Fig 3. Reported from adjusted models, the solid arrows represent direct effects (with p-values < .10) between the prepubertal risk factors and menarcheal age as well as menarcheal age and the adulthood CMR composite.

The dotted arrows represent the indirect (mediated) effects of these prepubertal risk factors on the adulthood CMR composite via menarcheal age. Results suggest earlier pubertal onset, marked by menarcheal age, is a pathway through which risk for poor cardiometabolic health in adulthood is transmitted both directly and indirectly. *Direct effects (not depicted) were also observed for child BMI percentile (0.006, p < .01) and child SES (-0.141, p = .076) predicting the adulthood CMR composite.