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Banack HR, Cook CE, Grandi SM, Scime NV, Andary R, Follis S, Allison M, Manson JE, Jung SY, Wild RA, Farland LV, Shadyab AH, Bea JW, Odegaard AO. The association between reproductive history and abdominal adipose tissue among postmenopausal women: results from the Women's Health Initiative. Hum Reprod 2024; 39:1804-1815. [PMID: 38890130 PMCID: PMC11291955 DOI: 10.1093/humrep/deae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/05/2024] [Indexed: 06/20/2024] Open
Abstract
STUDY QUESTION What is the association between reproductive health history (e.g. age at menarche, menopause, reproductive lifespan) with abdominal adiposity in postmenopausal women? SUMMARY ANSWER Higher visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) tissue levels were observed among women with earlier menarche, earlier menopause, and greater parity. WHAT IS KNOWN ALREADY Postmenopausal women are predisposed to accumulation of VAT and SAT. Reproductive health variables are known predictors of overall obesity status in women, defined by BMI. STUDY DESIGN, SIZE, DURATION This study is a secondary analysis of data collected from the baseline visit of the Women's Health Initiative (WHI). The WHI is a large prospective study of postmenopausal women, including both a randomized trial and observational study. There were 10 184 women included in this analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected from a reproductive health history questionnaire, dual-energy x-ray absorptiometry scans, and anthropometric measures at WHI baseline. Reproductive history was measured via self-report, and included age at menarche, variables related to pregnancy, and age at menopause. Reproductive lifespan was calculated as age at menopause minus age at menarche. Statistical analyses included descriptive analyses and multivariable linear regression models to examine the association between reproductive history with VAT, SAT, total body fat, and BMI. MAIN RESULTS AND THE ROLE OF CHANCE Women who reported early menarche (<10 years) or early menopause (<40 years) had the highest levels of VAT. Adjusted multivariable linear regression results demonstrate women who experienced menarche >15 years had 23 cm2 less VAT (95% CI: -31.4, -14.4) and 47 cm2 less SAT (95% CI: -61.8, -33.4) than women who experienced menarche at age 10 years or earlier. A similar pattern was observed for age at menopause: compared to women who experienced menopause <40 years, menopause at 50-55 years was associated with 19.3 cm2 (95% CI: -25.4, -13.3) less VAT and 27.4 cm2 (-29.6, 10.3) less SAT. High parity (>3 pregnancies) was also associated with VAT and SAT. For example, adjusted beta coefficients for VAT were 8.36 (4.33, 12.4) and 17.9 (12.6, 23.2) comparing three to four pregnancies with the referent, one to two pregnancies. LIMITATIONS, REASONS FOR CAUTION The WHI reproductive health history questionnaire may be subject to poor recall owing to a long look-back window. Residual confounding may be present given lack of data on early life characteristics, such as maternal and pre-menarche characteristics. WIDER IMPLICATIONS OF THE FINDINGS This study contributes to our understanding of reproductive lifespan, including menarche and menopause, as an important predictor of late-life adiposity in women. Reproductive health has also been recognized as a sentinel marker for chronic disease in late life. Given established links between adiposity and cardiometabolic outcomes, this research has implications for future research, clinical practice, and public health policy that makes use of reproductive health history as an opportunity for chronic disease prevention. STUDY FUNDING/COMPETING INTEREST(S) HRB and AOO are supported by the National Institute of Health National Institute of Aging (R01AG055018-04). JWB reports royalties from 'ACSM'S Body Composition Assessment Book' and consulting fees from the WHI. The remaining authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Hailey R Banack
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire E Cook
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sonia M Grandi
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Natalie V Scime
- Department of Health & Society, University of Toronto Scarborough, Scarborough, Canada
| | - Rana Andary
- School of Medicine, University of California, Irvine, CA, USA
| | - Shawna Follis
- Stanford Prevention Research Center, School of Medicine , Stanford University, Stanford, CA, USA
| | - Matthew Allison
- Division of Preventive Medicine, Department of Family Medicine, UC San Diego, San Diego, CA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Su Yong Jung
- Department of Epidemiology, Fielding School of Public Health, School of Nursing, UCLA, Los Angeles, CA, USA
| | - Robert A Wild
- Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - Leslie V Farland
- Epidemiology and Biostatistics Department, University of Arizona, Tucson, AZ, USA
| | - Aladdin H Shadyab
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, San Diego, CA, USA
| | - Jennifer W Bea
- Department of Health Promotion Science, University of Arizona, Tucson, AZ, USA
| | - Andrew O Odegaard
