

The definition of male hypogonadism, used in adult endocrinology, is not fully applicable to paediatrics. A clear understanding of the developmental physiology of the hypothalamic-pituitary-testicular axis is essential for the comprehension of the pathogenesis of hypogonadal states in boys and for the establishment of adequate definitions and classifications in paediatric ages. This is particularly true for central hypogonadism, usually called hypogonadotropic in adults. Because childhood is a period characterised by a physiological state of low gonadotropin and testosterone production, these markers of hypogonadism, typically used in adult endocrinology, are uninformative in the child. This review is focused on the physiological importance of prepubertal Sertoli cell markers – anti-Müllerian hormone (AMH) and inhibin B – and of the intratesticular actions of follicle-stimulating hormone (FSH) and testosterone during early infancy and the first stages of pubertal development. We discuss the role of FSH in regulating the proliferation of Sertoli cells – the main determinant of prepubertal testicular volume – and the secretion of AMH and inhibin B. We also address how intratesticular testosterone concentrations have different effects on the seminiferous tubule function in early infancy and during pubertal development.

Effect of high and low-supportive footwear on female tri-planar knee moments during single limb landing

BackgroundHigher landing-related external knee joint moments at later stages of female pubertal development likely contribute to a higher incidence of non-contact anterior cruciate ligament (ACL) injury. Athletic footwear may provide a potential strategy to alter higher knee moments.MethodsThirty-one late/post-pubertal girls (Tanner stage IV-V, menarche and growth spurt attained) performed a single limb drop lateral jump in three footwear conditions (barefoot, low support shoes and high support shoes), in which peak knee abduction moment (KAbM), flexion moment (KFM) and internal rotation moments (KIRM) were measured. Repeated measures ANOVA and ANCOVA were used to test for a main effect of footwear with and without foot posture index (FPI) as a covariate (p < 0.05) with post-hoc test carried out via Fisher’s Least Significant Difference (LSD).ResultsA main effect of footwear condition was observed for peak KFM (p < 0.05), but not KAbM or KIRM, in both unadjusted and adjusted models. Post-hoc analysis demonstrated that both high- and low-support shoes increased peak KFM compared with barefoot (p < 0.001).ConclusionOur findings indicate commercially available high- and low-supportive footwear increase peak KFM, but do not effect KAbM or KIRM while landing among late/post-pubertal girls. This suggests that these styles of footwear are inadequate at reducing higher knee moments in an at-risk cohort.

Principles for Improving the Content of the Female Athletes Training Process

The training multiannual process of female athletes is governed by training and education general laws, as well as training specific general principles. The sports training principles, used in female sport is distinguished by a specific content being determined by age biological development peculiarities of the female body and social-psychological factors. In continuous developing of the training system of young female athletes, a special place has the early stages of girls' pubertal development. The sudden variation of functional, emotional condition, physical work capacity at various phases of OMC, requires the mandatory development of governing principles of training effort in all sports samples, that women can practice them. Also, in female sport, along with general principles of sports training is necessary to take into account other theoretical and methodological guidelines. How to cite: Manolachi, V. (2017). Principles for Improving the Content of the Female Athletes Training Process. Revista Romaneasca pentru Educatie Multidimensionala, 9 (3), 11-16. https://doi.org/10.18662/rrem/2017.0903.02

Effects of harsh parenting and positive parenting practices on youth aggressive behavior: The moderating role of early pubertal timing.

Prior research indicates that early pubertal timing is associated with aggressive behavior, particularly in the context of adversity as postulated in the contextual amplification hypothesis. However, few studies have examined harsh parenting as the context for the effect of early pubertal timing. Even fewer studies have tested the interactive effect of early pubertal timing and positive parenting on aggressive behavior. In this study, we tested the proposition that early pubertal timing, contrary to the general conception of it as a vulnerability, indexed susceptibility, and thus early maturing individuals were affected more by their environment in a "for better and for worse" manner. The sample consisted of 411 community-recruited youth aged 11-12 years (51% boys, 80% African Americans). Participants reported Tanner Stages of pubertal development, aggressive behavior and harsh parenting practice of their parents. Puberty scores were standardized with groups of the same age, sex, and ethnicity, and those that scored the top one-third were defined as early maturing individuals. Parents reported youth's aggressive behavior and their parenting practices towards the youth, including harsh parenting and positive parenting. Early pubertal timing significantly moderated the relationship between harsh/positive parenting and aggressive behavior. Specifically, harsh parenting was positively associated with aggressive behavior to a larger degree among early maturing individuals than among on-time/late-maturing individuals. Positive parenting was inversely associated with aggressive behavior but only among early maturing individuals. This study is the first to document support for early pubertal timing as susceptibility to the environmental influences in relation to aggressive behavior. Theoretical and intervention implications are discussed.

Pubertal breast development in primary school girls in Sokoto, North-western Nigeria

Background. There is wide variation in normal pubertal timing among various populations. Objectives. To determine the mean age of pubertal stages of breast development and menarche, and the influence of nutrition and ethnicity on pubertal onset in primary school girls in Sokoto, North-Western Nigeria. Methods. A cross-sectional study using a multistage random sampling design was conducted on 994 primary school girls in grades 3 - 6. Weight and height measurements and Tanner breast staging were done. Body mass index (BMI) was calculated, and a BMI-for-age percentile was used to categorise nutritional status. There were four major ethnic groups. P≤0.05 was taken as showing statistical significance. Results. The participants’ mean age was 10.23 years (standard deviation (SD) 1.70, range 6 - 15 years). Of the 994 girls, 628 (63.2%) were pre-pubertal, and 366 (36.8%) were pubertal. Of the latter, 158 (15.9%) were in breast stage 2, while 112 (11.3%), 70 (7.0%) and 26 (2.6%) were in breast stages 3, 4 and 5, respectively. The mean ages (SD; range) of pubertal onset and menarche were 10.50 (1.33; 8 - 13), and 12.67 (1.65; 11 - 15), years, respectively. The overnourished (overweight/obese) and Igbo ethnic group girls had early-normal pubertal onset ( p =0.006 and p =0.001, respectively). Conclusion. The mean ages of Tanner breast stages 1 - 5 and menarcheal age of girls in Sokoto, North-Western Nigeria, were within the age ranges reported worldwide. Pubertal onset was influenced by nutrition.

