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Early menarche is associated with an increased risk of type 2 diabetes in rural Chinese women and is partially mediated by BMI

the Henan Rural Cohort Study

Zhang, Lulu MD1; Li, Yuqian MD, PhD2; Wang, Chongjian MD, PhD1; Mao, Zhenxing MD, PhD1; Zhou, Wen MD1; Tian, Zhongyan MD1; Dong, Xiaokang MD1; Zhang, Haiqing MD1; Yang, Xiu MD1; Fan, Mengying MD1; Li, Linlin MD, PhD1

doi: 10.1097/GME.0000000000001385
Original Study: PDF Only

Objective: The aim of the study was to determine if early menarche is associated with an increased risk of type 2 diabetes mellitus (T2DM) in rural Chinese women and to estimate the proportion that can be attributed to adiposity.

Methods: A total of 15,346 postmenopausal women were enrolled in this study. Logistic regression and restricted cubic spline analysis were performed to estimate the relationship between age at menarche and T2DM. Mediation analysis was used to investigate whether the association was mediated by body mass index (BMI).

Results: After adjusting for multiple confounders, the early menarche group (≤14 y) had a higher risk of T2DM (odds ratio [OR] = 1.21; 95% CI = 1.06-1.38; P = 0.004) compared with the reference group (16-17 y), whereas the late onset group (≥19 y) had a lower risk of T2DM (OR = 0.78; 95% CI = 0.66-0.92; P = 0.003). BMI partially mediated the association between age at menarche and T2DM, and the proportion of the effect was 28%.

Conclusions: Early menarche increases the risk of T2DM, whereas later menarche decreases the risk. The association seems to be partially mediated by BMI.

1Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China

2Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, China.

Address correspondence to: Linlin Li, MD, PhD, 100 Kexue Avenue, Zhengzhou, Henan 450001, China. E-mail:

Received 18 February, 2019

Revised 20 May, 2019

Accepted 20 May, 2019

Funding/support: This work was supported by the National Natural Science Foundation of China (grant number 81502879).

Financial disclosures/conflicts of interest: None reported.

© 2019 by The North American Menopause Society.