The Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 7 2509-2518
Copyright © 2000 by The Endocrine Society
Effect of Puberty on the Relationship between Circulating Leptin and Body Composition1
Mary B. HorlickK,
Michael Rosenbaum,
Margery Nicholson,
Lenore S. Levine,
Barbara Fedun,
Jack Wang,
Richard N. Pierson, Jr. and
Rudolph L. Leibel
Department of Pediatrics, Columbia University College of Physicians
and Surgeons (M.B.H., M.R., R.L.L., L.S.L.), New York, New York 10032;
Body Composition Unit, St. Lukes/Roosevelt Hospital Center (J.W.,
B.F., R.N.P.) New York, New York 10019; and Amgen Inc. (M.N.), Thousand
Oaks, California 91320-1789
Address correspondence and requests for reprints to: Michael Rosenbaum, M.D., Division of Molecular Genetics, Russ Berrie Medical Science Pavilion and Naomi Berrie Diabetes Center, 1150 St. Nicholas Avenue, New York, New York 10032. E-mail: mr475{at}columbia.edu
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Abstract
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Circulating concentrations of leptin are better correlated with
absolute amounts of adipose tissue [fat mass (FM)] than with relative
body fatness (body mass index or percent body fat). There is a clear
sexual dimorphism in circulating concentrations of leptin (females
> males) at birth and in adulthood. However, whether such dimorphism
is present in the interval between these periods of development remains
controversial. We examined body composition and clinical (Tanner stage)
and endocrine (pituitary-gonadal axis hormones) aspects of sexual
maturation in relationship to circulating concentrations of leptin in
102 children (53 males and 49 females, 619 yr of age) to evaluate the
relationship between circulating leptin concentrations and body
composition before and during puberty.
Pubertal stage was assigned by physical examination (Tanner staging)
and also assessed by measurement of plasma estradiol, testosterone, and
pituitary gonadotropins. Body composition was determined by dual-energy
x-ray absorptiometry and by anthropometry. Circulating concentrations
of leptin in the postabsorptive state were determined by a solid-phase
sandwich enzyme immunoassay. The effect of gender on the relationship
between circulating leptin concentrations and FM was determined by
ANOVA at each Tanner stage. Stepwise multiple linear regression
analyses, including circulating concentrations of pituitary-gonadal
axis hormones, and FM were performed, by gender, to determine whether
the relationship between circulating concentrations of leptin and FM
changes during puberty.
Plasma leptin concentrations were significantly correlated with FM at
all Tanner stages in males and females. Plasma leptin concentrations,
normalized to FM, were significantly higher in females than males at
Tanner stages IV and V but not at earlier stages of pubertal
development. Plasma leptin concentrations, normalized to FM, were
significantly greater in females at Tanner stage V compared with
females at Tanner stage I and significantly lower in males at Tanner
stage IV and V compared with males at Tanner stage I. These significant
gender and maturational differences were confirmed by demonstrating
that the regression equation relating circulating leptin concentrations
to FM in females and males at Tanner stages IV and V were significantly
different (predicted lower leptin concentrations in males than females
with identical body composition) and that the regression equations
relating circulating concentrations of leptin to FM in each gender
before puberty (Tanner stage I) were significantly different (predicted
higher plasma concentrations of leptin in prepubertal males and lower
leptin concentrations in prepubertal females) than the same regression
equations in later puberty. Circulating concentrations of testosterone
were significant negative correlates of circulating concentrations of
leptin normalized to FM in males when considered as a group over all
pubertal stages. The inclusion in multivariate regression analyses of
circulating concentrations of testosterone and estradiol, FM, fat-free
mass, and gender did not eliminate a significant gender-effect
(P < 0.05) on circulating concentrations of leptin at
Tanner stages IV and V.
The circulating concentration of leptin, normalized to FM, declines
significantly in males and rises significantly in females late in
puberty to produce a late-pubertal/adult sexual dimorphism. These
studies confirm a potent role for gonadal steroids as mediators of this
sexual dimorphism in circulating concentrations of leptin. The
persistence of a significant gender-effect on circulating leptin
concentrations at Tanner stages IV and V, even when the regression
equation includes body composition and circulating concentrations of
gonadal steroids, however, suggests that this sexual dimorphism also
reflects the direct or interactive effects of either other sex-related
metabolic variables (such as insulin, GH, or body fat distribution) or
additional X or Y- chromosome-linked gene effects that produce an
increasing sexual dimorphism of circulating leptin concentrations later
in puberty.
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Introduction
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CIRCULATING CONCENTRATIONS of leptin vary
directly with fat mass (FM) and constitute an afferent limb of a system
regulating body fatness (1, 2, 3). Circulating concentrations
of leptin, normalized to FM, are 23-fold higher in adult
premenopausal females than in males (2, 4, 5, 6, 7) and possibly
slightly greater in premenopausal females than postmenopausal females
(2, 8, 9). This sexual dimorphism in adults may be due, in
part, to effects of gonadal steroids, insulin, GH, catecholamines, body
fat distribution, or other biochemical or primary genetic influences on
circulating concentrations of leptin (2, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25). Several
studies (26, 27, 28, 29) have reported that leptin concentrations
in cord blood are significantly lower in male compared with female
neonates, perhaps reflecting primary genetic effects and/or prenatal
effects of endogenous sex steroids. This sexual dimorphism in
circulating leptin concentrations has generally not been detected
during childhood and early puberty (Tanner stages I and II) but has
been evident in later puberty (Tanner stages IV and or V)
(30, 31, 32, 33, 34, 35). Two studies have reported sexual dimorphism in
circulating concentrations of leptin in pre- and early-pubertal
children (15, 36). Few studies have examined the
relationship between gonadal steroids, absolute FM [as opposed to
relative body fatness as reflected in body mass index (BMI) or
percentage body fat], body fat distribution (skinfold thicknesses),
and circulating leptin concentrations in children throughout
puberty.
