Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Diabetes Care. 2023 Jun 1;46(6):1231-1238. doi: 10.2337/dc22-2017.
To investigate the association of plasma insulin levels and their trajectories from birth to childhood with the timing of menarche.
This prospective study included 458 girls recruited at birth between 1998 and 2011 and followed prospectively at the Boston Medical Center. Plasma nonfasting insulin concentrations were measured at two time points: at birth (cord blood) and in childhood (age 0.5-5 years). Age at menarche was obtained from a pubertal developmental questionnaire or abstracted from electronic medical records.
Three hundred six (67%) of the girls had reached menarche. The median (range) age at menarche was 12.4 (9-15) years. Elevated plasma insulin concentrations at birth (n = 391) and in childhood (n = 335) were each associated with an earlier mean age at menarche: approximately 2 months earlier per doubling of insulin concentration (mean shift, -1.95 months, 95% CI, -0.33 to -3.53, and -2.07 months, 95% CI, -0.48 to -3.65, respectively). Girls with overweight or obesity in addition to elevated insulin attained menarche about 11-17 months earlier, on average, than those with normal weight and low insulin. Considering longitudinal trajectories (n = 268), having high insulin levels both at birth and in childhood was associated with a roughly 6 months earlier mean age at menarche (mean shift, -6.25 months, 95% CI, -0.38 to -11.88), compared with having consistently low insulin levels at both time points.
Our data showed that elevated insulin concentrations in early life, especially in conjunction with overweight or obesity, contribute to the earlier onset of menarche, suggesting the need for early screening and intervention.
研究从出生到儿童期的血浆胰岛素水平及其变化轨迹与初潮时间的关系。
本前瞻性研究纳入了 1998 年至 2011 年间出生的 458 名女孩，在波士顿医疗中心进行了前瞻性随访。在两个时间点测量了血浆非禁食胰岛素浓度：出生时（脐血）和儿童期（0.5-5 岁）。初潮年龄通过青春期发育问卷或从电子病历中提取获得。
306 名（67%）女孩已经初潮。初潮的中位数（范围）年龄为 12.4（9-15）岁。出生时（n=391）和儿童期（n=335）升高的血浆胰岛素浓度均与初潮年龄较早相关：胰岛素浓度每增加一倍，平均初潮年龄提前约 2 个月（平均偏移，-1.95 个月，95%CI，-0.33 至-3.53，和-2.07 个月，95%CI，-0.48 至-3.65）。超重或肥胖合并高胰岛素的女孩，平均初潮年龄比体重正常、胰岛素水平低的女孩早 11-17 个月。考虑到纵向轨迹（n=268），出生和儿童期均有高胰岛素水平与初潮年龄平均提前约 6 个月相关（平均偏移，-6.25 个月，95%CI，-0.38 至-11.88），而在两个时间点均有低胰岛素水平的女孩初潮年龄较晚。
我们的数据表明，生命早期升高的胰岛素浓度，尤其是与超重或肥胖并存，导致初潮提前，表明需要早期筛查和干预。