- Division of Preventive Medicine, Department of Family Medicine, UC San Diego, San Diego, CA, USA
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Li K, Yin J, Qin Z, Ma B, He R, Zhuoma D, Wang Z, Liu Q, Zhao X. Age at menarche and metabolic dysfunction-associated fatty liver disease: Evidence from a large population-based epidemiological study in Southwest China. Prev Med 2023; 177:107776. [PMID: 37951543 DOI: 10.1016/j.ypmed.2023.107776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The relationship between age at menarche and metabolic dysfunction-associated fatty liver disease remains largely not clear. The objective of this study was to examine the association between age at menarche (AAM) and metabolic dysfunction-associated fatty liver disease (MAFLD) in Chinese women and whether any observed associations were mediated by early adulthood adiposity. METHODS The cross-sectional study included 46,873 Chinese women, aged 30-79 from baseline data of the China Multi-Ethnic Cohort study. Logistic regression models were used to evaluate the association between AAM and MAFLD. Mediation analysis was adopted to examine whether early adulthood adiposity (around 25 years) mediated the association between AAM and MAFLD. RESULTS AAM was linearly and inversely associated with the risk of MAFLD (P for nonlinearity =0.743). In a multivariable-adjusted model, the odds ratios and 95% confidence interval (ORs (95% CI)) for MAFLD comparing menarche at <12, 12, 13, 15, 16, 17, ≥18 years to menarche at 14 years were 1.290 (1.082-1.537), 1.172 (1.068-1.285), 1.042 (0.960-1.131), 0.937 (0.861-1.020), 0.911(0.835-0.994), 0.868 (0.786-0.959), and 0.738 (0.670-0.814), respectively (P for trend <0.001). The 6.4% increased MAFLD risk was associated with each preceding year in AAM. The association between AAM and MAFLD was modified by age, ethnicity, and menopause. Early adulthood adiposity partially mediated this association. CONCLUSION The findings of this study suggest that obesity prevention strategies are needed from young adulthood in women who undergo early menarche to reduce the risk of MAFLD.
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Affiliation(s)
- Kehan Li
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianzhong Yin
- Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming, Yunan, China; Baoshan College of Traditional Chinese Medicine, Baoshan, Yunan, China
| | - Zixiu Qin
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Bangjing Ma
- Qingbaijiang District Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Ruifeng He
- Tibet Center for Disease Control and Prevention, Lhasa, Tibet, China
| | - Duoji Zhuoma
- School of Medicine, Tibet University, Lhasa, Tibet, China
| | - Zihao Wang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Qiaolan Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xing Zhao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Prince C, Howe LD, Sharp GC, Fraser A, Richmond RC. Establishing the relationships between adiposity and reproductive factors: a multivariable Mendelian randomization analysis. BMC Med 2023; 21:350. [PMID: 37697382 PMCID: PMC10496263 DOI: 10.1186/s12916-023-03051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Few studies have investigated associations between adiposity and reproductive factors using causal methods, both of which have a number of consequences on women's health. Here we assess whether adiposity at different points in the lifecourse affects reproductive factors differently and independently, and the plausibility of the impact of reproductive factors on adiposity. METHODS We used genetic data from UK Biobank (273,238 women) and other consortia (EGG, GIANT, ReproGen and SSGAC) for eight reproductive factors: age at menarche, age at menopause, age at first birth, age at last birth, number of births, being parous, age first had sexual intercourse and lifetime number of sexual partners, and two adiposity traits: childhood and adulthood body size. We applied multivariable Mendelian randomization to account for genetic correlation and to estimate the causal effects of childhood and adulthood adiposity, independently of each other, on reproductive factors. Additionally, we estimated the effects of reproductive factors, independently of other relevant reproductive factors, on adulthood adiposity. RESULTS We found a higher childhood body size leads to an earlier age at menarche, and an earlier age at menarche leads to a higher adulthood body size. Furthermore, we find contrasting and independent effects of childhood and adulthood body size on age at first birth (beta 0.22 SD (95% confidence interval: 0.14, 0.31) vs - 2.49 (- 2.93, - 2.06) per 1 SD increase), age at last birth (0.13 (0.06,0.21) vs - 1.86 (- 2.23, - 1.48) per 1 SD increase), age at menopause (0.17 (0.09, 0.25) vs - 0.99 (- 1.39, - 0.59) per 1 SD increase), and likelihood of having children (Odds ratio 0.97 (0.95, 1.00) vs 1.20 (1.06, 1.37) per 1 SD increase). CONCLUSIONS Our findings demonstrate the importance of considering a lifecourse approach when investigating the inter-relationships between adiposity measures and reproductive events, as well as the use of 'age specific' genetic instruments when evaluating lifecourse hypotheses in a Mendelian randomization framework.
