IMPORTANCE A secular trend for earlier menarcheal age has been established in girls but there are few studies of pubertal timing for boys. OBJECTIVE To determine if there is a secular trend for earlier pubertal timing among boys. DESIGN, SETTING, AND PARTICIPANTS For this population-based retrospective cohort study conducted in Gothenburg, Sweden, we collected heights and weights from school health records for boys born consecutively from January 1 and onwards in 1947 and every 5 years from 1951 to 1996 (n = 375 for each birth cohort from 1947-1991, n = 340 for the birth cohort in 1996, and n = 4090 for the total cohort). We estimated age at the peak height velocity (PHV), the maximum growth velocity during puberty, and childhood body mass index (BMI) at age 8 years for all study participants. The data were analyzed during 2018 and 2019. Boys were eligible if they had a complete personal identity number and data to calculate their age at PHV and childhood BMI. Approximately 2.4% of the original study population was excluded because they lacked a personal identity number, and in the remaining study population, 4090 (69%) had sufficient data to calculate childhood BMI and age at PHV. EXPOSURES The exposure was birth year and a potential confounding factor was childhood BMI. MAIN OUTCOMES AND MEASURES The outcome was age at PHV. RESULTS Of the 4090 participants, most were white and the mean (SD) age at PHV was 13.9 (1.1) years. A linear regression model revealed a significant association between year of birth and age at PHV. Age at PHV was 1.5 months earlier for every decade increase in birth year (95% CI, −1.72 to −1.19; P < .001). After adjusting for childhood BMI, age at PHV was 1.2 months earlier per decade increase in birth year (95% CI, −1.41 to −0.89). All analyses were repeated in the subgroup of boys born in Sweden and with parents born in Sweden with similar results, indicating that the secular trend was not explained by demographic changes in the population between 1947 and 1996. CONCLUSIONS AND RELEVANCE We provide evidence of a secular trend for earlier pubertal timing in boys that is partially explained by an increased childhood BMI, but other factors that are unknown contribute.

BackgroundAn inverse association between childhood body mass index (BMI; in kg/m2) and pubertal timing is well established for girls. Among boys, studies are scarce and the results inconclusive.ObjectiveWe aimed to determine the association between childhood BMI and age at peak height velocity (PHV) in boys.DesignWe collected height and weight measurements between 6.5 and 22 y of age for boys born 1945–1961 (original cohort; n = 31,971; mean ± SD childhood BMI: 15.74 ± 1.41; age at PHV: 14.06 ± 1.11 y) and 1981–1996 (replication cohort; n = 1465; childhood BMI: 16.47 ± 2.06; age at PHV: 13.71 ± 1.08 y) attending schools in Gothenburg, Sweden, and examined at mandatory military conscription. Age at PHV was obtained from curve-fitting of measured heights with the use of a modified Infancy-Childhood-Puberty model.ResultsIn the original cohort, childhood BMI was inversely associated with age at PHV (P < 0.001) and a significant quadratic term for childhood BMI (P < 0.001) indicated the nonlinearity of this association. Via piecewise linear regression, we identified a threshold for the association at a childhood BMI of 18.42. A significant inverse association was observed below (β: −0.17 y/BMI unit; 95% CI: −0.18, −0.16 y/BMI unit) but not above (β: 0.02 y/BMI unit; 95% CI: −0.03, 0.06 y/BMI unit) this childhood BMI threshold. For every unit increase in childhood BMI, age at PHV was ∼2 mo earlier up to the childhood BMI threshold. Similar results were observed in the replication cohort, demonstrating a significant inverse association below (β: −0.16; 95% CI: −0.21, −0.11) but not above (β: −0.03; 95% CI: −0.11, 0.05) the childhood BMI threshold. The identified threshold was close to the cutoffs for overweight at 8 y of age, and childhood BMI was inversely associated with age at PHV below but not above the overweight cutoffs.ConclusionsThe present findings establish an inverse association between childhood BMI and pubertal timing in normal-weight but not overweight boys.

This long-term study captures both the rise and the recent decline of childhood obesity. As childhood obesity is strongly associated with subsequent adult obesity, we anticipate a similar reduction in adult obesity during the coming decades in Swedish men.

Abstract. Kindblom JM, Bygdell M, Sond en A, C elind J, Rosengren A, Ohlsson C (University of Gothenburg, Gothenburg, Sweden). BMI change during puberty and the risk of heart failure. J Intern Med 2018; 283: 558-567.Aim. Hospitalization for heart failure amongst younger men has increased. The reason for this is unknown but it coincides with the obesity epidemic. The aim of this study was to evaluate the association between childhood BMI (Body Mass Index) and BMI change during puberty for risk of adult heart failure in men.Methods. Using the BMI Epidemiology Study (BEST), a population-based study in Gothenburg, Sweden, we collected information on childhood BMI at age 8 years and BMI change during puberty (BMI at age 20 -BMI at 8) for men born 1945-1961, followed until December 2013 (n = 37 670). BMI was collected from paediatric growth charts and mandatory military conscription tests. Information on heart failure was retrieved from high-quality national registers (342 first hospitalizations for heart failure).Results. BMI change during puberty was independently of childhood BMI associated with risk of heart failure in a nonlinear J-shaped manner. Subjects in the upper quartile of BMI change during puberty (Q4) had more than twofold increased risk of heart failure compared with subjects in Q1 [HR (Hazard Ratio) = 2.29, 95% CI (Confidence Interval) 1.68-3.12]. Childhood BMI was not independently associated with risk of heart failure. Boys developing overweight during puberty (HR 3.14; 95% CI 2.25-4.38) but not boys with childhood overweight that normalized during puberty (HR 1.12, 95% CI 0.63-2.00) had increased risk of heart failure compared with boys without childhood or young adult overweight.Conclusion. BMI change during puberty is a novel risk factor for adult heart failure in men.

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