Age at menarche and its association with the metabolic syndrome and its components: results from the KORA F4 study

Exploring the link between age at menarche, anthropometry and body fat composition with type II diabetes in a Singapore multi-ethnic cohort

BACKGROUND

Early menarche is associated with lifelong health implications, including heightened risks for obesity, type 2 diabetes (T2D), cardiovascular disease, and overall mortality. This study explored the associations that link early menarche, major adiposity indices, and T2D in a group of multi-ethnic Asian women.

METHODS

A prospective, hospital-based study was conducted in Singapore. Two thousand seven hundred fifteen women were recruited from 2014 to 2016 (45-69 years old) and 1201 women were followed up from 2021 to 2023. At baseline, age at menarche (AAM) was divided into sub-categories: < 12 (early AAM), 12-13, 14-15 (reference), > 15 years. Major adiposity indices and glycemic profiles were assessed, including fat mass index (FMI), visceral adipose tissue (VAT), and HOMA-IR (homeostatic model assessment for insulin resistance). At the 6.6-year follow-up, T2D was assessed. One-way ANOVA and chi-square were performed for continuous and categorical variables, respectively. Multivariable regression analysis was performed to determine the association between AAM and primary outcomes, including adiposity measurements (FMI, VAT) and metabolic assessments (HOMA-IR) at baseline. Modified Poisson regression was performed to assess relative risk (RR) between AAM and T2D at follow-up. Serial mediation analysis was performed to determine potential mediators underlying the link between AAM and T2D. All analyses accounted for major confounders including age, ethnicity, and education.

RESULTS

Women with early AAM had significantly greater values in adiposity assessments, including increments in FMI (10.9 vs 10.3, p < 0.001), VAT (134 vs 113 cm2, p = 0.05) and HOMA-IR (1.20 vs 1.03, p = 0.08) at baseline. Early AAM (< 12 vs. 14-15 years) was associated with a 60% increased risk of developing T2D (RR 1.60 (95%CI: 1.04, 2.45)). Serial mediation analysis suggested a significant pathway underlying early AAM and T2D, which was firstly mediated by FMI, followed by VAT and lastly by HOMA-IR (p < 0.05).

CONCLUSIONS

Our study provided valuable insight into the pathophysiology of T2D development amongst mid-life women with early AAM. The findings could potentially indicate strategies to target FMI and VAT among Asian women in the menopausal phase with early AAM, to prevent the development of T2D.

Circulating adipokines in girls with central precocious puberty: A systematic review and meta-analysis

OBJECTIVES

This meta-analysis aimed to assess circulating adipokine levels in girls with central precocious puberty (CPP) and compare them with those in healthy controls.

METHODS

An exhaustive literature search was conducted, using the Embase, PubMed, Web of Science, Cochrane Library, and Scopus databases, from the inception of the study to October 31, 2023, to identify relevant studies. Studies comparing the serum levels of adiponectin, leptin, irisin, apelin, omentin,chemerin, resistin, vaspin, and visfatin in girls with CPP and healthy girls of the same age were included. The findings were summarized in Grading of Recommendations Assessment, Development, and Evaluation evidence profiles and synthesized qualitatively.

RESULTS

Eleven studies that included 701 girls with CPP and 590 healthy girls were analyzed after the selection process. Leptin levels were significantly increased, whereas adiponectin levels were decreased in girls with CPP. Irisin levels did not change significantly. Subgroup and meta-regression analyses indicated that the heterogeneity in the association of leptin with CPP might be due to factors such as the number of cases, diagnostic criteria for CPP, and measurement methods.

CONCLUSIONS

Adipokines levels were altered in girls with CPP compared with those in healthy controls. Preventing obesity in children and adolescents with CPP is crucial.

PROSPERO REGISTRATION NUMBER

CRD42022371490.

IMPACT

This meta-analysis is the first to explore the relationship between adipokines and central precocious puberty. The results of this systematic review provide evidence that adipokines levels are altered in girls with central precocious puberty (CPP) compared with those in healthy controls. CPP in girls increases the risk of cardiovascular disease in adulthood. Preventing obesity in children and adolescents, especially in those with precocious puberty, is crucial.

Age at Menarche and Coronary Artery Disease Risk: Divergent Associations with Different Sources of Variation

Background

In women, both earlier and later age at menarche (AAM) are associated with increased risk of coronary artery disease (CAD). This study sought to determine if the relationship of AAM with CAD and CAD risk factors differs for different underlying sources of variation in AAM - specifically, variation attributable to common genetic variants as represented by a polygenic score (PGS) vs. variation in AAM adjusted for the PGS.

Methods

Primary analyses were conducted on data from 201,037 women in the UK Biobank and validation studies on data from 23,268 women in the Women's Genome Health Study (WGHS). For each individual, a PGS for AAM was calculated, then two variables were estimated from linear regression models: the genetically predicted AAM (the estimated AAM for each woman solely due to the effects of common genetic variants) and the PGS-adjusted AAM (estimated AAM for each woman solely due to factors other than the PGS). Logistic regression and linear splines were then used to study the relationships of these variables with CAD and CAD risk factors.

Results

Genetically predicted AAM demonstrated a linear relationship with CAD and linear or roughly linear relationships with CAD risk factors. In contrast, PGS-adjusted AAM demonstrated a U-shaped relationship with CAD and with hemoglobin A1c, triglycerides, HDL-C, and waist-hip ratio. Validation studies using WGHS data produced similar results.

Conclusions

These results suggest that later AAM itself does not cause increased risk of CAD; rather, upstream sources of variation other than common genetic variants can cause both later AAM and increased risk of CAD. Dysglycemia, dyslipidemia, and central adiposity are candidate mediators of the association of later AAM with increased risk of CAD.

Exploring the Influence of Age at Menarche on Metabolic Syndrome and Its Components Across Different Women's Birth Cohorts

PURPOSE

Metabolic syndrome (MetS) is the primary cardiovascular risk factor, making it a global issue. Our objective was to assess the association between the age at menarche (AAM) and MetS and its components in different generations of women.

METHODS

In this cross-sectional study, 5500 eligible women aged ≥ 20 who participated in the Tehran lipid and glucose study in 2015-2017 were selected. Participants were divided into groups by birth cohorts (BC) (born ≤ 1959, 1960-1979, and ≥ 1980) and AAM (≤ 11, 12-15, and ≥ 16 years, early, normal, and late, respectively). The status of MetS and its components were compared amongst participants using logistic regression.

RESULTS

Normal AAM (12-15 years) was considered the reference group. The adjusted model revealed that AAM ≤ 11 is associated with a higher risk of 34% (95% confidence interval (CI): 1.04, 1.71) in MetS, and the prevalence of MetS in the early menarche group was higher in BCI, and BCII (odds ratio (OR): 1.87; 95% CI: 1.04, 3.36 and OR: 1.33; 95% CI: 1.00, 1.89, respectively). Those with late menarche demonstrated a lower risk (OR:0.72; 95% CI: 0.57, 0.91) of abdominal obesity, and early menarche showed a higher risk (OR: 1.45; CI: 1.14, 1.86). This higher risk in early menarche was observed in BCI and BCII (OR: 1.76; 95% CI: 1.16, 2.66 and OR: 1.80; 95% CI: 1.23, 2.64, respectively). However, the protective effect of late menarche was observed in BC II and BC III (OR: 0.74; 95% CI: 0.54, 1.00 and OR: 0.64; 95% CI: 0.44, 0.96, respectively).

CONCLUSIONS

The influential effect of AAM on metabolic disturbances varies amongst different generations.

Age at Menarche and Its Association With Adult-Onset Metabolic Syndrome and Related Disorders in Women: A Cross-Sectional Study of a Nationally Representative Sample Over 10 Years

The prevalence of metabolic syndrome (MetS) as well as related social costs and efforts is increasing. The purpose of this study was to investigate the association between age at menarche and the risk of MetS, obesity, diabetes, and cardiovascular disease (CVD) in women over 30 years, using data from the Korean National Health and Nutrition Examination Survey (2010-2020). The analysis of 30 916 participants showed that early menarche (before 11 years) significantly increased the risk of obesity, diabetes, and MetS compared with the median age of 14 years. Late menarche (after 17 years) was also linked to MetS and related disorders. The relationship between age at menarche (at <10 years and >19 years) and the risk of MetS and related disorders exhibited a reversed J-shaped (し) pattern characterized by a pronounced increased risk among those who experience early menarche, whereas the increased risk associated with late menarche was less consistent. These results will help to decrease the risk of MetS and related disorders by enabling early intervention in early and late menarche age groups.