We examined body composition by dual-energy x-ray absorptiometry (DEXA)
and anthropometry, pituitary-gonadal axis hormones, and circulating
concentrations of leptin in a cross-sectional study of children at
Tanner stages IV to assess the sex-specific relationship between
leptin and FM at all stages of puberty.
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Subjects and Methods
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Subjects
We recruited 102 subjects (53 males and 49 females; 61 Caucasian
Americans, 18 African Americans, 11 Hispanic Americans, 1 Asian
American, and 11 others) by advertisement. This study was approved by
the Institutional Review Board of St. Lukes/Roosevelt Hospital Center
(New York, NY). Parental consent was obtained from all subjects who
also gave their assent to participate. All subjects were in good health
and taking no chronic medications. Pubertal stage was assigned by
physical examination by a single investigator (MBH), according to the
criteria of Tanner for breast development in females and genital
development in males (37), and also assessed as a
continuous variable using the measurement of serum concentrations of
estradiol, testosterone, and gonadotropins (LH and FSH) (38, 39). No attempt was made to control for stage of menstrual cycle
in postmenarchal females. However, Demerath et al.(15) have reported no significant effects of
variation in stages of the menstrual cycle on circulating
concentrations of leptin in postmenarchal females. All biochemical
tests and measures of body composition were obtained in the
postabsorptive state (in the morning between 0800 and 1000 h
following an overnight fast). Subject characteristics are presented in
Table 1
.
Body composition
Body weight was measured to the nearest 0.1 kg (Weight Tronix,
New York, NY), and height was measured to the nearest millimeter using
a wall-mounted stadiometer (Holtain, Crosswell, Wales). Skinfold
thicknesses (subscapular, chest, thorax, abdominal and suprailiac,
biceps, triceps, thigh, and medial calf) in millimeters were measured
using a Lange skinfold caliper (Lange, Cambridge, MD) on the right side
of the body by two cross-trained observers
(40).
Body composition was determined by DEXA (41) using a Lunar
model DPX with pediatric software 3.8 G (Lunar Co., Madison, WI)
(42). The scanning time varied with subject height. Each
scan provided measurements of fat-free mass (FFM) and FM in kilograms.
The repeat measurements variability in measuring FM in adult subjects
by DEXA in our laboratory is 3.3% (42, 43).
Assays
Postabsorptive plasma leptin concentrations were assayed by a
solid-phase sandwich enzyme immunoassay using an affinity-purified
polyvalent antibody immobilized in microliter wells (Margery
Nicolson, Amgen Inc., Torrance, CA). Bound leptin was detected with
affinity-purified antibody conjugated to horseradish peroxidase and
quantified with a chromogenic substrate (TMB/peroxide). Leptin
concentrations were calculated from standard curves generated for each
assay using recombinant human leptin. Minimal detectable leptin is 20
pg/mL (2). Serum concentrations of testosterone and
estradiol were determined by RIA, and serum concentrations of LH and
FSH were determined by immunochemoluminometric assay (Endocrine
Sciences, Calabasas Hills, CA).
Statistical analyses
Standard multiple stepwise linear regression was used to
facilitate comparisons of our results with other studies that have used
this type of analysis (34). Forward stepwise linear
regression (F to enter = 1.00, F to remove = 0.00) analyses
were used to determine effects of gonadal axis maturation (circulating
concentrations of testosterone and estradiol), total skinfold
thicknesses or body composition (FM and FFM as determined by DEXA), and
gender (defined as a dichotomous variable; male = 1; female =
2) as independent variables on circulating concentrations of leptin
(dependent variable). Subjects who were clinically at Tanner stages II
or III were considered as a single early-pubertal group after it became
apparent that there were no trends toward any differences in the
relationship of body composition to circulating concentrations of
leptin between males or females at Tanner stages II or III (see Fig. 1
). Total skinfold thicknesses were
entered into regression equations containing testosterone, estradiol,
FFM, and gender to test the hypothesis of Roemmich et al.
(34) that gender differences in circulating leptin
concentrations during puberty are accounted for largely by the sc fat
depot, FM, and sex steroids, and that measures of total skinfold
thicknesses are better correlates of leptin than total FM. Between
groups, comparisons were made by one-way ANOVA.

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Figure 1. Mean (SEM) leptin/FM in females (A)
and males (B). *P < 0.05 compared with same-sex
subjects at Tanner stage I; **P < 0.05 compared with
females at the same Tanner stage.
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We have previously noted that regression equations relating circulating
leptin concentrations to body fat content may have non-zero intercepts,
which creates the possibility that the relationship between leptin and
body composition expressed as a ratio could be different between
individuals who are actually on the same regression line (1, 2). The effect of the non-zero intercept on the relationship
between leptin and FM would be accentuated at very low levels of FM
because in the equation leptin/FM = m1 + (b)/(FM)
(where m1 is the slope the line relating leptin to FM and b
is the y-intercept) the impact of b on the ratio of leptin to FM is
clearly increased the lower the FM. The effects of such a non-zero
intercept are demonstrated by the regression equation relating leptin
to FM in Tanner stage V females [leptin (ng/mL) = 2.7(FM (kg)]
- 34.0, r2 = 0.96, P = 0.0005; see
Table 2
). For
a female with a relatively high FM (25 kg), this regression equation
predicts a circulating leptin concentration of 33.5 ng/mL and a leptin
to FM ratio of 1.3 ng/mL·kg. For a female with a relatively low FM
(15 kg), the regression equation predicts a circulating leptin
concentration of leptin of 5.5 ng/mL and a leptin to FM ratio of 0.4
ng/mL·kg. Therefore, even though the relationship between leptin and
FM in both of these hypothetical cases is described by the same
regression equation, if one were to express data only as the ratio of
leptin to FM, one might incorrectly conclude (due to the non-zero
intercept of the regression line) that heavier women had a different
relationship of circulating concentrations of leptin to FM than less
obese women.
