Dr. Colette P Davis

Are dietary patterns associated with age at menarche after accounting for BMI-for-age (BMIz) and height?
We observed associations between both the Alternative Healthy Eating Index (AHEI) and the Empirical Dietary Inflammatory Pattern (EDIP) and age at menarche.
Dietary patterns have been sparsely examined in relation to age at menarche and no studies have examined the association between the AHEI, a healthier diet, and EDIP, a pro-inflammatory diet, and menarche.
The Growing Up Today Study (GUTS) is a prospective cohort of children ages 9-14 years at study enrollment. GUTS enrolled in two waves with enrollment beginning in 1996 (GUTS1) and 2004 (GUTS2). For this analysis, GUTS1 and GUTS2 participants were followed through 2001 and 2008, respectively.
We included 7530 participants who completed food frequency questionnaire(s) (FFQ) prior to menarche who then self-reported age at menarche during study follow-up. Cox proportional hazard models were used to calculate multivariable hazard ratios (HRs) and 95% CIs for the associations between two dietary patterns, the AHEI and EDIP, and age at menarche, with and without adjustment for time-varying BMIz and height.
Six thousand nine hundred ninety-two participants (93%) reported menarche during the study period. On average, participants completed the baseline FFQ 1.75 years prior to menarche. Participants in the highest quintile of AHEI diet score (indicating a healthier diet) were 8% less likely to attain menarche within the next month compared to those in the lowest quintile (95% CI = 0.85-0.99; Ptrend = 0.03). This association remained after adjustment for BMIz and height (corresponding HR = 0.93; 95% CI = 0.86-1.00; Ptrend = 0.04). Participants in the highest quintile of the EDIP score (i.e. most inflammatory diet), were 15% more likely to attain menarche in the next month relative to those in the lowest quintile (95% CI = 1.06-1.25; Ptrend = 0.0004), and the association remained following adjustment for BMIz and height (corresponding HR = 1.15; 95% CI = 1.06-1.25; Ptrend = 0.0004).
Self-reported questionnaires are subject to some error; however, given our prospective study design it is likely this error is non-differential with respect to the outcome.
Our findings of an association between both the AHEI and EDIP and age at menarche indicate that diet quality may play a role in age at menarche independent of BMI or height.
This work was supported by the Breast Cancer Research Foundation. The GUTS is supported by the National Institutes of Health U01 HL145386. C.P.D. was supported by National Institutes of Health T32 CA094880. The authors have no conflicts of interest to disclose.
N/A.

In the article that accompanies this editorial, O'Brien et al use a variety of methods to address the impact of bias on the association between intimate care products and hormone-related cancers (ovarian, uterine, and breast)—observing that genital powder use and douching were each associated with ovarian cancer risk even after accounting for multiple bias scenarios. Given that genital powder use and douching are modifiable exposures potentially associated with a highly fatal disease, these data suggest that people at risk for ovarian cancer, particularly those in their 20s and 30s, should be made aware of the potential risks.

To examine the association between consumption of fruits and vegetables and pesticide residue intake from consumption of fruits and vegetables and risk of ultrasound- or hysterectomy-confirmed fibroids. Only a few studies have evaluated the association of fruit and vegetable intake with uterine fibroids, with inconsistent results. No studies have examined pesticide exposure through fruits and vegetables with fibroid risk.
Prospective cohort study. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Not applicable.
A total of 81,782 premenopausal participants from the Nurses’ Health Study II cohort were followed from 1991 to 2009 for fruit and vegetable analysis, and 49,927 participants were followed from 1999 to 2009 for pesticide residue burden analysis. Their diet was assessed every 4 years with a food frequency questionnaire. Fruits and vegetables were classified into high- or low-pesticide residues using a validated method based on surveillance data from the US Department of Agriculture.
Not applicable.
Cases of ultrasound- or hysterectomy-confirmed fibroids were identified from self-reports to validated questionnaires.
From 1991 to 2009, 9,706 incident cases of ultrasound- or hysterectomy-confirmed fibroids were reported, and 4,195 incident cases were identified from 1999 to 2009. No association was observed between total fruit and vegetable consumption and uterine fibroid risk. Participants with the highest intake of total fruits (≥4/day) were 10% less likely to develop uterine fibroids compared with participants who consumed <1/day (95% CI = 0.80–1.01). No associations were observed with any other fruit or vegetable groups. An inverse association was observed between intake of high-pesticide-residue fruits and vegetables and fibroid risk (HR for 5th vs. 1st quintile = 0.87; 95% CI = 0.77–0.99), while no association with low-pesticide-residue fruits and vegetables was observed (HR for 5th vs. 1st quintile = 1.08; 95% CI = 0.95–1.23).
Our findings suggest that pesticide residues on fruits and vegetables are not associated with a higher risk of uterine fibroids. Furthermore, our results suggest that intake of fruits may be associated with a lower risk of fibroids. Future research in this area should focus on dietary exposures across the life course as well as assessment of class-specific pesticides.

