绝经后女性的生殖史与2型糖尿病风险：来自女性健康倡议的研究结果
Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Women's Health Initiative.
作者信息
LeBlanc Erin S, Kapphahn Kristopher, Hedlin Haley, Desai Manisha, Parikh Nisha I, Liu Simin, Parker Donna R, Anderson Matthew, Aroda Vanita, Sullivan Shannon, Woods Nancy F, Waring Molly E, Lewis Cora E, Stefanick Marcia
机构信息
1Kaiser Permanente Center for Health Research, Portland, OR 2Stanford University School of Medicine, Stanford University, Stanford, CA 3University of California, San Francisco, San Francisco, CA 4Warren Alpert Medical School and School of Public Health of Brown University, Providence, RI 5Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI 6Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX 7MedStar, Washington Hospital Center, Washington, DC 8University of Washington School of Nursing, Seattle, WA 9University of Massachusetts Medical School, Worcester, MA 10Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
出版信息
Menopause. 2017 Jan;24(1):64-72. doi: 10.1097/GME.0000000000000714.
OBJECTIVE
The aim of the study was to understand the association between women's reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk.
METHODS
Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Women's Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes.
RESULTS
In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37% (95% CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40 y). Women with the longest (45+ y) reproductive periods had a 23% (95% CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95% CI, 0.99-1.09 and HR 1.08; 95% CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment.
CONCLUSIONS
Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.
目的
本研究旨在了解女性生殖史与其患2型糖尿病风险之间的关联。我们假设，表明累积内源性雌激素暴露较低的特征与风险增加有关。
方法
对来自女性健康倡议（WHI）的124379名年龄在50至79岁之间的绝经后女性进行前瞻性队列分析。我们通过基线调查问卷确定初潮年龄和末次月经时间以及月经不规律史，并根据初潮年龄和末次月经时间计算生殖期长度。新发2型糖尿病情况通过自我报告获取。使用多变量Cox比例风险模型，我们评估了生殖变量与2型糖尿病发病率之间的关联。
结果
在年龄调整模型中，生殖期最短（<30年）的女性患2型糖尿病的风险比生殖期中度（36 - 40年）的女性高37%（95%CI，30 - 45）。生殖期最长（45年以上）的女性比生殖期中度的女性风险高23%（95%CI，12 - 37）。在进行全面调整后，这些关联减弱（最短生殖期的HR为1.07[1.01, 1.14]，最长生殖期的HR为1.09[0.99, 1.22]，与中等时长相比）。末次月经时间在45岁之前和55岁之后的女性患糖尿病的风险增加（HR分别为1.04；95%CI，0.99 - 1.09和HR 1.08；95%CI，1.01 - 1.14），相比之下末次月经时间在46至55岁之间的女性。在全面调整后，初潮时间和月经周期规律性与风险无关。
结论
生殖史可能与2型糖尿病风险相关。生殖期较短和较长的女性可能从预防2型糖尿病的生活方式咨询中受益。
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