1 Arquivos Brasileiros de Endocrinologia & Metabologia 2003 Vol: 47(2):. DOI: 10.1590/S0004-27302003000200009

Prevalência de obesidade e baixo peso ao nascer na pubarca precoce

The prevalence of obesity and presence of low birth weight (LBW) were evaluated retrospectively in 96 children with premature pubarche (PP), from which 90 cases of premature adrenarche were selected. Information on BW was found in 46 charts, and 5 prematures were excluded. Tanner stages, body mass index (BMI), presence of acanthosis nigricans and bone age (BA) were evaluated. Obesity was considered when BMI > the 95th percentile and overweight when BMI > the 85 and <95 percentiles. After a six-month follow-up, the BMI of 62 patients was reeva luated. The results showed that BA was higher than chronological age (7.9±1.97 x 7.0±1.7 years, p<0.001). 70% of the sample showed pubic hair in Tanner II stage in and 31% had acanthosis nigricans. The BW was 3,168.2±528.2g. In 12% of the cases a history of LBW was present, a result not different from the general population (10%). No correlation was found between BMI and BW. Obesity was observed in 31% and overweight in 19% of the cases. BMI increased after follow-up (18±3.0 x 19.4±3.5kg/m2, p=0.008). The prevalence of obesity was higher in children with PP than in the Brazilian population (31% x 15%, p<0.02). In conclusion, although excess weight is a common finding in PP, birth weight is normal. It is remarkable that these children must be stimulated to lose weight, since PP and obesity are associated with a higher risk for policystic ovary and plurimetabolic syndromes in adulthood.

