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Advanced Food Safety Management Quiz
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Introduction to Advanced Food Safety and Sanitation - Starter QuizPROFICIENCY FOOD+ ENVIRONMENT ADVANCED1. Paleolithic: relating to the earliest period of the Stone Age 2. Nomads: people who move from place to place as a group to find food 3. Method: a way of doing something; a procedure or process 4. Technology: the use of advanced methods to solve problems; an ability gained by the practical use of knowledge 5. Available: ready to be used 6. Constructed: to build by putting parts together; to build; to create 7. Communicated: to share information with someone; to exchange knowledge or information 8. Constantly: always happening 9. Ice Age: a time when glaciers covered much of the land. Sports center manager / Leisure manager They conduct daily activities at sports complexes and recreational facilities with gyms, pools, and activity rooms. Individuals need a bachelor's degree in leisure and recreation, facility management, or hospitality. 3. Food truck manager They oversee the daily operations of food trucks at tourist attractions and unique event venues. They may be responsible for coordinating work schedules, obtaining food service licenses in different areas, and ordering food inventory as needed. Food truck managers need a minimum of a high school diploma but can also benefit from previous work experience. 4. Pastry chef They specialize in making various pastries and other desserts for bakeries, restaurants, and patisseries. They work closely with other kitchen staff and chefs to create dough mixtures, develop new recipes, decorate dessert items, and monitor the baking process to ensure a finished product. To become a pastry chef, individuals can either earn a high school diploma and develop their skills or attend a pastry arts program and earn an associate degree or bachelorâs degree. 5. Airport manager / Aviation manager They ensure efficient operations at an airport while ensuring that all airlines follow FAA (Federal Aviation Administration) guidelines. They hire and train airport personnel and monitor activities relating to They usually have a few years of work experience in a role at an airport, along with a bachelor's degree in airport management 6 security, customer service, and customer amenities, including onsite restaurants. and operations or aviation management. A professional certification can also be beneficial. 6. Spa manager They lead daily operations at spa facilities. Their duties include hiring and training spa employees and maintaining an up-to-date inventory of cosmetic products, sheets, towels, robes, and other items for skin treatments. Spa managers may also promote their spa by hiring freelance marketers or organizing advertisements for digital or print platforms. They also administer advanced therapies like facials and massages to customers. The education requirements include earning an associate's or bachelor's degree in hospitality or business management. Prospective spa managers also need a few years of work experience at a spa business. 7. Hotel assistant general manager They support the job duties of the hotel's general manager. They help the available manager interview job candidates, make hiring decisions, and coordinate training efforts for staff. Hotel assistant general managers may also cover shifts for general managers and act as temporary general managers when the manager is sick or on vacation. Individuals need a high school diploma and a few years of hotel experience. They may also benefit from earning an associate's degree or bachelor's degree in hospitality and tourism. 8. Tour manager They oversee tour bookers, tour guides, tour bus drivers, and marketing staff for a tour company. They schedule work shifts for tour guides, develop marketing Individuals can become tour managers by earning a high school diploma and working for a tour 7 strategies to increase tour bookings, and read tourist reviews to determine how they can improve their overall experience. They may also accompany clients when they travel and attend to their needs. company for a few years. They can also earn a bachelor's degree or master's degree in an area like hospitality and tourism management. 9. Cafe manager They oversee the daily operations of cafes in shopping centers, hotels, and other areas. They hire and train cafe staff, adjust coffee and bakery selections, handle complex customer questions, and ensure the cleanliness of their facilities. Cafe managers also create work schedules to provide enough staff during peak business hours. To become a cafe manager, individuals need a minimum of a high school diploma and previous experience working in a cafe as a barista or supervisor. 10. Activity manager They work for hotels and resorts, travel companies, and cruise liners to oversee guest activities and ensure guests have a pleasant experience. This may include planning guests' itineraries, offering guests tours of the local area, and developing fun activities within their facilities. Activity managers typically have bachelor's degrees in hospitality and tourism, event planning, or recreation. 11. Hotel sales coordinator They work for hotels and help create and manage their marketing and customer service strategies. They also work with a team of sales coordinators and hotel managers to research ways to increase bookings and retain customers. They may To become a hotel sales coordinator, individuals need a bachelor's degree in sales, marketing, hospitality, and tourism. 8 design special offers, create branding and promotional strategies, and follow up with guests after they check out. 12. Resort manager They oversee the daily activities at resort facilities. They typically monitor the resort's housekeeping activities, finances, and marketing materials. They manage different departments to assist with general maintenance and ensure a high guest satisfaction rate. To become a resort manager, individuals need experience working in the resort industry, either a bachelor's degree or master's degree in hotel management or hospitality and tourism. 13. Travel agent They work for travel agencies or as self-employed individuals to help clients book transport and hotel accommodations. Their duties may also involve creating a trip itinerary for their clients and helping them reschedule canceled flights or transfer accommodations. Prospective travel agents need a high school diploma and an interest in travel. They may also benefit from earning an associate's or bachelor's degree in hospitality and tourism management or applying for a professional travel agent certification. Travel agents often start as employees and become managers as their careers progress. 9 14. Catering manager They oversee a kitchen and server staff team for a catering company or event venue. They hire and train catering staff and work with one or more chefs to create an effective catering menu. They also design schedules for staff members, depending on the time required to set up and prepare food before an event. To become a catering manager, individuals can benefit from earning either an associate degree or a bachelor's degree in an area like hospitality or food service. 15. Entertainment manager They collaborate with resorts, cruise liners, hotels, and other accommodations to book singers, musicians, dance groups, comedians, and other entertainers to perform for guests. Their duties include holding auditions for potential talent, scheduling bookings, and negotiating with clients to determine price points. They oversee many aspects of events, including their production and financing. To become an entertainment manager, individuals can attend a four-year bachelor's degree program in hospitality, tourism management, event planning, or events and entertainment. 16. Guest services manager They assist hotel guests with their needs from when they check in to when they check out. They provide guests with room keys, organize baggage assistance, and delegate tasks to other staff like housekeepers, front desk employees, or room service personnel. They're also responsible for hiring and training the guest services staff. This position typically requires a minimum of a high school diploma and a few years of guest service experience. 