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Affiliation(s)
- Claire Prince
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Psychology, University of Exeter, Exeter, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Soria-Contreras DC, Aris IM, Rifas-Shiman SL, Perng W, Hivert MF, Chavarro JE, Oken E. Associations of age at first birth and lifetime parity with weight and adiposity across midlife in women from Project Viva. Obesity (Silver Spring) 2023; 31:2407-2416. [PMID: 37485799 PMCID: PMC10524615 DOI: 10.1002/oby.23831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE This study aimed to evaluate the associations of age at first birth and parity with weight, waist circumference (WC), and body fat across midlife. METHODS A secondary data analysis was conducted with 735 participants from Project Viva who reported their age at first birth and lifetime parity at a midlife study visit. Weight, WC, and body fat were measured up to four times after the participants' final birth, and associations were examined using linear mixed-effects regression models. RESULTS Participants' mean (SD) age was 32.6 (4.9) years at enrollment and 30.4 (5.5) years at their first birth, and they had 2.4 (0.9) lifetime births. In adjusted models, women who had their first birth at age <23 or ≥40 years, versus age 30 to 34 years, had a higher trajectory of weight, WC, and body fat after their final birth (i.e., mean differences in weight 8.38 kg [95% CI: 4.13-12.63] for age <23 years and 6.54 kg [95% CI: 0.64-12.45] for age ≥40 years). Women with four or more births, versus two, had a higher trajectory of adiposity after accounting for covariates. CONCLUSIONS Women who have a first birth before age 23 years or after age 40 years and those with multiple births may benefit from more intensive monitoring for excess adiposity gain.
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Affiliation(s)
- Diana C. Soria-Contreras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA
| | - Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Aurora, CO 80045, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 12474 East 19 Ave, Aurora, CO 80045, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA
- Diabetes Unit, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA
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5
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Chen M, Wang Z, Xu H, Chen X, Teng P, Ma L. Genetic liability to age at first sex and birth in relation to cardiovascular diseases: a Mendelian randomization study. BMC Med Genomics 2023; 16:75. [PMID: 37024926 PMCID: PMC10080931 DOI: 10.1186/s12920-023-01496-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Growing evidence suggests that various reproductive factors, including early menarche, early menopause, and age at first birth, may increase the risk of developing cardiovascular disease (CVD) later in life. However, the associations between reproductive factors and CVDs are inconsistent and controversial. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis to explore the potential links between age at first sex (AFS) and age at first birth (AFB) and several CVDs. METHODS We obtained summary statistics for exposure from the largest genome-wide association studies of AFS and AFB. To serve as instrumental variables, we selected 259 SNPs associated with AFS and 81 SNPs associated with AFB at the genome-wide significance level. We employed a random-effects inverse-variance weighted method to pool estimates, and conducted multivariable MR analysis to determine the direct association between AFS and AFB with CVDs, while accounting for the effects of confounders. RESULTS The genetic liability to later AFS was associated with decreased risks of heart failure (odd ratio [OR] 0.700; 95% confidence interval [CI] 0.639-0.767; p = 2.23 × 10-14), coronary artery disease (OR 0.728; 95% CI 0.657-0.808; p = 1.82 × 10-9), myocardial infarction (OR 0.731; 95% CI 0.657-0.813; p = 8.33 × 10-9), stroke (OR 0.747; 95% CI 0.684-0.816; p = 6.89 × 10-11), and atrial fibrillation (OR 0.871; 95% CI 0.806-0.941; p = 4.48 × 10-4). The genetic liability to later AFB was also associated with decreased risks of CVDs, including myocardial infarction (OR 0.895; 95% CI 0.852-0.940; p = 8.66 × 10-6), coronary heart disease (OR 0.901; 95% CI 0.860-0.943; p = 9.02 × 10-6), heart failure (OR 0.925; 95% CI 0.891-0.961; p = 5.32 × 10-5), and atrial fibrillation (OR 0.944; 95% CI 0.911-0.978; p = 0.001). However, no association was found between AFB and stroke. The associations remained independent from the effects of AFS and AFB on potential confounders, including smoking, alcohol intake, body mass index, and depression. Mediation analysis suggested that education attainment partly mediates the link from AFS and AFB to CVD outcomes. CONCLUSION Our results observed a causal relationship between later AFS, AFB and lower CVDs risk; it emphasizes the importance of providing sex education since early sex and birth may have undesirable effects. Cardiovascular risk stratification that considers reproductive factors may help address CVD risk.
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Affiliation(s)
- Miao Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Zhen Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Hongfei Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Xiaofang Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Peng Teng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China.
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Ardissino M, Slob EAW, Carter P, Rogne T, Girling J, Burgess S, Ng FS. Sex-Specific Reproductive Factors Augment Cardiovascular Disease Risk in Women: A Mendelian Randomization Study. J Am Heart Assoc 2023; 12:e027933. [PMID: 36846989 PMCID: PMC10111460 DOI: 10.1161/jaha.122.027933] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 03/01/2023]
Abstract
Background Observational studies suggest that reproductive factors are associated with cardiovascular disease, but these are liable to influence by residual confounding. This study explores the causal relevance of reproductive factors on cardiovascular disease in women using Mendelian randomization. Methods and Results Uncorrelated (r2<0.001), genome-wide significant (P<5×10-8) single-nucleotide polymorphisms were extracted from sex-specific genome-wide association studies of age at first birth, number of live births, age at menarche, and age at menopause. Inverse-variance weighted Mendelian randomization was used for primary analyses on outcomes of atrial fibrillation, coronary artery disease, heart failure, ischemic stroke, and stroke. Earlier genetically predicted age at first birth increased risk of coronary artery disease (odds ratio [OR] per year, 1.49 [95% CI, 1.28-1.74], P=3.72×10-7) heart failure (OR, 1.27 [95% CI, 1.06-1.53], P=0.009), and stroke (OR, 1.25 [95% CI, 1.00-1.56], P=0.048), with partial mediation through body mass index, type 2 diabetes, blood pressure, and cholesterol traits. Higher genetically predicted number of live births increased risk of atrial fibrillation (OR for <2, versus 2, versus >2 live births, 2.91 [95% CI, 1.16-7.29], P=0.023), heart failure (OR, 1.90 [95% CI, 1.28-2.82], P=0.001), ischemic stroke (OR, 1.86 [95% CI, 1.03-3.37], P=0.039), and stroke (OR, 2.07 [95% CI, 1.22-3.52], P=0.007). Earlier genetically predicted age at menarche increased risk of coronary artery disease (OR per year, 1.10 [95% CI, 1.06-1.14], P=1.68×10-6) and heart failure (OR, 1.12 [95% CI, 1.07-1.17], P=5.06×10-7); both associations were at least partly mediated by body mass index. Conclusions These results support a causal role of a number of reproductive factors on cardiovascular disease in women and identify multiple modifiable mediators amenable to clinical intervention.