Body Mass Index and Hypertension as Mediators of the Association Between Age at Menarche and Subclinical Atherosclerosis: A Sex-Specific Mendelian Randomization Analysis

BACKGROUND

Early age at menarche (AAM) has been associated with a higher risk of carotid artery intima-media thickness (cIMT), an indicator of subclinical vascular disease, albeit the mechanisms underlying this association remain elusive. A better understanding of the relationship between AAM, modifiable cardiometabolic risk factors, and subclinical atherosclerosis may contribute to improved primary prevention and cardiovascular disease treatment. We aimed to investigate the putative causal role of AAM on cIMT, and to identify and quantify the potentially mediatory effects of cardiometabolic risk factors underlying this relationship.

METHODS AND RESULTS

We conducted linkage disequilibrium score regression analyses between our exposure of interest, AAM, our outcome of interest, cIMT and potential mediators of the AAM-cIMT association to gauge cross-trait genetic overlap. We considered as mediators the modifiable anthropometric risk factors body mass index (BMI), systolic blood pressure (SBP), lipid traits (total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), and glycemic traits (fasting glucose). We then leveraged the paradigm of Mendelian randomization to infer causality between AAM and cIMT, and to identify whether cardiometabolic risk factors served as potential mediators of this effect. Our analyses showed that genetically predicted AAM was inversely associated with cIMT, BMI, SBP, and triglycerides, and positively associated with high-density lipoprotein, low-density lipoprotein, and total cholesterol. We showed that the effect of genetically predicted AAM on cIMT may be partially mediated through BMI (20.1% [95% CI, 1.4% to 38.9%]) and SBP (13.5% [95% CI, 0.5%-26.6%]). Our cluster-specific Mendelian randomization revealed heterogeneous causal effect estimates of age at menarche on BMI and SBP.

CONCLUSIONS

We highlight supporting evidence for a potential causal association between earlier AAM and cIMT, and almost one third of the effect of AAM on cIMT may be mediated by BMI and SBP. Early intervention aimed at lowering BMI and hypertension may be beneficial in reducing the risk of developing subclinical atherosclerosis due to earlier age at menarche.

Reproductive risk factors across the female lifecourse and later metabolic health

Metabolic health is characterized by optimal blood glucose, lipids, cholesterol, blood pressure, and adiposity. Alterations in these characteristics may lead to the development of type 2 diabetes mellitus or dyslipidemia. Recent evidence suggests that female reproductive characteristics may be overlooked as risk factors that contribute to later metabolic dysfunction. These reproductive traits include the age at menarche, menstrual irregularity, the development of polycystic ovary syndrome, gestational weight change, gestational dysglycemia and dyslipidemia, and the severity and timing of menopausal symptoms. These risk factors may themselves be markers of future dysfunction or may be explained by shared underlying etiologies that promote long-term disease development. Disentangling underlying relationships and identifying potentially modifiable characteristics have an important bearing on therapeutic lifestyle modifications that could ease long-term metabolic burden. Further research that better characterizes associations between reproductive characteristics and metabolic health, clarifies underlying etiologies, and identifies indicators for clinical application is warranted in the prevention and management of metabolic dysfunction.

Age at menarche, type 2 diabetes and cardiovascular disease complications in US women aged under 65 years: NHANES 1999-2018

Background

Diabetes and diabetes complications are on the rise in US adults aged <65 years, while onset of menarche at a younger age is also increasing. We examined the associations of age at menarche with type 2 diabetes among women aged <65 years and with cardiovascular disease (CVD) complications among women with diabetes.

Methods

Using the nationally representative cross-sectional National Health and Nutrition Examination Survey 1999-2018, women aged 20-65 years free of cancer were included in the current analysis. Diabetes was defined as a self-reported diabetes diagnosis. CVD was defined as coronary heart disease or stroke. Age at menarche was self-reported age of first menstruation and categorised into ≤10, 11, 12, 13, 14 and ≥15 years.

Results

Of 17 377 women included in the analysis, 1773 (10.2%) reported having type 2 diabetes. Earlier age at menarche was associated with type 2 diabetes compared with median age at menarche of 13 years, after adjustment for age, race/ethnicity, education, parity, menopause status and family history of diabetes, smoking status, physical activity, alcohol consumption and body mass index (p for trend=0.02). Among women with diabetes, earlier age at menarche was associated with stroke with similar adjustment (p for trend=0.03), but not with total CVD. Extremely early age at menarche (≤10 years) was significantly associated with stroke (adjusted OR 2.66 (95% CI 1.07 to 6.64)) among women aged <65 years with diabetes with similar adjustment.

Conclusions

Earlier age at menarche was associated with type 2 diabetes among young and middle-aged women in the USA and with stroke complications among these women living with diabetes.

Age at menarche and metabolic dysfunction-associated fatty liver disease: Evidence from a large population-based epidemiological study in Southwest China

BACKGROUND

The relationship between age at menarche and metabolic dysfunction-associated fatty liver disease remains largely not clear. The objective of this study was to examine the association between age at menarche (AAM) and metabolic dysfunction-associated fatty liver disease (MAFLD) in Chinese women and whether any observed associations were mediated by early adulthood adiposity.

METHODS

The cross-sectional study included 46,873 Chinese women, aged 30-79 from baseline data of the China Multi-Ethnic Cohort study. Logistic regression models were used to evaluate the association between AAM and MAFLD. Mediation analysis was adopted to examine whether early adulthood adiposity (around 25 years) mediated the association between AAM and MAFLD.

RESULTS

AAM was linearly and inversely associated with the risk of MAFLD (P for nonlinearity =0.743). In a multivariable-adjusted model, the odds ratios and 95% confidence interval (ORs (95% CI)) for MAFLD comparing menarche at <12, 12, 13, 15, 16, 17, ≥18 years to menarche at 14 years were 1.290 (1.082-1.537), 1.172 (1.068-1.285), 1.042 (0.960-1.131), 0.937 (0.861-1.020), 0.911(0.835-0.994), 0.868 (0.786-0.959), and 0.738 (0.670-0.814), respectively (P for trend <0.001). The 6.4% increased MAFLD risk was associated with each preceding year in AAM. The association between AAM and MAFLD was modified by age, ethnicity, and menopause. Early adulthood adiposity partially mediated this association.

CONCLUSION

The findings of this study suggest that obesity prevention strategies are needed from young adulthood in women who undergo early menarche to reduce the risk of MAFLD.

Age at Menarche, Menopause Status and Metabolic Syndrome and its Components: Findings from the Henan Rural Cohort Study

INTRODUCTION

To evaluate the effect of age at menarche on metabolic syndrome (Mets) and its components and explore the impact of menopause status on the association between age at menarche and Mets in rural Chinese women.

METHODS

This cross-sectional study enrolled 23382 women from the Henan Rural Cohort study. The relationship between age at menarche and Mets was assessed using logistic regression and restricted cubic spline. Interaction plots were used to describe interactive effects of age at menarche and menopause status on Mets.

RESULTS

Age at menarche was inversely associated with the risk of Mets with the adjusted OR of 1.16, 0.98, 1.00, 0.82, and 0.77, respectively, for those with age at menarche≤13, 14, 15-16 (reference), 17, and≥18 years. Each year of delay in menarche age correlated with a 6.2% (P<0.001) lower risk of Mets. Among the components of Mets, an inverse association was observed between age at menarche and central obesity (OR (95% CI): 0.92 (0.90, 0.94)), abnormal FPG (OR (95% CI): 0.96 (0.94, 0.97)), abnormal BP (OR (95% CI): 0.967 (0.95, 0.98)), abnormal TG (OR (95% CI): 0.96 (0.94, 0.97)), and abnormal HDL-C (OR (95% CI): 0.96 (0.95, 0.98)). Significant interactions were discovered between age at menarche, menopause status, and the risk of Mets, central obesity, abnormal FPG, abnormal BP, and abnormal TG (all P interaction<0.001). The adverse effect of menopausal status on Mets, central obesity, abnormal FPG, abnormal BP, and abnormal TG decreased with delayed age at menarche.

CONCLUSIONS

Later menarche was associated with a lower risk of Mets. More importantly, the deleterious effect of menopause status on Mets decreased with the increase in age at menarche.

The association between arterial hypertension and menarcheal age

OBJECTIVE

Menarche, as a milestone of puberty, may have a long-term effect on health. The present study investigated the association of age at menarche with the incidence of arterial hypertension.

STUDY DESIGN

A total of 4747 post-menarcheal participants of the Tehran Lipid and Glucose Study who met the eligibility criteria were selected. Demographic, lifestyle, reproductive, and anthropometric data, as well as risk factors for cardiovascular diseases, were collected. Participants were classified according to their age at menarche: group I: ≤11 years, group II: 12-15 years, and group III: ≥16 years.

