한빛사논문
Jeong-Seon Lee, MD,1 Young Ah Lee, MD,2 Choong Ho Shin, MD,2 Dong In Suh, MD,2 Yun Jeong Lee, MD2*, Dong Keon Yon, MD3,4*
1 Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
2 Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
3 Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
4 Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, South Korea
*Corresponding Authors
Abstract
Background
There is limited comprehensive evidence on the potential association between early menarche and subsequent health outcomes.
Aim
To evaluate the existing evidence for the association of early menarche with later health outcomes and assess the strength and validity of the evidence for these associations.
Design
Umbrella review
Methods
We searched PubMed, Web of Science, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Google Scholar, and manually screened retrieved references to find systematic reviews and meta-analyses from inception to July 2021. Early menarche was defined taking into account the ethnicity and birth year, and the outcomes were long-term consequences in adulthood.
Results
Thirteen reviews encompassing 283 original articles and over 6.8 million participants from 39 countries across five continents were included. In categorical outcomes, early menarche was associated with metabolic syndrome (n = 37,543, pooled adjusted relative risk [aRR] 1.56, 95% CI 1.33-1.83; high certainty [Hi]), endometrial cancer (n = 874,188, aRR 1.40, 95% CI 1.17-1.68; Hi), type 2 diabetes mellitus/impaired glucose tolerance (n = 1,185,444, aRR 1.30, 95% CI 1.19-1.42; Hi), breast cancer (n = 103,574, aRR 1.19, 95% CI 1.06-1.33; Hi), death from all causes (n = 152,747, aRR 1.11, 95% CI 1.03-1.19; Hi), obesity (n = 54,006, aRR 1.68, 95% CI 1.53-1.84; moderate certainty [Mod]), gestational diabetes mellitus (n = 48,535, aRR 1.32, 95% CI 1.09-1.58; Mod), hypertension (n = 1,682,689, aRR 1.24, 95% CI 1.20-1.29; Mod), endometriosis (n = 885,390, aRR 1.22, 95% CI 1.09-1.37; Mod), ovarian cancer (n = 1,022,451, aRR 1.17, 95% CI 1.04-1.31; Mod), and asthma (n = 22,859, aRR 1.31, 95% CI 1.09-1.57; low certainty [Lo]). For continuous outcomes, early menarche was associated with increased BMI in adults ≥40 years of age (n = 121,943, adjusted pooled standardized mean difference [aSMD] 0.30, 95% CI 0.28-0.32; Mod), BMI in adults <40 years of age (n = 124,728, aSMD 0.39, 95% CI 0.36-0.43; Mod), serum fasting insulin level (n = 17,020, aSMD 0.52, 95% CI 0.48-0.57; Mod), and homeostatic model assessment of insulin resistance (n = 7,925, aSMD 0.27, 95% CI 0.19-0.35; Mod).
Conclusion
We found varied levels of evidence for the association between early menarche and the development of subsequent health problems. Our results recommend that physicians should pay attention to these associations, as early menarche can be a potential indicator of metabolic disorders and female-specific cancer and cause death in women.
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