10 17. Director of Housekeeping They work for a hotel, cruise line, or resort and manage its housekeeping staff. They maintain clean facilities for all guests by hiring and training housekeeping staff and monitoring inventory, including cleaning supplies, towels, bedsheets, and guest amenities. Housekeeping directors can benefit from earning a bachelor's degree in hospitality management and gaining several years of experience in the cleaning service industry. 18. Park manager They work at public and amusement parks and help develop marketing and promotional strategies to increase visitors. They may work with facilities managers to ensure the park remains clean and well-maintained. They also manage the park's budget, train managers in individual departments, and develop inclement weather or emergency policies. Prospective park managers need a bachelor's degree in leisure and recreation, management, or landscape design. 19. Food service director They work for hotels, cruises, and other accommodations to oversee food service operations for guests. Their job duties include developing a budget for food inventory and supplies, relaying information to food and beverage managers and kitchen staff, approving menu and drink ideas, and ensuring the quality of the food and dining operations. Directors at large hotels or other organizations may also To become a food service director, a bachelor's or master's degree in hospitality management, food service management, or culinary arts is necessary. 11 oversee the room service and catering from multiple restaurants. 20. Travel consultant They assist individuals, educational institutions, and corporations with their travel needs. They meet with clients to discuss their travel options to a destination and determine whether they need a passport, vaccinations, or weatherappropriate attire; they also help them find discounted hotels and airlines and arrange accommodations for clients with medical conditions and special needs. A high school diploma and a voluntary certification are typically necessary to become a travel consultant. An associate or bachelor's degree in tourism, international studies, or hospitality can also be beneficial.1. Settlements Importance of Rivers Fertile Land: The soil near rivers was great for farming, thanks to regular flooding that added nutrients. Trade and Travel: Rivers made moving things and people easy, which helped trade and communication. Protection: Rivers could act as natural barriers, making it harder for enemies to attack. Food: Rivers were full of fish and other food, adding to what people could eat. Energy: People used the river's flow to power machines, for example, grinding grain. Cleanliness: Rivers were used to wash away waste, keeping settlements cleaner. Culture: Rivers often had spiritual importance, and ceremonies and stories revolved around them. Common Geographic Features of Ancient Civilizations Mesopotamia: the Tigris and Euphrates Rivers in central Iraq Indus River Valley: the river runs in the northwestern part of India Nile River Valley: the major river of Egypt Yellow River Valley: a major river flowing through the southern part of China Rivers provided water, food, transportation, and shaped the way of life and development of these ancient civilizations. Impact of Mountains on Settlements Mountains served as barriers to early settlement due to the lack of technology to cross them. The Himalayan Mountains isolated much of India and China during their early development. Impact of Deserts on Migration Deserts posed significant challenges to people who wanted to migrate due to their harsh and unforgiving conditions. Notable deserts include the Empty Quarter in Saudi Arabia and the Sahara Desert in Africa. Changes in Migration and Cultural Blending Advancements in transportation technology post-Industrial Revolution increased cultural blending. Transportation advancements enabled global migration. Before, cultures were isolated, focusing on beliefs and local adaptations. The Industrial Revolution transformed migration and cultural blending. 2. How Humans Modify and Adapt to Their Environment Ways Humans Modify Their Environment Mining: Removing the earth's surface for precious metals. Irrigation: Diverting water for farming. Transportation: Moving goods with trains, cars, airplanes, and boats. Mining Strip mining removes large layers of the earth. Can impact the environment by removing plants and polluting water sources. Irrigation Diverting water for farming and urban development. Transportation Moving goods using trains, cars, airplanes, and boats. Human Adaptation to the Environment Adjusting to environmental conditions by changing behavior. Examples: Wearing specific clothing, using specific building materials. Human Modification of the Environment Changing the earth to meet human needs by physically altering the environment. Examples: Dams, canals, roads, bridges. Impact of Weather and Geological Events on Humans Events like earthquakes, hurricanes, and cold weather affect human settlements. Examples: Building earthquake-resistant buildings, creating levees, using ice for tourism. 3. Understanding Culture Introduction to Culture Culture refers to the way of life of a group of people who live in a particular place. It includes traditions, beliefs, values, and the way they do things. Cultural Characteristics Religious traditions Language Family values Laws Cultural characteristics make each culture unique. Cultural Representations Art Architecture Music Literature Cultural representations express a culture's creativity and show their beliefs and history to the world. Government and Culture Types of government reflect cultural beliefs and traditions. Examples: democratic republic, communist state. The way a country is governed tells a lot about its culture. Economic Systems and Cultures Economic systems reflect cultural values. Examples: bartering, modern economies (e.g., United States, China). How people earn and spend money also reflects their culture. Spread of Cultural Ideas Trade: Spreading ideas through interactions during trade. Travel: Visitors bringing new ideas. War: Conquering armies imposing beliefs. Cultural ideas spread through trade, travel, and war. Multicultural Societies Blending of multiple cultural and ethnic groups. Common in advanced societies with immigration. Multicultural societies create something new by bringing together different cultures. Cultural Adaptation Cultures can change and adapt by taking new ideas and blending them with their own traditions. Example: 'Tex-Mex' food, which blends Mexican and Texan traditions.Tobruk, a small town on the Libyan coast, was central to much of the fighting that took place in the Western Desert during the Second World War. It had originally been developed by the Italians during their colonisation of eastern Libya during the early decades of the 20th century. With a sheltered deep water harbour it became a key naval outpost. It was fortified during the 1930s with both coastal defence batteries and a 50 kilometre-long perimeter of reinforced concrete platoon posts, and other supporting infrastructure such as gun positions, headquarters bunkers, underground supply dumps, and observation towers. When British and Commonwealth forces advanced out of Egypt and into Libya in January 1941, Tobruk was their second objective. The Italian defence perimeter was attacked by the 6th Australian Division on the morning of 22 January and the town fell the next morning. The operation resulted in approximately 27,000 Italian prisoners and the capture of over 200 artillery pieces, but cost 49 Australian lives. The 6th Division's advance pressed on beyond Tobruk and eventually they were withdrawn from Libya to be deployed to Greece.The 9th Australian Division was moved in to Libya in February 1941 to garrison the territory captured by the 6th. By this time, however, German troops had arrived in Libya to reinforce their Italian allies and they launched an offensive that the British Commonwealth forces were ill-disposed to hold back. A retreat towards Egypt commenced. The 9th Division was ordered to fall back upon Tobruk, hold it in order deny its port facilities to the Germans, and delay their advance so as to provide time for defences on the Egyptian frontier to be prepared. Tobruk and the 9th Division were subsequently encircled, beginning what became known as "the siege of Tobruk". Reinforced by the 18th Brigade of the 7th Australian Division and other British and Commonwealth troops, and resupplied by