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The content related to the growth and development of adolescence has always been valued by experts in the field of pediatric endocrinology
.
This ESPE conference released important conclusions on important measurement indicators of growth and development, individual differences in endocrine diagnosis and treatment, and the correlation between body weight and long-term metabolic results in the treatment of precocious puberty
.
During the conference, Professor Luo Feihong was invited to receive an exclusive interview and made wonderful academic sharing and exchanges
on the important indicators of adolescent growth and development and endocrine personalized medicine.
Introduction by experts
Prof.
Feihong Luo
Chief physician and doctoral supervisor
Director of the Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Fudan UniversityVice Chairman of the Adolescence Medicine Committee of the Chinese Medical Doctor Association and leader of the Endocrinology Group
Consultant of the Endocrinology, Genetic and Metabolic Diseases Group, Pediatrics Branch of Chinese Medical Association
Member of Pediatrics Branch of Shanghai Medical Association
Member of Rare Disease Branch of Shanghai Medical Association
Vice President of Science Popularization Branch of Shanghai Medical Doctor Association
Consultant of Endocrinology, Genetic and Metabolic Diseases, Pediatrics Branch of Shanghai Medical Association
Past Director of the Asia-Pacific Pediatric Endocrine Association (APPES).
He is currently an associate editor of the Journal of Pediatric Endocrinology and Metabolism
Editorial Board Member of Chinese Practical Internal Medicine, Chinese Journal of Evidence-Based Pediatrics, and Editorial Board Member of Chinese Journal of Contemporary Pediatrics
He presided over 2 projects of the National Natural Science Foundation of China, 4 projects of the Shanghai Municipal Science and Technology Commission, 2 international cooperation diabetes projects, and participated in 3 national 11th and 12th Five-Year Science and Technology projects
.
Q1
Feihong Luo: As a high-profile event in the field of pediatric endocrinology, the ESPE Conference brings together the latest research progress in the diagnosis and treatment of pediatric endocrine diseases in the world, and has many academic highlights
worth learning and discussing.
We say that children's growth and development problems run through the important process
of infancy and adolescence.
For children and adolescents with chronic diseases, how to follow the principle of individualization to evaluate the indicators of prepuberty and adolescence is still a challenge, and this ESPE proposed a new concept
of endocrine personalized medicine.
Although the development of puberty varies greatly among individuals, traditional research and reference literature mostly describe growth and development based on chronological age rather than biological age1, so adolescent growth standards have limited role in monitoring individual growth in clinical practice and research.
Especially for children and adolescents with chronic diseases, there is a need to better assess changes in SD scores in prepuberty and adolescence to reflect poor care or early or late puberty
.
To fill this gap, Anton Holmgren et al.
shared their research to develop new pubertal height, weight, and BMI references for adolescence Standard to accommodate the dramatic changes
in growth that begin puberty.
The study established new reference indicators of adolescent height, weight and BMI through the QEPS growth model, making pediatric endocrine personalized medicine possible
。 In addition, the topic of children's growth and development is inseparable from the focus of attention to the pediatric endocrine disease of precocious puberty, in which BMI affects the reception of GnRHa in children with CPP (central precocious puberty).
Long-term anthropometric indicators after treatment, such as height, weight, etc.
, and metabolic status, are also hot topics
discussed in this conference.
Q2
.
Could you please tell us more specifically about the important results on this topic?
Prof.
Feihong Luo: In the past 150 years, puberty has begun earlier as human height has increased
.
Previous studies have analysed potential changes in growth patterns from birth to adulthood through QEPS assessments of two Swedish cohorts born in 1974 and 19901
.
where QEPS represents quadratic (Q), exponential (E), pubertal (P), and stop (S), respectively, that is, quadratic terms, exponential function terms, and pubertal initiation and stopping, and the combination of these functions explains growth
from fetal to adult height.
The QEPS model was used to analyze adult height and compare the growth characteristics of longitudinal cohorts born in 1974 and 1990, and found that changes in adult height were associated with
faster growth in childhood in boys and girls during adolescence.
