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. 2019 Oct;43(10):1978-1987.
doi: 10.1038/s41366-019-0446-5. Epub 2019 Aug 28.

Early breast development in overweight girls: does estrogen made by adipose tissue play a role?

Lauren Carlson #  1 , Vanessa Flores Poccia #  1 , Bob Z Sun  1 , Brittany Mosley  1 , Imke Kirste  1 , Annette Rice  1 , Rithi Sridhar  1 , Tairmae Kangarloo  2 , Hubert W Vesper  3 , Lumi Duke  3 , Julianne C Botelho  3 , Armando C Filie  4 , Judy M Adams  2 , Natalie D Shaw  5   6
Affiliations

Early breast development in overweight girls: does estrogen made by adipose tissue play a role?

Lauren Carlson et al. Int J Obes (Lond). 2019 Oct.

Abstract

Background: Girls who are overweight/obese (OB) develop breast tissue but do not undergo menarche (the first menstrual period) significantly earlier than girls of normal weight (NW). It has been proposed that estrogen synthesized by adipose tissue may be contributory, yet OB do not have higher serum estrogen levels than NW matched on breast stage. We hypothesized that estrogen synthesized locally, in mammary fat, may contribute to breast development. This hypothesis would predict that breast development would be more advanced than other estrogen-sensitive tissues as a function of obesity and body fat.

Methods: Eighty premenarchal girls (26 OB, 54 NW), aged 8.2-14.7 years, underwent dual-energy x-ray absorptiometry to calculate percent body fat (%BF), Tanner staging of the breast, breast ultrasound for morphological staging, trans-abdominal pelvic ultrasound, hand x-ray (bone age, BA), a blood test for reproductive hormones, and urine collection to determine the vaginal maturation index (VMI), an index of estrogen exposure in urogenital epithelial cells.

Results: When controlling for breast morphological stage determined by ultrasound, %BF was not associated with serum estrogen or gonadotropin (LH and FSH) levels or with indices of systemic estrogen action (uterine volume, endometrial thickness, BA advancement, and VMI). Tanner breast stage did not correlate with breast morphological stage and led to misclassification of chest fatty tissue as breast tissue in some OB.

Conclusions: These studies do not support the hypothesis that estrogen derived from total body fat or local (mammary) fat contributes to breast development in OB girls.

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Figures

Figure 1
Figure 1
Bruni scale of breast morphological stages during female pubertal development with corresponding breast ultrasound images from representative subjects in the current study. The breast bud diameter is marked by calipers (+---+) in ultrasound images of stages B and C. Adapted and reprinted with permission from “Breast Development in Adolescent Girls” by Bruni et al., Adolescent and Pediatric Gynecology, 3, Fig 1, p.203, Copyright Elsevier 1990 and from “Breast Disorders” by Mann et al. (eds.), Imaging of Gynecological Disorders in Infants and Children, Fig 5, p.229, Copyright Springer 2012.
Figure 2
Figure 2
Uterine volume, endometrial thickness, maximum ovarian volume, and maximum follicle size increased linearly with breast morphological stage maturity. Data is presented as means with standard error bars.
Figure 3
Figure 3
Potential sources of increased estradiol (E2) responsible for earlier breast development in obese/overweight girls compared with normal weight girls. The ovary, once activated by the hypothalamic-pituitary unit, is the primary source of E2 during normal pubertal development. Adipose tissue expresses aromatase (aro) and adipocytes (yellow spheres) in peripubertal girls that reside either in the periphery or near the developing mammary epithelium may also influence systemic or local E2 exposure, respectively. Evidence to date, however, does not support a contribution of estrogen derived from adipose tissue in breast development in overweight/obese and normal weight girls. AD, androstenedione.
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