Body composition in prepubertal children with idiopathic premature adrenarche: implications for cardiometabolic health

Background: Premature adrenarche (PA) has been reported as a potential precursor of metabolic disease. We aimed to explore the interaction between body composition and cardiometabolic health of prepubertal children with PA.

Methods: This observational study comprised of 87 children with PA (15 boys, 8.0 ± 1.2 years) and 87 healthy sex- and age-matched controls. Body composition was measured by bioelectrical impedance analysis.

Results: Children with PA had a higher median BMI z-scores (P = 0.001), higher median fat percentage (P = 0.006), and lower muscle-to-fat z-scores (P = 0.050) compared to controls. There were no significant group differences in blood pressure percentiles and lipid profiles. Fat percentage of children with PA was positively correlated and the MFR z-score was negatively correlated with: BMI z-score, systolic blood pressure percentile, and atherogenic dyslipidemia index (P < 0.001 for all). There were significant correlations between parental and offspring MFR z-scores in the control group (father-child: r = 0.528, P = 0.020; mother-child: r = 0.359, P = 0.031), but none in the PA group.

Conclusions: Children with PA exhibited an unfavorable body composition in association with their metabolic health even before the onset of puberty. Furthermore, while healthy children displayed heritable body composition traits, children with PA did not, possibly suggesting a relatively greater role for environmental factors in the PA group.

Impact: Prepubertal children with premature adrenarche have a low muscle-to-fat ratio compared to healthy sex- and age- matched controls. The body composition of prepubertal children with premature adrenarche is associated with their systolic blood pressure percentile and atherogenic dyslipidemia index. Children with premature adrenarche and healthy weight exhibited higher adiposity compared to healthy weight controls, and those with overweight/obesity showed higher rates of elevated blood pressure and higher dyslipidemic atherogenic indices compared to overweight/obesity controls. These findings highlight the importance of early identification, intervention, and lifestyle changes for children with premature adrenarche to help prevent cardiometabolic complications.