Dietary patterns and age at menarche in a prospective study of girls in the USA

Davis CP; Fest S; Cushing-Haugen K; Kensler TW; Chavarro JE; Harris HR

doi:10.1093/humrep/deaf072

Lifestyle and Environment · Nutrition and Metabolic Health

Dietary patterns and age at menarche in a prospective study of girls in the USA

Davis CP, Fest S, Cushing-Haugen K, Kensler TW, Chavarro JE, Harris HR

Published June 2025 Human Reproduction (Oxford, England), 40(6), 1087-1093

DOI 10.1093/humrep/deaf072 PMID 40328293 PMC PMC12127513

RRM Academy Synopsis

Healthier diets were linked to later first periods in 7530 US girls

A prospective cohort of 7530 US girls linked healthier diets to later first periods and more inflammatory diets to earlier ones. Girls in the highest fifth of diet quality were 8% less likely than the lowest fifth to start menstruating next month. The most inflammatory fifth were 15% more likely, compared with the lowest fifth.

Key Findings

Of 7530 girls who completed a food questionnaire before their first period, 6992 (93%) reported menarche during follow-up; the baseline questionnaire came on average 1.75 years before menarche.
Highest versus lowest fifth of Alternative Healthy Eating Index (AHEI) score: hazard ratio 0.92 (95% CI = 0.85–0.99), or 8% less likely to reach menarche in the next month.
Highest versus lowest fifth of Empirical Dietary Inflammatory Pattern (EDIP) score, the most inflammatory diet: hazard ratio 1.15 (95% CI = 1.06–1.25); 15% more likely to reach menarche next month.
After adding BMI-for-age and height to the models, the hazard ratios were 0.93 (95% CI = 0.86–1.00) for AHEI and 1.15 (95% CI = 1.06–1.25) for EDIP.
In the lower two BMI-for-age quartiles, the highest AHEI fifth had a hazard ratio of 0.84 (95% CI = 0.75–0.95); in the upper two quartiles, 1.03 (95% CI = 0.93–1.16).

Interpretation

The Growing Up Today Study is a prospective observational cohort, and the authors describe their findings as associations. Participants were children of Nurses' Health Study II members, and the sample was predominantly White. Girls reported their own diet and age at menarche, and body fat was not measured directly. After body-size adjustment, the AHEI interval reached 1.00. The difference between BMI groups for AHEI was not statistically significant (P interaction = 0.06). The authors found no significant mediation by BMI-for-age or height.

RRM Context

Restorative reproductive medicine reads the ovulatory cycle as a vital sign of whole-body health. Menarche marks where cycles begin. The study reports an association between diet quality and age at the first period. The authors cite earlier menarche as associated with higher risk of diabetes, obesity, cardiovascular disease, and breast cancer.

Our editorial summary of this paper, not the article's abstract.

Abstract

Study Question

Are dietary patterns associated with age at menarche after accounting for BMI-for-age (BMIz) and height?

Summary Answer

We observed associations between both the Alternative Healthy Eating Index (AHEI) and the Empirical Dietary Inflammatory Pattern (EDIP) and age at menarche.

What Is Known Already

Dietary patterns have been sparsely examined in relation to age at menarche and no studies have examined the association between the AHEI, a healthier diet, and EDIP, a pro-inflammatory diet, and menarche.

Study Design, Size, Duration

The Growing Up Today Study (GUTS) is a prospective cohort of children ages 9-14 years at study enrollment. GUTS enrolled in two waves with enrollment beginning in 1996 (GUTS1) and 2004 (GUTS2). For this analysis, GUTS1 and GUTS2 participants were followed through 2001 and 2008, respectively.

Participants/Materials, Setting, Methods

We included 7530 participants who completed food frequency questionnaire(s) (FFQ) prior to menarche who then self-reported age at menarche during study follow-up. Cox proportional hazard models were used to calculate multivariable hazard ratios (HRs) and 95% CIs for the associations between two dietary patterns, the AHEI and EDIP, and age at menarche, with and without adjustment for time-varying BMIz and height.

Main Results and the Role of Chance

Six thousand nine hundred ninety-two participants (93%) reported menarche during the study period. On average, participants completed the baseline FFQ 1.75 years prior to menarche. Participants in the highest quintile of AHEI diet score (indicating a healthier diet) were 8% less likely to attain menarche within the next month compared to those in the lowest quintile (95% CI = 0.85-0.99; Ptrend = 0.03). This association remained after adjustment for BMIz and height (corresponding HR = 0.93; 95% CI = 0.86-1.00; Ptrend = 0.04). Participants in the highest quintile of the EDIP score (i.e. most inflammatory diet), were 15% more likely to attain menarche in the next month relative to those in the lowest quintile (95% CI = 1.06-1.25; Ptrend = 0.0004), and the association remained following adjustment for BMIz and height (corresponding HR = 1.15; 95% CI = 1.06-1.25; Ptrend = 0.0004).

Limitations, Reasons for Caution

Self-reported questionnaires are subject to some error; however, given our prospective study design it is likely this error is non-differential with respect to the outcome.

Wider Implications of the Findings

Our findings of an association between both the AHEI and EDIP and age at menarche indicate that diet quality may play a role in age at menarche independent of BMI or height.

Study Funding/Competing Interests

This work was supported by the Breast Cancer Research Foundation. The GUTS is supported by the National Institutes of Health U01 HL145386. C.P.D. was supported by National Institutes of Health T32 CA094880. The authors have no conflicts of interest to disclose.

Trial Registration

N/A.

Topics

Lifestyle and Environment Nutrition and Metabolic Health Dietary Patterns

Lifestyle and Environment › Nutrition and Metabolic Health › Dietary Patterns

Jorge E Chavarro, Holly R Harris

J Chavarro, H Harris

PMID 40328293 40328293 DOI 10.1093/humrep/deaf072 10.1093/humrep/deaf072 Davis et al. 2025, Davis 2025

Dietary patterns and age at menarche in a prospective study of girls in the USA

Healthier diets were linked to later first periods in 7530 US girls

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Related research