MAIN OUTCOME MEASURES

A Cox proportional hazards regression model was used to estimate the associations between age at menarche and arterial hypertension outcomes. The generalized estimating equation models were used to compare the trend of changes in systolic and diastolic blood pressure between the three groups.

RESULTS

The mean age of participants at baseline was 33.9 (13.0). At the end of the study, 1261 (26.6 %) participants had arterial hypertension. Women in group III had a 2.04-fold higher risk of arterial hypertension than those in group II. The mean changes in systolic and diastolic blood pressure were 29 % (95 % CI: 0.02-0.57) and 16 % (95 % CI: 0.00-0.38) higher for women in group III compared with group II.

CONCLUSIONS

Late menarche could be a risk factor for arterial hypertension, so it is necessary to pay more attention to age at menarche in cardiovascular risk assessment programs.

Relationship between age at menarche and metabolic diseases in Korean postmenopausal women: The Korea National Health and Nutrition Examination Survey 2016-2018

BACKGROUND

Cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women. Early menarche may be associated with an increased risk of metabolic diseases such as diabetes and cardiovascular disease. This study aimed to investigate the effect of menarche age and the risk of diabetes and metabolic syndrome in Korean postmenopausal women.

METHODS

We analyzed 4,933 postmenopausal women (mean age: 64.7 years) using the Korean National Health and Nutritional Examination Survey 2016-2018. Subjects were divided into three groups according to menarche age (early menarche: ≤ 12 years (n = 451), reference: 13-16 years (n = 3,421), and late menarche: ≥ 17 years (n = 1,061)). Logistic regression analysis was used to estimate the odds ratio (OR) for diabetes and metabolic syndrome.

RESULTS

Women with an early menarche age were younger, more educated, and had higher income than the other groups (p-value < 0.001). There were no differences in body mass index, blood pressure, fasting glucose, HbA1c, and cholesterol levels among the three groups. After adjusting for potential confounding factors, early menarche age was significantly associated with the risk of diabetes (OR 1.435, 95% confidence interval (CI): 1.069-1.928). The prevalence of metabolic syndrome in all subjects was 41.1%. After adjusting for potential confounding factors, the OR of metabolic syndrome in the early menarche group was 1.213 (95% CI: 0.971-1.515).

CONCLUSION

The risk of diabetes was 1.43 times higher in postmenopausal Korean women with early menarche. Although the risk of metabolic syndrome was not statistically significant, it showed a tendency to increase in the early menarche group. Our results suggest that age at menarche may be helpful in diabetes risk stratification and early interventions for postmenopausal women.

Age at Menarche, Growth Velocity, and Adiposity Indices in Italian Girls Aged 10 to 14

Age at menarche (AAM) is an effective marker of puberty timing but its onset could be influenced by several intrinsic and extrinsic factors. This study aimed to assess the AAM in a sample of Italian adolescents and to investigate its association with anthropometric variables. Considering the rise in overweight/obesity worldwide, special attention was paid to a possible decrease in AAM as adiposity indices increase. A longitudinal study was carried out on 117 middle school girls in Northern Italy. Data concerning menarche and anthropometric traits (standing and sitting height, weight, waist circumference, and skinfold thicknesses) were directly collected. Lower limb length and indices of adiposity and growth were calculated. The median AAM was 11.66 (95% IC: 11.31-11.68). Age-adjusted ANCOVA between mature and non-mature girls showed significant differences in growth-related traits and WHtR. No preponderance of overweight/obesity among mature participants was found. AAM was not significantly associated with weight or the growth velocity of adiposity indices in a subsample of maturers. Moreover, the median AAM of our sample was similar to that found in women born about 60 years ago in the same region. In conclusion, in addition to a stabilization of AAM since the 1960s, our results suggest that there is no significant correlation between increased adiposity and early AAM.

Optimized Metabotype Definition Based on a Limited Number of Standard Clinical Parameters in the Population-Based KORA Study

The aim of metabotyping is to categorize individuals into metabolically similar groups. Earlier studies that explored metabotyping used numerous parameters, which made it less transferable to apply. Therefore, this study aimed to identify metabotypes based on a set of standard laboratory parameters that are regularly determined in clinical practice. K-means cluster analysis was used to group 3001 adults from the KORA F4 cohort into three clusters. We identified the clustering parameters through variable importance methods, without including any specific disease endpoint. Several unique combinations of selected parameters were used to create different metabotype models. Metabotype models were then described and evaluated, based on various metabolic parameters and on the incidence of cardiometabolic diseases. As a result, two optimal models were identified: a model composed of five parameters, which were fasting glucose, HDLc, non-HDLc, uric acid, and BMI (the metabolic disease model) for clustering; and a model that included four parameters, which were fasting glucose, HDLc, non-HDLc, and triglycerides (the cardiovascular disease model). These identified metabotypes are based on a few common parameters that are measured in everyday clinical practice. These metabotypes are cost-effective, and can be easily applied on a large scale in order to identify specific risk groups that can benefit most from measures to prevent cardiometabolic diseases, such as dietary recommendations and lifestyle interventions.

Mediator or moderator? The role of obesity in the association between age at menarche and blood pressure in middle-aged and elderly Chinese: a population-based cross-sectional study

OBJECTIVE

We investigated the moderation/mediation between the age of menarche and obesity parameters in predicting blood pressure (BP) in middle-aged and elderly Chinese.

DESIGN

Our study is a population-based cross-sectional study.

SETTING

Participants in this study came from the China Health and Retirement Longitudinal Study (CHARLS).

PARTICIPANTS

The analytical sample included 4513 participants aged 45-96 years.

MAIN OUTCOME MEASUREMENTS

Data were selected from the CHARLS, a cross-sectional study. Between-group differences were evaluated using χ², t-test and one-way analysis of variance. The trend of related variables by characteristics was also tested using contrast analysis, as appropriate. Then, correlations between characteristics, moderator, mediator, and independent and dependent variables were used by Spearman's correlation test and Pearson's correlation test. Finally, the mediation analysis was performed by model 4 in PROCESS V3.3 macro for SSPSS, and moderation analysis was used by model 1 for assessment. All covariates were adjusted in the moderation or mediation models.

RESULTS

In the correlation analysis, body mass index (BMI) and waist circle (WC) level were positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in women (BMI and DBP: r=0.221, p<0.001; WC and DBP: r=0.183, p<0.001; BMI and SBP: r=0.129, p<0.001; WC and SBP: r=0.177, p<0.001). Age of menarche was negatively correlated with DBP (r=-0.060, p<0.001). However, the age of menarche was not significantly correlated with SBP (r=-0.014, p=0.335). In the moderator analysis, after controlling for the potential confounders, the interaction term of obesity parameters×age of menarche was not significant for predicting either DBP (BMI: B=0.0260, SE=0.0229, p=0.2556, 95% CI -0.0189 to 0.071; WC: B=0.0099, SE=0.0074, p=0.1833, 95% CI -0.0047 to 0.0244) or SBP (BMI: B=0.0091, SE=0.0504, p=0.8561, 95% CI -0.0897 to 0.108; WC: B=-0.0032, SE=0.0159, p=0.8427, 95% CI -0.0343 to 0.028). All correlations were significant correlation between age of menarche, obesity parameters and BP except the path of the menarche age→SBP (with the addition of the BMI indicator: β=-0.0004, B=-0.0046, p=0.9797, 95% CI -0.3619 to 0.3526; with the addition of the WC indicator: β=0.0004, B=0.0044, p=0.9804, 95% CI -0.3439 to 0.3526) in crude model. In general, after controlling for potential confounders, BMI (DBP: β=-0.0471, B= -0.2682, p=0.0021, 95% CI -0.4388 to -0.0976; SBP: β=-0.0515, B=-0.6314, p<0.001, 95% CI -0.9889 to -0.2739) and WC (DBP: β=-0.0474, B= -0.2689, p<0.001, 95% CI -0.4395 to -0.0984; SBP: β=-0.0524, B=-0.6320, p<0.001, 95% CI -0.9832 to -0.2807) partly mediated the relationship between age of menarche and BP.

CONCLUSIONS

The interaction term of obesity parameters×age of menarche was not significant for predicting either DBP or SBP in women. Moreover, obesity parameters partly mediated the relationship between the age of menarche and BP.

Altered cardiometabolic profile in girls with central precocious puberty and adipokines: A propensity score matching analysis

OBJECTIVE

To compare cardiometabolic factors and adipokines between patients with recently diagnosed CPP and controls without CPP, paired by BMI Z scores (BMIz) and classified into girls with adequate nutritional status and girls who are overweight or obese.