the sea, the 9th Division held Tobruk from April to September 1941. During this period it repelled two major German attacks. In September and October the 9th Division, its condition steadily declining, was relieved by the British 70th Division, which continued to defend Tobruk until the siege was finally lifted by Operation Crusader in December. The defence of Tobruk resulted in 749 Australian deaths, and another 604 became prisoners of war. Tobruk was the scene of further heavy fighting in June 1942 when the fortunes of war again saw a British Commonwealth force seeking to deny the port to the enemy. The Axis forces, however, were in no mood for another siege and launched a massive attack to capture it on 20 June. It remained in their hands until their final retreat from Libya in November 1942.John Hurst Edmondson (1914-1941), soldier, was born on 8 October 1914 at Wagga Wagga, New South Wales, only child of native-born parents Joseph William Edmondson, farmer, and his wife Maude Elizabeth, nĂŠe Hurst. The family moved to a farm near Liverpool when Jack was a child. Educated at Hurlstone Agricultural High School, he worked with his father and became a champion rifle-shooter. He was a council-member of the Liverpool Agricultural Society and acted as a steward at its shows. Having served (from March 1939) in the 4th Battalion, Militia, he enlisted in the Australian Imperial Force on 20 May 1940 and was posted to the 2nd/17th Battalion. Later that month he was promoted acting corporal (substantive in November). Well built and about 5 ft 9 ins (175 cm) tall, Edmondson settled easily into army life and was known as a quiet but efficient soldier. His battalion embarked for the Middle East in October and trained in Palestine. In March 1941 the 2nd/17th moved with other components of the 9th Division to Libya and reached Marsa Brega before an Axis counter-attack forced them to retreat to Tobruk. The siege of the fortress began on 11 April. Two days later the Germans probed the perimeter, targeting a section of the line west of the El Adem Road near Post R33. This strong-point was garrisoned by the 2nd/17th's No.16 Platoon in which Edmondson was a section leader. The enemy intended to clear the post as a bridgehead for an armoured assault on Tobruk.Under cover of darkness thirty Germans infiltrated the barbed wire defences, bringing machine-guns, mortars and two light field-guns. Lieutenant Austin Mackell, commanding No.16 Platoon, led Edmondson's five-man section in an attempt to repel the intruders. Armed with rifles, fixed bayonets and grenades, the party of seven tried to outflank the Germans, but were spotted by the enemy who turned their machine-guns on them. Unknown to his mates, Edmondson was severely wounded in the neck and stomach. Covering fire from R33 ceased at the pre-arranged time of 11.45 p.m. and Mackell ordered his men to charge. Despite his wounds, Edmondson accounted for several enemy soldiers and saved Mackell's life. When the remaining Germans fled, the Australians returned to their lines. Although Edmondson was treated for his wounds, he died before dawn on 14 April 1941. The Germans' armoured attack that morning was thwarted, partly due to the earlier disruption of their plans. Edmondson was buried in Tobruk war cemetery. He had not married. His Victoria Cross, gazetted on 4 July, was the first awarded to a member of Australia's armed forces in World War II. In April 1960 Mrs Edmondson gave her son's medals to the Australian War Memorial, Canberra, where they are displayed alongside his portrait (1958) by Joshua Smith. At Liverpool a public clock commemorates Edmondson, as do the clubrooms used by the sub-branch of the Returned Services League of Australia.Perhaps my nerves will be more under control when I am by myself. There were no entries in the diary until Friday April 18 when she wrote: Fighting terrific in Greece and North AfricaâŚ. I dread the casualty list also the heaviest air raid over London to date. Account âŚ. of heavy fighting and much use of bayonet at Tobruk. Also gives an account of a charge in which a Lieutenant and a Corporal took prominent parts on Easter Sunday night. Of course, no names. When I read it âŚ. I was sure the Corporal was JackâŚ. It said no casualties but âŚ. I know ⌠that all is not well with Jack. âŚ.. (and) Stuffy âŚ.has not come home yet. On Wednesday April 23 she received a letter from Jack dated March 30 and for the first time he said the conditions were bad. The food short, water one bottle for 48 hours. It worried me terribly so I posted a parcel (of) milk tablets, chocolate milk, biscuits (and) cigarettes.Tuesday April 15 I was feeling afraid of something while I was working and packing the cake (and) had a couple of brandys to (keep going).April 26 Received the following telegram in the mail, the bus man brought it in. âIt is with deep regret that I have to inform you that Corporal John Hurst Edmondson was killed in action on the 14th April and desire to convey the profound sympathy of the Ministry for the Army and the Military Board.âHer final entryTo the Lakota, and other indigenous people on North America's Great Plains, the bison was an essential part of their culture ( expressed in the quote on the previous page). The bison provided meat for nutrition, a hide for clothing and shelter, bones for tools, and fat for soap. The bison was also central to their religious beliefs. So, when European settlers hunted the bison nearly to extinction, Lakota culture suffered. Culture is central to a society and the identity of its people, as well as its continued existence. Therefore, geographers study culture as a way to understand similarities and differences among societies across the world, and in some cases, to help preserve these societies. Analyzing Culture All of a group's learned behaviors, actions, beliefs, and objects are a part of culture. It is a visible force seen in a group's actions, possessions, and influence on the landscape. For example, in a large city you can see people working in offices, factories, and stores, and living in high-rise apartments or suburban homes. You might observe them attending movies, concerts, or sporting events. Culture is also an invisible force guiding people through shared belief systems, customs, and traditions. Culture is learned, in that it develops through experiences, and not merely transmitted through genetics. For example, many people in the United States have developed a strong sense of competitiveness in school and business, and believe that hard work is a key to success. These types of elements, visible and invisible, are cultural traits. A series of interrelated traits make up a cultural complex, such as the process of steps and acceptable behaviors related to greeting a person in different cultures. A single cultural artifact, such as an automobile, may represent many different values, beliefs, behaviors and traditions and be representative of a cultural complex. Since culture is learned there are many ways that one generation passes its culture to the next. Children and adults learn traits three ways: ⢠imitation, as when learning a language by repeating sounds or behaviors from a person or television ⢠informal instruction, as when a parent reminds a child to say "please" ⢠formal instruction, as when students learn history in school 132 HUMAN GEOGRAPHY: AP" EDITION CULTURAL COMPLEX OF THE AUTOMOBILE The automobile provides much more than just transportation, as it reflects many values that are central to American culture. Origins of Culture The area in which a unique culture or a specific trait develops is a culture hearth. Classical Greece was a culture hearth for democracy more than 2,000 years ago. New York City was a culture hearth for rap music in the 1970s. Geographers study how cultures develop in hearths and diffuse-or spread-to other places. Geographers also study taboos, behaviors heavily discouraged by a culture. For example, many cultures have taboos against eating certain foods, such as pork or insects. What is considered taboo changes over time. In the United States, marriages between Protestants and Catholics were once taboo, but they are not widely opposed now. Traditional, Folk, and Indigenous Cultures With the beginning of the Industrial Revolution in the late 18th century, modern transportation and communication connected people as never before and led to extensive cultural mixing, especially as cities have