Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
JAMA Netw Open. 2020 Dec 1;3(12):e2027928. doi: 10.1001/jamanetworkopen.2020.27928.
Menstrual cycle dysfunction is associated with insulin resistance, a key feature early in the pathogenesis of type 2 diabetes. However, the evidence linking irregular and long menstrual cycles with type 2 diabetes is scarce and inconsistent.
To evaluate the associations between menstrual cycle characteristics at different points throughout a woman's reproductive life span and risk of type 2 diabetes and the extent to which this association is modified by lifestyle factors.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included 75 546 premenopausal US female nurses participating in the Nurses' Health Study II from 1993 to June 30, 2017. Data analysis was performed from February 1 to December 30, 2019.
Self-reported usual length and regularity of menstrual cycles at the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years.
Incident type 2 diabetes identified through self-report and confirmed by validated supplemental questionnaires.
Among the 75 546 women in the study at baseline, the mean (SD) age was 37.9 (4.6) years (range, 29.0-46.0 years). A total of 5608 participants (7.4%) had documented new cases of type 2 diabetes during 1 639 485 person-years of follow-up. After adjustment for potential confounders, women reporting always having irregular menstrual cycles between the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years were, respectively, 32% (95% CI, 22%-44%), 41% (95% CI, 23%-62%), and 66% (95% CI, 49%-84%) more likely to develop type 2 diabetes than women reporting very regular cycles (within 3-4 days of expected period) in the same age range. Similarly, women reporting a usual cycle length of 40 days or more between the age ranges of 18 to 22 years and 29 to 46 years were, respectively, 37% (95% CI, 19%-57%) and 50% (95% CI, 36%-65%) more likely to develop type 2 diabetes during follow-up compared with women reporting a usual cycle length of 26 to 31 days in the same age ranges. These associations appeared to be stronger among women with overweight or obesity, a low-quality diet, and low levels of physical activity. The relative excess risk of type 2 diabetes due to the interaction between irregular and long menstrual cycles and the overall unhealthy lifestyle score was 0.73 (95% CI, 0.57-0.89) and 0.68 (95% CI, 0.54-0.83), respectively.
In this cohort study of US female nurses participating in the Nurses' Health Study II, irregular and long menstrual cycles throughout life were associated with a greater risk of type 2 diabetes, particularly among women with overweight or obesity, a low-quality diet, and low levels of physical activity.
月经周期功能障碍与胰岛素抵抗有关，而胰岛素抵抗是 2 型糖尿病发病早期的一个关键特征。然而，将不规律和长月经周期与 2 型糖尿病联系起来的证据很少且不一致。
评估女性生殖生命周期不同阶段的月经周期特征与 2 型糖尿病风险之间的关联，以及这种关联在多大程度上受到生活方式因素的影响。
设计、设置和参与者：这项前瞻性队列研究包括参加美国护士健康研究 II 的 75546 名绝经前美国女性护士，研究时间从 1993 年到 2017 年 6 月 30 日。数据分析于 2019 年 2 月 1 日至 12 月 30 日进行。
在 14 至 17 岁、18 至 22 岁和 29 至 46 岁的年龄范围内，自我报告的通常月经周期长度和规律性。
通过自我报告和经证实的补充问卷确认的新发生的 2 型糖尿病病例。
在研究中的 75546 名女性中，平均（SD）年龄为 37.9（4.6）岁（范围，29.0-46.0 岁）。在 1639485 人年的随访中，共有 5608 名参与者（7.4%）确诊为新的 2 型糖尿病。在调整了潜在混杂因素后，报告在 14 至 17 岁、18 至 22 岁和 29 至 46 岁年龄范围内月经周期一直不规律的女性，分别有 32%（95%CI，22%-44%）、41%（95%CI，23%-62%）和 66%（95%CI，49%-84%）更有可能患上 2 型糖尿病，而在相同年龄范围内报告月经周期非常规律（预期经期的 3-4 天内）的女性。同样，报告在 18 至 22 岁和 29 至 46 岁年龄范围内的周期长度为 40 天或更长的女性，与在相同年龄范围内报告周期长度为 26 至 31 天的女性相比，在随访期间更有可能患上 2 型糖尿病，分别为 37%（95%CI，19%-57%）和 50%（95%CI，36%-65%）。这些关联在超重或肥胖、低质量饮食和低水平身体活动的女性中似乎更为明显。由于不规律和长月经周期与整体不健康的生活方式评分之间的相互作用而导致的 2 型糖尿病的相对超额风险分别为 0.73（95%CI，0.57-0.89）和 0.68（95%CI，0.54-0.83）。
在这项参与美国护士健康研究 II 的美国女性护士的队列研究中，整个生命周期的不规律和长月经周期与 2 型糖尿病风险增加相关，尤其是在超重或肥胖、低质量饮食和低水平身体活动的女性中。
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