Diet influences menarche timing

Menarche appears to occur later for girls with good diet quality, regardless of BMI and height, as shown in a US cohort study.

In an analysis of food frequency questionnaire (FFQ) data from participants in the Growing Up Today Study (GUTS), those in the highest quintile of the Alternative Healthy Eating Index (AHEI) diet score and thus had had the healthiest diet were 8-percent less likely to have their first menstrual period within the next month relative to those in the lowest quintile (hazard ratio [aHR], 0.92, 95 percent confidence interval [CI], 0.85–0.99; p=0.03). [Hum Reprod 2025;40:1087-1093]

The association persisted despite adjusting for BMI z-scores and height (HR, 0.93, 95 percent CI, 0.86–1.00; p=0.04).

Meanwhile, participants in the highest quintile of the Empirical Dietary Inflammatory Pattern (EDIP) score and therefore had the most inflammatory diet were 15-percent more likely to have their first menstrual period in the next month compared with those in the lowest quintile (HR, 1.15, 95 percent CI, 1.06–1.25; p=0.0004). This association remained unchanged following adjustment for BMI z-scores and height (HR, 1.15, 95 percent CI, 1.06–1.25; p=0.0004).

“Our findings [point to] dietary patterns as a modifiable factor that could shift age at menarche,” according to senior investigator Prof Holly Harris from the Fred Hutchinson Cancer Center in Seattle, Washington, US.

“Earlier age at menarche is associated with multiple [adverse] later life outcomes, including higher risk of diabetes, obesity, cardiovascular disease, and breast cancer,” Harris added.

As such, it is important that children and adolescents have access to healthy meal options and that school breakfasts and lunches are prepared based on evidence-based guidelines, she said.

The analysis included 7,530 female participants who were premenarchal at baseline and completed a baseline FFQ. A total of 6,992 (93 percent) reported menarche during the study, with FFQ data collected an average of 1.75 years before its occurrence. The median age at menarche was 13.1 years.

Participants who had higher AHEI scores had fewer hours of physical inactivity, had a slightly lower BMI z-score, and ate more family dinners compared with those who had lower scores. In contrast, participants with higher EDIP scores tended to be more physically inactive and have a slightly higher BMI z-score relative to those with lower EDIP scores.

The AHEI scores were based on intake levels of its components: fruits, vegetables, whole grains, sugar-sweetened beverages, nuts and legumes, red and processed meats, trans fat, long-chain fatty acids, polyunsaturated fatty acids, and sodium. For EDIP, scores were calculated from weighted sums of 18 food groups including processed meat, red meat, organ meat, refined grains, high- and low-energy beverages, leafy green vegetables, snacks (popcorn and crackers), fruit juice, and pizza, among others. 

Harris acknowledged that the study was limited by the use of self-reported questionnaires, which are subject to some error. “However, given our prospective study design it is likely this error is nondifferential with respect to the outcome.”

Overall, the study reinforces that eating a healthy diet could also have benefits in adolescence, she said. “Generally, eating fruits, vegetables, whole grains, fatty fish, nuts and legumes, and polyunsaturated fatty acids, while limiting intake of red and processed meats, refined grains, sugar-sweetened beverages and added salt, benefits everyone regardless of age.”