Genital powder use is more common among African-American women; however, studies of genital powder use and ovarian cancer risk have been conducted predominantly in White populations, and histotype-specific analyses among African-American populations are limited.
We used data from five studies in the Ovarian Cancer in Women of African Ancestry consortium. Participants included 620 African-American cases, 1,146 African-American controls, 2,800 White cases, and 6,735 White controls who answered questions on genital powder use prior to 2014. The association between genital powder use and ovarian cancer risk by race was estimated using logistic regression.
The prevalence of ever genital powder use for cases was 35.8% among African-American women and 29.5% among White women. Ever use of genital powder was associated with higher odds of ovarian cancer among African-American women [OR = 1.22; 95% confidence interval (CI) = 0.97-1.53] and White women (OR = 1.36; 95% CI = 1.19-1.57). In African-American women, the positive association with risk was more pronounced among high-grade serous tumors (OR = 1.31; 95% CI = 1.01-1.71) than with all other histotypes (OR = 1.05; 95% CI = 0.75-1.47). In White women, a significant association was observed irrespective of histotype (OR = 1.33; 95% CI = 1.12-1.56 and OR = 1.38; 95% CI = 1.15-1.66, respectively).
While genital powder use was more prevalent among African-American women, the associations between genital powder use and ovarian cancer risk were similar across race and did not materially vary by histotype.
This is one of the largest studies to date to compare the associations between genital powder use and ovarian cancer risk, overall and by histotype, between African-American and White women.

Dietary factors may play a role in uterine fibroids etiology due to their potential to modify endogenous hormones and their inflammatory effects – these processes may be influenced by food contaminants including pesticides. We sought to examine the association between pesticide residue intake from consumption of fruits and vegetables and risk of ultrasound or hysterectomy-confirmed fibroids.
A prospective cohort study using data collected from 52,982 premenopausal women from 1999–2009 in the Nurses’ Health Study II. Every four years, diet was assessed with a validated food frequency questionnaire. We classified fruits and vegetables into high- or low-pesticide-residues using a validated method based on surveillance data from the U.S. Department of Agriculture. Multivariable Cox proportional hazards models were used to calculate RR and 95% CIs for the association between high- and low-pesticide-residue fruit and vegetable intake and fibroids.
During 10 years of follow-up (median age at baseline 42 years), 4,285 incident cases of ultrasound or hysterectomy-confirmed fibroids were reported. No association was observed between intake of high-pesticide-residue (RR for 5th vs 1st quintile = 0.91; 95% CI = 0.80–1.03; ptrend = 0.12) nor the low-pesticide-residue (RR for 5th vs 1st quintile = 1.01; 95% CI = 0.88–1.14; ptrend = 0.84) fruits and vegetables and fibroids.
No clear associations were observed between intake of high- or low-pesticide-residue fruits and vegetables and risk of uterine fibroids. These results suggest that pesticide residues on fruits and vegetables are not strong contributors to fibroid risk among women in their 30s, 40s, and 50s. Additional studies examining an exposure window more proximal to fibroid initiation among younger women and assessing class specific pesticides are needed.
National Institutes of Health.