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Open Access Original investigation

Earlier age at menarche is associated with higher diabetes risk and cardiometabolic disease risk factors in Brazilian adults: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Noel T Mueller126*, Bruce B Duncan1, Sandhi M Barreto4, Dora Chor5, Marina Bessel1, Estela ML Aquino3, Mark A Pereira6 and Maria Inês Schmidt1

Author Affiliations

1 Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos n. 2600, sala 414, Porto Alegre, Rio Grande do Sul, Porto Alegre 90035-003, Brazil

2 Department of Epidemiology, Columbia University, New York, NY, USA

3 Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil

4 Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

5 National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

6 Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

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Cardiovascular Diabetology 2014, 13:22  doi:10.1186/1475-2840-13-22

Published: 16 January 2014

Abstract

Objectives

Early menarche has been linked to higher risk of type 2 diabetes in Western and Asian societies, yet whether age at menarche is associated with diabetes in Latin America, where puberty and diabetes may have different life courses, is unknown. We tested the hypothesis that earlier menarche is associated with higher diabetes risk in Brazilian adults.

Methods

We used data from 8,075 women aged 35-74 years in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had complete information on age at menarche, diabetes status, and covariates. Diabetes was defined based on self-reported physician diagnosis, medication use, and laboratory variables (fasting glucose, 2-hour glucose, and glycated hemoglobin). Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI).

Results

Menarche onset < 11 years [vs. 13-14 years (referent)] was associated with higher risk of diabetes (RR = 1.34; 95% CI: 1.14-1.57) after adjusting for sociodemographic factors, maternal education, maternal and paternal diabetes, and birth weight. This persisted after further control for BMI at age 20 years and relative leg length. Additionally, among those not taking diabetes medications, earlier menarche [<11 years vs. 13-14 years (referent)] was associated with higher % glycated hemoglobin (p < 0.001), alanine aminotransferase (p < 0.001), triglycerides (p < 0.001), C-reactive protein (p = 0.003), waist circumference (p < 0.001), and BMI measured at baseline exam (p < 0.001).

Conclusion

These findings support the hypothesis that earlier menarche is associated with greater risk for adult diabetes and cardiometabolic disease in the Brazilian context.

Keywords:
Puberty; Menarche; Diabetes; Cardiometabolic risk; Metabolic syndrome; Obesity; Brazil; Nutrition transition; Primordial prevention; Epidemiology