Early Pubertal Development and Cardiometabolic Risk: A Life Course Approach

University of Minnesota Ph.D. dissertation. September 2013. Major: Epidemiology. Advisors: Ellen Demerath, Aaron Folsom. 1 computer file (PDF); ix, 197 pages.A number of reports have linked early pubertal development to adverse health conditions among women. Despite race disparities in pubertal timing and later cardiovascular disease (CVD)-related health in adulthood, few studies have investigated if associations of early maturation with cardiometabolic risk factors differ for African-American and white women. Furthermore, there are limited longitudinal data tracking the trajectory of change in cardiometabolic risk factors after puberty and into adolescence and adulthood. The three primary aims of this thesis were to 1) examine the relationship between earlier age at menarche and CVD risk factors at different points in the life course, 2) account for the role of adiposity in associations, and 3) explore possible race differences in associations. These aims were explored using data from three prospective cohort studies that included different age groups: the National Growth and Health Study (NGHS) for ages 9-19 years, the Coronary Artery Risk Development in Young Adults (CARDIA) study for ages 18-54 years, and the Atherosclerosis Risk in Communities (ARIC) study for ages 45-75 years. The results from the three manuscripts included in this thesis suggested that earlier age at menarche was associated with a more adverse cardiometabolic profile over the life course, but higher lifetime accumulated adiposity among early maturing women explained most associations. Earlier menarche was more strongly related to adulthood adiposity and metabolic syndrome among white compared with African-American women, but there were no other differences by race. Targeted efforts to prevent obesity starting before puberty, as well as among early maturing girls even if normal weight, might be helpful for primordial prevention of cardiovascular disease