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J Pediatr Endocrinol Metab. 2018 Nov 27;31(11):1221-1229. doi: 10.1515/jpem-2018-0120.

Leptin and adiposity as mediators on the association between early puberty and several biomarkers in European adolescents: the HELENA Study.

Author information

Youth/Child and cArdiovascular Risk and Environmental (YCARE) Research Group, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Growth, Exercise, NUtrition and Development (GENUD) Research Group, Faculty of Health Science (EUCS), Instituto Agroalimentario de Aragón (IA2), University of Zaragoza-CITA, Zaragoza, Spain.
Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
Metabolic Diseases, Exercise and Nutrition (DOMEN) Research Group, Federal University of Piauí, Teresina, Brazil.
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
CHU Lille, Univ Lille 2, Inserm U995, LIRIC, Hôpital J de Flandre, Lille, France.
Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
Department of Social Medicine, School of Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Crete, Greece.
Department of Pediatrics, Private Medical University, Salzburg, Austria.
Department of Pediatrics, Medical University of Vienna, Salzburg, Austria.
Department of Public Health, Ghent University, Ghent, Belgium.
University College Ghent Vesalius, Ghent, Belgium.
Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
Inmunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frío, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain.
ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport-INEF, Universidad Politécnica de Madrid, Madrid, Spain.
Institut für Ernährungs- und Lebensmittelwissenschaften - Ernährungphysiologie, Rheinische Friedrich Wilhelms Universität, Bonn, Germany.
CRA-NUT, Food and Nutrition Research Center, Agricultural Research Council Roma, Rome, Italy.
Department of Preventive Medici, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.


Background Adolescents having early puberty (EP) are more likely to have obesity and increased cardiometabolic and inflammatory markers and atherosclerosis risk. We aimed to assess the indirect and mediated effects of leptin and adiposity on the relation between EP and cardiometabolic and inflammatory markers in European adolescents. Methods A sample of 511 adolescents with EP (12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study was studied. To assess whether leptin levels and adiposity mediate the relation between EP and several biomarkers, linear regression models for mediation analyses were performed. Results EP was positively associated with the atherogenic index (Ath-I) (β=0.174; 95%CI 0.029-0.265) and negatively associated with the C-reactive protein (CRP) (β=-0.284; 95%CI -0.542 to -0.028) in girls. These associations were fully mediated by leptin levels (9.5%) and adiposity (44%), respectively. Moreover, EP has indirect effects on the apolipoprotein A-1 (ApoA-1) levels through adiposity in girls (for body mass index [BMI], β=0.014; 95%CI 0.005-0.028, and for waist circumference [WC], β=0.011; 95%CI 0.003-0.024), and on ApoA-1 (β=0.012; 95%CI 0.004-0.025), apolipoprotein B (ApoB) (β=-0.004; 95%CI -0.011 to -0.0004) and CRP (β=-0.265; 95%CI -0.819 to -0.047) through abdominal fat in boys. Conclusions Leptin levels and adiposity seem to play an important indirect and mediation role in the association between EP and cardiometabolic and inflammatory markers in adolescents. Weight control should be recommended in order to control the impaired cardiometabolic and inflammatory status arising in early pubertal adolescents.


adiposity; adolescents; early puberty; indirect effect; leptin; mediation

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