Figure 1
  1. Ginzbarg D, Teixeira RJ, Bordallo MAN, et al. Pubarca precoce: variante normal do desenvolvimento puberal. Arq Bras Pediat2 , 95-8 (1995) .
  2. Borges MF, Paula F, Nomeline MB, Tavares FS, Fonseca ER, Ferreira BP, et al. Pubarca precoce: Estudo retros pectivo clínico e laboratorial. Arq Bras Endocrinol Metab44 , 405-12 (2000) .
  3. Saenger P, Reiter EO. (Editorial) Premature adrenarche: a normal variant of puberty? J Clin Endocrinol Metab74 , 236-8 (1992) .
  4. Rosenfield RL. Hyperandrogenism in peripubertal girls. Pediatric Clin North Am37 , 1333-59 (1990) .
  5. Rosenfield RL. Puberty and its disorders in girls. Endocrinol Metab Clin North Am20 , 115-42 (1991) .
  6. Ibañez L, Virdis R, Potau N, et al. Natural history of premature pubarche: an auxological study. J Clin Endocrinol Metab74 , 254-7 (1992) .
  7. Rosenfield RL. Normal and almost normal precocious variations in pubertal development premature pubarche and premature telarche revisited. Horm Res41 , 7-13 (1994) .
  8. Ibañez L, Potau N, Chacon P, Pascual C, Carrascosa A. Hyperinsulinemia, dyslipaemia and cardiovascular risk in girls with a history of premature pubarche. Diabetologia41 , 1057-63 (1998) .
  9. DiMartino-Nardi J. Premature adrenarche: findings in prepubertal African-American and Caribbean-Hispanic girls. Acta PaediatrSuppl 433 , 67-72 (1999) .
  10. Ibañez L, Potau N, François I, de Zegher F. Precocious pubarche, hyperinsulinism and ovarian hyperandrogenism in girls: relation to reduce fetal growth. J Clin Endocrinol Metab83 , 3558-62 (1998) .
  11. Teixeira RJ, Ginzbarg D, Bordallo MAN. Tipos de resposta ao teste de estimulação com ACTH em meninas com pubarca precoce. In: VIII Reunión Anual Sociedad Latinoamericana de Endocrinología Pediátrica, Pucón /Chile p.57 , (1994) .
  12. Schonnfeld-Warden N, Warden CH. Obesidade Pediátrica: uma visão global da etiologia e tratamento. In: Styne DM, redator convidado. Clínicas pediátricas da América do Norte. Rio de Janeiro: Interlivros Edições Ltda;p , 343-66 (1997) .
  13. Parizzi MR. Obesidade na infância. In: Fonseca JGM, editor convidado. Obesidade e outros distúrbios alimentares. Clínica médica. Rio de Janeiro: MEDSI; p , 279-89 (2001) .
  14. Segre CAM. Perinatologia = Terminologia. In: Miranda LEV, org. Manual de Perinatologia. Sociedade Brasileira de Pediatria. Comitê de Perinatologia. Rio de Janeiro: Diretoria de Publicações da Sociedade Brasileira de Pediatria; p , 1-5 (1990) .
  15. Sanchez MB, Sarria-Chueca A. Obesidad. In: Tratado de endocrinologia pediátrica. M Pombo Arias, ed. 2a. edição. Madrid: Diaz de Santos S.A.p , 1157-70 (1997) .
  16. Monteiro CA. Epidemiologia da Obesidade. In: Obesidade. São Paulo: Lemos Editorial.p , 15-30 (1998) .
  17. Neutzling MB, Taddei JAAC, Rodrigues EM, Sigulem DM. Overweight and obesity in Brazilian adolescents. Intern J Obesity24 , 869-74 (2000) .
  18. Ribeiro RQC, Lotufo PA, Lamounier JA, Oliveira RG. Overweight and obesity associations with cardiovascular risk factors. Intern J Obesity26:122 , (2002) .
  19. Charney E, Goodman HC, McBride M, Lyon B, Pratt R. Childhood antecedents of adult obesity. Do chubby infants become obese adults? N Engl J Med295 , 6-9 (1976) .
  20. Rosner B, Prineas R, Loggie J, Daniels SR. Percentiles for body mass index in the U.S. children 5 to 17 years of age. J Pediatr132 , 211-22 (1998) .
  21. Freedman DS. Clustering of Coronary Heart Disease Risk Factors among Obese Children. JPEM15 , 1099-108 (2002) .
  22. Ilyés I, Pósán E, Sári S. Insulin resistance in obese boys with acanthosis nigricans. Acta Paed Hung32 , 325-32 (1992) .
  23. Teixeira RJ, Gazolla HM, Cunha SB, Bordallo MAN, Guimarães MM. Resistência à Insulina na pubarca precoce – Relação com os androgênios. Arq Bras Endocrinol Metab45 , 278-84 (2001) .
  24. Oppenheimer E, Linder B, DiMartino-Nardi J. Decreased insulin sensitivity in prepubertal girls with premature adrenarche and acanthosis nigricans. J Clin Endocrinol Metab80 , 614-8 (1995) .
  25. MINISTÉRIO DA SAÚDE – Secretaria de Assistência à Saúde - Coordenação Materno-infantil. Recém-Nascido de Baixo Peso. In: Joaquim MCM, org. Manual de assistência ao recém-nascido. Brasília: Projeto Nordeste; p , 41-7 (1994) .
  26. Barker DJP, Hales CHD, Osmond C, Clark PMS. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia36 , 62-7 (1993) .
  27. Dunaif A, Sorbara L, Delson R, Grren G. Ethnicity and polycystic ovary syndrome are associated with independent and additive decreased in insulin action in Caribbean Hispanic women. Diabetes42 , 1462-8 (1993) .
  28. Banerjee S, Raaghavan S, Wasserman EJ, Linder BL, Saenger P, DiMartino-Nardi J. Hormonal findings in African-American and Caribbean Hispanic girls with premature adrenarche: implications for polycystic ovarian syndrome. Pediatrics102 , 1-4 (1998) .
  29. Ibañez L, Potau N, Virdis R, Zampolli M, Terzi C, Gussinyé M, et al. Postpubertal outcome in girls diagnosed of premature pubarche during childhood: Increased frequency of functional ovarian hyperandrogenism. J Clin Endocrinol Metab76 , 1599-603 (1993) .
  30. Rittmaster RS, Deshwal N, Lehman L. The role of adrenal hyperandrogenism, insulin resistance, and obesity in the pathogenesis of polycistic ovarian syndrome. J Clin Endocrinol Metab72 , 46-50 (1991) .
  31. Teixeira RJ, Silva VCG, Freitas JR, Dimetz T, Cunha SB, Guimarães MM. The relationship between ovarian structure and hyperandrogenism in premature pubarche. JPEM14 , 257-65 (2001) .
  32. Teixeira RJ, Silva VCG, Gazolla HM, Cunha SB, Guimarães MM. The relationship between ovarian structure and serum insulin, Insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP-1 and IGFBP-3) levels in premature pubarche. JPEM15 , 69-75 (2002) .
  33. Dunaif A. Insulin resistance and the polycistic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev18 , 774-800 (1997) .
  34. Kiess W, Reich A, Muller G, Meyer K, Galler A, Bennek J, et al. Clinical aspects of obesity in childhood and adolescence. Intern J Obesity25 , 75-9 (2001) .
  35. MillerD, Emans SJ, Kohane I. Follow-up study of adolescent girls with a history of premature pubarche. J Adolesc Health18 , 301-5 (1996) .