METHODS

This cross-sectional study was performed from January 2012 to May 2015 at two tertiary care pediatric centers in Mexico City. We included female patients with idiopathic CPP without other chronic pathology and healthy controls. Patients were divided into groups, BMI < 85th and BMI ≥ 85th percentile, according to 2000 CDC Growth Charts. Anthropometric data and fasting plasma concentrations of lipids, glucose, insulin, and leptin were assessed.

RESULTS

There were 73 patients with CPP and 82 without CPP. Sixty-six patients were matched between the groups; no significant difference was noted between the groups according to zBMI. However, differences in the bone/chronological age relationship, birth weight and proportions in different Tanner stages were observed. Among girls with normal BMI, the percentage of body fat (24.6% vs 18.9%, p < 0.001), serum triglycerides (102.9 vs 54.3 mg/dl, p < 0.001), leptin (7.46 vs 5.4 ng/ml, p = 0.010) and free leptin (0.44 vs 0.29 ng/ml, p = 0.044) were higher in those with CPP; additionally, girls with CPP presented a higher proportion of hypertriglyceridemia. In the overweight/obese group, adiponectin levels were lower in girls with CPP (6.23 vs 7.28 pg/ml, p = 0.011).

CONCLUSIONS

Girls with CPP and normal BMI at diagnosis had a worse cardiometabolic profile, as reflected by higher levels of free leptin, and higher proportion of hypertriglyceridemia than girls without CPP.

The role of multiparity and maternal age at first pregnancy in the association between early menarche and metabolic syndrome among middle-aged and older women

OBJECTIVE

To analyze whether maternal age at first pregnancy and parity are mediators of the association between early menarche and metabolic syndrome in a sample of middle-aged and older women.

METHODS

Cross-sectional study of 428 women (40 to 80 y), who had experienced a pregnancy in their lifetime, was performed between 2014 and 2016. Age at first pregnancy, parity, and early menarche were self-reported. Metabolic syndrome was assessed using the criteria described by the National Cholesterol Education Program's Adult Treatment Panel III. The association between metabolic syndrome and early menarche was assessed by logistic regression analysis. The mediating role of age at first pregnancy and multiparity in the relationship between early menarche and metabolic syndrome was assessed through mediation analysis, adjusted for covariates.

RESULTS

According to adjusted logistic regression models, early menarche was associated with higher odds of prevalent metabolic syndrome (OR: 2.26; 95% CI: 1.15-4.46). Mediation analysis showed a significant direct effect of early menarche on metabolic syndrome (β: 0.808; 95% CI: 0.107-1.508). Of the two mediators tested, age at first pregnancy was significant (β: 0.065; 95% CI: 0.004-0.221), ie, participants with and without early menarche differ, on average, by 0.879 SDs in the log odds of MetS (total effect), of which 0.065 SDs (8%), on average, would be attributable to the effect of early menarche on age at first pregnancy (indirect effect), which, in turn, affects MetS.

CONCLUSIONS

Age at first pregnancy may partially contribute to the association between early menarche and metabolic syndrome among middle-aged and older women who had experienced a pregnancy over their lifetime.

Relationship between age at menarche and risk of glucose metabolism disorder: a systematic review and dose-response meta-analysis

OBJECTIVE

Studies investigating the impact of age at menarche on glucose metabolism disorder have reached inconsistent conclusions, and a quantitative comprehensive assessment of the dose-response association between age at menarche and glucose metabolism disorder has not been reported. We performed a systematic review and meta-analysis of studies assessing the risk of glucose metabolism disorder by age at menarche.

METHODS

MEDLINE via PubMed and EMBASE databases were searched up to March 13, 2019. Restricted cubic splines were used to model the dose-response association.

RESULTS

Twenty-five publications (including 34 studies) were included in the meta-analysis. The summary risk ratios (RRs) and 95% confidence limit (CL) per 1-year increase in age at menarche were 0.98 (95% CL 0.98, 0.99) for type 2 diabetes mellitus (T2DM), 0.97 (95% CL 0.96, 0.99) for impaired fasting glucose (IFG), and 0.98 (95% CL 0.97, 0.99) for gestational diabetes mellitus (GDM). We identified linear negative correlations between age at menarche and T2DM (Pnonlinearity = 0.052) and IFG (Pnonlinearity = 0.145), a nonlinear dose-response between age at menarche and GDM (Pnonlinearity = 0.038).

CONCLUSIONS

Older age at menarche (range 8-18 years old) is associated with reduced risk of glucose metabolism disorder. The strongest reduction in risk of GDM is observed at menarche age of 14.5 years.

Early menarche and its consequence in Korean female: reducing fructose intake could be one solution

The mean age at menarche (AAM) of Korean females has been rapidly decreasing over the last 50 years; currently, the prevalence of early menarche (<12 years) is 22.3%. Female adolescents who experience early menarche are known to be at greater risk of psychosocial and behavioral problems along with several physical health problems such as menstrual problems. They also tend to achieve a shorter final height and develop obesity. Population-based Korean studies have shown a strong association between early menarche and the risk of obesity, insulin resistance, metabolic syndrome, nonalcoholic fatty liver disease, diabetes, breast cancer, and cardiovascular disease in adulthood. Although the exact mechanism of how early menarche causes cardiometabolic derangement in later adulthood is unknown, childhood obesity and insulin resistance might be major contributors. Recent studies demonstrated that an excessive consumption of fructose might underlie the development of obesity and insulin resistance along with an earlier AAM. A positive association was observed between sugar-sweetened beverages (a major source of fructose) intake and obesity, metabolic syndrome, insulin resistance, and cardiometabolic risk in Korean females. In pediatrics, establishing risk factors is important in preventing disease in later life. In this regard, early menarche is a simple and good marker for the management of cardiometabolic diseases in adulthood. Decreasing one's fructose intake might prevent early menarche as well as the development of obesity, insulin resistance, and cardiometabolic diseases.

Knowledge of peri-menarcheal changes and a comparative analysis of the age at menarche among young adolescent school girls in urban and rural Cameroon

Background

Menarche is an expected event that occurs during the development of every normal young girl. We designed this study to evaluate the knowledge of young school girls on puberty, menarche, and menstruation, and to update data on the age at menarche in a rural and urban setting in Cameroon.

Methods

We conducted a cross-sectional survey from February to March 2017, targeting female students aged 9 to 16 years in Yaoundé (urban) and Bamougoum (rural). Participants were included using a randomised cluster sampling and data collected using an auto-administrable questionnaire. Student t-test or the Kruskal-Wallis test was used to compare means, and the odds ratio used as the measure of association between age at menarche and selected covariates.

Results

1157 participants were included in the study; 49.3% from an urban setting and 50.7% from a rural setting. Regarding the knowledge of our participants on puberty, menarche, and menstruation, 67.20% of rural participants had good knowledge, whereas only 46.00% had good knowledge in the urban setting. Mean age at menarche was 12.76 ± 1.33 years, with the mean age at menarche in the urban setting of 12.48 ± 1.12 years and the rural setting of 13.03 ± 1.46 years. Mean age at menarche was significantly lower in participants aged below 14 years (p-value = 0.000), those with both parents alive (p-value = 0.0461), those whose fathers had skilled occupations (p-value = 0.005), those of urban resident (p-value = 0.000), and those who watched TV everyday (p-value = 0.030). Urban residence and age below 14 years were significantly associated with an earlier onset of menarche.

Conclusion

Rural participants had better knowledge of puberty, menarche, and the menstrual cycle than their counterparts in the urban setting. The mean age at menarche over the last two decades has dropped by 7.4 and 4.2 months per decade in urban and rural Cameroon respectively. Mean age at menarche varies significantly with age group, urban/rural residence, state of both parents (both alive/at least one dead), occupation of the father, and frequency of watching TV. Age and urban/rural residence are associated with age at onset of menarche. The continually declining age at menarche is an alarm for future early menarche-linked morbidities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09787-y.

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

OBJECTIVE

To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease.

DESIGN

Umbrella review.

DATA SOURCES

Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019.

REVIEW METHODS

Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke.

RESULTS

32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment.

CONCLUSIONS

From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019120076.

Negative Effects of Age at Menarche on Risk of Cardiometabolic Diseases in Adulthood: A Mendelian Randomization Study

CONTEXT

Observational studies have demonstrated that early menarche is associated with cardiometabolic diseases, but confounding factors make it difficult to infer causality.

OBJECTIVE

We used Mendelian randomization (MR) to examine whether age at menarche (AAM) is causally associated with type 2 diabetes (T2D), coronary artery disease (CAD) and cardiometabolic traits.

