Central precocious puberty and risk of atopic diseases: The mediating role of obesity and sex hormones

BACKGROUND: Atopic diseases, including atopic dermatitis, allergic rhinitis, and asthma, are complex inflammatory conditions with increasing prevalence in children. Central precocious puberty (CPP) has also become increasingly common. The potential role of CPP in atopic diseases remains unclear. Given that both conditions are heritable and affected by hormonal and immune mechanisms, we examined the association between CPP and atopic diseases. METHODS: We analyzed data from the Taiwan Pubertal Longitudinal Study (2018-2021; n = 2317), a multicenter cohort of adolescents aged 6-15 years. Inclusion criteria included confirmed CPP and physician-diagnosed atopic diseases. Sex hormone levels were measured using immunoassays. Logistic regression and structural equation modeling (SEM) were performed to examine associations among CPP, obesity, sex hormones, sleep quality, and atopic diseases. RESULTS: Among children with CPP, obesity was significantly associated with an increased risk of atopic diseases. In sex-stratified analyses, this association was significant only in boys. Testosterone exerted a protective effect against asthma in the overall cohort, particularly in boys, and nonsignificantly in girls. SEM revealed no direct associations between CPP and sex hormones or between sex hormones and atopic diseases. CPP was associated with a higher zBMI and longer sleep duration. Only obesity directly mediated the relationship between CPP and atopic diseases; sleep duration had no direct association with atopic diseases. CONCLUSIONS: CPP is associated with increased atopic disease risk, primarily through obesity. This effect was particularly robust in boys with CPP, while testosterone may confer additional protection against asthma in males. Early metabolic screening and weight management, especially in boys with CPP, may help reduce the future allergic disease burden.