I would like to thank Dr. Hüseyin Anıl Korkmaz for his comments (1) regarding “early onset of puberty or faster maturation in children with small for gestational age (SGA) may be adaptive mechanism for using energy due to hepato-visceral fat. He described that the energy can be used for starting puberty and precocious puberty may occur in SGA children, because these children could necessitate to use extra energy. There is normal energy balance between prenatal and postnatal period. As long as energy balance is positive because of central adiposity, puberty maturation will be faster and it will result in exaggerated precocious adrenarche or earlier onset of pubertal development. The mismatch between prenatal and postnatal weight gain may change biological clock of puberty because of energy imbalance due to central adiposity. As long as SGA children maintain energy restriction in later life, they may not develop faster puberty maturation.
I believe that many children born SGA have a normal adrenarche and normal pubertal timing, but some SGA children are also prone to have precocious adrenarche and early onset of puberty. The underlying mechanism for early onset of puberty in SGA children remains unclear but difference in ethnic background, nutrition, and other yet unknown variables may be related (2,3,4). On the other hand, mismatch between prenatal and postnatal weight gain in SGA children might lead to energy imbalance inducing puberty. Therefore, these children may have increased risk of precocious puberty or premature adrenarche.”
Sincerely,
Il Tae Hwang
References
- 1.Anıl Korkmaz HA. Nutritional thrift can be associated with precocious puberty and premature adrenarche in children born small for gestational age. Clin Pediatr Endocrinol 2020;29: 131–132. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Persson I, Ahlsson F, Ewald U, Tuvemo T, Qingyuan M, von Rosen D, et al. Influence of perinatal factors on the onset of puberty in boys and girls: implications for interpretation of link with risk of long term diseases. Am J Epidemiol 1999;150: 747–55. doi: 10.1093/oxfordjournals.aje.a010077 [DOI] [PubMed] [Google Scholar]
- 3.Boonstra V, van Pareren Y, Mulder P, Hokken-Koelega A. Puberty in growth hormone-treated children born small for gestational age (SGA). J Clin Endocrinol Metab 2003;88: 5753–8. doi: 10.1210/jc.2003-030512 [DOI] [PubMed] [Google Scholar]
- 4.Ibáñez L, Potau N, Francois I, de Zegher F. Precocious pubarche, hyperinsulinism, and ovarian hyperandrogenism in girls: relation to reduced fetal growth. J Clin Endocrinol Metab 1998;83: 3558–62. doi: 10.1210/jcem.83.10.5205 [DOI] [PubMed] [Google Scholar]