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Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Eric A. W. Slob
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUnited Kingdom
- Department of Applied Economics, Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University RotterdamRotterdamThe Netherlands
| | - Paul Carter
- Department of MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Tormod Rogne
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenCT
- Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Joanna Girling
- Department of Obstetrics and GynaecologyChelsea and Westminster Hospital NHS Foundation TrustLondonUnited Kingdom
| | - Stephen Burgess
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUnited Kingdom
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Fu Siong Ng
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
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Amiri M, Mousavi M, Azizi F, Ramezani Tehrani F. The relationship of reproductive factors with adiposity and body shape indices changes overtime: findings from a community-based study. J Transl Med 2023; 21:137. [PMID: 36814308 PMCID: PMC9948339 DOI: 10.1186/s12967-023-04000-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Studies focusing on the relationships of adiposity and body shape indices with reproductive factors have reported conflicting results. This study aimed to investigate the influence of reproductive factors on adiposity and body shape indices changes overtime. MATERIALS AND METHODS In this community-based prospective study, 1636 postmenopausal women were selected from Tehran Lipid and Glucose Study (TLGS). The unadjusted and adjusted Generalized Estimating Equation models (GEE) were applied to investigate secular longitudinal trends of adiposity and body shape indices. RESULTS According to the adjusted GEE models, mean changes in body mass index (BMI) in women with early menarche was 1.18 kg/m2 higher than those with normal menarche age (P = 0.030). Moreover, the mean changes in BMI overtime were 0.11 kg/m2 higher in women with premature/early menopausal age than those with normal menopausal age (P = 0.012). Mean changes of waist circumference (WC) in women with late menopause were 2.27 cm higher than those with normal menopausal age (P = 0.036). We also observed higher mean changes in a body shape index (ABSI) in women with late menopause (P = 0.037), compared to those with normal menopausal age. We found a marginal effect of parity on BMI and WC as well. CONCLUSIONS This study demonstrated higher BMI in females with earlier menarche age. We also showed higher values of BMI overtime in women with premature/ early menopause, whereas women with late menopausal age had higher WC and ABSI values. However, more longitudinal studies investigating body composition indices by adjusting all potential confounders are still required to confirm our study findings.
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Affiliation(s)
- Mina Amiri
- grid.411600.2Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh, Yaman Street, Velenjak, P. O. Box 19395-4763, 1985717413 Tehran, I. R. of Iran
| | - Maryam Mousavi
- grid.411600.2Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh, Yaman Street, Velenjak, P. O. Box 19395-4763, 1985717413 Tehran, I. R. of Iran ,grid.412266.50000 0001 1781 3962Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fereidoun Azizi
- grid.411600.2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I. R. of Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh, Yaman Street, Velenjak, P. O. Box 19395-4763, 1985717413, Tehran, I. R. of Iran.
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Obesity indicators as mediators of the association between age at menopause and blood pressure values. Hypertens Res 2023; 46:1100-1109. [PMID: 36702925 DOI: 10.1038/s41440-023-01184-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Abstract
Having a later age at menopause is associated with having a higher blood pressure (BP) value, but the mediation pathways remain unclear. We quantitatively examined the mediation effects of various obesity indicators using baseline data from phase 4 of the Guangzhou Biobank Cohort Study. The product of coefficients approach and bootstrapping procedures were used to assess the mediation effects of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) on the association between age at menopause and BP values. Age, education, occupation, family income, smoking, drinking, diet, physical activity, age at menarche, number of births, fasting glucose, triglycerides, and high-density lipoprotein cholesterol were adjusted as covariates. Of 5429 women with natural menopause, the mean age and menopausal age were 60.0 (standard deviation = 5.8) and 50.3 (3.1) years, respectively. The prevalence of hypertension was 29.6%. In women with a menopausal age of ≥50 years, BMI, WC, WHR and WHtR showed significant mediation effects on the positive association between menopausal age and BP. The adjusted proportion (95% confidence interval) of the mediation effects for those variables were 26.04% (10.40-116.82%), 25.92% (10.19-108.57%), 14.11% (3.59-62.78%), and 23.17% (8.70-95.81%), respectively, for systolic BP values and 22.59% (10.72-53.60%), 20.67% (9.83-49.31%), 9.21% (2.73-23.92%), and 17.19% (7.56-41.31%) for diastolic BP values. In women with a menopausal age of <50 years, no significant association between age at menopause and systolic/diastolic BP values was found. In conclusion, obesity indicators showed significant mediating effects on the association between having a later age at menopause and having a higher BP value. Further longitudinal studies with detailed and accurate measurements of metabolic changes after menopause and sufficient follow-up are warranted to confirm these results. We demonstrated obesity indicators showed significant mediating effects on the association between later age at menopause (≥50 years) and higher BP.
