title: Reproductive and dietary determinants of the age at menopause in EPIC-Heidelberg.
abstract: OBJECTIVE
  The aim of the study was to explore the influence of reproductive and dietary factors on the age at menopause.
  
  
  METHODS
  During follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort in Heidelberg (median duration 5.8 years), 1009 women experienced natural menopause. They were compared to 3798 women who did not experience menopause. Baseline dietary intake was obtained by means of validated food frequency questionnaires. Data on reproductive history and medication was collected by means of questionnaires. Cox' proportional hazard models were applied in order to identify determinants of the age at natural menopause.
  
  
  RESULTS
  Increasing age at first full term pregnancy and a longer time interval until occurrences of regular menses are associated with later onset of natural menopause. Compared to never smokers, current smokers have the risk of younger age at menopause. High carbohydrate consumption and high intake of vegetable, fibre and cereal products are inversely related to the age at natural menopause. Women with higher intake of total fat, protein and meat experienced a delayed onset of natural menopause.
  
  
  CONCLUSIONS
  Age at natural menopause is influenced by lifestyle and dietary factors. Further studies including biological markers are needed to clarify these associations.
authors: Division of Clinical Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. g.nagel@dkfz-heidelberg.de
authors: Gabriele
authors: G
authors: Nagel
authors: Hans-Peter
authors: HP
authors: Altenburg
authors: Alexandra
authors: A
authors: Nieters
authors: Paolo
authors: P
authors: Boffetta
authors: Jakob
authors: J
authors: Linseisen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D015331:Cohort Studies; D004032:Diet; D004522:Educational Status; D005260:Female; D006801:Humans; D008019:Life Style; D017533:Marital Status; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D011446:Prospective Studies; D017584:Reproductive History; D012907:Smoking; D011795:Surveys and Questionnaires; D013997:Time Factors