Character Of Girls In Shenzhen With Precocious Puberty And The Association Between Phthalate Exposure And Precocious Puberty In Them

ObjectTo analyze the behavior patterns,environmental exposure and dietary pattern of girls with precocious puberty in Shenzhen,and to analyze the relationship between PAEs exposure and precocious puberty,to explore the risk factors or causes of precocious puberty,which providing guidance for the prevention and control of it.ContentCase samples were selected from the Department of Endocrinology of Shenzhen Children’s Hospital which is diagnosed as central precocious puberty and premature puberty.The control samples were selected from Shenzhen targeted physical examination school.Case-control matching was carried out for 1:1 cases,which in same sex and age within 3 months.A total of 284 case-control samples were included.Questionnaires and urine were both collected from the case control group.The metabolites of five phthalate in urine samples were determined by high performance liquid chromatography tandem mass spectrometry.The data were processed and analyzed by using t-test,Chi-square test,Wilcoxon signed-rank test,Wilcoxon rank sum test,canonical correlation analysis,factor analysis and logistic regression analysis.To explore the characteristics of precocious puberty girls in Shenzhen and their relationship with precocious puberty.ResultsGeneral situation:This study included 568 subjects,284 in case group and 284 in control group.Among them,the age group of 8-year-old is the largest,accounting for 44%.The second group was the 7-year-old group（33%）and the 9-year-old group（18%）.The 6-year-old group（4%）and the 10-year-old group（1%）were relatively small.The median age of full-time was the same in the case group and the control group,both of which were 8.0 years old.The median height,weight and BMI of the case group were 135.0 cm,30.2 kg and 16.6 kg/m²,respectively,which were higher than those of the control group（129.2 cm）,body weight（25.0 kg）and BMI（15.3 kg/m²）.Case-control univariate analysis:the basic situation in height,weight,BMI,overweight and obesity rate,antibiotic use in the case group was higher than that in the control group,the difference was statistically significant.(z=11.07,z=8.98,z=4.85,z=1.96,z=1.96,χ²_CΜΗ=18.21,χ²=0.46,P<0.05).The malnutrition rate,birth weight and weaning time of the control group were higher than those of the case group,and the difference was statistically significant(χ²_CΜΗ=18.21,z=1.96,z=4.22,P<0.05).Family situation:the proportion of only child（42.9%）and mother’s overweight and obesity（21.1%）in the case group were higher than those in the control group（26.7%,12.2%）;the sleep time（9 hours）and the age of menarche（14 years）in the control group were higher than those in the case group（8 hours,13 years）.Exposure:In terms of decoration time,frequency of using plastic utensils and time of using plastic utensils,there was significant difference（χ²=104.29,30.41,20.79,P<0.05）,while there was no significant difference in frequency of using skin care products between the two groups（χ²=0.46,P>0.05）.Dietary pattern:The dietary part of the questionnaire involves the intake frequency of 14 kinds of food,and standardizes the frequency of each kind of food to be:times per day.The t-test showed that the case group was higher than the control group in cereals,foreign fast food,supplements and nutrients（t=5.55,3.83,4.77）,and the control group was higher in meat,nuts,fresh vegetables,fresh fruits,milk and dairy products and carbonated beverages（t=6.29,1.69,3.51,4.88,2.87,3.95 respectively）,with significant differences（P<0.05）.The concentration of plasticizer metabolites in urine was determined by LC-MS/MS.The detection rates of MMP,MEP,MiBP,MBP and MEHP were97%¹00%.The relative recovery of the five plasticizers ranged from 0.4to 1.03.After adjusting the age and BMI of the covariance model,there were significant differences in MBP and MEHP among the five plasticizer metabolites（F=10.30,3.93,P≤0.05）,and there were no significant differences in MMP,MEP and MiBP among the other three metabolites.Case-control multivariate analysis:The criteria for inclusion and exclusion were 0.10 and 0.15 by using binary logistic regression analysis.Children nutritional assessment（OR=2.326,95%CI:1.397-1.397-3.871）,eating frequency of plastic utensils（OR=1.625,95%CI:1.625,95%CI:1.069-2.465）,high protein and high fat diet（OR=3.940,95%CI:2.515-6.168）,MEHP exposure（OR=2.099,95%CI:1.099,95%CI:95%CI:1.477-2.979）were risk factors,family monthly income（OR=0.750,95%CI:0.95%CI:0.95%CI:0.583-0.583-0.583-0.583-0.964 OR）,mother’s age 727,95%CI:0.580-0.910)was the protective factor.Conclution1.The main dietary pattern of healthy school-aged children in Shenzhen is the balanced diet pattern.The main dietary pattern of precocious puberty children is the high-protein and high-fat diet pattern.Health education should be given to children with precocious puberty to change their bad eating habits.2.The more overweight and obese children,the more frequently they eat plastic utensils,the more high-protein and high-fat diets,the more MEHP exposure,the less family monthly income,and the younger their mother’s age at menarche,the greater the risk of premature puberty.