grown. The world prior to this time was very different; however, remnants of the past are still evident in our modern cultures. Traditional, folk, and indigenous cultures share some important characteristics and are often grouped together, but they do have some subtle differences. Traditional Culture Recently, the meanings of traditional, folk, and indigenous culture have begun to merge, causing geographers to debate when each should be used. Increasingly, the term traditional culture is used to encompass all three cultural designations. All three types share the function of passing down long-held beliefs, values, and practices and are generally resistant to rapid changes in their culture. Folk Culture The beliefs and practices of small, homogenous groups of people, often living in rural areas that are relatively isolated and slow to change, are known as folk cultures. Like all cultures, they demonstrate the diverse ways that people have adapted to a physical environment. For example, people around the world learned to make shelters out of available resources, whether 3.1: INTRODUCTION TO CULTURE 133 it was snow or mud bricks or wood. However, people used similar resources such as wood differently. In Scandinavia, people used trees to build cabins. In the American Midwest, people processed trees into boards, built a frame, and attached the boards to it. Many traits of folk culture continue today. Corn was first grown in Mexico around 10,000 years ago, and it is still grown there today. While many elements of folk culture exist side by side with modern culture, there are people whose societies have changed little, if at all, from long ago. These people practice traditional cultures, those which have not been affected by modern technology or influences. They often live in remote regions, such as some small tribes in the Amazon rainforest, and have scant knowledge of the outside world. As the lines continue blurring between cultural designations, the Amish of Pennsylvania are often referenced as both folk and traditional culture. Indigenous Culture When members of an ethnic group reside in their ancestral lands, and typically possess unique cultural traits, such as speaking their own exclusive language, they are considered an indigenous culture. Some indigenous peoples have been displaced from their native lands, but still practice their indigenous culture. Native Americans in the United States, such as the Navajo, have kept indigenous cultural practices. First Nations of Canada, such as the Inuit, have also retained their indigenous culture. Globalization and Popular Culture As a result of the Industrial Revolution, improvements in transportation and communication have shortened the time required for movement, trade, or other forms of interaction between two places. This development, known as space-time compression (see Topics 1.4 and 3.6), has accelerated culture change around the world. In 1817, a freight shipment from Cincinnati needed 52 days to reach New York City. By 1850, because of canals and railroads, it took half that long. And by 1852, it took only 7 days. Today, an airplane flight takes only a few hours, and digital information takes seconds or less. Similar change has occurred on the global scale. People travel freely across the world in a matter of hours, and communication has advanced to a point where people share information instantaneously across the globe. The increased global interaction has had a profound impact on cultures, from spreading English across the world to instant sharing of news, events and music. Globalization specifically refers to the increased integration of the world economy since the 1970s. The process of intensified interaction among peoples, governments, and companies of different countries around the globe has had profound impacts on culture. The culture of the United States is intertwined with globalization. Through the influence of its corporations, Hollywood movies, and government, the United States exerts widespread influence in other countries. But other countries also shape American culture. For example, in 2019, the National Basketball Association included players from 38 countries or territories. When cultural traits- such as clothing, music, movies, and types of 134 HUMAN GEOGRAPHY: AP. EDITION businesses-spread quickly over a large area and are adopted by various groups, they become part of popular culture. Elements of popular culture often begin in urban areas and diffuse quickly through globalization processes such as the media and Internet. These elements can quickly be adopted worldwide, making them part of global culture. People around the world follow European soccer, Indian Bollywood movies, and Japanese animation known as anime. With people in many nations wearing similar clothes, listening to similar music, and eating similar food, popular cultural traits often promote uniformity in beliefs, values, and the cultural landscape across many places The cultural landscape, also known as the built environment (see Topic 3.2), is the modification of the environment by a group and is a visible reflection of that group's cultural beliefs and values. Traditional Culture to Popular Culture Popular culture emphasizes trying what is new rather than preserving what is traditional. Many people, especially older generations or those who follow a folk culture, openly resist the adoption of popular cultural traits. They do this by preserving traditional languages, religions, values, and foods. While older generations often resist the adoption of popular culture, they seldom are successful in keeping their traditional cultures from changing, especially among the young people of their society. One clash between popular and traditional culture is occurring in Brazil. As the population expands to the interior of the rain forest, many indigenous cultures, like the Yanamamo tribe, have more contact with outside groups. Remaining isolated by the forest is becoming increasingly difficult as many young people from the indigenous cultures become exposed to popular culture and begin to integrate into the larger Brazilian society. As the young people leave their communities, they are more likely to accept popular culture at the expense of their indigenous cultural heritage, which threatens the very existence of their folk culture. Traditional culture typically exhibits horizontal diversity, meaning each traditional culture has its own customs and language that makes it distinct from other culture groups. Yet, people people within each group are usually homogeneous, or very similar to each other. By contrast, popular culture typically exhibits vertical diversity, meaning that modern urban societies are usually heterogeneous, or exhibiting differences, within the society and usually contain numerous multiethnic neighborhoods. However, on a global scale popular cultures are relatively similar with the same type of malls, shops, fast food, and clothing. Urban global culture centers are not identical, yet, global cities often do not have as much horizontal diversity across space as folk cultures. 3.1: INTRODUCTION TO CULTURE 135 COMPARING TRADITIONAL AND POPULAR CULTURE Trait Traditional Culture Popular or Global Culture Society ⢠Rural and isolated location ⢠Urban and connected location ⢠Homogeneous and ⢠Diverse and multiethnic indigenous population population ⢠Most people speak an ⢠Many people speak a global indigenous or ethnic local language such as English or language Arabic ⢠Horizontal diversity ⢠Vertical diversity Social ⢠Emphasis on community and ⢠Emphasis on individualism and Structure conformity making choices ⢠Families live close to each ⢠Dispersed families other ⢠Weakly defined gender roles ⢠Well-defined gender roles Diffusion ⢠Relatively slow and limited ⢠Relatively rapid and extensive ⢠Primarily through relocation ⢠Often hierarchical ⢠Oral traditions and stories ⢠Social media and mass media Buildings and ⢠Materials produced locally, ⢠Materials produced in distant Housing such as stone or grass factories, such as steel or glass ⢠Built by community or owner ⢠Built by a business ⢠Similar style for community ⢠Variety of architectural styles ⢠Different between cultures ⢠Similar between cities ⢠Traditional architecture ⢠Postmodern / contemporary architecture Food ⢠Locally produced ⢠Often imported ⢠Choices limited by tradition ⢠Wide range of choice ⢠Prepared by the family or ⢠Purchased in restaurants community Spatial Focus ⢠Local and regional ⢠National and global Artifacts, Mentifacts, and Sociofacts Whether a cultural attribute is considered traditional, folk, indigenous, or popular in nature, it is valuable to differentiate between elements of culture that can be seen and those that can not. There are artifacts that comprise the material culture, which consists of tangible things, or those that can be experienced by the senses. Art, clothing, food, music, sports, and housing types are all tangible elements of culture. Another element of the study of artifacts is understanding the techniques to use or build a specific artifact. Artifacts can be unique to a particular culture, or can be shared. For example, people of all cultures need to communicate through language, yet there are many groups that possess languages unique to their culture. The ability to read, write and understand the English language is an artifact of importance for much of popular global culture. 