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Table 2A. Regression analyses relating circulating leptin
concentrations to body composition, gonadal steroid concentrations, and
gender
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To account for the potential effects of the non-zero intercept of
the regression analysis on the ratio of leptin to FM, the predicted
concentrations of leptin in females at each Tanner stage were
calculated using the regression equation relating plasma leptin and FM
in males at the same Tanner stage. Residual values were then calculated
as "measured minus predicted" and tested against the null
hypothesis that "residual = 0." Similar calculations were made
within each gender using the regression equations at Tanner stage I to
calculate residual values of circulating concentrations of leptin in
the same gender subjects at other pubertal stages. Residual values that
are significantly different from zero indicate that the regression
equations describing the relationship between leptin and FM differ
significantly between the two groups (i.e. males
vs. females or later pubertal stage vs.
prepubertal) and can be used to confirm or disprove conclusions reached
from simply comparing ratios of leptin to FM between the same
groups.
Adjusted cell means of circulating leptin concentrations for all males
and females and for males and females at each Tanner stage were
calculated from an analysis of covariance in which gender was the
grouping variable, leptin was the dependent variable, and FM, FFM,
testosterone, and estradiol were covariates.
All analyses were performed on a Dell Dimension XPS M200 PC using the
Statistica (Statsoft, Tulsa, OK) statistical analysis package, version
5.1 (44). Statistical significance was prospectively
defined as P
< 0.05. Statistically
significant equations, correlation coefficients, and P
values are reported in bold. In multiple stepwise regression
analyses, covariates dropped by the forward stepwise linear regression
analyses are not reported.
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Results
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Subject biochemical, endocrine, and anthropometric characteristics
are presented in Table 1
. Plasma leptin concentrations were
significantly correlated with FM at all Tanner stages in males and
females (Table 2
). The addition of FFM to the regression equations
improved the fraction of variance in circulating concentrations of
leptin accounted for by forward stepwise linear regression analysis at
Tanner stages II and III, IV, and V in males and Tanner stages IV and V
in females (Table 2A
). In multiple linear regression analyses treating
plasma leptin as the dependent variable and FM, gonadal steroid
concentrations, and gender (entered as a dichotomous variable:
male = 1; female = 2) as independent variables, gender was
significantly related to plasma leptin concentrations only at Tanner
stages IV and V (partial r = 0.53, P = 0.006)
(Table 2A
). In all multiple linear regression analyses, which included
subjects at multiple Tanner stages, a greater proportion of the
variance was explained by regressions, including gonadal steroid
concentrations as an index of pubertal development compared with the
same regression using clinical Tanner stage (analyses not shown) as a
covariate instead of gonadal steroids. Furthermore, in forward stepwise
linear regression analyses relating circulating concentrations of
leptin to all variables (FM, FFM, skinfold, testosterone, estradiol,
and gender), skinfold thicknesses were always dropped from the final
equation (i.e. there is no evidence that skinfold
thicknesses have any detectable effect on the variance in circulating
concentrations of leptin once corrected for the other variables; Table 2A
).
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Table 2B. Regression analyses relating circulating leptin
concentrations to body composition and gonadal steroid concentrations
in females and males1
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We detected no sexual dimorphism in circulating concentrations of
leptin prior to Tanner stage IV. Gender remained a significant
covariate of circulating concentration of leptin in pubertal subjects
(Tanner stages IV and V) in multiple regression equations, which
included gonadal steroid concentrations, FFM, and FM (measured as total
FM by DEXA or estimated as sc FM by skinfold thicknesses) (Table 2A
).
We repeated the analysis of Roemmich et al.
(34) and found no significant gender effect on circulating
leptin concentrations corrected for testosterone, estradiol, and total
skinfold thicknesses if children from Tanner stages IIV were
considered as a group (Table 2B
). There was no instance in which a
greater proportion of the variance in the circulating concentration of
leptin was accounted for by using skinfold thicknesses and FFM as
independent variables as compared with FM and FFM (Table 2A
). A
significant sexual dimorphism (females > males) in circulating
concentrations of leptin was still noted using the sum of skinfold
thicknesses (representing sc adipose tissue) as an indicator of FM
(Table 2B
) instead of absolute total adipose tissue mass (Table 2A
). It
is clear (Table 1
) that females at Tanner stages IV and V have
significantly greater sc adipose tissue thickness than males at the
same Tanner stages. To determine whether this sexual dimorphism in
partitioning of fat to sc vs. visceral adipose tissue depots
could account for the sexual dimorphism in circulating leptin
concentrations, a standard stepwise linear regression analysis was
performed in which leptin concentrations at Tanner stages IV and V was
the dependent variable and FM, FFM, skinfold thicknesses, gonadal
steroid concentrations, and gender were the independent variables.
Skinfold thickness was not a significant covariate of the circulating
leptin concentrations in this analysis, but the significant gender
effect remained, indicating that the relatively greater partitioning of
fat in sc vs. visceral adipose tissue in Tanner stage IV and
V females did not account for a significant proportion of the sexual
dimorphism in circulating leptin concentrations.
