Study Examines Link Between Increased Sedentary Time, Precocious Puberty Diagnoses in Italy

A new study from Italy describes provides insight into possible links between increases in sedentary behavior during the COVID-19 pandemic and an increase in the rate of diagnosis for central precocious puberty.

With previous studies suggesting rates of diagnosis for central precocious puberty had increased during the pandemic, investigators sought to assess how lifestyle changes related to lockdown may have played a role in this phenomenon and found notable increases in use of electronic devices and sedentary lifestyle before and during the pandemic among girls with central precocious puberty compared to the rest of the 2020 population.

“To our knowledge, no previous studies have analyzed the impact of daily lifestyle changes on puberty. The sharp increase in cases of precocious puberty observed during the first COVID-19 pandemic wave suggests that rapid changes in physical activity, use of electronic devices, and pandemic-related stress may trigger the GnRH pulsatile secretion leading to puberty onset,” wrote investigators.

With a previous study indicating rates of precocious puberty had increased during the pandemic despite no apparent increase in consultations, investigators sought to explore potential associations between increased prevalence, decreased physical activity, and increased stress during the COVID-19 pandemic. To do so, investigators from the Bambino Gesù Children’s Hospital designed a retrospective study using data from patients presenting to 5 Italian tertiary medical centers specializing in pediatric endocrinology between March-September 2020 and March-September 2019.

A total of 490 children were identified for inclusion, including 338 referred for suspected precocious puberty from March-September 2020. Compared to March-September 2019, this figure represents a 122% increase in diagnoses, with only 152 occurring during the pre-COVID-19 period. This increase was most apparent among girls, with 328 subjects referred during 2020 and 152 referred during 2019, compared to 10 and 12, respectively, among boys during the same time periods. Investigators also pointed out the increase in diagnoses was more apparent during the latter half of the study period, with 236 girls referred for suspected precocious puberty from June-September and 92 referred from March-May.

Further analysis suggested the proportion of girls with confirmed central precocious puberty was greater in 20202 than in 2019 (41% vs 26%; P <.01). Data suggested there were no differences in anthropometric and hormonal parameters in girls with confirmed central precocious puberty in 2019 and 2020. However, results indicated overall time spent on electronic devices was greater among those in the 2020 group than those in the 2019 group, with no differences observed among different 2020 subgroups. Additionally, physical activity per week was significantly lower among the 2020 group with central precocious puberty compared to other 2020 subgroups. In their discussion, investigators underlined the belief that while their study had innate limitations, the sample size and comparability of precocious puberty diagnoses in other clinics provide backing for their results.

“We are aware that the retrospective design of our study, together with the fact that living habits and physical activity were self-reported, represents clear limitations in the evaluations of the results. However, it was a multicenter study with relatively large sample size, and similar increases of precocious puberty were observed across the five Italian centers involved,” investigators wrote.

This study, “Sedentary lifestyle and precocious puberty in girls during the COVID-19 pandemic: an Italian experience,” was published in Endocrine Connections.