Menarche Age And Risk For Adult Onset Diabetes
Overview
This cross-sectional study explores the association between menarche age and overt diabetes in women aged 35 to 70. The research, involving 6094 participants from the Zahedan Adult Cohort Study, utilizes a questionnaire to collect demographic, fertility, anthropometric, and disease history data. Menarche age is categorized into five groups, and diabetes is defined as a blood sugar level of 126 or higher. Statistical analyses, including chi-square and logistic regression tests, are performed using SPSS 26 software.
The mean age of participants is 49.41 ± 8.88, with an average menarche age of 13 ± 1.49. Of the participants, 22.8% (1389 women) have diabetes, while 77.2% (4705 women) do not. The study reveals a significant association between menarche age and diabetes risk. Women with menarche occurring under 12 years have a higher likelihood of developing diabetes compared to those with menarche at 13 years (reference) (OR = 1.23, 95% CI: 0.96, 1.51). This association remains significant after adjusting for variables such as body mass index, education level, fertility factors, history of diabetes, and reproductive diabetes (OR = 1.21, 95% CI: 0.90, 1.44, p = 0.04).
In conclusion, the findings suggest that an early age at menarche may serve as a risk factor for diabetes in adulthood. The study emphasizes the importance of incorporating this information into diabetes screening, aiming to identify individuals at risk and implement preventive measures to mitigate the adverse consequences of diabetes. The authors recommend further prospective studies to validate these results.
Introduction
Diabetes is a global public health challenge, contributing significantly to non-communicable disease-related deaths. This study emphasizes its impact on mortality, particularly from infections, cardiovascular diseases, stroke, kidney and liver diseases, and cancer. Diabetes, characterized by chronic hyperglycemia, results from heterogeneous metabolic disorders affecting insulin secretion. Despite advances in healthcare, diabetes remains a major factor negatively affecting life expectancy, ranking second in its impact globally.
The International Diabetes Federation reported 451 million diagnosed cases in 2017, projected to rise to 693 million by 2045. The Middle East and North Africa region face the highest prevalence, with 10.9% affected. In Iran, the prevalence is 9.6% in men, 11.1% in women, and 10.3% in the adult population, expected to reach 9.2 million cases by 2030. Identifying risk factors, particularly biological ones, is crucial, considering their impact on glucose control. Puberty-related biological processes, including early menarche, are proposed determinants of later-life diseases.
Obesity, a recognized risk factor for diabetes, often traces its roots to childhood. The complex interplay of insulin, testosterone, growth factors, hormones, and fatty acids contributes to insulin resistance, a key element in type 2 diabetes development. Early menarche is posited to increase obesity risk, potentially elevating blood glucose levels and insulin resistance. While studies on the age of menarche and diabetes risk yield conflicting results, this study in Zahedan city aims to address these discrepancies comprehensively. Acknowledging menarche as a pivotal aspect of female puberty, the research seeks to elucidate its relationship with the risk of diabetes in women.
Methods
This cross-sectional study, part of the larger Persian cohort study, investigates the correlation between menarche age and diabetes in 6099 women participants from Zahedan city. The cohort was established from October 2015 to January 2019 using a multistage stratified sampling method, dividing Zahedan into three regions based on municipal areas and socioeconomic class. Eligible women aged 35–70 with Iranian citizenship and a residence duration of at least 9 months in Zahedan were included. Those with disabilities hindering cooperation or incomplete questionnaires were excluded.
After selecting participants, invitations were extended via phone calls, followed by detailed explanations of the research and its significance. Trained personnel completed questionnaires for consenting participants. The data collection tools, validated in the Persian cohort study, encompassed general, medical, and nutritional information, totaling 482 questions. These covered demographics, economic and social factors, lifestyle, medical history, fertility, and dietary habits. Anthropometrics and a 25 mL blood sample were obtained after a 12-hour fast. Abnormal results prompted further testing, and participants were informed via SMS.
Statistical analysis in SPSS 26 involved descriptive metrics and chi-square and logistic regression tests (forward method). Ethical approval was secured from relevant committees, ensuring participant confidentiality, obtaining informed consent, and allowing voluntary withdrawal from the study. The ethical considerations were upheld in accordance with the approvals from the Ministry of Health and Medical Education and Zahedan University of Medical Sciences.
Result
In a study involving 6094 participants, 1389 women had diabetes. The mean age and age at menarche were 49.41 ± 8.88 and 13 ± 1.49, respectively. Of the participants, 37.7% were overweight, and 81.2% were inactive. Individuals reporting menarche onset before 12 years had higher rates of diabetes, overweight, and number of children.
The chance of diabetes significantly increased in women with menarche before 12 years compared to the reference group (menarche at 13 years) (OR = 1.23). This association persisted even after adjusting for body mass index (BMI) (OR = 1.25) and remained slightly significant with further adjustments for education (OR = 1.19). Family history of diabetes and gestational diabetes increased the chance of diabetes by 23% (OR = 1.23).
Fertility factors did not show a significant relationship with menarche age and diabetes, but women with more children (≥5) had a significantly higher chance of diabetes (OR = 2.25). In the final model, menarche age <12 years was associated with a 21% higher chance of diabetes (OR = 1.21). Higher education (above a bachelor’s degree) reduced the chance of diabetes by 67% (OR = 0.33), while a BMI of 30 or more increased the chance by 3.38 times. A history of family diabetes and gestational diabetes significantly increased the chance of diabetes.
Age and BMI showed a positive correlation with diabetes, with individuals aged 65 years and older having an eightfold increased risk, and those with a BMI of 30 or more having a sixfold increased risk. Higher education was associated with a 64% lower chance of diabetes. Birth control pill use and smoking did not impact diabetes risk.
Conclusion
The study delved into the intricate relationship between the age of menarche, a critical milestone in female puberty, and the likelihood of developing diabetes in a cohort of women aged 35–70 from Zahedan. The key finding of a 21% increased risk of diabetes in women reporting menarche at the age of 12 or below, even after meticulous adjustments for various factors, underscores the potential significance of this early reproductive event as a predictive marker for diabetes.
Researchers considered the impact of menarche in conjunction with body mass index (BMI), revealing a subtle rise in diabetes risk for those with an earlier onset of menarche. This observation aligns with the complex interplay of factors involving obesity, early puberty, and insulin resistance. The study illuminated the intricate relationship between these variables, shedding light on the multifaceted nature of diabetes risk in women.
Moreover, the protective effect of higher education against diabetes emerged as a noteworthy finding. Women with advanced education levels exhibited a 67% lower likelihood of developing diabetes, suggesting that educational attainment might contribute to healthier lifestyle choices and greater awareness of health-related factors.
The study also explored the influence of fertility factors on the menarche-diabetes relationship. While the number of children did not exhibit a direct correlation with early menarche and diabetes risk, the research uncovered an independent association between having more children and a 25% increased risk of diabetes. This underscores the intricate interplay of reproductive factors and their potential impact on diabetes risk.
Recognizing the limitations of self-reported data and the absence of certain diagnostic tests, the study cautiously recommended further research. It emphasized the need for more diverse populations and comprehensive control for additional demographic characteristics to enhance the robustness of future investigations.
In conclusion, the study’s findings suggest that considering the age of menarche in diabetes screening protocols could offer valuable insights for identifying individuals at risk. Proposing preventive measures targeting early menarche alongside other risk factors may contribute to reducing the adverse consequences of diabetes in women. The study not only adds to the growing body of knowledge on diabetes risk factors but also underscores the importance of tailoring prevention strategies based on the unique life experiences of women.
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