In regression equations in which adipose tissue mass was the dependent
variable and the sum of skinfold thicknesses and circulating
gonadotropins were independent variables, circulating concentration of
estradiol was a significant covariate of adipose tissue mass in females
(P = 0.01) but not in males. No significant effect of
circulating concentrations of testosterone on this relationship was
noted in either gender (Table 3
).
Circulating concentrations of leptin per kilogram of FM were
significantly greater in Tanner stage V than Tanner stages IIV
females (Fig. 1
). This difference was not due to a non-zero intercept
of the regression equation relating leptin to FM because residual
concentrations of leptin calculated for Tanner stage V females using
the regression equation relating plasma leptin concentration to FM in
Tanner stage I females were significantly greater than zero. In males,
the ratios of circulating concentrations of leptin to FM were
significantly lower at Tanner stages IV and V than at Tanner stages I,
II, or III (Fig. 1
). This difference was not due to a non-zero
intercept of the regression equation relating leptin to FM because
residual concentrations of leptin calculated for Tanner stages IV and V
males using the regression equation relating plasma leptin
concentrations to FM in Tanner stage I males were significantly less
than zero (Table 4
).
The ratios of plasma leptin concentrations to FM were significantly
higher in females than males at Tanner stages IV and V but not at
earlier stages of puberty (Fig. 1
). This difference was not due to a
non-zero intercept of the regression equation relating leptin to FM
because residual concentrations of leptin calculated using the
regression equation relating circulating concentrations of leptin to FM
in males at the same Tanner stage were significantly greater than zero
only at Tanner stages IV and V. In addition, adjusted cell means for
circulating concentrations of leptin were significantly greater in
females than males only at Tanner stages IV and V (Tables 4
and 5
). Similarly, significant negative
residuals of circulating leptin concentrations in males were noted at
Tanner stages IV and V using the regression equation relating
circulating concentrations of leptin to FM in females at the same
Tanner stage (data not shown).
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Table 5. Adjusted cell means for circulating concentrations
of leptin in males and females after correction for FM, FFM, and
circulating concentrations of testosterone and
estradiol1
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In multiple linear regression analyses treating plasma leptin as
the dependent variable and FM, FFM, and circulating concentrations of
gonadal steroids as independent variables [i.e. leptin
= m1(FM) + m2(FFM) +
m3(testosterone) + m4(estradiol) +
b], plasma leptin concentrations were significantly correlated with:
1) circulating concentrations of testosterone in females at Tanner
stage V and in the entire population of males considered as a single
group; 2) circulating concentrations of estradiol in females at Tanner
stage V. (Also noted in linear regression analysis by gender of the
ratio of plasma concentration of leptin to FM with gonadal steroid
concentrations over all Tanner stages as a single group.) The ratio of
leptin to FM was significantly negatively correlated with testosterone
(r2 = 0.24, P < 0.001) but not
estradiol in males and with neither gonadal steroid circulating
concentration in females (Fig. 2
). Serum
concentrations of estradiol were significantly correlated with serum
concentrations of LH (r2 = 0.56, P <
0.0001) and FSH (r2 = 0.25, P =
0.0003) in females. As expected, serum concentrations of testosterone
were significantly correlated with serum concentrations of LH
(r2 = 0.50, P < 0.0001) and FSH
(r2 = 0.26, P < 0.0001) in males
(Table 1
). Despite the significant correlations between serum
concentrations of gonadotropins and testosterone and between serum
testosterone concentrations and ratios of plasma concentrations of
leptin to FM in males, no significant correlation between gonadotropins
and circulating concentrations of leptin normalized to FM were noted
(data not shown).

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Figure 2. Regressions of plasma concentrations of leptin
normalized to FM and circulating concentrations of estradiol in females
[A; leptin/FM = 0.005 (estradiol) + 0.71;
r2 = 0.005, N.S.] and testosterone in males [B;
(leptin)/FM = -0.007 (testosterone) + 0.65;
r2 = 0.22, P = 0.0004].
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Discussion
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The major findings of this study are: 1) there are no
statistically significant gender-based differences in the relationship
between circulating concentrations of leptin and FM in prepubertal and
early pubertal children (i.e. a single regression line
relating circulating leptin concentrations to FM is applicable to males
and females at these stages of sexual development); 2) there are
statistically significant gender-based differences in circulating
concentrations of leptin in late puberty (Tanner stages IV and V).
These differences persist even when circulating leptin concentrations
are adjusted for gender-based differences in testosterone, estradiol,
and body composition (total FM and FFM by DEXA and sc fat by skinfold
thicknesses); 3) the sexual dimorphism in the circulating
concentrations of leptin, which is evident at Tanner stages IV and V,
is due to both significant decreases of circulating leptin
concentrations in males and to increases in circulating leptin
concentrations in females; and 4) in multiple linear regression
analyses containing FM, FFM, and circulating concentrations of gonadal
steroids, of subjects over all Tanner stages, there is a significant
negative correlation between circulating concentrations of testosterone
and leptin in males, but not females.
The observation that there is a significant sexual dimorphism in
circulating leptin concentrations at Tanner stage IV (prior to a
significant increase in circulating leptin concentrations per unit of
FM in females, but at the same time that there is a significant
decrease in this measure in males) suggests that the higher
concentrations of leptin normalized to FM observed in female adults
(2, 4, 5, 6, 7) are due both to suppression of leptin messenger
RNA expression and leptin secretion by androgens in males and to
estrogen-mediated augmentation of leptin secretion in females.
