OBJECTIVE-Younger age at menarche, a marker of pubertal timing in girls, is associated with higher risk of later type 2 diabetes.We aimed to confirmthis association and to examine whether it is explained by adiposity. RESEARCH DESIGN AND METHODSdThe prospective European Prospective Investigation into Cancer andNutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from26 research centers across eight European countries.We tested the association between age at menarche and incident type 2 diabetes using Prentice-weighted Cox regression in 15,168 women (n = 5,995 cases). Models were adjusted in a sequential manner for potential confounding and mediating factors, including adult BMI. RESULTS-Mean menarcheal age ranged from 12.6 to 13.6 years across InterAct countries. Each year latermenarche was associated with 0.32 kg/m2 lower adult BMI. Women in the earliest menarche quintile (8-11 years, n = 2,418) had 70%higher incidence of type 2 diabetes compared with those in the middle quintile (13 years, n = 3,634), adjusting for age at recruitment, research center, and a range of lifestyle and reproductive factors (hazard ratio [HR], 1.70; 95% CI, 1.49- 1.94; P <0.001). Adjustment for BMI partially attenuated this association (HR, 1.42; 95% CI, 1.18-1.71; P <0.001). Later menarche beyond the median age was not protective against type 2 diabetes. CONCLUSIONS-Women with history of earlymenarche have higher risk of type 2 diabetes in adulthood. Less than half of this association appears to be mediated by higher adult BMI, suggesting that early pubertal development also may directly increase type 2 diabetes risk.
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Advanced and Specialised Nursing