Early Pubertal Development and Insulin Sensitivity among School-Aged Girls: Mediation Via Adiposity - 17/01/13

Doi : 10.1016/j.jpag.2012.09.007

Jennifer B. Hillman, MD ^1,^⁎ , Bin Huang, PhD ², Susan M. Pinney, PhD ³, Frank M. Biro, MD ¹
¹ Cincinnati Children’s Hospital Medical Center, Division of Adolescent Medicine and University of Cincinnati College of Medicine, Cincinnati, OH
² Cincinnati Children’s Hospital Medical Center, Center for Epidemiology and Biostatistics, Cincinnati, OH
³ University of Cincinnati College of Medicine, Cincinnati, OH

Address correspondence to: Jennifer B. Hillman, MD, 3333 Burnett Avenue, MLC 4000, Cincinnati, OH 45229; Phone: (513) 636-3539; Fax: (513) 636-1129

Abstract

Study Objective

To examine whether the known association between early pubertal breast maturation and insulin sensitivity (SI) is mediated by adiposity.

Design

Cross-sectional analyses.

Setting

Observational study examining the roles of environment, diet, and obesity on puberty.

Participants

379 girls with a mean age, 7.03 years; 62% were white and 29% black.

Main Outcome Measures

Pubertal development was assessed via physical examination and adiposity by body mass index Z score (BMI Z) and waist-to-height ratio. Fasting blood samples were obtained for insulin and glucose concentrations. SI was calculated with the quantitative insulin sensitivity check index (QUICKI). Analysis of variance and Sobel’s test was used to assess mediation.

Results

Fifty-five girls were pubertal (Tanner 2 breast). Breast maturation was inversely associated with SI (P = .005) and positively associated with BMI Z (P < .001) and waist-to-height ratio (P < .001). The effect of breast maturation on SI was no longer significant (P = .41) after adjusting for the effect of BMI Z, which remained significant (P < .001). Similar results were obtained when waist-to-height ratio replaced BMI Z in the models. Mediation analyses demonstrated that 75% of the association between breast maturation and SI is mediated by adiposity.