Teachers’ Expectations of Girls’ Classroom Performance and Behavior: Effects of Girls’ Race and Pubertal Timing

Experiencing an early pubertal transition has been shown to increase the risk for internalizing and externalizing outcomes among girls. It is less clear how the expectations of other individuals can be critical determinants of vulnerability for early developers. This study used an experimental design to examine whether the expectations of teachers might be influenced by girls’ pubertal timing (early, on-time, late) and race (Black, White). Elementary school teachers ( N = 220; Mage = 43 years; 91% female; 84% White) were randomly shown behavior vignettes consisting of drawings of girls in varying stages of pubertal development. They then rated each girl’s future academic/social functioning. Results demonstrated that teachers expected White and Black early developers to have more academic/social problems. Teachers also ascribed more academic/social problems to Black early developers relative to White early developers. The findings offer new insights into the synergistic linkages between pubertal timing and teachers’ expectations, with girls’ race accentuating this relationship.

Subclinical Hypothyroidism in Danish Lean and Obese Children and Adolescents.

Objective:Thyroid abnormalities are common in obese children. The aim of the present study was to examine the prevalence of subclinical hypothyroidism (SH) and to determine how circulating thyroid hormone concentrations correlate with anthropometrics in Danish lean and obese children and adolescents.Methods:In this cross-sectional study, we included 3006 children and adolescents, aged 6-18 years, from the Registry of the Danish Childhood Obesity Biobank. The overweight/obese group (n=1796) consisted of study participants with a body mass index (BMI) standard deviation score (SDS) ≥1.28. The control group (n=1210) comprised lean children with a BMI SDS <1.28. All participants were characterized by anthropometrics (weight, height, and waist circumference) and fasting serum concentrations of thyroid-stimulating hormone (TSH), free triiodothyronine, and free thyroxine (fT4) at baseline.Results:The prevalence of SH was higher among overweight/obese compared to lean study participants (10.4% vs. 6.4%, p=0.0001). In the overweight/obese group, fasting serum TSH concentrations were associated positively with BMI SDS (p<0.0001) and waist-height ratio (WHtR) (p<0.0001) independent of age, sex, and pubertal developmental stage, whereas fasting serum fT4 concentrations were associated positively only with WHtR. The odds ratio of exhibiting SH was 1.8 when being overweight/obese compared with lean (p=0.0007) and 1.8 when presenting with a WHtR >0.5 (p=0.0003).Conclusion:The prevalence of SH was higher among overweight/obese study participants. The positive correlations of circulating TSH and fT4 with WHtR suggest that central obesity, independent of the overall degree of obesity, augments the risk of concurrent thyroid abnormalities in children and adolescents with obesity.

Association of Maternal Smoking During Pregnancy and Birth Weight With Retinal Nerve Fiber Layer Thickness in Children Aged 11 or 12 Years

Both maternal smoking during pregnancy and low birth weight have been implicated in impaired development of the retina. To investigate the associations of maternal smoking during pregnancy and low birth weight with retinal nerve fiber layer (RNFL) thickness in preadolescent children. The Copenhagen Child Cohort 2000 Eye Study is a prospective, population-based, birth cohort study that included all children (n = 6090) born in 2000 in Copenhagen, Denmark. Maternal smoking data were collected through parental interviews. Birth weight, pregnancy, and medical history data were obtained from the Danish Medical Birth Registry. As a follow-up, the study performed eye examinations on 1406 of these children from May 1, 2011, to October 31, 2012, when the children were aged 11 or 12 years. The participants were predominantly (1296 [92.4%]) of European descent. Study data were analyzed from June 1, 2016, to October 1, 2016. Peripapillary RNFL thickness measured using optical coherence tomography at the 11- or 12-year examination. Of the 1406 children in the study, 1323 were included in the analysis (mean [SD] age was 11.7 [0.4] years; 633 [47.8%] were boys and 690 [52.2%] were girls). The mean (SD) RNFL thickness was 104 (9.6) μm. In 227 children whose mothers had smoked during pregnancy, the peripapillary RNFL was 5.7 μm (95% CI, 4.3-7.1 μm; P < .001) thinner than in children whose mothers had not smoked after correction for age, sex, birth weight, height, body weight, Tanner stage of pubertal development, axial length, and spherical equivalent refractive error. In low-birth-weight children (<2500 g), the RNFL was 3.5 μm (95% CI, 0.6-6.3 μm; P = .02) thinner than in normal-birth-weight children after adjustment for all variables. Exposure to maternal smoking during uterine life and low birth weight were independently associated with having a thinner RNFL at age 11 or 12 years. These observations support previous findings that intrauterine and perinatal factors can have long-lasting effects on the retina and the optic nerve. The results of this study add evidence to existing recommendations to avoid smoking during pregnancy and support measures that promote maternal and fetal health.

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment.

The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001). Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS. Clinicaltrials.gov, ID-no.: NCT02013843.