Early periods, fewer CV health parameters increase the risk of type 2 diabetes

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December 07, 2020

3 minutes to read

Source / Disclosures

Disclosures: The authors do not report any relevant financial disclosures.


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Chinese women who had a first period were more likely to develop type 2 diabetes in adulthood, with a higher risk for those with less than ideal cardiovascular health, according to data from the REACTION study .

“Our study further indicated that an early age at menarche was associated with an increased risk of diabetes in adulthood,” Jieli Lu, MD, PhD, from the Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School, and colleagues wrote in a study published in the Diabetes Journal. “More importantly, the increased risk of diabetes associated with early age at menarche was significantly reduced in people with at least four ideal CV health parameters. There was a clear interaction between the number of ideal CV health measures and age at menarche on diabetes risk.

Women with early menarche and four or more ideal CV parameters had a lower risk of developing diabetes than those with one or fewer parameters.

Measuring Ideal CV Health

In the REACTION study, researchers recruited 259,657 adults aged 40 or older from 25 locations across China in 2011 and 2012. For this study, data was analyzed from 121,431 women (mean age, 56 , 96 years old) who participated in the study. Participants provided socio-demographic information, lifestyle factors, medical history, and reproductive history in a series of questionnaires. All participants underwent a physical examination, blood and plasma samples were taken, and underwent an oral glucose tolerance test.

The researchers counted the number of ideal CV health metrics for each participant. Ideal CV health has been defined by five elements:

  • have never smoked or stopped smoking for at least 1 year;
  • having a BMI less than 24 kg / m2;
  • participate in at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous activity per week;
  • register a food score of three or more; participants were awarded one point each for consuming 4.5 or more cups of fruit and vegetables per day, at least 198 g of fish per week, no more than 450 kcal of sugary or sugary drinks per week, and at least 25 g of soy protein per day; and
  • having an untreated total cholesterol level below 200 mg / dL and untreated blood pressure below 120/80 mm Hg.

early menarche and diabetes

Type 2 diabetes was prevalent in 23.73% of women who had an early period under 14 years old, 23.39% in those who had periods between 14 and 17 years old and 26.37% in women who had had a period. late periods over 17 years of age. After adjusting for age, education, alcohol consumption, family history of diabetes, reproductive factors, and number of CV health parameters, women in the first period group were more likely to develop diabetes. in adulthood than those who had their first period between 14 and 17 years old (adjusted OR = 1.22; 95% CI, 1.17-1.28), while people in the menarche cohort late were less likely to develop diabetes (aOR = 0.89; 95% CI 0.85 to 0.93).

“Potential mechanisms underlying the association of age at menarche and diabetes risk have been proposed,” the researchers wrote. “Early age at menarche was associated with higher cumulative exposure to estrogen, which may decrease serum levels of sex hormone-binding globulin, while high plasma estradiol levels and low levels of binding globulin. sex hormones may be associated with an increased risk of diabetes. … A higher accumulation of progesterone induced by early menarche may impair the function of insulin-secreting cells through oxidative stress-dependent mechanisms, suppress the release of insulin and the glucose-4 transporter, resulting in a insulin resistance and diabetes. In addition, epidemiological studies have also confirmed that an early age at menarche is associated with a higher risk of obesity, insulin resistance and non-alcoholic fatty liver disease.

CV health associated with diabetes

Total cholesterol and BP influenced the risk of developing diabetes. In the first period group, people with non-ideal total cholesterol (OR = 1.3; 95% CI, 1.22-1.4) were more at risk of developing diabetes than those with an ideal cholesterol level (OR = 1.16; 95% CI, 1.08-1.23; P = .0091). Women with a non-ideal BP level were also more likely to develop diabetes (OR = 1.25; 95% CI, 1.19-1.32) than those with an ideal BP (OR = 1.13; 95% CI, 1.03-1.26; P = 0.0019).

The prevalence of diabetes was higher among participants with fewer parameters of ideal CV health. Women with early menarche and one or no ideal metric had the highest risk of developing diabetes (OR = 1.34; 95% CI: 1.15 to 1.57), while those with early menarche and four ideal metrics (OR = 1.11; 95% CI, 0.999 -1.24) and five or more ideal metrics (OR = 0.96; 95% CI: 0.8-1.16) n ‘ had no increased risk. The association was similar between the different generations, although the researchers noted that the estimates were higher for the younger generations than for the older ones.

“Our study emphasizes the importance of promoting healthy lifestyles and comprehensive management of metabolic factors, including BP and total cholesterol levels, in the prevention of type 2 diabetes”, wrote the researchers.

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