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Sun Z, Zhu Y, Sun X, Lian Z, Guo M, Lu X, Song T, Feng L, Zhang Y, Xu Y, Ji H, Guo J. Association of age at menarche with valvular heart disease: An analysis based on electronic health record (CREAT2109). Front Cardiovasc Med 2023; 10:1029456. [PMID: 37139127 PMCID: PMC10149805 DOI: 10.3389/fcvm.2023.1029456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
Background The association between age at menarche and coronary heart disease has been reported, but the association between age at menarche and valvular heart disease (VHD) has not been described. We aimed to examine the association between age at menarche and VHD. Methods By collecting data from four medical centers of the Affiliated Hospital of Qingdao University (QUAH) from January 1, 2016, to December 31, 2020, we sampled 105,707 inpatients. The main outcome of this study was newly diagnosed VHD, which was diagnosed based on ICD-10 coding, and the exposure factor was age at menarche, which was accessed through the electronic health records. We used logistic regression model to investigate the association between age at menarche and VHD. Results In this sample (mean age 55.31 ± 13.63 years), the mean age at menarche was 15. Compared with women with age at menarche 14-15 years, the odds ratio of VHD in women with age at menarche ≤13, 16-17, and ≥18 years was 0.68 (95% CI 0.57-0.81), 1.22 (95% CI 1.08-1.38), and 1.31 (95% CI 1.13-1.52), respectively (P for all < 0.001). By restricting cubic splines, we found that later menarche was associated with increased odds of VHD (P < 0.001). Furthermore, in subgroup analysis of different etiologies, the similar trend persisted for non-rheumatic VHD. Conclusions In this large inpatient sample, later menarche was associated with higher risk of VHD.
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Affiliation(s)
- Zhiyu Sun
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Chinese Patient-Oriented Metabolic and Ischemic Risk Evaluation (CREAT) Study, Qingdao, China
- Qingdao University, Qingdao Medical College, Qingdao, China
| | - Yongjie Zhu
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyan Sun
- Department of Geriatrics, Qingdao Eighth People's Hospital, Qingdao, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Chinese Patient-Oriented Metabolic and Ischemic Risk Evaluation (CREAT) Study, Qingdao, China
- Correspondence: Hongwei Ji Zhexun Lian Junjie Guo
| | - Mengqi Guo
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohong Lu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ting Song
- Qingdao University, Qingdao Medical College, Qingdao, China
| | - Luxin Feng
- Qingdao University, Qingdao Medical College, Qingdao, China
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Hongwei Ji
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Chinese Patient-Oriented Metabolic and Ischemic Risk Evaluation (CREAT) Study, Qingdao, China
- Correspondence: Hongwei Ji Zhexun Lian Junjie Guo
| | - Junjie Guo
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Chinese Patient-Oriented Metabolic and Ischemic Risk Evaluation (CREAT) Study, Qingdao, China
- Qingdao Municipal Key Laboratory of Hypertension (Key Laboratory of Cardiovascular Medicine), Qingdao, China
- Correspondence: Hongwei Ji Zhexun Lian Junjie Guo
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Associations between Age at Menarche and Dietary Patterns with Blood Pressure in Southwestern Chinese Adults. Nutrients 2022; 14:nu14081610. [PMID: 35458171 PMCID: PMC9029714 DOI: 10.3390/nu14081610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of our study was to examine the relationship between age at menarche (AM) and hypertension and to evaluate whether different dietary patterns have an effect on associations between AM and hypertension in a large-scale Han Chinese population in southwest China. A cross-sectional study was performed that included 44,900 participants from 17 districts in southwest China from September 2018 to January 2019. The study comprised 23,805 individuals in the final analysis. Logistic regression and multivariable linear regression were applied to estimate the dietary pattern-specific associations between AM and hypertension or systolic/diastolic blood pressure (SBP/DBP). Restricted cubic spline regression was utilized to calculate the shape of the relationship between AM and the odds ratio of hypertension. After adjusting for multiple variables, women who had a history of AM > 14 years were associated with an increased risk of hypertension (OR 1.12, 95%CI 1.04−1.19) and elevated levels of SBP (β 0.90, 95%CI 0.41−1.38) compared with those with AM ≤ 14 years among the total population, and this association was still statistically significant when we further adjusted for body mass index (BMI). In participants with AM > 14 years, the odds ratio values of hypertension increased with increasing menarche age. After stratification by age at recruitment, the positive association between menarche age and hypertension only remained in the middle-aged group, and this association was not found in the young and old groups. After stratification by the Dietary Approaches to Stop Hypertension (DASH) score among the total population, the positive association between AM and hypertension was presented only in the low DASH score group; however, this association was not found in the high DASH score group. Women who have a history of AM > 14 years should pay close attention to blood pressure levels and incorporate the DASH diet more in order to achieve the early prevention of hypertension, especially middle-aged women.
