1Department of Nutrition, Science and Research Islamic Azad University, Tehran, Iran

2Department of Urology, Imam Reza Hospital, AJA College of Medical Sciences, Tehran, Iran

3Department of Pediatrics, Golestan Hospital, AJA College of Medical Sciences, Tehran, Iran


How to Cite:RezakhanihaS, RezakhanihaB, AarabiN, SiroosbakhtS. Is It Necessary to Weight Loss in Obese Boys through Small Penile Length? A Case-Control Study,J Compr Ped.2020; 11(4):e107272. doi: 10.5812/compreped.107272.

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Background: Nowadays, paleas are paying more attention to the penis size of their kids, specifically obese kids.

Objectives:The aim of this study wregarding investigate the correlation in between obesity, testosterone, and estradiol in prepubertal non-obese and obese kids via micropenis.

Methods:This case-regulate examine was done on 58 non-obese and 86 obese micropenis youngsters aged 8 - 13 years at Golestan Hospital, Tehran, Iran, from June 2018 to May 2020. The body mass index (BMI), testosterone and estradiol levels, stretched penile size (SPL), and the correlation in between these were stupassed away.

Results:The mea period of kids in non-obese and obese teams was 10.2 ± 1.34 and also 10.5 ± 1.6 years, respectively. SPL in non-obese and also obese subjects was 3.1 ± 1.3 and 2.9 ± 1.22 cm, respectively. SPL in both groups was significantly associated with height and testosterone (height: r = 0.239, P = 0.009; testosterone: r = 0.344, P = 0.001) yet not through BMI, weight, and estradiol. After the adjustment for age, BMI, weight, and also estradiol, adjusted odds ratio through confidence interval 95% for penile length across to elevation and testosterone levels in non-obese team was 1.52 (0.91 - 1.83; P = 0.001) and 0.56 (0.36 - 0.98; P = 0.001), respectively and in the obese group was 1.42 (0.81 - 1.66; P = 0.001) and also 0.75 (0.51 - 0.87; P = 0.001), respectively.

Conclusions:Penile size is positively correlated through height and testosterone but not with weight and estradiol in non-obese and also obese kids. It is most likely not vital and obligatory to recommfinish weight loss for this problem and weight loss need to not be pertained to by children and their paleas.


Keywords


ObesityTestosteroneBody Mass IndexEstradiolMicropenis

1. Background

Nowadays, weight problems and weight gain are one of the troubles of cultures, which impact around 35.1% of youngsters (1). Obese children may refer because of a little penis. The penis size is largely normal in these boys, and this is because of the fatty pubis, which hides the penis. This problem is referred to as concealed or buried penis (2).

Micropenis is truly tiny with a normal framework with a extended penis length (SPL) of 3). These boys and also their parental fees are came to through decrease top quality of life, tension, depression, fear of sex-related relationship, and also impotence (4, 5). Today, paleas are paying even more attention to the penis dimension of their children, specifically obese youngsters (6). On the various other hand also, delay in diagnosis of true micropenis in these children might decrease response to treatment and boost parental worry. As such, review of the penile length and also its correct measurement are crucial to both paleas and also health and wellness workers.

Accordingly, the knowledge of the relationship in between micropenis and weight and also hormonal levels is critically pertinent. To day, few studies have focused on true micropenis and its relationship via body mass index (BMI) and also hormonal levels in non-obese and also obese children. Tbelow is no consensus and agreement on the relationship between these factors and also micropenis. Different results have actually been obtained from previous studies, which suggests the prestige of even more research studies to accomplish even more definite results.

2. Objectives

The aim of this examine was to investigate the correlation in between weight, height, testosterone, and also estradiol and also micropenis in prepubertal non-obese and also obese prepubertal kids to carry out clear suggestions for this concern.

3. Methods

3.1. Study Populations

This case-regulate research was done on kids at Golestan Hospital, Tehran, Iran, from June 2018 to May 2020 schosen by basic convenience sampling technique. In this research, 765 prepubertal youngsters aged 8 - 13 years that referred because of little penis size and were based on evaluations, consisting of extended penile size (SPL) were studied. Patients were evaluated by a urologist and also a pediatrician, and also if they had true micropenis, they were enrolled in the study. Inclusion criteria were healthy boys aged 8 - 13 years and true micropenis (much less than 2.5 SD listed below the intend penis size for age) without any kind of chronic disease and also abnormality of the penis, such as curvature, scarring, and also penile surgical treatment. Exclusion criteria were background of taking corticosteroids, chronic illness, endocrine illness, such as thyroid condition and expansion hormone deficiency, surprise penis, undescfinishing testis, testis atrophy, varicocele, and also any kind of create of hypospadias. By reviewing the previous researches and making use of the below formula, and also C = 1.5, at least 56 non-obese children and also 84 obese kids were thought about for the study.


n=Z1-α2+1-1cP-1-P-+Z1-βP11-P1+P01-P0C2P1-P02

Figure 1.Flow diagram of the study

Based on the previous research studies, we discovered the most confounders of micropenis: abnormality of the penis, such as curvature, background of taking corticosteroids, chronic and also endocrine diseases, such as thyroid illness and development hormone deficiency, undescfinishing testis, testis atrophy, varicocele, and also any kind of create of hypospadias. Non-vital and gained factors were excluded by considering the inclusion and also exemption criteria. We concentrated on the selection of the main and also potential confounders in isolated micropenis in healthy and balanced prepubertal kids, consisting of age, sex steroid factors, height, weight, and BMI.

