Association between glucolipid metabolic indicators and the risk of suspected precocious puberty in children living with obesity: a retrospective cohort study

Objective To investigate the association between glucolipid metabolic indicators and suspected precocious puberty (PP) in children living with obesity. Methods This retrospective observational study initially included 100 children with obesity (BMI ≥95th percentile) hospitalized between March 2022 and June 2025. Sexual development was assessed by Tanner staging. Children were categorized into suspected PP ( n = 32) and non-PP ( n = 68) groups based on age-specific criteria. After excluding 5 girls in the suspected PP group who had isolated pubic hair without breast development (premature adrenarche), the final analysis included 95 children (suspected PP: n = 27; non-PP: n = 68). Fasting plasma glucose (FPG), fasting insulin (FINS), HOMA-IR, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C, uric acid (UA), sex hormones, and bone age advancement were compared. Spearman correlation and multivariable logistic regression (adjusted for age, sex, and waist-to-height ratio) were performed. Sensitivity analyses were conducted excluding children with basal LH >0.5 IU/L in the control group. Results The suspected PP group had significantly higher FPG, FINS, HOMA-IR, TG, TC, LDL-C, uric acid, sex hormones, and bone age advancement (1.88 ± 0.64 vs. 0.86 ± 0.48 years), and lower HDL-C (all P < 0.05). Correlation analysis showed positive associations between Tanner stage/bone age and all metabolic indicators except HDL-C. Logistic regression identified HOMA-IR (OR = 2.38), TG (OR = 2.07), and uric acid (OR = 1.71) as independent risk factors, and HDL-C (OR = 0.56) as protective (all P < 0.05). Excluding control children with LH > 0.5 IU/L ( n = 5 remaining) showed similar trends but lacked power. Conclusion Suspected precocious puberty in children living with obesity is closely associated with insulin resistance, elevated triglycerides, and hyperuricemia, whereas higher HDL-C is protective. These findings highlight the importance of early metabolic monitoring in this inpatient population, with the caveat that the cohort represents a selected hospitalized sample.