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van den Broek T, Fleischmann M. The causal effect of number of children on later-life overweight and obesity in parous women. An instrumental variable study. Prev Med Rep 2021; 24:101528. [PMID: 34976605 PMCID: PMC8683859 DOI: 10.1016/j.pmedr.2021.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Many older women in Europe are overweight or obese. One of the factors linked to overweight and obesity among older women is childbearing. However, results of observational studies on the association between women’s number of children and excess weight should be interpreted with caution, because they may be prone to bias due to residual confounders or reverse causation. We use data of women aged 50 and older with at least two births from seven waves the Survey of Health, Ageing and Retirement in Europe (n = 113,932) collected between 2004 and 2020. We adopt an instrumental variable approach that exploits the well-established preference for mixed-sex offspring to estimate the causal effect of number of children on older parous women’s body mass index (BMI) and their risk of overweight (BMI >= 25 kg/m2) and obesity (BMI >= 30 kg/m2). The instrumental variable models provided evidence for a causal positive effect of having 3 + children as opposed to 2 children on mothers’ body mass index, overweight (BMI >= 25 kg/m2) risk and obesity (BMI >= 30 kg/m2) risk. Predicted BMI was 1.8 kg/m2 higher for mothers with 3 + children than for mothers with 2 children, and their predicted probability of overweight and obesity was 18.3 and 8.6 percentage points higher, respectively. Results remained virtually unchanged after adjusting for age, educational attainment, country and wave of data collection.
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12
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Su H, Jiang C, Zhang W, Zhu F, Jin Y, Cheng K, Lam T, Xu L. Natural menopausal age and cardiovascular disease risk factors in older Chinese women: Guangzhou Biobank Cohort Study. Menopause 2021; 28:1410-1417. [PMID: 34520415 DOI: 10.1097/gme.0000000000001856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the associations of natural menopausal age with cardiovascular disease risk factors and whether the associations varied by parity in older Chinese women. METHODS Information of demographic characteristics, lifestyles, and reproductive factors was collected by face-to-face interview. Framingham Risk Score was used as an indicator of cardiovascular disease risk, with a score ≥ 10% considered as high cardiovascular disease risk (vs low, dichotomous). Multivariable logistic and linear regressions were used to examine the associations of menopausal age with cardiovascular disease risk factors. RESULTS Of 18,339 women aged 50+ years, the average (standard deviation) age was 61.8 (6.9) years. Compared with women with menopausal age of 45 to 54 years, after adjustment for multiple potential confounders, women with menopausal age <45 years or ≥55 years had higher Framingham Risk Score (0.93%, 95% confidence interval: 0.40-1.46, and 0.69%, 95% confidence interval: 0.18-1.20, respectively). Women with menopausal age <45 or ≥55 years had higher odds of high cardiovascular disease risk (vs low) (odds ratio [95% confidence interval]:1.26 (1.10-1.44) and 1.17 (1.02-1.33), respectively). The associations of menopausal age with the Framingham Risk Score varied by parity (P for interaction ≤0.001). The Framingham Risk Score was higher in those with one to three parity (<45 y: 1.01 [0.43-1.59]; ≥55 y: 1.14 [0.60-1.68]) and lower for parity ≥4 (<45 y: -0.33 [-1.84 to 1.18]; ≥55 y: -2.02 [-3.82 to -0.22]). In nulliparous women, the Framingham Risk Score was highest in menopausal age <45 years (3.97 [1.67-6.26]), but the differences were nonsignificant in menopausal age ≥55 years (0.66 [-1.38 to 2.71]). CONCLUSIONS Both early and late natural menopausal ages were associated with a higher cardiovascular disease risk, and the associations were stronger in those with lower parity.