136 HUMAN GEOGRAPHY: AP" EDITION Mentifacts comprise a group's nonmaterial culture and consist ofintangible concepts, or those not having a physical presence. Beliefs, values, practices, and aesthetics (pleasing in appearance) determine what a cultural group views as acceptable and desirable. Mentifacts can also be unique or shared. People of many cultures possess an belief in one or many deities, and often the deities are unique to that culture. The belief in a god is a mentifact-the religious building or symbols are artifacts. Cultural groups also possess sociofacts, which are the ways people organize their society and relate to one another. Taken altogether, people tend to see the whole of their culture as greater than the sum of its individual parts. Sociofacts are embodied through families, governments, sports teams, religious organizations, education systems, and other social constructs. As with artifacts and mentifacts, sociofacts may also be unique or similar to other societies. Families are the foundations of most societies, yet what constitutes the structure of a family may vary widely between cultural groups. For example, Western cultures tend to view the nuclear family, consisting of the parents and their children as the basic family unit. By contrast, in many Western African cultures the norm is the extended family, consisting of several generations and other family members such as cousins living under one roof. Received: 26 November 2019 Revised: 10 January 2020 Accepted: 19 January 2020 DOI: 10.1111/obr.13005 PEDIATRICS/PHYSIOLOGY Adipokines: A gear shift in puberty DesirĂŠe Nieuwenhuis | NatĂ lia Pujol-Gualdo Amanda J. Kiliaan Department of Anatomy, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Preclinical Imaging Center PRIME, Nijmegen, The Netherlands Correspondence Amanda J. Kiliaan, PhD, Associate Professor, Department of Anatomy, Donders Institute for Brain, Cognition, and Behaviour, Preclinical Imaging Center PRIME, Radboud university medical center, 6500 HB Nijmegen, Geert Grooteplein 21N 6525 EZ Nijmegen, The Netherlands. Email: amanda.kiliaan@radboudumc.nl Funding information Europees Fonds voor Regionale Ontwikkeling (EFRO), Grant/Award Number: BriteN 2016 1 | INTRODUCTION The prevalence of obesity in adolescents and children is increasing in | Ilse A.C. Arnoldussen | Summary In this review, we discuss the role of adipokines in the onset of puberty in children with obesity during adrenarche and gonadarche and provide a clear and detailed overview of the biological processes of two major players, leptin and adiponectin. Adipokines, especially leptin and adiponectin, seem to induce an early onset of puberty in girls and boys with obesity by affecting the hypothalamic-pituitary- gonadal (HPG) axis. Moreover, adipokines and their receptors are expressed in the gonads, suggesting a role in sexual maturation and reproduction. All in all, adipokines may be a clue in understanding mechanisms underlying the onset of puberty in child- hood obesity and puberty onset variability. KEYWORDS adipokines, obesity, puberty 1,2 the age of 5 years were overweight or were with obesity in 2016, and 3 Obesity is defined by an excessive accumulation of white adipose tissue (WAT), and it is often indicated by a body mass index (BMI) 4 above 30. Two main types of adipose tissue were described: WAT and brown adipose tissue (BAT), which differ in morphology and func- 5-7 Ilse A.C. Arnoldussen and Amanda J. Kiliaan contributed equally to this work. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Š 2020 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation Obesity Reviews. 2020;21:e13005. wileyonlinelibrary.com/journal/obr 1 of 10 https://doi.org/10.1111/obr.13005 alarming rates. Specifically, worldwide, 41 million children below this number is expected to increase to 70 million in 2025. obesity is associated with various severe health complications, includ- ing increased risk of diabetes mellitus type 2, hypertension, heart dis- eases, and disturbances in sex hormone levels. 5,6 and mitochondria and plays a role in thermogenesis. Adipocytes in tion. BAT consists of adipocytes containing multiple lipid droplets WAT contain only a few mitochondria and a single lipid droplet. Adipose tissue has several functions including the storage of energy, thermogenesis, and the production and secretion of adipokines Generally, two physiological processes, adrenarche and gonadarche, 11,24 Childhood 5,7,8 a key role in puberty onset. Puberty is known as a period through which the body changes physically, being a physiological process resulting in the maturation of children, i.e. they develop sexual characteristics and obtain reproduc- 9,11 Adipokines are involved in a number of physiological processes including blood pressure, metabo- lism, glucose, and vascular homeostasis and may play amongst others 8-10 (hormones, cytokines, and peptides). tive functions. between obesity and puberty,2,12-23 the biological mechanisms under- lying obesity and puberty onset remain unclear. Hereafter, we review in detail the role of adipokines in the onset of puberty in childhood obesity. Although many studies have shown associations 2 | INITIATION OF PUBERTY PHYSIOLOGICAL PROCESSES IN THE interact to regulate the onset of puberty. During adrenarche, the adrenal cortex secretes steroid hormones (including 2 of 10 NIEUWENHUIS ET AL. androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and cortisol), insulin-like growth factor, and growth hormone, which contribute to the pubertal insights on new genetic loci (e.g. melanocortin-4 receptor, mitochon- drial carrier 2, and mitogen-activated protein kinase 13) and on sev- eral pathways that regulate the timing of puberty; however, it partly 34 9,24,25 Both adrenarche and gonadarche are involved in the development growth spurt, body odor, skin oiliness, and skeletal maturation. explains puberty timing variation. Thereby, defining the role of 25 adipokines is of importance in elucidating the variability in puberty as the expression of adipokines is sex-specific and is altered with body composition, adiposity, and during growth spurts. Moreover, adipokines and their receptors are expressed in gonads and several brain regions suggesting involvement in the onset of puberty and sex- ual maturation. Lastly, adipokines interfere in processes regulating timing and duration of puberty, for instance in the HPA and HPG axes which are both key players during adrenarche and gonadarche. Involvement of adipokines in the onset of puberty and specifically in individuals with obesity will be further reviewed in the next 2,24 3 | Puberty onset in girls is assessed using different markers, such as thelarche (breast development), menarche (the start of of pubic hair. pituitary-gonadal (HPG) axis is activated,2,26 and several hormones have been identified to participate in the activation of the HPG axis During gonadarche (Figure 1), the hypothalamic- 2,27 Kisspeptin, neurokinin B, and dynorphin are released by specialized including kisspeptin, neurokinin B, dynorphin, leptin, and ghrelin. 28 key regulator of the pulsatile secretion of gonadotropin releasing neurons, the KNDy neurons in the hypothalamus. Kisspeptin is a 29,30 B stimulates, and dynorphin inhibits the release of kisspeptin, which hormone (GnRH) from the hypothalamus. In addition, neurokinin implies that both coordinate a pulsatile release of kisspeptin. 