DESIGN AND METHODS

A 2-sample MR analysis was conducted using genome-wide association study (GWAS) summary statistics from the Diabetes Genetics Replication and Meta-analysis (DIAGRAM) consortium (n = 159 208) for T2D and the Coronary Artery Disease Genome-wide Replication and Meta-analysis plus the Coronary Artery Disease Genetics (CARDIoGRAMplusC4D) consortium (n = 184 305) for CAD. We used 122 instrumental variables (IVs) extracted from a published GWAS meta-analysis incorporating 182 416 women to determine the causal effect of AAM on cardiometabolic diseases, treating childhood and adult body mass index (BMI) as the confounders. Sensitivity analyses were also performed to detect the pleiotropy of the IVs.

RESULTS

Employing the MR approach, we found that later AAM was associated with decreased risk of CAD (OR, 0.92 [95% CI, 0.88-0.96]; P = 2.06 × 10-4) in adults, as well as lower blood levels of log fasting insulin, log homeostatic model assessment of insulin resistance (HOMA-IR), log HOMA of β-cell function (HOMA-B), triglycerides, and diastolic blood pressure, but higher blood level of high-density lipoprotein. However, the associations were substantially attenuated after excluding BMI-related variants. MR analyses provide little evidence on the causal effect between AAM and T2D.

CONCLUSIONS

Our findings showed that AAM did not appear to have a causal effect on the risk of cardiometabolic diseases in adult life, as their associations observed in epidemiological studies might be largely mediated through excessive adiposity. We propose adiposity might be a primary target in future intervention strategy.

Stunting, recovery from stunting and puberty development in the MINIMat cohort, Bangladesh

AIM

This paper aimed to analyse the association between small for size at birth, stunting, recovery from stunting and pubertal development in a rural Bangladeshi cohort.

METHODS

The participants were 994 girls and 987 boys whose mothers participated in the Maternal and Infant Nutrition Interventions in Matlab trial. The birth cohort was followed from birth to puberty 2001-2017. Pubertal development according to Tanner was self-assessed. Age at menarche was determined and in boys, consecutive height measurements were used to ascertain whether pubertal growth spurt had started. The exposures and outcomes were modelled by Cox's proportional hazards analyses and logistic regression.

RESULTS

There was no difference in age at menarche between girls that were small or appropriate for gestational age at birth. Boys born small for gestational age entered their pubertal growth spurt later than those with appropriate weight. Children who were stunted had later pubertal development, age at menarche and onset of growth spurt than non-stunted children. Children who recovered from infant or early childhood stunting had similar pubertal development as non-stunted children.

CONCLUSION

Infant and childhood stunting was associated with a later pubertal development. Recovery from stunting was not associated with earlier puberty in comparison with non-stunted children.

Relationship of age at menarche and serum leptin with the metabolically unhealthy phenotype in adolescents

Introduction

Objective: to analyze the relationship of age at menarche and leptin with the metabolically healthy (MH) and metabolically unhealthy (MUH) phenotypes in adolescent girls in different body mass index (BMI) categories. Method: an observational and cross-sectional study consisting of 139 female adolescents attended to at the Adolescent Reference Center in Macaé, Rio de Janeiro. Menarche was classified as early (EM) when the first menstruation occurred at or before 11 years of age; normal menarche (NM) was categorized at ages 12 to 14; menarche was considered late (LM) when it occurred at age 15 or older. The factors required to ascertain the subjects' phenotype, as well as their leptin levels, weight, and height, were measured and their BMIs were calculated. The girls were classified as MH or MUH based on the NCEP-ATP III criteria as adapted for children and adolescents. Results: 82 % (n = 114) of the girls were classified as MH and 18 % (n = 25) as MUH. Mean age at menarche was 11.79 ± 1.39 years. There was a higher prevalence of MUH amongst the girls who had EM (p = 0.04). A higher inadequacy of serum leptin concentrations was found in girls who had EM (p = 0.05) and in those classified as MUH (p = 0.01). The adolescents who were severely obese exhibited inadequate leptin levels (p < 0.01) and had gone through EM (p = 0.02). A total of 8.1 % (n = 7) of the normal-weight girls were classified as MUH, and 29.4 % (n = 5) of those who were severely obese were classified as MH (p < 0.01). Conclusion: early menarche and high serum leptin concentrations are related with the MUH phenotype in adolescent girls in different BMI categories.

Early menarche and blood pressure in adulthood: systematic review and meta-analysis

Background

It has been reported that early menarche is associated with high blood pressure and hypertension. However, some studies have failed to observe such association. We carried out a systematic review and meta-analysis on the association of early menarche with hypertension and high blood pressure in adulthood.

Methods

PUBMED, SciELO, Scopus and LILACS databases were searched. Studies that evaluated the association of early menarche with hypertension or high blood pressure, among women aged 20 years or more were included. Random effects models were used to pool the estimates. Meta-regression was used to evaluate the contribution of different co-variables to heterogeneity.

Results

We identified 17 studies with 18 estimates on the association of early menarche with hypertension and high blood pressure. The odds of hypertension/high blood pressure was higher among women with early menarche [pooled (OR):1.25; 95% confidence interval (CI): 1.17-1.34; P < 0.001]. In the meta-regression analysis, studies evaluating 1500 subjects or more had a higher pooled OR [1.27; 95%CI (1.19;1.36)] than those with less participants. Although funnel plots showed some asymmetry, Egger tests were not statistically significant. Therefore, it is unlikely that the observed association was to publication bias.

Conclusions

Early menarche is associated with hypertension among adult woman.

Age at menarche and risk of all-cause and cardiovascular mortality: a systematic review and dose-response meta-analysis

OBJECTIVE

The evidence between age at menarche and mortality risk is controversial. We aimed to quantify the dose-response association of age at menarche and risk of all-cause and cardiovascular disease (CVD) mortality based on cohort studies.

METHODS

PubMed, EMBASE, Web of Science, and Scopus databases were searched up to March 15, 2018 for relevant articles. Random-effects models and restricted cubic splines were used for this meta-analysis.

RESULTS

Twelve cohort studies, with 79,363 deaths and 2,341,769 participants, met the inclusion criteria. With each 1-year increase in menarche age, the relative risk (RR) was reduced for all-cause mortality (RR: 0.977, 95% confidence interval [CI]: 0.970-0.984), CVD mortality (RR: 0.993, 95% CI: 0.975-1.011), ischemic heart disease (IHD) mortality (RR: 0.969, 95% CI: 0.947-0.993), and stroke mortality (RR: 0.983, 95% CI: 0.954-1.012). We found a nonlinear dose-response association (Pnonlinearity = 0.001) between age at menarche and all-cause mortality, with the lowest risk observed at menarche age 15 years (RR: 0.849 95% CI: 0.800-0.901), but no evidence of a nonlinear association between menarche age and CVD mortality (Pnonlinearity = 0.543), IHD mortality (Pnonlinearity = 0.310), or stroke mortality (Pnonlinearity = 0.824).

CONCLUSIONS

Age at menarche is inversely associated with all-cause and IHD mortality.

In utero and peripubertal metals exposure in relation to reproductive hormones and sexual maturation and progression among girls in Mexico City

There is increasing evidence that several metals are endocrine disrupting chemicals (EDCs). In utero development and adolescence are critical windows of susceptibility to EDC exposure. With the exception of a few heavy metals, few human studies have evaluated the impact of metal exposure on pubertal development. Our aim was to investigate measures of in utero and peripubertal metal exposure in relation to reproductive hormone levels and sexual maturation and progression among girls from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohorts. We measured urinary concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), cobalt (Co), copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), nickel (Ni), antimony (Sb), selenium (Se), and zinc (Zn) in samples collected from women during their third trimester of pregnancy and from their female children at 8-13 years (n = 132). We measured serum testosterone, estradiol, dehydroepiandrosterone sulfate (DHEA-S), inhibin B, and sex hormone-binding globulin (SHBG) at age 8-13, and assessed Tanner stages for sexual maturation (breast, pubic hair development, and menarche status), at two time points (8-13, 14-18 years). We used linear regression to independently examine in utero and peripubertal metal concentrations as predictors of peripubertal hormones. In a longitudinal analysis using generalized estimation equations, we evaluated Tanner stage and menarche progression in relation to individual in utero and peripubertal metal concentrations. We found that higher in utero Zn was associated with increased inhibin B. Several metals at 8-13 years were associated with higher DHEA-S and estradiol, while Ni was positively but Cu was negatively associated with testosterone. In utero Ni, Al, and Cd were associated with slower progression of breast development after adjustment for child age and BMI z-score. For example, an IQR increase in in utero Al exposure was associated with 0.82 times lower odds of progressing to a higher Tanner stage for breast development per year (95% CI: 0.68, 0.99). Peripubertal concentrations of Ba and Al were also associated with being at a higher pubic hair Tanner stage and menarche at 8-13, but lower odds of progressing to the next stage at 14-18 years. We used Bayesian kernel machine regression (BKMR) to model the joint effect of multiple metals while accounting for correlated exposures, as well as potential non-linear relationships between metals and outcomes of interest, which yielded results similar to individual analyses. These findings suggest that female reproductive development may be vulnerable to the effects of metal exposure, and using both Tanner stages and hormone levels may provide clues about underlying mechanisms in two sensitive periods of development.