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Affiliation(s)
- Huimin Su
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chaoqiang Jiang
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Weisen Zhang
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yali Jin
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Karkeung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Taihing Lam
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Chen L, Zhang L, Chen Z, Wang X, Zheng C, Kang Y, Zhou H, Wang Z, Gao R. Age at menarche and risk of hypertension in Chinese adult women: Results from a large representative nationwide population. J Clin Hypertens (Greenwich) 2021; 23:1615-1621. [PMID: 34255920 PMCID: PMC8678727 DOI: 10.1111/jch.14321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
This study explored the association between age at menarche and the risk of hypertension in Chinese women. A total of 234 867 women aged ≥18 years from the China Hypertension Survey were included in this study. Participants were required to complete a standard questionnaire. Blood pressure and physical examination of the participants were performed by trained medical staff. Spearman correlation analysis was used to explore the correlation between age at menarche and other individual characteristics. Logistic regression was used to estimate the odds ratios for hypertension by age in years at menarche. The average age at menarche in Chinese women was 14.8 years. Women who were older at menarche were more likely to have a higher body mass index, larger waist circumference, smoke, and have a primary education (p < .05). After adjustments, odds ratios (95% confidence interval) for hypertension across age at menarche groups were 0.912 (0.877-0.948), 0.927 (0.893-0.963), 1.00 (reference), 1.061 (1.020-1.102), and 1.129 (1.090-1.169) for those aged ≤13, 14, 15 (reference), 16, and ≥17 years at menarche, respectively. Each 1-year delay in menarche was associated with a 6.2% increase in the prevalence of hypertension (odds ratio, 1.062; 95% confidence interval, 1.053-1.071). The positive association between age at menarche and hypertension was evident among age at recruitment groups, BMI categories, and education levels. This association was stronger in urban women and postmenopausal women. Our findings suggest that late menarche is related to a higher risk of hypertension among Chinese adult women, and this association appeared similar among different subgroups.
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Affiliation(s)
- Lu Chen
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Linfeng Zhang
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Zuo Chen
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Xin Wang
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Congyi Zheng
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Yuting Kang
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Haoqi Zhou
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Zengwu Wang
- Division of Prevention and Community HealthNational Center for Cardiovascular DiseaseFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesMentougou DistrictBeijingChina
| | - Runlin Gao
- Department of CardiologyFuwai Hospital, Peking Union Medical College & Chinese Academy of Medical SciencesXicheng DistrictBeijingChina
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Okhai H, Sabin CA, Haag K, Sherr L, Dhairyawan R, Burns F, Gilson R, Post F, Ross J, Mackie N, Sullivan A, Shepherd J, Tariq A, Jones R, Fox J, Rosenvinge M, Tariq S. Menopausal status, age and management among women living with HIV in the UK. HIV Med 2021; 22:834-842. [PMID: 34309177 DOI: 10.1111/hiv.13138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/15/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is currently little evidence exploring menopausal status, age at last menstrual period (LMP) and management of menopause among women living with HIV aged 45-60 years in England. METHODS Socio-demographic, lifestyle and clinical data were collected through a self-completed cross-sectional survey. Longitudinal CD4 count and viral load data were available from linkage to clinical records, if consent was provided. Women were categorised as pre-, peri- or post-menopausal. Factors associated with menopausal stage were examined using ordinal logistic regression adjusting for age. Age at LMP was estimated using Kaplan-Meier survival analysis. RESULTS The 847 women had a median age of 49 [interquartile range (IQR): 47-52] years. Most were of black ethnicity (81.3%), were born outside the UK (85.0%) and had completed secondary education (88.7%); 177 (20.4%), 373 (43.0%) and 297 (34.2%) were pre-, peri- or post-menopausal, respectively. After adjusting for age, associations of menopausal status with non-cohabiting relationship [adjusted odds ratio = 0.63 (95% confidence interval: 0.43-0.91)], baseline viral load ≥ 100 000 copies/mL [2.67 (1.20-5.94)] and unemployment [1.34 (0.97-1.84)] remained significant. Median (IQR) age at LMP was 54 (51-55) years in the group. In total, 27.9% (233/836) of women reported severe menopausal symptoms; 45.6% of those with somatic symptoms had heard of hormone replacement therapy and 8.7% had used it. Only 5.6% of women with urogenital symptoms had used topical oestrogen. CONCLUSIONS Our findings highlight the importance of educating both women and their healthcare providers about menopausal symptoms and management options.
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Affiliation(s)
- Hajra Okhai
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | | | - Fiona Burns
- Institute for Global Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Frank Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ann Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Anjum Tariq
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Rachael Jones
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Shema Tariq
- Institute for Global Health, University College London, London, UK
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Żurawiecka M, Wronka I. Association between age at menarche and body mass index, waist circumference, waist to hip ratio, and waist to height ratio in adult women. Am J Hum Biol 2020; 33:e23523. [PMID: 33085157 DOI: 10.1002/ajhb.23523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of the present study was to examine associations between age at menarche and body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) in young adult women. METHODS Anthropometric data and age at menarche information were collected in two cross-sectional surveys conducted in the years 2004-2006 (Cohort 1) and 2016-2018 (Cohort 2). A total of 2419 women, aged 19-24 years., were included. RESULTS Statistically significant relationships between age at menarche and BMI, WHtR, and WC were observed. The values of the anthropometric parameters decreased with increasing age at menarche. The onset of menstruation before the age of 12 years. was linked to a heightened risk of overweight and obesity (BMI ≥ 25) and abdominal obesity defined as WC > 80 cm and/or WHtR ≥ 0.5. First menstruation after the age of 14 y. was associated with a lower risk of overweight and obesity (BMI ≥ 25, WC > 80 cm and/or WHtR ≥ 0.5), as well as a higher risk of being underweight (BMI < 18.5 and/or WHtR < 0.4). Associations between anthropometry and menarcheal timing were stronger in Cohort 1. CONCLUSION Both early and late onset of menarche are associated with abnormal body composition: Early menarche is associated with overweight, while later maturing girls have a heightened risk of underweight.