31 Sub- sections. sequently, the activated HPG axis induces the pituitary gland to secrete luteinising hormone (LH) and follicle stimulating hormone (FSH). As a result, gametogenesis occurs, and the gonads will release sex hormones. Consequently, secondary sex characteristics develop including breast development in girls and an increased testicular vol- 2,26,32 is possibly due to differences in levels of body fat, hypothalamic-pitui- THE ONSET OF PUBERTY IN GIRLS ume in boys. The age at puberty onset varies greatly among individuals, which 19 35 menstruation), and pubic hair development. 33 genome-wide association studies have provided important new tary-adrenal (HPA) axis activity, and genetic background. Recent The average age of However, this age differs between cultures and ethnicities, and since 1980, age at menarche is girls at start of menarche is 12.4 years. 36 significantly decreasing. 36-39 F I G U R E 1 Hormonal regulation in the initiation of puberty in boys and girls. The secretion of kisspeptin, neurokinin B, and dynorphin from KNDy neurons initiate the release of gonadotropin releasing hormone (GnRH) from the hypothalamus. This activates the pituitary gland to produce and secrete luteinising hormone (LH) and follicle stimulating hormone (FSH), which in turn stimulate the gonads to produce estrogen and testosterone in girls and boys, respectively 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License NIEUWENHUIS ET AL. 3 of 10 T A B L E 1 Summary of included studies Authors Year Country Study Design Primary Outcome Sex Sample Size (n) Age (y) Data Collection Lian et al21 2019 China Cross-sectional Puberty starts earlier in Chinese Han girls with obesity compared with Chinese Han girls with normal weight. Girls 2996 9-19 2012 and 2013 Biro et al12 Lazzeri et al20 2018 USA 2018 Italy Longitudinal Cross-sectional Body mass index had a greater effect on age at menarche than did race and ethnicity. Girls 946 6-16 2004-2014 Li et al23 2018 China Longitudinal For both, boys and girls, a higher BMI (ie, overweight and obese) is associated with earlier onset of puberty Girls Girls Boys Girls 542 Deng et al22 Flom et al15 2017 China Cross-sectional Increased BMI is associated with early timing spermarche and menarche. Boys Girls Girls 1278258 9-15 2005-2012 He et al24 Holmgren et al17 2017 China 2017 Sweden Cross-sectional Longitudinal Onset of puberty is not related to obesity in boys. Boys Boys Girls Girls 782 7-17 972 929 5839 Kelly et al19 2017 UK 2016 Brazil 2016 USA Longitudinal prospective cohort Higher BMI in girls is associated with the onset of menstruation at an earlier age. 11 10-18 11-17 Barcellos Gemelli et al25 Cross-sectional Longitudinal Excess weight is associated with early age of menarche. Girls 727 2014 2003-2009 Glass et al16 Lee et al26 In girls, but not in boys, greater adiposity is associated with the earlier onset of puberty. Boys Girls 135 Cabrera et al27 Leonibus et al14 2014 USA 2013 Italy Cross-sectional Longitudinal Thelarche occurred earlier than recently reported, while age of menarche remained unchanged. Girls 610 3-17.9 2007 2005-2012 Currie et al13 2012 Europe, USA, Canada Cross-sectional Overweight/obesity during childhood predicts the early onset of puberty in girls. Girls 20410 11, 13, 15 2005-2006 2017 USA Prospective birth cohort Overweight/obese status at the age of 7 ye was associated with increased risk of early menarche 788 From birth to menarche occurred Pregnancies 1959-1966 2016 USA Cross-sectional Boys with overweight enter puberty earlier compared with boys with normal weight or obesity, while puberty starts later in boys with obesity compared with boys with normal weight and overweight. Boys 3872 6-16 2005-2010 Overweight during childhood shows a relation with the early onset of puberty in girls. 6535 4259 695 11 15 5.8-12.2 2009/2010 2013/2014 2014-2017 Higher BMI during childhood is associated with early puberty. 2008 and 2009 2000-2002 Obesity during childhood is related to the earlier onset of puberty. Boys Girls 84 123 71 (Continues) 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4 of 10 NIEUWENHUIS ET AL. 3.1 | Fat storage For the initiation of puberty, the timing of stimulation and/or inhibi- tion of different hormones is important, and additionally, a certain amount and distribution of body fat is needed in order to start menar- che, which emphasizes the importance of body fat. From an evolution- ary point of view, body fat increases in mammalian females during puberty onset, and it highlights the need to guarantee a healthy preg- 40 women with anorexia nervosa. particularly body fat localized predominantly on the gluteofemoral fat depots, is profoundly associated with start of menarche, more than nancy, offspring, and maternal survival. fat, sex-hormones, and neuroendocrine alterations can evolve in men- strual dysfunction, for instance, in women with severe obesity or in 41-43 44-46 to gluteofemoral fat depots suggesting that leptin may convey infor- amount of total body fat. mation on body fat distribution to the hypothalamus during puberty. An improper level of body Importantly, body fat distribution, Blood leptin levels are strongly related 45 3.2 | HPG axis The HPG axis is activated by the release of kisspeptin resulting in the release of GnRH from the hypothalamus, and LH and FSH from the pituitary gland. In girls, FSH is involved in the development of the folli- cles in the ovaries, and it promotes the secretion of estrogen. LH stim- ulates the production of androgen hormones and induces ovulation 48 9,47 the release of kisspeptin and neurokinin B, and kisspeptin thereby (Figure 1). The secretion of estrogen has an inhibitory effect on inhibits the GnRH release from the hypothalamus. pattern of GnRH is important for the regulation of the menstrual cycle. This roughly 28-day-cycle comprises several phases, including the follicular phase and luteal phase. During the follicular phase, increasing levels of FSH stimulate the maturation of follicles and the production of estrogen from the ovaries. This in turn inhibits the release of FSH from the pituitary gland. A high level of estrogen will induce the production of LH by the pituitary gland, resulting in ovula- tion. The matured follicle secretes progesterone thereby inhibiting the release of GnRH. When the corpus luteum is demolished, there is less 48 3.3 | Adipokines According to results from studies reported in Table 1, girls with obe- sity enter puberty earlier compared with girls with normal higher leptin concentrations inhibit the intake of food and increases inhibition of GnRH. As a consequence, the cycle will start again. whole process, starting from the activated HPG axis, results in the development of the secondary sex characteristics in girls including 9,47 thelarche and menarche. 13,14,16-23,49-51 weight. these girls might be found in the secretion of adipokines. For instance, leptin is positively associated with the amount of body fat. Generally, energy expenditure. 9,52-54 An explanation for the early onset of puberty in The expression This TABLE 1 (Continued) Authors Year Country Study Design Primary Outcome Sample Sex Size (n) Age (y) Data Collection Herman-Giddens et al28 2012 USA Cross-sectional Observed mean ages of beginning genital and pubic hair growth and early testicular volumes were earlier than in past studies, depending on the characteristic and race/ethnicity. Boys 4131 6-16 2005-2010 Sorensen et al29 Aksglaede et al30 2010 2009 Denmark Denmark Cross-sectional/longitudinal Longitudinal Puberty onset at earlier ages was associated with an increased BMI in boys. Boys 1528 5.8-19.9 1991-1993/2006-2008 1930-1969 Juul et al31 Ribeiro et al32 2007 2006 Denmark Portugal Retrospective cohort Cross-sectional Higher BMI is associated with early voice break. 11-15 10-15 1990-1999 Kaplowitz et al18 Abbreviation: BMI, body mass USA Cross-sectional The early onset of puberty in Caucasian girls is likely related to an increased BMI. 5-12 1992-1993 2001 index. The higher BMI in boys and girls at 7 y of age, the earlier they enter puberty. Boys 21 612 Girls 135 223 Boys 463 Boys 382 Girls 437 Girls 10 750 Early sexual maturation in boys and girls is associated with overweight. 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License NIEUWENHUIS ET AL. 5 of 10 Leptin may possibly play a role in adrenarche as its plasma level increases with higher levels of body fat and as it can modulate both girls. 