The QEPS model proved to be effective at detecting small changes
in growth patterns between two longitudinal growth cohorts.
After introducing the background of previous research, let's take a look at the latest results
of the 2022 ESPE study on QEPS models.
The latest study by Patrizia Bruzzi et al.
established a QEPS weighting model2 using data from 3595 subjects (including 1779 girls) from two cohort studies, Gothenburg GrowUp1974 and Gothenburg GrowUp1990
.
According to height and weight, the QEPS height model is converted into the corresponding QEPS weight model.
Thereafter, QEPS weight is corrected
by individual weight height factor (WHF).
New standards for pubertal height, weight, and BMI take into account individual differences in the timing of puberty; These new reference standards will improve growth monitoring, especially for children with chronic diseases and who are overweight, obese or underweight
.
As demonstrated at ESPE 2022, a consistent growth reference indicator for pubertal development may be a practical tool
in pediatric endocrinology for individualized medicine.
Q3
.
So, in children with CPP treated with GnRHa, does high BMI before treatment affect long-term anthropometric indicators and metabolic outcomes? Prof.
Feihong Luo: Looking back over the past few decades, the increase in childhood overweight and obesity is considered to be a potential driver of long-term trends in adolescence
.
Studies have shown that girls with higher levels of obesity have a higher
risk of precocious puberty.
Then, in clinical practice, we pay special attention to whether body weight and BMI have long-term effects
on the treatment of CPP in the process of GnRHa treatment of CPP.
There is a consensus that GnRHa treatment is effective in improving adult height in children with precocious puberty, rapid progression, and good growth potential3
.
The Chinese Consensus on the Diagnosis and Treatment of Central Precocious Puberty (2015)4 proposed that some girls with CPP had a BMI higher than the normal average at the beginning of diagnosis and treatment, and long-term GnRHa treatment would not aggravate the obesity trend
.
In an observational, single-center cohort study published in ESPE 2022, 57 girls with idiopathic central precocious puberty (ICPP) treated with GnRHa were included in the study, which were divided into group A (normal weight, n=33) and group B (overweight and obesity, n=24) according to their weight, observed the nodes from the beginning of treatment (baseline, T0), end of treatment (T1), and near-lifetime high (T2), collected anthropometric data, Bone age, fasting lipids, and blood glucose data
.
The results showed that the age of groups A and B was 7.
86±0.
81 vs.
7.
06±1.
61 years (p<0.
05), and the difference in bone age was 1.
73±1.
04 vs.
2.
26±1.
20 years (p=0.
10).
In this study, the adult lifetime height obtained by both groups was consistent with the predicted height, with an average absolute height increase of 11.
82±5.
35 cm
compared to the predicted height assessed at T0.
No deterioration
in lipid metabolism and insulin resistance was found in either group.
The findings dispelled clinicians' concerns that overweight and obesity did not impair long-term anthropometric outcomes
of GnRHa in children with CPP.
In addition, GnRHa treatment may not worsen long-term metabolic status
in patients who are already overweight and obese in the CCP diagnosis.
The results of the study provide a new basis
for the safety and efficacy of clinical use of GnRHa in the treatment of CPP.
References:
1.
Holmgren A，Niklasson A, et al.
Pediatr Res.
2018 Jul; 84(1):41-49.
2.
Novel puberty aligned references for height, weight and BMI -making personalized medicine in paediatric endocrinology possible，ESPE 2022 FC7.
4
3.
Can pre-treatment BMI influence long-term anthropometric and metabolic outcomes in girls with idiopathic central precocious puberty treated with GnRHa?，ESPE FC9.
2
4.
Endocrinology Genetics and Metabolism Group, Pediatrics Branch of Chinese Medical Association.
Editorial Board of Chinese Journal of Pediatrics.
Chinese Journal of Pediatrics.
2015,53(6):412-8.
Approval number: DIP-CN-010471 Valid until: November 13, 2024
