Serum Vitamin D Deficiency and Its Association with Idiopathic Central Precocious Puberty in Iranian Girls: A Case-Control Study
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Masoume Aliabadi
,
Mohammadreza Azadi Pourghahestani
,
Mitra Nourbakhsh
,
Maryam Razzaghy-Azar
,
Mona Nourbakhsh
Abstract
Objective: Precocious puberty is a significant pediatric endocrine disorder with potential long-term physical and psychosocial consequences, including short stature, obesity, and increased risk of certain malignancies. Vitamin D (vitD) has been proposed to play a role in reproductive maturation. However, the evidence regarding its association with precocious puberty remains inconsistent across populations. This study aimed to investigate the relationship between serum vitD levels and idiopathic central precocious puberty (ICPP) in Iranian girls.
Methods: This case-control study included 81 girls diagnosed with central precocious puberty and 51 healthy girls as controls. Demographic, anthropometric, and laboratory data (including age, weight, height, and serum levels of estradiol, LH, FSH, TSH, T4, and 25-hydroxyvitamin D) were extracted from clinical records. BMI z-scores, weight-for-age z-scores, and weight-for-height z-scores were calculated using standardized tools. Serum vitD levels were compared between groups, and correlations with anthropometric and biochemical parameters were assessed using appropriate statistical tests.
Results: Median serum vitD levels were significantly lower in the case group than in controls (27.05 vs. 41.00 ng/mL; P = 0.0006). BMI z-score and weight-for-age z-score were significantly higher in girls with precocious puberty (P < 0.0001). Cases showed a larger discrepancy between bone age and chronological age (P < 0.0001). Serum vitD showed significant inverse correlations with BMI z-score (r = −0.236, P = 0.035) and weight-for-height z-score (r=−0.605, P=0.028), and a significant positive correlation with T4 (r = 0.317, P = 0.010). No significant correlations were observed between vitD and reproductive hormones, including estradiol, LH, or FSH.
Conclusion: Serum vitD levels are significantly lower in Iranian girls with ICPP compared to healthy controls. These findings suggest that vitD may influence pubertal development; therefore, routine assessment of vitD status in girls presenting with precocious puberty may be clinically warranted, particularly in populations with a high background prevalence of deficiency.
2. Aksglaede L, Sorensen K, Petersen JH, Skakkebaek NE, Juul A. Recent decline in age at breast development: the Copenhagen Puberty Study. Pediatrics 2009;123:e932–e9.https://doi.org/10.1542/peds.2008-2491
3. Carel JC, Léger J. Precocious puberty. N Engl J Med 2008;358:2366–77.https://doi.org/10.1056/NEJMra0800459
4. Partsch CJ, Heger S, Sippell WG. Management and outcome of central precocious puberty. Clin Endocrinol (Oxf) 2002;56:129–48.https://doi.org/10.1046/j.1365-2265.2002.01493.x
5. Prentice P, Viner RM. Pubertal timing and adult obesity and cardiometabolic risk in women and men: a systematic review and meta-analysis. Int J Obes (Lond) 2013;37:1036–43.https://doi.org/10.1038/ijo.2013.73
6. Romundstad R, Løvaas R, Træen B, Opdahl S, Støylen A, Mørch LS. Height, age at menarche and risk of hormone receptor-positive and -negative breast cancer: a cohort study. Int J Cancer 2013;132:2619–29.https://doi.org/10.1002/ijc.27813
7. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752–e62.https://doi.org/10.1542/peds.2008-1783
8. Abrams SA, Coss-Bu JA, Tiosano D. Vitamin D: effects on childhood health and disease. Nat Rev Endocrinol 2013;9:162–70.https://doi.org/10.1038/nrendo.2012.259
9. Aloia JS, Li-Ng M. Update in vitamin D. J Clin Endocrinol Metab 2010;95:471–8.https://doi.org/10.1210/jc.2009-2630
10. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol 2014;144:138–45.https://doi.org/10.1016/j.jsbmb.2013.11.003
11. Nascimento C, Doyen A, Forhan A, Saldanha-Gomes C, Massin M, Philippi A. Maternal vitamin D deficiency programs reproductive dysfunction in female mice offspring through adverse effects on the neuroendocrine axis. Endocrinology 2016;157:1535–45.https://doi.org/10.1210/en.2015-1845
12. Laganà AS, Vitale SG, Ban Frangež H, Vrtačnik-Bokal E, D'Anna R. Vitamin D in human reproduction: the more, the better? An evidence-based critical appraisal. Eur Rev Med Pharmacol Sci 2017;21:4243–51.https://doi.org/10.26355/eurrev_201709_10994
13. Kinuta K, Tanaka H, Moriwake T, Aya K, Kato S, Seino Y. Vitamin D is an important factor in estrogen biosynthesis of both female and male gonads. Endocrinology 2000;141:1317–24.https://doi.org/10.1210/endo.141.4.7403
14. Halloran BP, DeLuca HF. Effect of vitamin D deficiency on fertility and reproductive capacity in the female rat. J Nutr 1980;110:1573–80.https://doi.org/10.1093/jn/110.8.1573
15. Kadowaki S, Kadowaki Y, Nakamura T, Tominaga S. Advanced onset of menarche and higher bone mineral density depending on vitamin D receptor gene polymorphism. Eur J Endocrinol 1998;139:522–7.https://doi.org/10.1530/eje.0.1390522
16. Villamor E, Marin C, Mora-Plazas M, Baylin A. Vitamin D deficiency and age at menarche: a prospective study. Am J Clin Nutr 2011;94:1020–5.https://doi.org/10.3945/ajcn.111.018168
17. Aypak C, Türedi Ö, Yüce A. The association of vitamin D status with cardiometabolic risk factors, obesity and puberty in children. Eur J Pediatr 2014;173:367–73.https://doi.org/10.1007/s00431-013-2216-5
18. Lee HS, Kim YJ, Shim YS, Jung HR, Kim E, Hwang JS. Associations between serum vitamin D levels and precocious puberty in girls. Ann Pediatr Endocrinol Metab 2014;19:91–5.https://doi.org/10.6065/apem.2014.19.2.91
19. Zhang Y, Li W, Dong C, Yang H, Wang S, Niu Q. Prevalence of vitamin D deficiency in girls with idiopathic central precocious puberty. Front Med 2018;12:174–81.https://doi.org/10.1007/s11684-017-0575-2
20. Durá-Travé T, Gallinas-Victoriano F. Vitamin D status and parathyroid hormone assessment in girls with central precocious puberty. J Endocrinol Invest 2022;45:2069–75.https://doi.org/10.1007/s40618-022-01838-y
21. de Bruin G, Bouvatier R, Stoupa JC. There is no association between vitamin D status and characteristics of central precocious puberty in girls. Eur J Pediatr 2017;176:1677–80.https://doi.org/10.1007/s00431-017-3022-2
22. Chou JH, Roumiantsev S, Singh R. PediTools Electronic Growth Chart Calculators: Applications in Clinical Care, Research, and Quality Improvement. J Med Internet Res 2020;22:e16204.https://doi.org/10.2196/16204
23. Rafati M, Zarei D, Rostami Shurgshti SN, Fakheri F, Aghaei M, Rostami Dovom H. Serum vitamin D levels in girls with central precocious puberty. Pharm Biomed Res 2018;4:15–9.https://doi.org/10.18502/pbr.v4i1.140
24. Torkaman M, Alaei A, Alaei MR, Barari F, Amirsalari S, Karimzadeh P. Comparison of the vitamin D status of children younger and older than 2 years in Tehran. Int J Endocrinol Metab 2016;14:10.5812/ijem.34104
25. Drincic AT, Armas LA, Van Diest EE, Heaney RP. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring) 2012;20:1444–8.https://doi.org/10.1038/oby.2011.387
26. Choi HS, Kim BK, Kim JH, Lee SH, Kim KM. Association between serum vitamin D levels and sensitivity to thyroid hormone indices: a cross-sectional observational study in NHANES 2007–2012. Front Endocrinol (Lausanne) 2023;14:1243999.https://doi.org/10.3389/fendo.2023.1243999
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| Issue | Vol 2026 No 4 (2) | |
| Section | Original Articles | |
| Keywords | ||
| 25-hydroxyvitamin D Iran Case-control study Girls Idiopathic central precocious puberty Vitamin D deficiency | ||
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