The Relationship Between Earlier Onset of Natural Menopause and Elevated Urinary Albumin-Creatinine Ratio in Postmenopausal Chinese Women

Figures & data

Figure 1 Flowchart of participants from the REACTION Study.

Table 1 Characteristics of Participants Categorized by Age at Natural Menopause

Characteristics	Total	≤45 y (n=2846)	45–50 y (n=10,809)	>50 y (n=8017)	P value
Age (y)	59.14(55.10–65.37)	60.12(54.82–67.79)	58.89(54.50–65.63)	59.10(55.82–64.32)	<0.0001
Age at menarche (y)	15.00(14.00–17.00)	15.00(14.00–17.00)	15.00(14.00–17.00)	15.00(14.00–17.00)	<0.0001
Menopausal age (y)	50.00(48.00–52.00)	44.00(42.00–45.00)	49.00(48.00–50.00)	53.00(52.00–54.00)	<0.0001
BMI (kg/m^2)	24.22(22.03–26.58)	24.13(21.83–26.61)	24.12(21.93–26.44)	24.56(22.38–26.89)	<0.0001
WC (cm)	85.00(78.30–92.00)	85.00(78.20–92.03)	85.00(78.20–91.50)	86.00(80.00–93.00)	<0.0001
WC/HC	0.88(0.84–0.92)	0.88(0.84–0.93)	0.88(0.84–0.92)	0.88(0.84–0.93)	<0.0001
SBP (mmHg)	130.67(118.00–145.67)	129.33(116.00–144.67)	130.00(117.67–145.00)	132.00(119.33–146.67)	<0.0001
DBP (mmHg)	75.67(69.33–83.00)	74.67(68.67–82.00)	75.67(69.33–82.67)	76.00(69.67–83.33)	<0.0001
FBG (mmol/L)	5.54(5.12–6.16)	5.59(5.17–6.20)	5.54(5.12–6.15)	5.55(5.13–6.17)	0.0061
PBG (mmol/L)	7.59(6.20–9.94)	7.80(6.30–10.46)	7.59(6.20–9.90)	7.43(6.14–9.80)	0.0001
HbA1c(%)	6.00(5.70–6.30)	6.00(5.70–6.40)	5.90(5.70–6.30)	6.00(5.70–6.30)	0.0237
Insulin (μU/mL)	7.60(5.50–10.50)	7.70(5.70–10.70)	7.60(5.50–10.50)	7.80(5.70–10.70)	0.0002
TG (mmol/L)	1.40(1.01–1.99)	1.44(1.02–2.04)	1.41(1.02–2.01)	1.44(1.05–2.03)	0.0328
LDL-c (mmol/L)	3.04(2.45–3.66)	2.90(2.31–3.56)	3.05(2.48–3.66)	3.14(2.56–3.74)	<0.0001
HDL-c (mmol/L)	1.34(1.14–1.57)	1.32(1.11–1.53)	1.35(1.15–1.57)	1.35(1.15–1.57)	<0.0001
ALT (mmol/L)	15.00(11.00–20.00)	14.00(10.00–20.00)	14.00 (11.00–20.00)	15.00 (11.00–21.00)	0.0187
AST (mmol/L)	20.00(17.00–25.00)	21.00 (17.00–25.00)	21.00 (17.00–25.00)	21.00 (18.00–25.00)	<0.0001
GGT (mmol/L)	19.00(14.00–28.00)	19.00 (14.00–28.00)	19.00 (14.00–29.00)	20.00 (15.00–29.00)	<0.0001
eGFR(mL/min/1.73m^2)					0.0027
>90	11,789(54.44%)	1480(52.08%)	5848(54.13%)	4461(55.69%)
≤90	9867(45.56%)	1362(47.92%)	4955(45.87%)	3550(44.31%)
Education (%)					<0.0001
Low	5208(24.14%)	854(30.16%)	2663(24.75%)	1691(21.17%)
Intermediate	14,526(67.32%)	1797(63.45%)	7254(67.42%)	5475(68.56%)
High	1844(8.55%)	181(6.39%)	843(7.83%)	820(10.27%)
Sleep quality (%)					0.0478
Good	16,621(76.69%)	2151(75.58%)	8252(76.34%)	6218(77.56)
Poor	5031(23.31%)	695(24.42%)	2557(23.66%)	1799(22.44%)
Smoking status (%)					0.3053
No smoking	21,105(98.23%)	10,528(98.16%)	2749(97.97)	7828(98.40%)
Smoking	324(1.51%)	163(1.52%)	51(1.82%)	110(1.38%)
Quit smoking	57(0.27%)	34(0.32%)	6(0.21%)	17(0.21%)
Drinking status (%)					0.6932
No drinking	19,035(88.52%)	2488(88.45%)	9485(88.46%)	7062(88.63%)
Drinking	2400(11.16%)	320(11.38%)	1201(11.20%)	879(11.03%)
Quit drinking	68(0.32%)	5(0.18%)	36(0.34%)	27(0.34%)
Prevalence of diseases (%)
Diabetes mellitus	2618(12.13%)	400(14.13%)	1253(11.64%)	965(12.07%)	0.0014
Hypertension	5268(25.12%)	630(23.23%)	2562(24.52%)	2076(26.58%)	0.0003
Dyslipidemia	2126(10.22%)	264(9.83%)	986(9.52%)	876(11.29%)	0.0004
CVD	1080(5.19%)	172(6.39%)	508(4.91%)	400(5.16%)	0.0085
Tumor	649(3.02%)	99(3.52%)	324(3.02%)	226(2.84%)	0.1943
Medication (%)
Antihypertensive drugs	3379(15.6%)	382(13.4%)	1622(15.0%)	1375(17.2%)	<0.0001
Hypoglycemic drugs	2191(18.98%)	328(20.10%)	1050(18.00%)	813(19.92%)	0.0261
Lipid-lowering drugs	99(0.46%)	10(0.35%)	47(0.43%)	42(0.52%)	0.4484
Hormone therapy	798(4%)	115(4.4%)	400(4.1%)	283(3.9%)	0.5423
Family history (%)
Family history of diabetes	3722(17.33%)	410(14.54%)	1789(16.70%)	1523(19.15%)	<0.0001
Family history of tumor	3201(14.9%)	361(12.81%)	1545(14.43%)	1295(16.29%)	<0.0001