Androgen-mediated leptin suppression of leptin secretion occurs in
males at Tanner stage IV. Later in puberty (Tanner stage V, after
androgen-induced suppression of leptin in males has already become
evident), estrogen-mediated augmentation of circulating concentrations
of leptin in late pubertal females further augments the sexual
dimorphism in circulating leptin concentrations. Ahmed et al.(45) reported that girls continued to show increases
in their serum leptin concentrations with age even beyond Tanner stage
V and also suggest that estrogen augments serum leptin levels.
Some studies have reported that the same degree of sexual dimorphism in
circulating leptin concentrations is present in neonates (27, 46, 47), whereas others have noted no gender effects on circulating
concentrations of leptin in neonates (48, 49). In cord
blood, Matsuda et al. (27) reported no
significant differences between male and female neonatal concentrations
of testosterone and estradiol, but noted approximately 2-fold higher
leptin concentrations in females. However, Ertl et al.
(50) reported that circulating concentrations of leptin in
males and females at birth were negatively correlated with neonatal
testosterone concentrations. The observed sexual dimorphism of leptin
concentrations in cord blood may reflect the effects of either primary
genetic determinants or the prenatal sexual dimorphisms in androgen
concentrations (male > female), which begin in the second
trimester of gestation (38, 39). Helland et al.
(51) reported that women carrying female fetuses have
higher circulating concentrations of leptin than women carrying male
fetuses. Tome et al. (47) noted that neonatal
cord leptin concentrations were also affected by placental weight and
that both placental weight and circulating leptin concentrations were
higher in female neonates. Because it is not possible to distinguish
the origins of neonatal leptin (maternal, placental, or fetal), it is
also possible that any neonatal sex differences in circulating leptin
concentrations are due to different maternal or placental production
rates (52, 53).
A sexual dimorphism in the effects of puberty on circulating
concentrations of leptin was also found by Carlsson et al.
(33), who noted that circulating concentrations of leptin,
not corrected for FM, rose during puberty in females but not in males,
and by Blum et al. (32), who reported that
circulating concentrations of leptin normalized to BMI rose
significantly to a maximum at Tanner stage V in girls and declined to a
minimum at Tanner stage V in boys.
In the present study, and contrary to the data of Roemmich et
al. (34), gender remained a significant covariate of
circulating concentrations of leptin in pubertal males and females even
when adjusted for FM, skinfold thicknesses, and gonadal steroid
concentrations (Table 2B
). Roemmich et al. (34)
looked for significant gender effects on circulating concentrations of
leptin corrected for skinfold thicknesses and gonadal steroid
concentrations in prepubertal subjects vs. subjects at
Tanner stages IIV. Our data indicate that the inclusion of subjects
in early puberty (Tanner stages II and III), as in the analysis by
Roemmich et al. (34) masks a significant,
unexplained sexual dimorphism that is not evident until later
puberty.
Argente et al. (36) found that circulating
concentrations of leptin, not corrected for FM, rose in males and
females from Tanner stages IIII but fell significantly in males at
Tanner stages IV and V while continuing to rise in females, so that a
significant sexual dimorphism in circulating leptin concentrations
(females > males) was achieved at Tanner stage V. In a
longitudinal study of eight males, Mantzoros et al.
(54) also noted an early pubertal rise in circulating
leptin, followed by a decline. Similarly, Lahlou et al.
(55) reported that sexual dimorphism in circulating
concentrations of leptin (both at usual weight and during active weight
gain) was not evident until later puberty. Wabitsch et al.
(56) reported an inverse relationship between circulating
concentrations of testosterone and the ratio of leptin to BMI in boys,
but not girls. The same group also reported that incubation of primary
adipocytes with testosterone or dihydrotestosterone was associated with
significant declines in rates of leptin messenger RNA expression and
leptin peptide release (56). In contrast, Arslanian
et al. (57) found no differences in the
relationship of circulating concentrations of leptin to FM between
males and females (prepubertal and pubertal). This apparent discrepancy
with our findings may be due to the fact that Arsalanian et
al. (57) neither included Tanner stage V subjects in
their study population nor analyzed their "late" pubertal (Tanner
stage IV) subjects as a separate group from earlier pubertal
stages.
The presence of sexual dimorphism in circulating leptin concentrations
in prepubertal children (which was not noted in the present study)
would support the view that there is a primary gender difference in
leptin physiology, not accounted for by circulating gonadal steroid
concentrations. In contrast to the present study, Ellis and Nicolson
(58) reported that the ratios of circulating concentration
of leptin to FM were significantly greater in females than males at
Tanner stages I, III, IV, and V. However, the Tanner stage I males in
the study by Ellis et al. (58) had an
approximately 40% lower FM than Tanner stage I females. As discussed
previously, regression lines relating circulating leptin concentrations
to FM have non-zero intercepts (Table 2
). Application of the regression
equation relating circulating concentrations of leptin to FM for all
Tanner stage I subjects in our study [leptin = 1.16 - 3.7
FM (kg), r2 = 0.71, P < 0.0001] to
the data of Ellis et al. (58) illuminates this
problem. Ellis et al. (58) report mean FMs in
Tanner stage I males (4.7 kg) and in Tanner stage I females (6.5 kg).
Predicted circulating concentrations of leptin for these FMs based on
our Tanner stage I regression equation would be 1.7 ng/mL in males and
3.8 ng/mL in females. Assuming that these were the measured values, the
ratio of leptin to FM would be approximately 0.36 ng/mL·kg in males
and 0.58 ng/mL·kg in females. Assuming that males and females fall on
the same regression line relating plasma leptin concentrations to FM,
the predicted female to male ratio in concentrations of leptin per unit
of FM is 1.5 at these low FMs. This is similar to the ratio of 1.6
reported by Ellis et al. (58). Thus, the
seemingly significant gender difference in the ratio of circulating
concentrations of leptin to FM in early puberty reported by Ellis
et al. (58) may be an artifact of the non-zero
intercept of the regression line relating leptin to FM.