Minimizing and manage of the confounders in research design was done by restricting the study population to male prepubertal children aged 8 - 13 years. Period distribution was comparable in both groups, so that cofounding was decreased. Furthermore, we tried to keep the homogeneity of the teams via respect to feasible confounders, such as age, sex steroid determinants, height, weight, and also BMI, by corresponding the two teams. The Cochran-Mantel-Haenszel technique was used to control confounders, and statistical analysis was perdeveloped by multiple variable regression evaluation.

For result modification, pooled data converted to stratum-certain measures, and also stratified analysis was perdeveloped. If stvalidated actions of association were similar, but they differed from the total crude estimate by 10% or even more, there was just conbeginning, no modifiers.

To evaluate the outcomes, a sensitivity evaluation was perdeveloped that actions how the affect of unpredictabilities of input variables deserve to lead to uncertainties on the output variables. In this study, because of the variety of parameters, the one-at-a-time (OAT) strategy was supplied to rethink about the correlation in between height, testosterone, weight, and estradiol and the penile size. The sensitivity evaluation making use of graphs for each variable was performed.

All examicountries were percreated in a supine place at a temperature of 20°C - 23°C. Measurements were done through a leader (cm), and also after compushing the adipose tworry on the pubis, the SPL was calculated from the distance of the symphysis pubis to the reminder of the penis, which was totally extended. Measurements were done twice for each kid by only one urologist, and also the expect of these was tape-recorded.

Height measurement (cm) was perdeveloped through a standing meter without shoes through an accuracy of 0.5 cm. Beurer scale (Germany) was offered for measuring children’s weight (kg) without shoes and through light clothing with an accuracy of 100 g. BMI was taken into consideration as follows: Weight (kg)/Height2 (m2). Those through BMI ≥ 95 percentile were considered obese, and also those with BMI 1). Measurements were done twice for each kid by just one pediatrician, and the mean of these was tape-recorded.

Venous blood samples were taken at the hospital laboratory and kept at -20°C temperature. Testosterone was measured via radioimmunoassay via the detection limits 1 ng/mL and also intra-assay and inter-assay coefficients of variation (CV) of 3.2. Key Outcome Measures

The testosterone, estradiol, weight, height, BMI, and SPL and the connection between penile size and these variables in obese and non-obese teams were stupassed away as the study outcomes.

3.3. Statistical Analysis

Data were analyzed by SPSS statistical software program version 24 (SPSS Inc, Chicago, IL, USA). For quantitative variables, expect and also SDs, and for qualitative variables, frequency and also frequency percent were calculated. The distinction between SPL and also anthropometrics and also hormonal variables evaluated by student t-test and also Pearson’s correlation coeffective (r) was used for statistical analyses. In subgroups, stratified variables were compared by the chi-square test. Also, a multiple logistic regression version was done to evaluate the odds ratio (OR) with confidence intervals 95% (CI 95%) to manage the conbeginning variables. P worth

4. Results

The mea period of children in the non-obese and obese teams was 10.2 ± 1.34 and also 10.5 ± 1.6 years, respectively. Adjustment for confounding variables in research style was percreated by restricting the research population to male healthy prepubertal kids aged 8 - 13 years. Median, and SD of SPL in non-obese and also obese were 3.1 ± 1.3 and also 2.9 ± 1.22 cm, respectively. Anthropometric procedures and hormonal assessments of the non-obese group were as follows: height: 143.5 ± 10.3 cm, weight: 50.3 ± 11.6 kg, BMI: 20.12 ± 4.34 kg/m2, testosterone: 1.4 ±1.82 ng/mL, and also estradiol: 49.54 ± 9.7 pg/mL and height: 148.83 ± 11.63 cm, weight: 60.58 ± 16.27 kg, BMI: 39.24 ± 6.01 kg/m2, testosterone: 1.05 ± 1.66 ng/mL, and also estradiol: 52.28 ± 12.22 pg/mL for obese kids. Demographic attributes and also hormones levels of the subjects are displayed in Table 1. Non-obese and also obese teams were matched regarding basic qualities. Furthermore, the study groups did not differ via respect to possible confounders, such as age, sex steroid determinants, height, and also weight.

Table 1. Basic Characteristics and also Hormonal Levels of Micropenis Children in Obese and Non-Obese Groupsa
Groups Non-Obese (N = 58)Obese (N = 86)P ValueMinMaxMean ± SDMinMaxMean ± SD
Period, y81310.2 ± 1.3481310.5 ± 1.60.72
Height, cm131169143.5 ± 10.3123176148.83 ± 11.630.43
Weight, kg317350.3 ± 11.63013260.58 ± 16.270.04
BMI, kg/m214.0626.520.12 ± 4.3430.448.4839.24 ± 6.010.02
SPL, cm14.93.1 ± 1.31.35.52.9 ± 1.220.52
Testosterone, ng/dL0.710.21.4 ± 1.820.0112.71.05 ± 1.660.33
Estradiol, pg/mL18.969.749.54 ± 9.7167552.28 ± 12.220.29

Abbreviations: BMI, body mass index; SD, typical deviation; SPL, stretched penile size.

aObese and non-obese teams were matched regarding standard features.


SPL in non-obese group was positively associated with elevation and also testosterone (height: r = 0.210, P = 0.023; testosterone: r = 0.332, P = 0.001) but not through BMI, weight, and also estradiol (r = -0.156, P = 0.091; r = - 0.036, P = 0.696; r = 0.088, P = 0.341, respectively). Similarly, SPL in obese kids was positively and considerably associated with elevation and also testosterone (height: r = 0.239, P = 0.009; testosterone: r = 0.344, P = 0.001) but not with BMI, weight, and also estradiol (r = -0.175, P = 0.058; r = - 0.036, P = 0.701; r = 0.093, P = 0.317, respectively) (Table 2).

Table 2. Correlation Coefficients (r) of Penile Length, BMI and Hormonal Levels in Each Groupa
GroupsHeightWeightBMITE
SPL (non-obese)
r0.210-0.036-0.1560.3320.088
p0.0230.6960.0910.0010.341
SPL (obese)
r0.239-0.036-0.1750.3440.093
p0.0090.7010.0580.0010.317

Abbreviations: BMI, body mass index; E, estradiol; SPL, stretched penile length; T, testosterone.

aSPL was positively and significantly associated through elevation and also testosterone however not via weight, estradiol, and BMI in both teams.


For result alteration, the data were stvalidated by elevation, weight, testosterone, and estradiol. Stratified steps of association were comparable to each various other, yet they differed from the complete crude estimate by 10% or even more. As such, tbelow was only constarting, no modifiers. The categorical element with substantial OR (P Table 3).

Table 3. Stratifying Data through Odds Ratio (95% Confidence Interval) For Obese and Non-Obese Groups Regarding Confounder Variablesa, b
GroupsNon-ObeseObeseCrudeAdjustedP ValueOR95% CI (Lower-Upper)OR95% CI (Lower-Upper)
Height, cm1.43(0.82 - 1.68)1.57(0.91 - 1.85)0.009
120 - 15020 (34.5)37(43)
151 - 18038 (65.5)49 (57)
Weight0.39(0.24 - 0.67)0.43(0.26 - 0.74)0.69
30 - 7037 (63.8)35 (40.6)
71 - 13021 (36.2)51 (59.4)
Testosterone0.76(0.51 - 0.89)0.84(0.56 - 0.98)0.001
NL40 (68.9)66 (76.4)

Abbreviation: NL, normal; 0R, odds proportion.

aValues are expressed as No. (%).

bIn the multiple variable regression analysis, obese micropenis youngsters had not a significant odds regarding weight, and also estradiol levels compared through non-obese youngsters. Height and also testosterone had considerable odds ratio (P

Crude and also readjusted ORs through CI 95% for penile length in non-obese and also obese children via micropenis throughout to height and also Testosterone levels were presented in Table 4. After adjustment by age, BMI, weight and Estradiol, in relation to elevation in non-obese team, OR through 95% CI was 1.52 (0.91 - 1.83), P = 0.001 and in relation to Testosterone levels was 0.56 (0.36 - 0.98), P = 0.001. In relation to elevation in obese team, OR via 95% CI was 1.42 (0.81 - 1.66), P = 0.001 and also in relation to Testosterone levels was 0.75 (0.51 - 0.87), P = 0.001.

Table 4. Overall Crude and also Adjusted Odds Ratio with 95% Confidence Interval for Penile Length in Non-Obese and also Obese Groups Regarding Height and Testosterone Levels
Penile LengthNon-Obese (N = 58)Obese (N = 86)P ValueORb95% CI (Lower-Upper)OR95% CI (Lower-Upper)
Height0.001
Crude1.39(0.82 - 1.66)1.29(0.74 - 1.51)
Adjusteda1.52(0.91 - 1.83)1.42(0.81 - 1.66
Testosterone0.001
Crude0.51(0.33 - 0.89)0.68(0.46 - 0.79)
Adjusted0.56(0.36 - 0.98)0.75(0.51 - 0.87)

Abbreviations: CI, confidence interval; OR, odds ratio.

aAdjusted = adjusted for age, BMI, weight and estradiol.

bThe odds proportion was figured out by the multiple logistic regression evaluation.


The sensitivity analysis-graph for each variable had actually analyzed in the offered charts (Figure 2). The line graphs proved the sensitivity of SPL to the elevation and testosterone yet not to weight and estradiol.



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