Pubertal timing and adult obesity and cardiometabolic risk in women and men: a systematic review and meta-analysis

Abstract

Obesity has complex multifactorial aetiology. It has been suggested by many, but not all, reports that earlier pubertal maturation may increase adult obesity risk. We conducted a systemic review and meta-analysis in both women and men, and hypothesised that any association between pubertal timing and adult obesity is likely to be confounded by childhood adiposity. In addition, we investigated whether pubertal timing is related to other cardiometabolic risk and long-term cardiovascular morbidity/mortality. Literature search was undertaken using MEDLINE, EMBASE, Web of Knowledge and TRIP databases, with a hand search of references. Both authors independently reviewed and extracted pre-defined data from all selected papers. Meta-analyses were conducted using Review Manager (RevMan) 5.0.24. A total of 48 papers were identified. Out of 34 studies, 30 reported an inverse relationship between pubertal timing and adult body mass index (BMI), the main adiposity measure used. Meta-analysis of 10 cohorts showed association between early menarche (menarche <12 vs ≥12 years) and increased adult BMI, with a standardised mean difference of 0.34 kg m(-2) (95% confidence interval: 0.33-0.34). Heterogeneity was large (I(2)=92%) but reduced significantly when grouped by outcome age. Late menarche (menarche ≥15 vs <15 years) was associated with decreased adult BMI, with a standardised mean difference of -0.26 kg m(-2) (95% confidence interval: -0.36, -0.21) (seven cohorts). Only eight papers included data on childhood BMI; the majority reported that childhood BMI only partially attenuated association between early menarche and later obesity. Although not suitable for meta-analysis, data on cardiometabolic risk factors and puberty suggested negative association between earlier pubertal timing and cardiovascular mortality, hypertension, metabolic syndrome (MetS) and abnormal glycaemia. Earlier pubertal timing is predictive of higher adult BMI and greater risk of obesity. This effect appears to be partially independent of childhood BMI. Earlier pubertal development appears to also be inversely correlated with risk of other cardiometabolic risk factors and cardiovascular mortality. Further work is needed to examine potential mechanisms and the level at which interventions may be targeted.

Impact of age at menarche on obesity and glycemic control in Japanese patients with type 2 diabetes: Fukuoka Diabetes Registry

“…In a meta‐analysis of 10 studies including 246,671 women12, mostly from Western populations, early menarche (<12 vs 12 years) was associated with 0.34 kg/m 2 higher BMI. Of 303,000 women in the China Kadoorie Biobank, increases in BMI and abdominal circumference per 1‐year earlier onset of menarche were reported to be 0.19 kg/m 2 and 0.38 cm, respectively5.…”

“…In Japan, the mean age at menarche decreased from 13.2 years in 1961 to 12.2 years in 2011 in school‐aged girls1. Earlier‐onset menarche is reported to be associated with obesity2, 3, 4, 5, type 2 diabetes mellitus4, 6, 7, 8, 9, 10, 11, cardiovascular disease4, 12, 13, 14, breast cancer15 and increased all‐cause mortality4, 13, 16, 17, 18. It is therefore possible that age at menarche can provide important information to help prevent non‐communicable diseases.…”

Age at menarche and the risk of diabetic microvascular complications in patients with type 1 diabetes

“…However, delayed menarche has been associated with other diseases and conditions such as irregular menstruation and other gynaecological disturbances [17]. In the general population, menarcheal age has been associated with several other conditions, such as pre-eclampsia, decreased bone mineral density, type 2 diabetes, breast cancer and cardiovascular disease [32][33][34]. Puberty is known to accelerate microvascular complications.…”

Age at Menarche and Cardiometabolic Health: A Sibling Analysis in the Scottish Family Health Study

“…Early menarche is associated with reduced insulin sensitivity and higher glucose,1, 2, 3, 4, 5, 6, 7, 8, 9 higher triglycerides and cholesterol levels,2, 6, 10 higher blood pressure,4, 5, 11, 12 and greater waist circumference and body mass index (BMI) 4, 5, 13, 14, 15. In line with these findings, there is some but less consistent evidence of an association between age at menarche and cardiovascular disease (CVD) events 12, 16, 17, 18.…”