Metabolic syndrome (MetS) is the primary cardiovascular risk factor, making it a global issue. Our objective was to assess the association between the age at menarche (AAM) and MetS and its components in different generations of women. In this cross-sectional study, 5500 eligible women aged ≥ 20 who participated in the Tehran lipid and glucose study in 2015-2017 were selected. Participants were divided into groups by birth cohorts (BC) (born ≤ 1959, 1960-1979, and ≥ 1980) and AAM (≤ 11, 12-15, and ≥ 16 years, early, normal, and late, respectively). The status of MetS and its components were compared amongst participants using logistic regression. Normal AAM (12-15 years) was considered the reference group. The adjusted model revealed that AAM ≤ 11 is associated with a higher risk of 34% (95% confidence interval (CI): 1.04, 1.71) in MetS, and the prevalence of MetS in the early menarche group was higher in BCI, and BCII (odds ratio (OR): 1.87; 95% CI: 1.04, 3.36 and OR: 1.33; 95% CI: 1.00, 1.89, respectively). Those with late menarche demonstrated a lower risk (OR:0.72; 95% CI: 0.57, 0.91) of abdominal obesity, and early menarche showed a higher risk (OR: 1.45; CI: 1.14, 1.86). This higher risk in early menarche was observed in BCI and BCII (OR: 1.76; 95% CI: 1.16, 2.66 and OR: 1.80; 95% CI: 1.23, 2.64, respectively). However, the protective effect of late menarche was observed in BC II and BC III (OR: 0.74; 95% CI: 0.54, 1.00 and OR: 0.64; 95% CI: 0.44, 0.96, respectively). The influential effect of AAM on metabolic disturbances varies amongst different generations.
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