Demerath et al. (15) reported a significant
sexual dimorphism in circulating leptin concentrations adjusted for
total body fat (females > males) in prepubertal children, which
increased further during puberty and postpuberty. Unlike the study by
Ellis et al. (58), mean total body fat in
prepubertal males was approximately 40% higher in males (8.2 ± 3.7
kg) than in females (5.9 ± 2.2 kg). Application of our prepubertal
regression equations relating leptin to FM in the population reported
by Demerath et al. (15) does not, therefore,
suggest any artifact influencing the prepubertal sexual dimorphism in
circulating leptin concentrations. The detection of this sexual
dimorphism in prepubertal children by Demerath et al.
(15) may be due to the larger sample of Tanner stage I
males and females in that study: 29 males and 27 females vs.
13 males and 15 females in the present study. The observation of a
significant sexual dimorphism in circulating leptin concentrations
before puberty supports the data in the present study, which suggest
that factors other than gonadal steroids may account for some of the
gender difference in circulating leptin.
Leptin secretion is pulsatile, and pulse frequencies and amplitudes at
each pubertal stage were not measured in this study. However,
ultraradian periodicities in leptin secretion detected by Fourier
analysis are similar in adult men and women (59), and the
major gender-related differences in leptin secretion in adults seem to
be due to pulse amplitude rather than frequency (60). Most
studies of the sexual dimorphisms in circulating leptin concentrations
have focused on postabsorptive concentrations. However, it is possible
that that puberty influences pulse frequency as well as amplitude.
Alterations in either of these parameters, as well as possible changes
in leptin-clearance rates (i.e., gender-effects similar to
those seen in the metabolism of growth hormone) (61),
could also play a role in observed sexual dimorphism in circulating
leptin concentrations.
After adjustment for effects of circulating gonadal steroid
concentrations, sc fat content, and body composition, circulating
concentrations of leptin were still significantly higher in late
pubertal females than males (Table 5
). This difference suggests that
factors besides gonadal steroids, fat distribution (sc vs.
visceral), and body composition cause the sexual dimorphism in
circulating leptin concentrations that is apparent in late puberty.
Candidates for these "factors" include a primary effect of genes on
the X or Y chromosomes or other metabolic or hormonal variables
affecting circulating leptin concentrations that were not quantified in
this study (e.g. insulin, GHs, glucocorticoids, or
catecholamines) (24). Knowledge of these factors, and the
mechanisms by which they act, may enable the therapeutic manipulation
of endogenous leptin production.
 |
Footnotes
|
|---|
1 Supported in part by NIH Grants DK-37352 and DK-30583. 
Received December 20, 1999.
Revised March 21, 2000.
Accepted March 21, 2000.
 |
References
|
|---|
-
Rosenbaum M, Nicolson M, Hirsch J, Murphy E, Chu F,
Leibel R. 1997 Effects of weight change on plasma leptin
concentrations and energy expenditure. J Clin Endocrinol Metab. 82:36473654.[Abstract/Free Full Text]
-
Rosenbaum M, Nicolson M, Hirsch J, et al. 1996 Effects of gender, body composition, and menopause on plasma
concentrations of leptin. J Clin Endocrinol Metab. 81:34243427.[Abstract]
-
Leibel R. 1997 And finally, genes for human
obesity. Nat Genet. 16:218220.[CrossRef][Medline]
-
Hickey M, Israel R, Gardiner S, et al. 1996 Gender
differences in serum leptin levels in humans. Biochem Mol Med. 59:16.[CrossRef][Medline]
-
Hickey M, Houmard J, Considine R, et al. 1997 Gender-dependent effects of exercise training on serum leptin levels in
humans. Am J Physiol. 272:E562E566.
-
Kennedy A, Gettys T, Watson P, et al. 1997 The
metabolic significance of leptin in humans: gender-based differences in
relationship to adiposity, insulin-sensitivity, and energy expenditure. J Clin Endocrinol Metab. 82:12931300.[Abstract/Free Full Text]
-
Saad M, Damani S, Gingerich R, et al. 1997 Sexual
dimorphism in plasma leptin concentration. J Clin Endocrinol
Metab. 82:579584.[Abstract/Free Full Text]
-
Sumner A, Falkner B, Kushner H, Considine R. 1998
Relationship of leptin concentration to gender, menopause, age,
diabetes, and fat mass in African Americans. Obes Res. 6:128133.
-
Shimizu H, Shimomura Y, Nakanishi Y, et al. 1997 Estrogen increases in vivo leptin production in rats and
human subjects. J Endocrinol. 154:285292.[Abstract/Free Full Text]
-
Behre H, Simoni M, Nieschlag E. 1997 Strong
associations between serum levels of leptin and testosterone in men. Clin Endocrinol. 37:237240.
-
Bjarnason R, Bogaszewski M, Dahlgren J, et al. 1997 Leptin levels are strongly correlated with those of GH-binding protein
in prepubertal children. Eur J Endocrinol. 137:6873.[Abstract]
-
Brabant G, Horn R, Mayr B, Mahlen Avz, Honegger
J, Buchfelder M. 1996 Serum leptin levels following hypothalamic
surgery. Horm Metab Res. 28:728731.[Medline]
-
Carro E, Senaris R, Considine R, Casanueva F, Dieguez
C. 1997 Regulation of in vivo growth hormone secretion
by leptin. Endocrinology. 138:22032206.[Abstract/Free Full Text]
-
Casebielli X, Pineiro V, Peino R, et al. 1998 Gender differences in both spontaneous and stimulated leptin secretion
by human omental adipose tissue in vitro: dexamethasone and
estradiol stimulated leptin release in women, but not men. J Clin
Endocrinol Metab. 83:21492155.[Abstract/Free Full Text]
-
Demerath E, Towne B, Wisemandle W, Blangero J, Chumlea
W, Stervogel R. 1999 Serum leptin concentration, body composition,
and gonadal hormones during puberty. Int J Obes. 23:678685.
-
Donahoo W, Jensen D, Yost T, Eckel R. 1997 Isoproterenol and somatostatin decrease plasma leptin in humans: a
novel mechanism regulating leptin secretion. J Clin Endocrinol
Metab. 82:41394143.[Abstract/Free Full Text]
-
Fisker S, Vahl N, Hansen T, et al. 1997 Serum
leptin is increased in growth hormone-deficient adults: relationship to
body composition and affects of placebo-controlled growth hormone
therapy for 1 year. Metabolism. 46:812817.[CrossRef][Medline]
-
Harmelen VV, Reynisdottir S, Eriksson P, et al. 1998 Leptin secretion from subcutaneous and visceral adipose tissue in
women. Diabetes. 47:913917.[Abstract]
-
Havel P, Kasimirakas S, Mueller W, Johnson P, Gingerich
R, Stern J. 1996 Relationship of plasma leptin to plasma insulin
and adiposity in normal weight and overweight womeneffects of dietary
fat content and sustained weight loss. J Clin Endocrinol Metab. 81:44064413.[Abstract]
-
Haynes W, Sivitz W, Morgan D, Walsh S, Mark A. 1997 Sympathetic and cardiorenal actions of leptin. Hypertension. 30:619623.[Abstract/Free Full Text]
-
Kolaczynski J, Nyce M, Considine R, et al. 1996 Acute and chronic effects of insulin on leptin production in humans:
studies in vitro and in vivo. Diabetes. 45:699701.[Abstract]
-
Li H, Matheny M, Scarpace P. 1997 ß
3-Adrenergic-mediated suppression of leptin gene expression in rats.
Am J Physiol. 272:E1031E1036.
-
Montague C, Prins J, Sanders L, Digby J, ORahilly
S. 1997 Depot- and sex-specific differences in human leptin mRNA
expression: implications for the control of regional fat distribution. Diabetes. 46:342347.[Abstract]
-
Rosenbaum M, Leibel R. 1998 Leptin: a molecule
integrating somatic energy stores, energy expenditure, and fertility. Trends Endocrinol Metab. 9:117123.
-
Rosenbaum M, Leibel R. 1999 Role of gonadal
steroids in the sexual dimorphisms in body composition and circulating
concentrations of leptin. J Clin Endocrinol Metab. 84:17841789.[Free Full Text]
-
Jaquet D, Leger L, Levy-Marchal C, Oury J, Czernichow
P. 1998 Ontogeny of leptin in human fetuses and newborns: effect
of intrauterine growth retardation on serum leptin concentrations. J Clin Endocrinol Metab. 83:12431246.[Abstract/Free Full Text]
-
Matsuda J, Yokota I, Iida M, et al. 1997 Serum
leptin concentrations in cord blood: relationship to birth weight and
gender. J Clin Endocrinol Metab. 82:16421644.[Abstract/Free Full Text]
-
Tome M, Lage M, Camina J, Garcia-Mayor R, Dieguez C,
Casanueva F. 1997 Sex-based differences in serum leptin
concentrations from umbilical cord blood at delivery. Eur J Endocrinol. 137:655658.[Abstract]
-
Ertl T, Funke S, Sarkany I, et al. 1999 Postnatal
changes of leptin levels in full-term and preterm neonates: their
relation to intrauterine growth, gender, and testosterone. Biol
Neonate. 75:167176.[CrossRef][Medline]
-
Nagy T, Bower G, Trowbridge C, Dezenberg C, Shewchuk R,
Goran M. 1997 Effects of gender, ethnicity, body composition, and
fat distribution on serum leptin levels in children. J Clin
Endocrinol Metab. 82:21482152.[Abstract/Free Full Text]
-
Clayton P, Gill M, Hall C, Tillman V, Whatmore A, Price
D. 1997 Serum leptin through childhood and adolescence. Clin
Endocrinol. 46:737733.
-
Blum W, Englaro P, Hanitsch S, et al. 1997 Plasma leptin levels in healthy children and adolescents: dependence on
body mass index, body fat mass, gender, pubertal stage, and
testosterone. J Clin Endocrinol Metab. 82:29042910.[Abstract/Free Full Text]
-
Carlsson B, Ankarberg C, Rosberg S, Norjavaara E,
Albertsson-Wikland K, Carlsson L. 1997 Serum leptin concentrations
in relation to pubertal development. Arch Dis Child. 77:396400.[Abstract/Free Full Text]
-
Roemmich J, Clark P, Berr S, et al. 1998 Gender
differences in leptin levels during puberty are related to the
subcutaneous fat depot and sex steroids. Am J Physiol.
275:E543E551.
-
Garcia-Mayor R, Andrade M, Rios M, Lage M, Dieguez C,
Casanueva F. 1997 Serum leptin levels in normal children:
relationship to age, gender, body mass index, pituitary-gonadal
hormones, and pubertal stage. J Clin Endocrinol Metab. 82:28492855.[Abstract/Free Full Text]
-
Argente J, Barrios V, Chowen J, Sinha M, Considine
R. 1997 Leptin levels in healthy Spanish children and adolescents,
children with obesity, and adolescents with anorexia nervosa and
bulimia nervosa. J Pediatr. 131:833838.[CrossRef][Medline]
-
Tanner J. 1962 Growth and adolescence. Oxford:
Blackwell, Inc.
