Highlights
- •Reproductive years represent the total duration of estrogen exposure.
- •A short reproductive period is associated with elevated levels on HOMA-IR and decreased levels on the QUICKI over time.
- •A short reproductive period is significantly associated with a higher risk of new-onset insulin resistance.
Abstract
Objectives
We hypothesized that reproductive years, a marker of total estrogen exposure, may
play an important role in insulin resistance.
Study design
A total of 3327 middle-aged and older women (age range 40–69 years) from the Korean
Genome and Epidemiology Study were included in this large prospective cohort study
with a mean follow-up of 10.8 years.
Main outcome measures
Insulin resistance and sensitivity were calculated using the homeostatic model assessment
of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI).
A linear mixed model for a repeated-measures covariance pattern with unstructured
covariance within participants was used to assess longitudinal associations between
baseline reproductive years and subsequent changes in HOMA-IR and QUICKI. Cox proportional
hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence intervals
(CIs) for new-onset insulin resistance according to quartiles of reproductive years.
Results
Changes in HOMA-IR were significantly greater in Q1 (fewest reproductive years) than
in Q4 (most reproductive years) (beta[SE] = 0.038[0.016]; p-value = 0.022), while
changes in QUICKI were significantly smaller in Q1 than in Q4 (beta[SE] = −0.001[0.000];
p-value = 0.048) after adjusting for possible confounders over time. Compared with
Q1, HRs (95 % CIs) for the incidence of new-onset insulin resistance were 0.807 (0.654−0.994)
for Q2, 0.793 (0.645−0.974) for Q3, and 0.770 (0.622−0.953) for Q4 after adjusting
for possible confounders.
Conclusion
A short reproductive period is associated with elevated levels on the HOMA-IR and
decreased levels on the QUICKI over time. The lowest quartile of reproductive years
was significantly associated with a higher risk of new-onset insulin resistance.
Keywords
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Article info
Publication history
Published online: July 09, 2020
Accepted:
July 7,
2020
Received in revised form:
May 18,
2020
Received:
January 10,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
