Implicating factors in the increase in cases of central precocious puberty (CPP) during the COVID-19 pandemic: Experience of a tertiary centre of pediatric endocrinology and review of the literature.

Sexual development is a complex mechanism activated by the hypothalamic-pituitary-gonadal axis. Over the last one hundred years there has been a decline in the age at puberty onset in industrialised countries. Some Italian studies showed an increase in diagnoses of Central Precocious Puberty (CPP) during the COVID-19 pandemic. It is thus supposed that in this period there was an increased impact of factors that can influence pubertal development. Our retrospective monocentric study aimed to confirm the existence of this phenomenon and analysed possible related factors. We retrospectively evaluated clinical, laboratory, radiological and ultrasound (US) data of 154 girls referred to our Tertiary Centre of Paediatric Endocrinology from January 2019 to April 2021 for different forms of Precocious Puberty. We subdivided the cases into subgroups according to the final diagnosis: CPP, Early Puberty (EP), isolated thelarche and isolated pubarche. The observation period was subdivided into: Period 1, before lockdown (1 January 2019 - 8 March 2020) and Period 2, lockdown and the following months (9 March 2020 - 30 April 2021). Period 2 was further divided into "restrictive lockdown period" (Period 2.1) (March 2020 - 14 June 2020, in which the schools were closed) and "less restrictive lockdown period" (Period 2.2) (15 June 2020 - 30 April 2021). We analysed data regarding the use of electronic devices before and during lockdown in a group of girls with CPP diagnosed in Period 2 and we compared the data with that of a control group. Our data show an increase in the number of new diagnoses of CPP during lockdown and in the following months, compared with the previous period. We also detected a higher use of PCs and smartphones in girls with CPP diagnosed in Period 2, compared with the control group. The percentage of the presence of endometrial rhyme detected during the pelvic ultrasound was higher in girls with CPP in Period 2, compared with the previous period. Based on our data we assume there was an environmental effect on pubertal timing that calls our attention to factors such as food, use of electronic devices and stress. We will need further studies to better understand this data.

COVID-19: How the pandemic has increased food insecurity and altered the Italian families’ diet

Background - The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic and subsequent containment measures are causing a worldwide increase in food insecurity (FI). Food insecurity has been related to a number of negative health implications, particularly for the most vulnerable population, including children and adolescents. Aim - To investigate the effects on FI during the lockdown in Italy and the changes in eating habits and body weight in the paediatric population 6 months after the beginning of the pandemic. Materials and Methods - An online anonymous cross-sectional survey was elaborated and proposed to the parents of children < 18 years old. Results - 8.3% reported that their families were at risk of FI before the outbreak of SARSCoV-2 pandemic. This percentage dramatically doubled after the pandemic began. Moreover, 27.3% of the parents reported that their children were eating more, with a concomitant increase in “junk food” consumption. About one third of respondents declared an increase in children’s weight, while weight loss were uncommon and prevailed among adolescents. It was observed that parents’ higher age, higher parents’ school grade and working parents were protective factors against FI. Conclusion - Since the SARS-CoV-2 pandemic is requiring restrictions again, it is crucial that health care and social protection programmes take into account concepts of equity and sustainability to ensure adequate food and nutrition security for everyone.