-
Speroff L. 1981 The ovary. In: Felig P, Baxter J,
Broadus A, Frohman L, eds. Endocrinology and metabolism. New York:
McGraw Hill; 669724.
-
Troen P, Oshima H. 1981 The testis. In: Felig P,
Baxter J, Broadus A, Frohman L, eds. Endocrinology and metabolism. New
York: McGraw Hill; 627668.
-
Steinkamp RC, Cohen NL, Siri WE, Sargent TW, Walsh
HE. 1965 Measures of body fat and related factors in normal
adults. J Chron Dis. 18:12791289.[CrossRef][Medline]
-
Mazess R, Barden H, Bisek J, Hanson J. 1990 Dual-energy x-ray absorptiometry for total-body and regional
bone-mineral and soft-tissue composition. Am J Clin Nutr. 51:11061112.[Abstract/Free Full Text]
-
Ellis K, Shypailo R, Pratt J, Pone W. 1994 Accuracy
of dual-energy x-ray absorptiometry for body-composition measurement in
children. Am J Clin Nutr. 60:660665.[Abstract/Free Full Text]
-
Russel-Aulet M, Wang J, Thornton J, Pierson Jr
RN. 1991 Comparison of dual-photon absorptiometry systems
for total-body bone and soft tissue measurements: dual-energy x-rays
versus gadolinium 153. J Bone Min Res. 6:411.[Medline]
-
Statsoft. 1997 Statistica, release 5, 1997 edition.
Tulsa, OK: Statsoft.
-
Ahmed M, Ong K, Morrell D, et al. 1999 Longitudinal
study of leptin concentrations during puberty: sex differences and
relationship to changes in body composition. J Clin Endocrinol
Metab. 84:899905.[Abstract/Free Full Text]
-
Gomez L, Carrascosa A, Yeste D, et al. 1999 Leptin
values in placental cord blood of human newborns with normal
intrauterine growth after 3042 weeks of gestation. Horm Res. 51:1014.[CrossRef][Medline]
-
Tome M, Lage M, Camina J, Garcia-Mayor R, Dieguez C,
Casanueva F. 1997 Sex-based differences in serum leptin
concentrations from umbilical cord blood at delivery. Eur J Endocrinol. 137:655658.
-
Hytinantti T, Koistinen H, Koivisto V, Karonen S,
Andersson S. 1999 Changes in leptin concentration during the early
postnatal period: adjustment to extrauterine life. Pediatr Res. 45:197201.[Medline]
-
Shekawat P, Garland J, Shivpuri C, et al. 1998 Neonatal cord blood leptin: its relationship to birth weight, body mass
index, maternal diabetes, and steroids. Pediatr Res. 43:338343.[Medline]
-
Ertl T, Funke S, Sarkany I, et al. 1999 Postnatal
changes of leptin levels in full-term and pre-term neonates: their
relationship to intrauterine growth, gender and testosterone. Biol
Neonate. 75:167176.
-
Helland I, Reseland J, Saugstad O, Drevon C. 1998 Leptin levels in pregnant women and newborn fetuses: gender differences
and reduction during the neonatal period. Pediatrics. 101:E12.
-
Masuzaki H, Ogawa Y, Sagawa N, et al. 1997 Nonadipose tissue production of leptinleptin as a novel
placenta-derived hormone in humans. Nat Med. 3:10291033.[CrossRef][Medline]
-
Hassink S, Delancey E, Sheslow D, et al. 1997 Placental leptinan important new growth factor in intrauterine and
fetal development. Pediatrics. 100:1116.
-
Mantzoros CS, Flier JS, Rogol D. 1997 A
longitudinal assessment of hormonal and physical alterations during
normal puberty in boys. V. Rising leptin levels may signal the onset of
puberty. J Clin Endocrinol Metab. 82:10661070.[Abstract/Free Full Text]
-
Lahlou N, Landais P, Boissieu DD, Bougneres P. 1997 Circulating leptin in normal children and during the dynamic phase of
juvenile obesity: relation to body fatness, energy metabolism, caloric
intake, and sexual dimorphism. Diabetes. 35:989993.
-
Wabitsch M, Blum W, Muche R, et al. 1997 Contribution of androgens to the gender difference in leptin production
in obese children and adolescents. J Clin Invest. 100:808813.[Medline]
-
Arslanian S, Suprasongsin C, Kalhan S, Drash A, Brna R,
Janosky J. 1998 Plasma leptin in children: relationship to
puberty, gender, body composition, insulin sensitivity, and energy
expenditure. Metabolism. 47:309312.[CrossRef][Medline]
-
Ellis K, Nicolson M. 1997 Leptin levels and body
fatness in children: effects of gender, ethnicity, and sexual
development. Pediatr Res. 42:484448.[Medline]
-
Licinio J, Negrao A, Mantzoros C, et al. 1998 Sex
differences in circulating human leptin pulse amplitude: clinical
implications. J Clin Endocrinol Metab. 83:41404147.[Abstract/Free Full Text]
-
Saad M, Riad-Gabriel M, Khan A, et al. 1998 Diurnal
and ultradian rhythmicity of plasma leptin: effects of gender and
adiposity. J Clin Endocrinol Metab. 83:453459.[Abstract/Free Full Text]
-
Rosenbaum M, Gertner J. 1989 Metabolic clearance
rates of synthetic human growth hormone in children, adult women and
adult men. J Clin Endocrinol Metab. 69:820824.[Medline]
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