Visceral adiposity index (VAI), lipid accumulation product (LAP), and product of triglycerides and glucose (TyG) to discriminate prediabetes and diabetes

The present study evaluated the ability of the visceral adiposity index (VAI), the lipid accumulation product (LAP), and product of triglycerides and glucose (TyG), three novel, insulin resistance-related markers, to discriminate prediabetes/diabetes in the general German population. Altogether 2,045 Germans (31-72 years, 53.3% women) without known diabetes and a history of Myocardial Infarction (MI)/stroke from the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study were eligible. The discriminatory accuracy of the markers for oral glucose tolerance test (OGTT)-defined prediabetes/diabetes according to the American Diabetes Association (ADA) criteria was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The Youden Index (YI) was used to determine optimal cut-off values, and a non-parametric ROC regression was used to examine whether the discriminatory accuracy varied by sex and age. 365 men (38.2%) and 257 women (23.6%) were newly diagnosed with prediabetes/diabetes. AUCs for TyG, LAP and VAI were 0.762 (95% CI 0.740-0.784), 0.743 (95% CI 0.720-0.765), and 0.687 (95% CI 0.662-0.712), respectively. The optimal cut-off values for the LAP and TyG were 56.70 and 8.75 in men, and 30.40 and 8.53 in women. In conclusion, TyG and LAP provide good discrimination of persons with prediabetes/diabetes.

Sibling relatedness rather than father absence predicts earlier age at menarche in ELSPAC cohort

Many studies during the past 50 years have found an association between father absence and earlier menarche. In connection with these findings, several evolutionary theories assume that father absence is a causal factor accelerating reproductive development. However, a recent study analysing data from the Avon Longitudinal Study of Parents and Children (ALSPAC) found that father absence does not predict age at menarche when adjusted for sibling relatedness. In this study, we have replicated these results in the Czech section of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), which used the same questionnaires as ALSPAC to study a geographically distinct population. Our results support the conclusion that sibling relatedness rather than father absence predicts age at menarche. Furthermore, our results show that age at menarche in 1990s UK and Czech cohorts is very similar despite socioeconomic differences between the two countries.

Associations between maternal age at menarche and anthropometric and metabolic parameters in the adolescent offspring

OBJECTIVE

We examined the associations between maternal age at menarche and anthropometry and metabolism in adolescent offspring.

METHODS

Anthropometric, metabolic and blood pressure data were obtained from 304 girls and 190 boys aged 11-16 years attending school in Hangzhou (China). Age at menarche for both mothers and daughters was self-reported. Fasting blood samples were obtained and all participants underwent clinical examinations. Obesity was defined as BMI ≥95th percentile for age and sex.

RESULTS

Older maternal age at menarche was associated with older age of their daughters at menarche (r = 0.21; P < 0.001). Mother's age at menarche was not associated with anthropometry or metabolism of daughters. However, younger maternal age at menarche was associated with increased hip and waist circumferences, and BMI SDS of their sons. Boys whose mothers were ≤13 years at menarche had an adjusted relative risk of obesity 3-fold greater than sons of mothers with a later menarcheal onset (2.96; 95% CI 1.49, 5.87). Among daughters, every 1-year increase in their age at menarche was associated with a 0.34 SDS reduction in BMI. Increasing age at menarche was also associated with reduced waist and hip circumferences (-1.5 and -1.8 cm/y, respectively) and waist-to-height ratio (-0.008 per year). Girls in the youngest menarcheal age tertile (8.8-11.6 years) had diastolic blood pressure 2.2 mm Hg higher than other girls (P = 0.029).

CONCLUSIONS

Younger maternal age at menarche is associated with increased obesity risk in their sons, but not daughters. However, girls who experience menarche earlier have a less favourable anthropometric profile.

Older menarche age and short reproductive period linked to chronic kidney disease risk

This study aimed to investigate the association between reproductive period and menarche age and chronic kidney disease (CKD) in South Korean postmenopausal women.This was a cross-sectional study of the data for 8510 postmenopausal women using the results of Korean National Health and Nutrition Examination Surveys over the past 6 years.Of the total 8510 postmenopausal women, 790 (10.23%) were CKD patients. The menarche age in the CKD group was 16.2 ± 1.9 years old, which was higher than that in the non-CKD group (P < .001). The reproductive period of the CKD group was 32.4 ± 5.7 years, which was shorter than 33.3 ± 5.4 years in the non-CKD group (P < .001). The prevalence of CKD was 4.7% at a menarche age of 11 years or younger, which increased with increasing of menarche age, reaching 9.9% at menarche age of 16 years or older. According to the length of the reproductive period, the prevalence of CKD was 13.9% for the group less than 20 years of period and decreased significantly with increasing length of reproductive period. The prevalence of proteinuria was 7.2% in women with reproductive period of less than 20 years and significantly less in women with a reproductive period longer than 45 years (2.3%). The prevalence of CKD and proteinuria increased with increasing of menarche age, and the prevalence of CKD and proteinuria decreased with increasing of reproductive period.The results suggest that CKD was associated with older menarche age and a short reproductive period. Management of life patterns and medical problems in women with old age at menarche and a short reproductive period should be considered.

Age at menarche and risk of gestational diabetes mellitus: a population-based study in Xiamen, China

Background

It has been reported that earlier age at menarche is associated with a higher risk for type 2 diabetes mellitus. However, the relationship between age at menarche and gestational diabetes mellitus is inconsistent across studies. We hypothesized that an earlier age at menarche would predict the gestational diabetes mellitus risk.

Methods

This was a population-based, retrospective cohort study of 70,041 women aged 18 to 53 years old, conducted between 2011 and 2018. The subjects were recruited from the Medical Birth Registry in Xiamen, China. Age at menarche was categorized as 8–12, 13, 14, 15, 16–19 years old. Logistic regression analysis and spline analysis was used to assess the risk of the menarche age group for gestational diabetes mellitus. Linear regression analysis was performed to evaluate independent associations between age at menarche and fasting plasma glucose and blood glucose 1 hour and 2 hours after a 75-g of glucose load between 24 and 28 weeks’ gestation.

Results

The overall prevalence of GDM was 17.6%. After adjustment for family history of diabetes, earlier age at menarche (8–12, and 13 years old) was associated with increased odds for GDM (OR, 1.08; 95% CI, 1.02–1.15, and OR, 1.07; 95% CI, 1.03–1.14, respectively) compared with average age at menarche (14 years old). With further adjustment for pre-pregnancy body mass index, blood pressure, educational level, age at delivery, and hepatitis B surface antigen status, this association was attenuated (OR, 0.93, and OR, 1.02, respectively). Multivariable-adjusted spline regression models showed a linear dose-response association between age at menarche and GDM (P for nonlinearity, 0.203; P for linearity, 0.006). On linear regression analysis, earlier age at menarche was significantly associated with increased blood glucose one and 2 hours after a glucose load but not with the fasting plasma glucose.

Conclusions

As expected, early age at menarche was found to be associated with an increased risk of gestational diabetes mellitus. However, this association may be mediated by potential confounding factors other than age. An additional finding was that earlier menarche was significantly related with elevated pregnancy glucose concentrations after a glucose load.

Effect of Interaction between Early Menarche and Genetic Polymorphisms on Triglyceride

Early menarche has been associated with increased risk of metabolic syndrome. Therefore, investigating the association of each component of metabolic syndrome with age at menarche, and interactions between them, might lead to a better understanding of metabolic syndrome pathogenesis. In this study, we evaluated age at menarche for risk of metabolic syndrome and associations with its components. As a result, the risk of MetS incidence was significantly increased only at ≤12 years of age at menarche (OR = 1.91, P < 0.05). Women with early menarche (≤12 years) had significantly higher levels of triglycerides (β coefficient = 37.83, P = 0.02). In addition, hypertriglyceridemia was significantly increased at early menarche with 1.99 (95% CI: 1.16–3.41, P < 0.01). With GWAS-based pathway analysis, we found the type 2 diabetes mellitus, stress-activated protein kinase signaling, and Jun amino-terminal kinase cascade pathways (all nominal P < 0.001, all FDR < 0.05) to be significantly involved with early menarche on triglyceride levels. These findings may help us understand the role of early menarche on triglyceride and interaction between gene and early menarche on triglyceride for the development of metabolic syndrome.

Age at menarche and childhood body mass index as predictors of cardio-metabolic risk in young adulthood: A prospective cohort study

OBJECTIVE

This study aimed to examine the association between age at menarche and a range of cardiovascular disease (CVD) risk factors at 17 and 20 years of age, and whether this was influenced by childhood body mass index (BMI).

METHODS

Of the 1413 girls born in the Western Australian Pregnancy Cohort (Raine) Study, 846 had age at menarche recorded. Subsequently 557 underwent metabolic assessment at 17 years and 541 at 20 years. Associations between age at menarche and cardiovascular risk factors, and being in a high-risk metabolic cluster at 17 and 20 years, or having the metabolic syndrome at 20 years, were investigated by linear mixed effects and logistic regressions, respectively.

RESULTS

Each year later of onset of menarche was associated with a 0.75 kg/m2 reduction in BMI (coefficient -0.75 [95%CI -1.06, -0.44]), and an approximate 30% reduction in the odds of being in the high-risk metabolic cluster at 17 years (OR = 0.73 [95%CI 0.57, 0.94]) and 20 years of age (OR = 0.68 [95%CI 0.52, 0.87]), and a 40% reduction in the odds of having the metabolic syndrome at 20 years (OR = 0.60 [95% CI 0.41, 0.88]). These data show earlier age at menarche was associated with increased BMI and odds of being in the high-risk metabolic cluster at 17 and 20 years, and increased odds of having the metabolic syndrome at 20 years. However, these associations were no longer statistically significant after adjustment for BMI at age 8 years. Current smoking, alcohol consumption, physical activity, socio-economic status, or hormonal contraceptives use did not affect these associations.

CONCLUSIONS

Earlier age at menarche may be indicative of a higher risk profile for CVD in young adulthood. Our findings suggest that targeted interventions to reduce BMI in girls who experience menarche at younger age may reduce CVD risk in the future.

Diseases of Civilization - Cancer, Diabetes, Obesity and Acne - the Implication of Milk, IGF-1 and mTORC1

Nutrition and food are one of the most complex aspects of human lives, being influenced by biochemical, psychological, social and cultural factors. The Western diet is the prototype of modern dietary pattern and is mainly characterized by the intake of large amounts of red meat, dairy products, refined grains and sugar. Large amounts of scientific evidence positively correlate Western diet to acne, obesity, diabetes, heart disease and cancer, the so-called "diseases of civilization". The pathophysiological common ground of all these pathologies is the IGF-1 and mTORC pathways, which will be disscussed further in this paper.

Early Menarche and Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND

The association between age at menarche and metabolic syndrome was inconsistent across studies and remains unclear. We conducted a systematic review and meta-analysis of observational studies to assess the association between age at menarche and risk of metabolic syndrome, comprehensively.

MATERIALS AND METHODS

The PubMed and ISI Web of Science databases were searched for all articles published through May 2017, and the reference lists of the retrieved articles were reviewed. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model through combining the study-specific estimates adjusting for potential confounders.

RESULTS

Sixteen observational studies were eligible for the meta-analysis of age at menarche and metabolic syndrome, which included 13,657 cases among 51,453 subjects. The pooled RR of metabolic syndrome for the youngest versus the oldest categories of age at menarche was 1.62 (95% CI: 1.40-1.88) (p for heterogeneity = 0.01, I² = 57.3%). The analysis of 1-year decrease in age at menarche conferred a pooled RR of 1.08 (95% CI: 1.01-1.15), suggesting an 8% increase in risk of metabolic syndrome. The association between age at menarche and the risk of metabolic syndrome did not vary by study design, geographical region, number of subjects, and adjustment for confounders.

CONCLUSIONS

Our findings from the current meta-analysis suggest that earlier menarcheal age is associated with higher risk of metabolic syndrome. Age at menarche may help identify women with higher risk of metabolic syndrome. Further well-designed cohort studies are warranted to provide definitive evidence.

Higher parity and risk of metabolic syndrome in Korean postmenopausal women: Korea National Health and Nutrition Examination Survey 2010-2012

AIM

We sought to examine whether parity is associated with higher incidence of metabolic syndrome in postmenopausal women.

METHODS

We conducted a cross-sectional study on 4098 Korean postmenopausal women by using nationally representative data from the Korea National Health and Nutrition Examination Survey 2010-2012. Multivariate logistic regression was performed to evaluate the relationship between parity and metabolic syndrome, with adjustment for potential confounding variables.

RESULTS

The rate of metabolic syndrome was significantly higher with increasing number of parity, with dose-response relationship in univariate analysis (P <0.001). In addition, higher parity (≥3 live births) was associated with more prevalence of all components of metabolic syndrome compared with two live births (parity 2 vs 3 vs ≥4: 5.5 vs 12.1 and 14.4%, respectively; P < 0.001). However, after adjusting for demographic, socioeconomic, lifestyle and reproductive factors, we found that only higher parity was significantly associated with metabolic syndrome compared with two live births, and failed to show a dose-dependent relationship (parity 2 vs 3 vs ≥4: odds ratio 1 vs 1.404 vs 1.379, respectively; P = 0.043). We also proved that among the components of metabolic syndrome, only waist circumference had a significant positive relationship with parity in a multivariable adjusted model (parity 2 vs 3 vs ≥4: odds ratio 1 vs 1.559 vs 1.656, respectively; P < 0.001).

CONCLUSION

Higher parity was independently associated with a higher risk of metabolic syndrome in postmenopausal women.

Timing of pubertal growth and menarche in indigenous Qom girls of Argentina

BACKGROUND

Pubertal timing is in part mediated by environmental factors, with greater energy availability often associated with earlier or more rapid development. Many indigenous populations are undergoing socioeconomic change that may affect pubertal development and related health risks, necessitating fundamental longitudinal research on growth and development in these populations.

AIM

Growth velocity and time to menarche among peri-urban indigenous Qom (Toba) girls in Argentina are described.

SUBJECTS AND METHODS

From 2011-2015, monthly anthropometrics and menstrual status were collected from 61 Qom girls aged 7-14. Growth velocity curves were generated using the 'Super-imposition by translation and rotation' (SITAR) method. Median time to menarche was estimated by Kaplan-Meier survival analysis.

RESULTS

Mean ages at peak height, weight and BMI velocity were estimated at 10.8, 10.5 and 10.7 years and median age at menarche at 11.6 years (95% CI = 11.4-11.9). At menarche, 45% of girls were overweight or obese and only one participant was short-statured by international standards.

CONCLUSION

Qom participants in this study exhibit relatively fast pubertal development as compared to other Latin American indigenous populations studied previously by others. Genetic and environmental factors influencing body size, diet and/or activity levels should be investigated further in this population.

Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study

BACKGROUND

We compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI-CAD]) and among patients with MINOCA by sex and subtype.

METHODS AND RESULTS

Between 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI-CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1- and 12-month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI-CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29-7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI-CAD patients (3.0% versus 1.3%; P=0.036). Women with MI-CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One- and 12-month mortality with MINOCA and MI-CAD was similar (1-month: 1.1% and 1.7% [P=0.43]; 12-month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12-month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06).

CONCLUSIONS

Young patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI-CAD patients.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.

Is age at menarche associated with total mortality? The Tromsø Study

Purpose

Early age at menarche (AAM) has been associated with increased mortality and morbidity, including premature death from all causes, breast cancer and cardiovascular diseases. The aim of this study was to examine the association between AAM and all-cause mortality.

Subjects and methods

A total of 12,409 women aged 25–94 years who took part in the fourth Tromsø Study in Norway during 1994–1995 were included in this prospective population-based study with a mean 18.7 years of follow-up. Multivariate Cox proportional hazard analysis was used to investigate the association between AAM and all-cause mortality with adjustment for known confounders (age, body mass index, physical activity, level of education and smoking history).

Results

During the 18.7 years of follow-up, a total of 2,203 women died. There was no association between AAM and all-cause mortality before or after adjusting for possible confounding factors.

Conclusion

This prospective study of 12,409 women did not find any association between AAM and all-cause mortality

Early-life nutritional status and metabolic syndrome: gender-specific associations from a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVE

In the present study we investigated gender-specific associations of low birth weight (LBW) and shorter relative leg length with metabolic syndrome (MetS) after adjusting for sociodemographic characteristics and health-related behaviours. We also investigated whether these associations are independent of age at menarche and BMI at 20 years old.

DESIGN

Cross-sectional analysis.

SUBJECTS

Baseline data from 12 602 participants (35-74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), 2008-2010.

SETTING

MetS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III guidelines. LBW (<2·5 kg) and age- and sex-standardized relative leg length (high, medium and low) were the explanatory variables studied. The strength of the associations between the explanatory variables and MetS was estimated by Poisson regression with robust variance.