Note: The data were expressed as median (interquartile range) for skewed distributed continuous variables and numbers (percentages) for categorical variables.

Abbreviations: BMI, body mass index; WC, waist circumference; WC/HC, waist-to-hip ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, 0-hour fasting blood glucose; PBG, 2-hour postprandial blood glucose; HbA1c, glycated hemoglobin; TG, triglyceride; LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyltranspeptidase; eGFR, estimated glomerular filtration rate; CVD, cardiovascular diseases.

Figure 2 Percentage of urinary albumin-creatinine ratio (UACR) levels at diverse nature menopausal ages.

Table 2 Multiple Factors Related to UACR

	OR (95% CI)	P value
Menopausal age (y)		<0.0001
≤45	1.11(0.99–1.25)
45–50	1.00
>50	0.86(0.79–0.94)
BP (mmHg)		<0.0001
SBP <120 and DBP <80	1.00
120≤SBP<140 and/or 80≤DBP <90	1.09(0.97–1.22)
SBP≥140 or DBP≥90	1.78(1.60–1.99)
Blood glucose(mmol/L)		<0.0001
FBG <5.6 and PBG <7.8	1.00
5.6≤FBG<7.0 or 7.8≤PBG<11.1	1.12(1.02–1.23)
FBG≥7.0 or PBG≥11.1	1.67(1.50–1.85)
eGFR(mL/min/1.73m^2)		<0.0001
>90	1.00
≤90	1.22(1.11–1.33)
Age (y)	1.03(1.03–1.04)	<0.0001
HDL-c (mmol/L)	0.72(0.63–0.83)	<0.0001
LDL-c (mmol/L)	0.80(0.76–0.84)	<0.0001
TG (mmol/L)	1.09(1.06–1.13)	<0.0001
AST (mmol/L)	1.00(1.00–1.01)	0.0085
GGT (mmol/L)	1.00(1.00–1.00)	0.0002
BMI(kg/m^2)	1.031(1.022–1.041)	<0.0001

Abbreviations: UACR, urinary albumin-creatinine ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, 0-hour fasting blood glucose; PBG, 2-hour postprandial blood glucose; eGFR, estimated glomerular filtration rate; LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; TG, triglyceride; AST, aspartate aminotransferase; GGT, gamma-glutamyltranspeptidase; BMI, body mass index.

Table 3 Adjusted Odds Ratios (95% Confidence Intervals) for UACR According to Age at Natural Menopause

Menopausal Age	Nonadjusted		Model 1		Model 2		Model 3
	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value
All subjects		<0.0001		<0.0001		<0.0001		<0.0001
≤45 y	1.18(1.06–1.31)	0.0027	1.14(1.02–1.27)	0.0205	1.19(1.06–1.34)	0.0025	1.18(1.04–1.33)	0.0097
45–50 y	1.00		1.00		1.00		1.00
>50 y	0.87(0.80–0.94)	0.0006	0.87(0.80–0.94)	0.0008	0.85(0.78–0.93)	0.0004	0.86(0.78–0.94)	0.0009
Continuous menopausal age	0.98(0.97–0.99)	<0.0001	0.97(0.97–0.98)	<0.0001	0.97(0.96–0.98)	<0.0001	0.97(0.96–0.98)	<0.0001

Notes: Nonadjusted model. Model 1 was adjusted for age and age at menarche; model 2 was additionally adjusted for education level, sleep quality, cardiovascular history, medication usage (hormone therapy, antihypertensive drugs, and hypoglycemic drugs), eGFR, and family history of cancer/diabetes; model 3 was additionally adjusted for BMI, WC/HC, FBG, PBG, insulin, HbA1c, SBP, DBP, TG, LDL-c, HDL-c, AST, ALT, and GGT.

Figure 3 Odds ratios for logistic regression model 3 of the association between nature menopausal ages and urinary albumin-creatinine ratio (UACR) in postmenopausal women with different subgroups.

Abbreviations: BMI, body mass index; eGFR, estimated glomerular filtration rate; FBG, 0-hour fasting blood glucose; PBG, 2-hour postprandial blood glucose; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure.