Percentage of participants on Tanner stages 1-5 based on standard deviation score (SDS) body mass index (BMI) and the presence of hyperinsulinemia, insulin resistance, or type 2 diabetes mellitus (T2DM) in <9-year children. (A) shows the percentage of participants in each Tanner stage based on SDS BMI. The percentage of normal-weight (−1≤ SDS <1) participants on Tanner stage 1 was significantly lower in the normal-weight group than in overweight (1≤ SDS <2), obese (2≤ SDS <3), and severely obese (SDS ≥3) groups. The frequency of Tanner stage 3 was significantly higher in normal weight than in the other groups. No difference was found for the other Tanner stages. (B) shows the percentage of participants in each Tanner stage based on the presence of hyperinsulinemia (insulin ≥20 µIU/mL) or normal insulin serum levels (<20 µIU/mL). The frequency of each Tanner stage was similar between the two subgroups. (C) shows the percentage of participants in each Tanner stage based on the presence of insulin resistance (IR) (homeostatic model assessment [HOMA] index ≥2.5 for age <9 years and 14-16 years, >3.2 for age 9-14 years) or its absence (HOMA index <2.5 for age <9 years and 14-16 years, ≤3.2 for age 9-14 years). Compared to the insulin-resistant group, a trend toward a higher percentage of patients on Tanner stage 1 was found in the HOMA index <2.5 group. A significantly higher frequency of Tanner stage 2 was found in the group with insulin resistance than in that without. No difference in the frequency of the other Tanner stages was found between the two groups. (D) shows the percentage of participants in each Tanner stage based on the absence of T2DM or the presence of pre-diabetes. No difference in the percentage of each Tanner stage was found.