title: Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls.
abstract: OBJECTIVE
  Is sugar-sweetened beverage (SSB) consumption associated with age at menarche?
  
  
  CONCLUSIONS
  More frequent SSB consumption was associated with earlier menarche in a population of US girls.
  
  
  BACKGROUND
  SSB consumption is associated with metabolic changes that could potentially impact menarcheal timing, but direct associations with age at menarche have yet to be investigated.
  
  
  METHODS
  The Growing up Today Study, a prospective cohort study of 16 875 children of Nurses' Health Study II participants residing in all 50 US states. This analysis followed 5583 girls, aged 9-14 years and premenarcheal at baseline, between 1996 and 2001. During 10 555 person-years of follow-up, 94% (n = 5227) of girls reported their age at menarche, and 3% (n = 159) remained premenarcheal in 2001; 4% (n = 197) of eligible girls were censored, primarily for missing age at menarche.
  
  
  METHODS
  Cumulative updated SSB consumption (composed of non-carbonated fruit drinks, sugar-sweetened soda and iced tea) was calculated using annual Youth/Adolescent Food Frequency Questionnaires from 1996 to 1998. Age at menarche was self-reported annually. The association between SSB consumption and age at menarche was assessed using Cox proportional hazards regression.
  
  
  RESULTS
  More frequent SSB consumption predicted earlier menarche. At any given age between 9 and 18.5 years, premenarcheal girls who reported consuming >1.5 servings of SSBs per day were, on average, 24% more likely [95% confidence interval (CI): 13, 36%; P-trend: <0.001] to attain menarche in the next month relative to girls consuming ≤2 servings of SSBs weekly, adjusting for potential confounders including height, but not BMI (considered an intermediate). Correspondingly, girls consuming >1.5 SSBs daily had an estimated 2.7-month earlier menarche (95% CI: -4.1, -1.3 months) relative to those consuming ≤2 SSBs weekly. The frequency of non-carbonated fruit drink (P-trend: 0.03) and sugar-sweetened soda (P-trend: 0.001), but not iced tea (P-trend: 0.49), consumption also predicted earlier menarche. The effect of SSB consumption on age at menarche was observed in every tertile of baseline BMI. Diet soda and fruit juice consumption were not associated with age at menarche.
  
  
  CONCLUSIONS
  Although we adjusted for a variety of suspected confounders, residual confounding is possible. We did not measure SSB consumption during early childhood, which may be an important window of exposure.
  
  
  CONCLUSIONS
  More frequent SSB consumption may predict earlier menarche through mechanisms other than increased BMI. Our findings provide further support for public health efforts to reduce SSB consumption.
  
  
  BACKGROUND
  The Growing up Today Study is supported by grant R03 CA 106238. J.L.C. was supported by the Breast Cancer Research Foundation; Training Grant T32ES007069 in Environmental Epidemiology from the National Institute of Environmental Health Sciences, National Institutes of Health; and Training Grant T32HD060454 in Reproductive, Perinatal and Pediatric Epidemiology from the National Institute of Child Health and Human Development, National Institutes of Health. A.L.F. is supported by the American Cancer Society, Research Scholar Grant in Cancer Control. K.B.M. was supported in part by the National Cancer Institute at the National Institutes of Health (Public Health Service grants R01CA158313 and R03CA170952). There are no conflicts of interest to declare.
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
authors: J L
authors: JL
authors: Carwile
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors: W C
authors: WC
authors: Willett
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA.
authors: D
authors: D
authors: Spiegelman
authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA.
authors: E
authors: E
authors: Hertzmark
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors: J
authors: J
authors: Rich-Edwards
authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Boston, MA 02115, USA.
authors: A L
authors: AL
authors: Frazier
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA kmichels@research.bwh.harvard.edu.
authors: K B
authors: KB
authors: Michels
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001628:Beverages / Q000009:adverse effects*; D002253:Carbonated Beverages / Q000009:adverse effects; D002648:Child; D019422:Dietary Sucrose / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008572:Menarche / Q000187:drug effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013549:Sweetening Agents / Q000009:adverse effects; D014481:United States
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents
keywords: diet; menarche; sugar-sweetened beverage
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