RESULTS

MetS prevalence was 34·2 %; it was more prevalent in men (36·8 %) than in women (32·2 %). In multivariate analysis, LBW was associated (prevalence ratio; 95 % CI) with MetS only in women (1·28; 1·24, 1·45). Shorter leg length was associated with MetS in both men (1·21; 1·09, 1·35 and 1·46; 1·29, 1·65 for low and medium lengths, respectively) and women (1·12; 1·00, 1·25 and 1·40; 1·22, 1·59 for low and medium lengths, respectively). Additional adjustments for age at menarche and BMI at 20 years old did not change the associations.

CONCLUSIONS

Poor nutritional status as estimated by LBW and lower leg length in childhood was associated with a higher prevalence of MetS, although LBW was a significant factor only among women.

Age at Menarche and Cardiometabolic Health: A Sibling Analysis in the Scottish Family Health Study

BACKGROUND

Previous studies of age at menarche and cardiometabolic health report conflicting findings, and only a few could account for childhood characteristics. We aimed to estimate the associations of age at menarche with cardiovascular risk factors in unrelated women and within sister groups, under the assumption that within-sibship estimates will be better adjusted for shared genetics and early life environment.

METHODS AND RESULTS

Our study included 7770 women, from 5984 sibships, participating in the GS:SFHS (Generation Scotland: Scottish Family Health Study). We used fixed- and between-effects linear regression to estimate the associations within sister groups and between unrelated individuals, respectively. Within sibships, the mean difference between sisters with early menarche (≤11 years) and sisters with menarche at 12 to 13 years was 1.73 mm Hg (95% confidence interval [CI], -0.41 to 3.86) for systolic blood pressure, 1.26 mm Hg (95% CI, -0.02 to 2.55) for diastolic blood pressure, -0.06 nmol/L (95% CI, -0.11 to -0.02) for high-density lipoprotein, 0.20 nmol/L (95% CI, 0.08-0.32) for non-high-density lipoprotein, -0.34% (95% CI, -1.98 to 1.30) for glucose, 1.60 kg/m² (95% CI, 0.92-2.28) for body mass index, and 2.75 cm (95% CI, 1.06-4.44) for waist circumference. There was weak evidence of associations between later menarche (14-15 or ≥16 years) and lower body mass index, waist circumference, and blood pressure. We found no strong evidence that estimates from within- and between-sibship analyses differed (all P values >0.1). The associations with other cardiovascular risk factors were attenuated after adjustment for adult body mass index.

CONCLUSIONS

Our results suggest that confounding by shared familial characteristics is unlikely to be a major driver of the association between early menarche and adverse cardiometabolic health but do not exclude confounding by individual-level characteristics.

Duration of Reproductive Years and the Risk of Cardiovascular and Cerebrovascular Events in Older Women: Insights from the National Health and Nutrition Examination Survey

BACKGROUND

Studies have shown conflicting information regarding the association between the age at menarche and/or menopause and cardiovascular and cerebrovascular diseases in older women. This study aimed to determine whether a longer duration of reproductive years in older women in the U.S. population was associated with a lower risk of cardiovascular and cerebrovascular diseases.

MATERIALS AND METHODS

Women ≥60 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2012 were included. Subjects provided information about the age of menarche and menopause along with the presence/absence of cardiovascular and cerebrovascular diseases. Participants were categorized into either a longer reproductive duration group (>30 years) or shorter reproductive duration group (≤30 years). Subgroup analysis for each 5-year increment in the longer reproductive duration group was conducted. Relative risk (RR) regression was performed using a generalized linear model adjusting for several confounding factors.

RESULTS

3081 participants were included in the analysis. A longer duration of reproductive years was associated with a lower risk of cardiovascular and cerebrovascular diseases, compared with a shorter duration (RR 0.70, 95% confidence interval [CI] 0.53-0.92). This association was due to a reduction in the risk of stroke (RR 0.53, 95% CI 0.34-0.88) and angina (RR 0.57, 95% CI 0.34-0.97). A 1 year increase in the reproductive duration was associated with a 3% reduction in the risk of events (RR 0.97, 95% CI 0.95-0.99).

CONCLUSION

Among women ≥60 years, a longer duration of reproductive years was associated with lower risk of cardiovascular and cerebrovascular diseases. This association was mainly due to a reduction in the risk of stroke and angina.

The reproducibility of self-reported age at menarche: The Tromsø Study

BACKGROUND

Previous studies of the reproducibility of self-reported age at menarche have been limited because of small study samples, short follow-up and the limited age span of the women included.

METHODS

The present study assessed the reproducibility of age at menarche in 6731 women with a wide variation of age when giving the information about age at menarche. The women reported age at menarche in a self-administered questionnaire, both in 1986-1987 and 1994-1995. They were all residents of Tromsø, Norway, and aged 25-73 in 1994-1995. In order to investigate the agreement between self-reported age at menarche at the two points in time, Pearson's correlation coefficient was applied to assess the linear correlation between the reported menarcheal age at the two occasions. Analyses were stratified for age. A Bland-Altman plot was produced and limits of agreement computed.

RESULTS

We found a high correlation and a strong agreement between self-reported age at menarche in 1986-1987 and 1994-1995. The overall Pearson's correlation coefficient was 0.84 and was not attenuated by increasing age of the women. The Bland-Altman plot showed a strong agreement in self-reported age at menarche. The mean difference between self-reported age at menarche was 0.01 years with limits of agreement -1.52 to 1.54.

CONCLUSION

We found high reproducibility of self-reported age at menarche. The mean menarcheal age in the two surveys was identical (13.2 years) with 95% of the women reporting the same age at menarche or with a difference of 1 year. Only 0.7% of the women reported age at menarche with a difference of more than 2 years in 1986-1987 and 1994-1995.

Age at menarche and cardiovascular risk factors using Mendelian randomization in the Guangzhou Biobank Cohort Study

Observational studies show earlier age at menarche associated with higher risk of cardiovascular disease although these studies could be confounded by childhood obesity or childhood socioeconomic position. We tested the hypothesis that earlier age at menarche is associated with poorer cardiovascular risk factors using a Mendelian randomization design. We conducted a Mendelian randomization study in a large Southern Chinese cohort, the Guangzhou Biobank Cohort Study (n=12,279), to clarify the causal role of menarche in cardiovascular disease risk factors including blood pressure, lipids, fasting glucose, adiposity and type 2 diabetes. A genetic allele score was obtained from single nucleotide polymorphisms associated with age at menarche using stepwise regression and with cross validation. Estimates of the association of age at menarche with cardiovascular disease risk factors were obtained using two stage least squares regression. Height was included as a positive control outcome. The F-statistic for the allele score (rs17268785, rs1859345, rs2090409, rs4452860 and rs4946651) was 19.9. Older age at menarche was associated with lower glucose (-0.39mmol/L per year older menarche, 95% confidence interval (CI) -0.78 to -0.001) but not clearly with any other cardiovascular risk factors. Older age at menarche was also associated with taller height. Age at menarche did not appear to affect cardiovascular disease risk factors except for glucose in an inverse manner. However, these results need to be confirmed in larger Mendelian randomization studies.

Association of insulin resistance with near peak bone mass in the femur and lumbar spine of Korean adults aged 25-35: The Korean National Health and Nutrition Examination Survey 2008-2010

Objective

This study aimed to evaluate the relationship between insulin resistance and the bone mineral density (BMD) of femur and lumbar spine in Korean adults who are expected to exhibit near peak bone mass.

Methods

Data from the Korean National Health and Nutrition Examination Survey 2008–2010 were analyzed. A total of 2,750 participants aged 25−35 years were included. Insulin resistance was assessed using a homeostatic model assessment of insulin resistance (HOMA-IR) and serum fasting insulin.

Results

In a multivariate linear regression analysis, the HOMA-IR was significantly inversely associated with the BMD of the total hip (TH, β = −0.052, P = 0.002), femoral neck (FN, β = −0.072, P<0.001), femoral trochanter (FTr, β = −0.055, P = 0.003), femoral intertrochanter (FITr, β = −0.041, P = 0.015), and lumbar spine (LS, β = −0.063, P = 0.001) among all study subjects after adjustment for gender, age, height, weight, whole body fat mass percentage, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, vitamin D, smoking, alcohol intake, physical activity, education level, and household income in both genders as well as labor, the use of oral contraceptives, and age at menarche in females. The serum fasting insulin was significantly inversely associated with the BMD of the TH (β = −0.055, P = 0.001), FN (β = −0.072, P<0.001), FTr (β = −0.055, P = 0.003), FITr (β = −0.045, P = 0.009), and LS (β = −0.064, P = 0.001) among all subjects in a multivariate linear regression analysis.

Conclusion

Our results suggest that insulin resistance may be independently and inversely associated with the near peak bone mass of the femur and lumbar spine.