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Pubertal onset with adulthood lung function mediated by height growth in adolescence

Liang Li, Hongmei Zhang, John W. Holloway, A. John Henderson, Susan Ewart, Caroline L. Relton, S. Hasan Arshad, Wilfried Karmaus
ERJ Open Research 2020 6: 00535-2020; DOI: 10.1183/23120541.00535-2020
Liang Li
1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Hongmei Zhang
1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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  • For correspondence: hzhang6@memphis.edu
John W. Holloway
2Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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  • ORCID record for John W. Holloway
A. John Henderson
3Population Health Sciences, University of Bristol, Bristol, UK
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Susan Ewart
4College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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Caroline L. Relton
5MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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S. Hasan Arshad
6Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
7The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
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Wilfried Karmaus
1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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  • ORCID record for Wilfried Karmaus
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    FIGURE 1

    The path diagram with two mediators: height growth and lung function at age 18 years. #: asthma status at age 10 years, height at age 10 years, body mass index at age 10 years, socioeconomic status at age 10 years, birth weight status and maternal smoking during pregnancy; ¶: smoking at age 18 years.

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  • TABLE 1

    Comparison of the analytical subsample (n=888) with the whole Isle of Wight (IOW) cohort (n=1261) with regard to age of onset of pubertal event, lung function and height

    VariablesCohort samplesSubsamplesp-value
    Subjects n1261888
    Age of pubertal events years
     Female
      Breast growth12.43±1.5812.45±1.580.87
      Body hair growth12.25±1.4312.26±1.410.91
      Growth spurt12.52±1.7012.54±1.700.90
      Skin changes13.11±1.5013.06±1.500.55
      Menarche12.72±1.4212.72±1.370.95
     Male
      Body hair growth13.41±1.3713.28±1.340.10
      Growth spurt13.72±1.6713.58±1.640.14
      Voice deepening14.24±1.2414.14±1.210.14
      Facial hair growth15.38±1.1615.28±1.150.11
      Skin changes13.99±1.3813.97±1.360.81
    Lung function age 26 years L
     Female
      FVC4.24±0.544.27±0.540.32
      FEV13.42±0.433.44±0.420.49
     Male
      FVC5.85±0.825.88±0.810.58
      FEV14.61±0.724.63±0.710.67
    Height cm
     Female
      Age 10139.10±6.47139.10±6.400.92
      Age 18164.70±6.33164.80±6.170.78
     Male
      Age 10139.00±5.89139.10±5.840.74
      Age 18178.20±6.87177.90±6.630.42

    Data are presented as mean±sd unless otherwise stated. FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s.

    • TABLE 2

      Statistically significant effects of age of pubertal events onset on lung function at age 26 years through height growth and lung function at age 18 years in females in the Isle of Wight (IOW) cohort, further tested in the replication cohort, Avon Longitudinal Study of Parents and Children (ALSPAC)

      CohortAge of onset of pubertal eventsLung functionTotal effect#Direct effect#Indirect effect#
      Est (95% CI)p-valueEst (95% CI)p-valueEst (95% CI)p-value
      IOWMenarcheFVC0.18 (0.09–0.28)1.71×10−40.05 (−0.03–0.14)0.1980.13 (0.05–0.20)1.28×10−3
      Body hair growthFVC0.14 (0.04–0.23)4.27×10−30.06 (−0.02–0.13)0.1400.08 (0.01–0.15)0.017
      MenarcheFEV10.21 (0.11–0.30)1.88×10−50.12 (0.04–0.20)5.15×10−30.09 (0.01–0.17)0.028
      Body hair growthFEV10.13 (0.03–0.23)8.01×10−30.06 (−0.02–0.13)0.1220.07 (0.01–0.14)0.043
      ALSPACMenarcheFVC0.25 (0.21–0.30)<10−310.05 (0.00–0.10)0.0540.21 (0.17–0.24)<10−31
      Body hair growth¶FVC0.16 (0.12–0.20)5.99×10−140.02 (−0.01–0.06)0.2520.13 (0.11–0.16)<10−31
      MenarcheFEV10.25 (0.21–0.29)<10−310.05 (0.00–0.10)0.0660.20 (0.17–0.24)<10−31
      Body hair growthFEV10.15 (0.11–0.19)1.67×10−120.02 (−0.02–0.06)0.5700.13 (0.11–0.17)<10−31

      For the IOW, only statistically significant results are included in the table. Est: regression coefficient estimate; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s. #: unit for all the regression coefficients is L·year−1 representing expected lung function change for 1-year increase in pubertal age; ¶: age at body hair growth is identified by age at attainment of Tanner stage >2 in ALSPAC cohort. Bold indicates statistically significant p-values.

      • TABLE 3

        Statistically significant effects of age of pubertal events onset on lung function at age 26 years through height growth and lung function at age 18 years in males in the Isle of Wight (IOW) cohort, further tested in the replication cohort, Avon Longitudinal Study of Parents and Children (ALSPAC)

        CohortAge of onset of pubertal eventsLung functionTotal effect#Direct effect#Indirect effect#
        Est (95% CI)p-valueEst (95% CI)p-valueEst (95% CI)p-value
        IOWBody hair growthFVC0.15 (0.04–0.25)5.77×10−30.07 (−0.01–0.15)0.0780.08 (0.01–0.15)0.047
        Growth spurtFVC0.13 (0.02–0.24)0.0170.04 (−0.04–0.12)0.2820.09 (0.01–0.17)0.034
        Facial hair growthFVC0.18 (0.08–0.28)5.35×10−40.09 (0.01–0.16)0.0260.09 (0.02–0.16)0.014
        ALSPACBody hair growth¶FVC0.07 (0.02–0.12)0.0060.03 (−0.02–0.08)0.2190.04 (0.01–0.07)0.003

        For the IOW, only statistically significant results are included in the table. Est: regression coefficient estimate; FVC: forced vital capacity. #: unit for all the regression coefficients is L·year−1 representing expected lung function change for 1-year increase in pubertal age. ¶: in the IOW cohort, mediation effects were observed for FVC only. Thus, in the replication cohort ALSPAC, only FVC was evaluated. The ages of growth spurt and facial hair growth were not available in ALSPAC. Age at body hair growth is identified by age at attainment of Tanner stage >2 in ALSAPC cohort. Bold indicates statistically significant p-values.

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        Pubertal onset with adulthood lung function mediated by height growth in adolescence
        Liang Li, Hongmei Zhang, John W. Holloway, A. John Henderson, Susan Ewart, Caroline L. Relton, S. Hasan Arshad, Wilfried Karmaus
        ERJ Open Research Oct 2020, 6 (4) 00535-2020; DOI: 10.1183/23120541.00535-2020

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        Pubertal onset with adulthood lung function mediated by height growth in adolescence
        Liang Li, Hongmei Zhang, John W. Holloway, A. John Henderson, Susan Ewart, Caroline L. Relton, S. Hasan Arshad, Wilfried Karmaus
        ERJ Open Research Oct 2020, 6 (4) 00535-2020; DOI: 10.1183/23120541.00535-2020
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