33 ing adrenarche. In coherence, in children with obesity, the androgen These findings suggested that lower reproductive status was associated with higher total adiponectin concentrations and that a higher reproductive status was related to higher HMW adiponectin the HPA and HPG axes. These axes are functionally integrated dur- DHEAS was positively associated with leptin levels. Nevertheless, concentrations in girls. In addition, individuals with obesity often another study showed that enhanced adrenal androgen secretion in girls with premature adrenarche was not explained by leptin or BMI 55 ated with androgen levels in girls ; however, it was not related to levels. and IL-6. TNF-Îą alters, and IL-6 inhibits the expression of 56 8 In addition, the adipokine adiponectin was negatively associ- 57 differences of adiponectin seem to develop during the progression of 56 adiponectin (Figure 2). Thereby, a low level of total adiponectin and/or high levels of inflammatory cytokines in individuals with obe- sity can promote the onset of puberty. Many more adipokines are secreted by WAT including omentin, 52,65-67 9,36,62,68 adrenarche in girls with Prader-Willi syndrome. Interestingly, sex puberty. adrenarche; however, both are not required factors. Thus, leptin and adiponectin might be able to influence In gonadarche, leptin can stimulate the secretion of kisspeptin, and subsequently activation of the HPG axis, which eventually increases the expression of estrogen and androstenedione in the ova- 58 2,60 65-67 The expression of these ries (Figure 2). Ob gene in WAT, resulting in the synthesis and secretion of leptin. Thus, high levels of leptin promote onset of puberty in girls via secre- tion of kisspeptin, and estrogen stimulates leptin secretion addition- ally. Moreover, adiponectin can affect the HPG axis due to the expression of adiponectin receptors in the hypothalamus, pituitary In return, estrogen stimulates the expression of the 59 gland, and gonads. onset as it inhibits the secretion of kisspeptin and GnRH in the hypo- thalamus and the release of GH and LH in the pituitary gland, and 2,60-62 52,60 63 girls with central precocious puberty (CPP). Moreover, total adiponectin had negative correlations with progression of puberty in girls (defined by Tanner stages), whereas HMW adiponectin had FIGURE 2 Adipokinesaffectingthe initiation of puberty in girls. Leptin stimulates the release of kisspeptin in KNDy neurons, which activates the hypothalamus to produce gonadotropin releasing hormone (GnRH). In response to the release of GnRH, the pituitary gland secretes follicle stimulating hormone (FSH) and luteinising hormone (LH), which stimulates the ovaries to release estrogen resulting in the formation of secondary sex characteristics in girls. Estrogen stimulates the production of leptin. Adiponectin inhibits GnRH release resulting in reduced levels of GnRH and thereby a delayed onset of puberty. TNF- Îą and IL-6 inhibit the production of adiponectin and therefore stimulate the onset of puberty In detail, adiponectin is a regulator of puberty thereby inhibiting the onset of puberty (Figure 2). with obesity often have low levels of adiponectin. et al. showed that total adiponectin was significantly lower, whereas high molecular weight (HMW) adiponectin was significantly higher in ment. 55 63 develop a chronic low-grade inflammatory state, which can be indi- cated by a high level of circulating inflammatory cytokines like TNF-Îą 64 Individuals Sitticharoon positive associations with LH levels and the progression of puberty in 63 visfatin, resistin, and chemerin. and visfatin are expressed in the ovaries. adipokines in the ovaries suggests a role within the reproductive sys- tem; however, the exact biological processes have to be examined. Thus, specifically leptin, adiponectin, and inflammatory cytokines pro- duced by WAT could be permissive key players during an early onset of puberty in girls with obesity. As an exception, HMW adiponectin seems to have a stimulatory effect on peripheral repro- ductive function as HMW is not able to cross the blood brain 63 barrier. 4 | Markers that are used to assess puberty onset in boys are THE ONSET OF PUBERTY IN BOYS spermarche, voice break, testicular volume, and pubic hair develop- 35 spermarche develop in the early stages of puberty onset, voice In women, omentin, chemerin, While pubic hair development, larger testicular volume, and 69 testicular volume increases, which occurs at an average age of break usually appears in later stages of puberty. Generally, first 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6 of 10 NIEUWENHUIS ET AL. 11.9 years, followed by the development of pubic hair at 12.2 years of average, and lastly, boys experience spermarche around an aver- 55 related with leptin levels. Thereby, leptin plausibly has a minor impact in adrenarche in boys. Since leptin receptors are found in the hypothalamus, pituitary gland, and testes, they might be involved in the onset of puberty by affecting the HPG axis during gonadarche. Leptin stimulates the release of kisspeptin and GnRH, and as a consequence, it accelerates the onset of puberty (Table 1, Figure 3). In contrast, adiponectin inhibits the secretion of GnRH, GH, LH, and FSH therewith delaying the onset of puberty. However, adiponectin levels are generally lower in men compared with women and even lower in men with obe- age age of 13.4 years. 70 4.1 | Fat storage Many aspects of the reproductive physiology are energetically demanding,71 and therefore, an adequate energy level is necessary. In boys, a dynamic change in body composition occurs around the age of 10 to 13 years, in which they gain approximately 40% of sity. culating inflammatory cytokines. levels can stimulate the HPG axis and therewith an early onset of puberty in boys. Nevertheless, leptin can inhibit the production of tes- 72 mostly consisting of lean mass, which causes exhaustion of most of fat. Subsequently, a growth spurt follows in which they gain tissue 72 in boys, an adequate amount of body fat is important in the onset of their body fat. These alterations in amount of body fat indicate that 4.2 | Puberty in boys is initiated by the release of kisspeptin. As mentioned before, this activates the HPG axis, resulting in the release of GnRH from the hypothalamus, and consequently the release of LH and FSH 9,74 puberty. tosterone from the testes, to estrogen (Figure 3). of the development of secondary sex characteristics in boys. Additionally, leptin can affect fertility in men as it can modulate the nutritional support of spermatogenesis, and moreover, dysfunction of spermatogenesis is associated with an increased leptin level and 73 58 2,60-62 HPG axis from the pituitary gland (Figure 1). and LH stimulates the secretion of testosterone from the testes, which inhibits the release of kisspeptin from the KNDy neurons and 9,48 in men, the release of kisspeptin is more consistent, causing a con- 29,48 subsequently GnRH from the hypothalamus. receptors expressed on KNDy neurons. In humans, KNDy neurons Contrarily to women, LH-induced testosterone levels lead to the stant release of LH. development of secondary sex characteristics in boys. differences between sexes in kisspeptin release are related to a sex- specific and sex steroid-dependent kisspeptin system as estrogen and progesterone modulate kisspeptin activity through the sex-steroid 48 in the infundibular nucleus are involved in negative and positive sex- 48 tal exposure to sex steroids and result in sex-specific differences in steroid feedbacks. kisspeptin release. These sexual dimorphisms are induced by perina- 75,76 4.3 | Adipokines The association between obesity and puberty onset in boys is rather controversial compared with findings in girls. Most studies reported an early onset of puberty in boys associated with increased ate adipose tissue from actual breast tissue. stages are more difficult to assess than female stages as boys lack a more determined marker such as menarche. Thirdly, puberty onset can be indicated by the activation of the HPG axis, and the presence of these secondary sex characteristics is the result of hormonal 2 14,17,22,23,50,51,77,78 BMI, 20,49 all while others reported no associations at Current markers used 79 16,80 or a delayed onset of puberty (Table 1). The presence of excessive adipose tissue can be involved in puberty onset in boys as the secretion of adipokines can modulate both adrenarche and gonadarche. Leptin can affect adrenarche by modulating both the HPG and HPA axes,33 and moreover, androgen levels were positively 55 nal androgen secretion in boys with premature adrenarche was not associated with plasma leptin levels. Nevertheless, enhanced adre- 9 In more detail, 61,62 adiponectin, and individuals with obesity often have high levels of cir- Moreover, inflammatory cytokines, TNF-Îą, and IL-6, inhibit expression of the leptin receptor in the testis. FSH induces spermatogenesis, too. function and role still have to be examined. 