Earlier menarche is associated with non-alcoholic fatty liver disease and abdominal ectopic fat in midlife, independent of young-adult BMI: The CARDIA Study

OBJECTIVE: We test the hypothesis that earlier menarche is associated with higher non-alcoholic fatty liver disease (NAFLD) and ectopic adiposity, independent of young-adult BMI. DESIGN AND METHODS: We use data from 1,214 black and white women in the Coronary Artery Risk Development in Young Adults (CARDIA) study who reliably reported menarche age at exam years 0 and 2, had multiple-slice abdominal computed tomography (CT) at exam year 25, and had no known liver disease or secondary causes of steatosis. Women were aged 18–30 at year 0 and 43–55 at year 25. Liver attenuation, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and inter-muscular adipose tissue (IMAT) were derived from CT. NAFLD was defined as liver attenuation <51 Hounsfield units. RESULTS: One-year earlier menarche was associated with higher NAFLD (RR=1.15; 95% CI: 1.07–1.24), and VAT (6.7; 95% CI: 4.3–9.0cc), IMAT (1.0; 95% CI: 0.6–1.4cc), and SAT (19.3; 95% CI: 13.2–26.0cc) after confounder adjustment. Associations remained significant (p<0.05) after further adjustment for year-0 BMI. Only VAT remained significant (p=0.047) after adjustment for weight gain between year 0 and 25. CONCLUSION: Earlier menarche is positively associated with NAFLD and ectopic fat independent of confounders and young-adult BMI. Weight gain between young adulthood and midlife explains some of this association.