Age at Menarche and Type 2 Diabetes Risk
Open accessAbstract
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 confirm this association and to examine whether it is explained by adiposity. RESEARCH DESIGN AND METHODS: The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from 26 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 later menarche 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 early menarche 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.
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The age of puberty onset is associated with subsequent health outcomes.
“The age of puberty onset is associated with subsequent health outcomes.”
From Pubertal development and regulation (2016) · cites this paper as [16]
Early age at menarche is a risk factor for breast cancer, cardiovascular disease, depression, behavioural disorders, diabetes, and increased all-cause mortality.
“Early age at menarche is a risk factor for breast cancer,15 cardiovascular disease, depression, behavioural disorders, diabetes, and increased all-cause mortality.16,17”
From Pubertal development and regulation (2016) · cites this paper as [16]
Successful, field-altering risk-factor and subphenotype investigations among many centers have been demonstrated by large consortia across an array of health outcomes.
“Indeed, successful, field-altering risk-factor and subphenotype investigations among many centers have been demonstrated by large consortia across an array of health outcomes (5–11).”
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- Authors
- Elks, C. E., Ong, K. K., Scott, R. A., van der Schouw, Y. T., Brand, J. S., Wark, P. A., Amiano, P., Balkau, B., Barricarte, A., Boeing, H., Fonseca-Nunes, A., Franks, P. W., Grioni, S., Halkjaer, J., Kaaks, R., Key, T. J., Khaw, K. T., Mattiello, A., Nilsson, P. M., Overvad, K., Palli, D., Quirós, J. R., Rinaldi, S., Rolandsson, O., Romieu, I., Sacerdote, C., Sánchez, M.-J., Spijkerman, A. M. W., Tjonneland, A., Tormo, M.-J., Tumino, R., van der A, D. L., Forouhi, N. G., Sharp, S. J., Langenberg, C., Riboli, E., Wareham, N. J., & The InterAct Consortium
- Affiliations
- University of Cambridge (GB)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- University Medical Center Utrecht (NL)
- Imperial College London (GB)
- Basque Government (ES)
- Université Paris-Sud (FR)
- Instituto de Salud Pública de Navarra (ES)
- German Institute of Human Nutrition (DE)
- Department of Epidemiology, Nutrition, Environment, and Cancer Unit, Catalan Institute of Oncology, L'Hospitalet de Lolgbregat, Barcelona, Spain
- Lund University (SE)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Danish Cancer Society Research Center, Copenhagen, Denmark
- German Cancer Research Center (DE)
- University of Oxford (GB)
- Federico II University Hospital (IT)
- Aarhus University (DK)
- Istituto per lo Studio e la Prevenzione Oncologica (IT)
- Consejería de Sanidad, Public Health Directorate, Oviedo-Asturias, Spain
- Centre international de recherche sur le cancer (FR)
- Umeå University (SE)
- Italian institute for Genomic Medicine (IT)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- National Institute for Public Health and the Environment (NL)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública), Madrid, Spain
- Azienda Usl 8 Arezzo (IT)
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, London, U.K.
- Corresponding author
- Elks, Cathy E.
- ORCID
- Ong, Ken K.
- Scott, Robert A.
- Brand, Judith S.
- Wark, Petra A.
- Amiano, Pilar
- Balkau, Beverley
- Barricarte, Aurelio
- Boeing, Heiner
- Franks, Paul W.
- Grioni, Sara
- Kaaks, Rudolf
- Key, Timothy J.
- Khaw, Kay Tee
- Mattiello, Amalia
- Nilsson, Peter M.
- Overvad, Kim
- Palli, Domenico
- Quirós, J. Ramón
- Rinaldi, Sabina
- Rolandsson, Olov
- Sacerdote, Carlotta
- Sánchez, María-José
- Tumino, Rosario
- Forouhi, Nita G.
- Sharp, Stephen J.
- Langenberg, Claudia
- Wareham, Nicholas J.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2013-10-15
- Volume
- 36
- Issue
- 11
- Pages
- 3526-3534
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3816901
- OpenAlex
- W1978720848
- Cited by
- 186
- References
- 40
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 22 · 2023: 10 · 2022: 15 · 2021: 17 · 2020: 19 · 2019: 11 · 2018: 16 · 2017: 14 · 2016: 15 · 2015: 14 · 2014: 10
- FWCI
- 15.70
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Pure (Coventry University) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0512-10114, NF-SI-0512-10135)
- Medical Research Council (MC_UU_12015/5, MC_UU_12015/2, MC_UU_12015/1)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- age at menarche, type 2 diabetes, pubertal timing, adult body mass index, adiposity, women, incident diabetes risk
- MeSH terms
- Adult, Age Factors, Diabetes Mellitus, Type 2, Europe, Female, Humans, Life Style, Longitudinal Studies, Menarche, Middle Aged, Neoplasms, Obesity, Prospective Studies, Risk, Risk Factors, Incidence, Adiposity
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