64 High leptin and low adiponectin and fat tissue can convert testosterone Both processes might result in the delay 29,61,79 81,82 In men, other adipokines like chemerin are found in the gonads 65 Thus, particularly high leptin and low adiponectin levels stimulate the HPG axis and thereby accelerate the onset of puberty in boys. Additionally, leptin can dysregulate the development of secondary sex characteristics and spermatogenesis by affecting testosterone levels and nutritional sup- port of spermatogenesis. 5 | LIMITATIONS AND FUTURE RESEARCH DIRECTIONS Even though multiple epidemiological studies have shown the link between puberty onset and obesity, there are some important limita- tions. Firstly, determining both the onset and stage of puberty is rather difficult. For instance, assessing the stage of breast develop- ment in girls with obesity is complicated as clinicians should differenti- 2 changes in response to the activated HPG axis. to determine the onset of puberty refer to secondary sex characteris- tics, such as testicular volume in boys and breast development in girls. A more accurate measurement of puberty onset would be to combine secondary sex characteristics with plasma or serum hormone level measurements such as LH, FSH, adipokines, e.g. leptin. Thereby, differences in puberty measurements could explain variations in the age of puberty onset between boys and girls within different Thereby, resistin is expressed in the testes of rats, but its exact 83 Secondly, male pubertal 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License NIEUWENHUIS ET AL. 7 of 10 FIGURE 3 Adipokines affecting the initiation of puberty in boys. Leptin activates kisspeptin secretion in KNDy neurons, this activates the production of gonadotropin releasing hormone (GnRH) from the hypothalamus. GnRH stimulates the pituitary gland to secrete follicle stimulating hormone (FSH) and luteinising hormone (LH), activating the production of testosterone from the testes allowing the development of secondary sex characteristics. Leptin also inhibits the production of testosterone, which may cause a delayed onset of puberty. Adiponectin inhibits GnRH release. Low levels of adiponectin, as a result of TNF-Îą and IL-6 expression, lead to a reduced inhibition of GnRH. In response to GnRH release, the pituitary gland will secrete FSH and LH, and the testes will produce testosterone resulting in the development of secondary sex characteristics in boys countries, and In addition, the inclusion of a of puberty. ferent time points is complicated, as subjects examined several decades ago presented pronounced differences concerning lifestyle patterns such as nutrition and exercise habits. Lastly, obesity or over- weight is often determined by BMI, a classification based on weight and height measurements. Additionally, it is important that all studies studies or across continents, ethnicities proper age range (8-16 years) is important when assessing the onset (Figure 4). 12-15,17,20-23,49,77-79,84,85 30,47 Furthermore, comparison between studies from dif- 86 Specifically in children, BMI is often dependent on age and growth use the same anthropometric standards and sex-specific cut-offs. 13,14,16-23,49-51,77-80 fat and would represent a more accurate measurement in its regard. Based on this review, several suggestions can be made for further research. Firstly, the roles of adipokines like resistin, chemerin, visfatin, and omentin in puberty onset, fertility, and sexual maturation should be examined in detail. Secondly, future research examining the onset of puberty should combine indicators of puberty onset (e.g. breast development or testicular volume) with plasma or serum hor- mone measurements such as LH, FSH, sex-steroids, adipokines (e.g. spurts. ment in case of growth spurts. distribution of body fat should be taken into account in determining puberty and obesity in children. For instance, the body adiposity index (BAI), which was introduced in 2011 by Bergman et al.,87 uses hip cir- cumference and height in order to estimate the percentage of body 87 Thereby, BMI is a less accurate measure- F I G U R E 4 87,88 Therefore, both percentage and Average age of puberty onset in Europe, China, and the United States according to several studies from Table 1. Age of puberty onset ranges from 8.47 to 13.33 years in girls and from 8.63 leptin), and body fat distribution (e.g. BAI,87 waist-hip ratio's and/or dual-energy X-ray absorptiometry (DXA)2). Additionally, defining con- sistent and general measurements of puberty in both boys and girls, combined with a proper age range (8-16 years), would facilitate the comparisons between different studies and their results. 12-15, 17, 20-23, 25-29, 31 to 13.7 years in boys. included if average age of markers used to assess puberty was not reported. Pink: girls. Blue: boys Studies (Table 1) were not 39, 56 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 8 of 10 NIEUWENHUIS ET AL. 6 | CONCLUSION In conclusion, epidemiological data regarding obesity and puberty onset in girls show similar outcomes as adiposity results in the early onset of puberty in girls. The majority of the studies examining boys with obesity indicate an early onset of puberty, while not all reported an earlier onset of puberty. In detail, high leptin, TNF-Îą, and IL-6 levels combined with low adiponectin levels stimulate the activation of the HPG axis in girls and boys with obesity, and 5, 45, 50, 51 REFERENCES 1. Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. May- o Clin Proc. 2017;92(2):251-265. 2. Reinehr T, Roth CL. Is there a causal relationship between obesity and puberty? The Lancet Child & adolescent health. 2019;3(1):44-54. 3. WorldHealthOrganization. Facts and figures on childhood obesity. 2017. 4. Guglielmi V, Sbraccia P. Obesity phenotypes: depot-differences in adipose tissue and their clinical implications. Eat Weight Disord. 2018; 23(1):3-14. 5. Gomez-Hernandez A, Beneit N, Diaz-Castroverde S. Escribano O. 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BMC Womens Health. 2018;18(1):168-174. thereby an early onset of obesity. leptin can inhibit the production of testosterone in boys and subse- quently inhibit the development of secondary sex characteristics affecting spermatogenesis. for other adipokines, like resistin and omentin, are present in the testes and ovaries suggesting a role in puberty or reproduction; 58, 71 however, their plausible function is still unknown. that adipokines may be key regulators in an early onset of puberty in both girls and boys with obesity, specifically by affecting the HPG axis during gonadarche. Future research should focus on assessing puberty onset by measuring consistent puberty markers and determine the percentage of body fat and its distribution and adipokines and hormone serum levels particularly involved in the HPG axis. CONFLICTS OF INTEREST The authors declare no conflict of interest. FUNDING INFORMATION This research was funded by Europees Fonds voor Regionale Ontwikkeling (EFRO), project BriteN 2016. ORCID Ilse A.C. Arnoldussen Amanda J. Kiliaan https://orcid.org/0000-0002-7395-5284 https://orcid.org/0000-0002-2158-6210 13, 14, 16-26, 29-32 Furthermore, several receptors Nevertheless, We conclude Search strategy We searched PubMed for articles published before Novem- ber 15th, 2019 using relevant keywords, including âonset of puberty and adiposity/obesityâ, âonset of pubertyâ, âchildren with obesityâ, âadipose tissueâ, âchildhood obesityâ, âadiposityâ, âobesityâ, âadipokine(s)â, âHPG axisâ, âadipokines ovary/ova- riesâ, or âadipokines testesâ, either alone or in combination. 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Obesity Reviews. 2020;21:e13005. https://doi.org/ 10.1111/obr.13005 1467789x, 2020, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13005, Wiley Online Library on [10/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are gover