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Affiliation(s)
- Martyna Żurawiecka
- Department of Anthropology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Krakow, Krakow, Poland
| | - Iwona Wronka
- Department of Anthropology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Krakow, Krakow, Poland
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de Jong M, Oskam MJ, Sep SJS, Ozcan B, Rutters F, Sijbrands EJG, Elders PJM, Siegelaar SE, DeVries JH, Tack CJ, Schroijen M, de Valk HW, Abbink EJ, Stehouwer CDA, Jazet I, Wolffenbuttel BHR, Peters SAE, Schram MT. Sex differences in cardiometabolic risk factors, pharmacological treatment and risk factor control in type 2 diabetes: findings from the Dutch Diabetes Pearl cohort. BMJ Open Diabetes Res Care 2020; 8:8/1/e001365. [PMID: 33023896 PMCID: PMC7539590 DOI: 10.1136/bmjdrc-2020-001365] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Sex differences in cardiometabolic risk factors and their management in type 2 diabetes (T2D) have not been fully identified. Therefore, we aimed to examine differences in cardiometabolic risk factor levels, pharmacological treatment and achievement of risk factor control between women and men with T2D. RESEARCH DESIGN AND METHODS Cross-sectional data from the Dutch Diabetes Pearl cohort were used (n=6637, 40% women). Linear and Poisson regression analyses were used to examine sex differences in cardiometabolic risk factor levels, treatment, and control. RESULTS Compared with men, women had a significantly higher body mass index (BMI) (mean difference 1.79 kg/m2 (95% CI 1.49 to 2.08)), while no differences were found in hemoglobin A1c (HbA1c) and systolic blood pressure (SBP). Women had lower diastolic blood pressure (-1.94 mm Hg (95% CI -2.44 to -1.43)), higher total cholesterol (TC) (0.44 mmol/L (95% CI 0.38 to 0.51)), low-density lipoprotein cholesterol (LDL-c) (0.26 mmol/L (95% CI 0.22 to 0.31)), and high-density lipoprotein cholesterol (HDL-c) sex-standardized (0.02 mmol/L (95% CI 0.00 to 0.04)), and lower TC:HDL ratio (-0.29 (95% CI -0.36 to -0.23)) and triglycerides (geometric mean ratio 0.91 (95% CI 0.85 to 0.98)). Women had a 16% higher probability of being treated with antihypertensive medication in the presence of high cardiovascular disease (CVD) risk and elevated SBP than men (relative risk 0.84 (95% CI 0.73 to 0.98)), whereas no sex differences were found for glucose-lowering medication and lipid-modifying medication. Among those treated, women were less likely to achieve treatment targets of HbA1c (0.92 (95% CI 0.87 to 0.98)) and LDL-c (0.89 (95% CI 0.85 to 0.92)) than men, while no differences for SBP were found. CONCLUSIONS In this Dutch T2D population, women had a slightly different cardiometabolic risk profile compared with men and a substantially higher BMI. Women had a higher probability of being treated with antihypertensive medication in the presence of high CVD risk and elevated SBP than men, and were less likely than men to achieve treatment targets for HbA1c and LDL levels.
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Affiliation(s)
- Marit de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marieke J Oskam
- Department of Internal Medicine, School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Behiye Ozcan
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam UMC - VUMC location, Amsterdam, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, Amsterdam UMC - VUMC location, Amsterdam, The Netherlands
| | - Sarah E Siegelaar
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Hans DeVries
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marielle Schroijen
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Harold W de Valk
- Department of Internal Medicine, Universty Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ingrid Jazet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Miranda T Schram
- Department of Internal Medicine, School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Ning K, Zhao L, Franklin M, Matloff W, Batta I, Arzouni N, Sun F, Toga AW. Parity is associated with cognitive function and brain age in both females and males. Sci Rep 2020; 10:6100. [PMID: 32269255 PMCID: PMC7142076 DOI: 10.1038/s41598-020-63014-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/03/2020] [Indexed: 12/20/2022] Open
Abstract
Previous studies of the association between parity and long-term cognitive changes have primarily focused on women and have shown conflicting results. We investigated this association by analyzing data collected on 303,196 subjects from the UK Biobank. We found that in both females and males, having offspring was associated with a faster response time and fewer mistakes made in the visual memory task. Subjects with two or three children had the largest differences relative to those who were childless, with greater effects observed in men. We further analyzed the association between parity and relative brain age (n = 13,584), a brain image-based biomarker indicating how old one's brain structure appears relative to peers. We found that in both sexes, subjects with two or three offspring had significantly reduced brain age compared to those without offspring, corroborating our cognitive function results. Our findings suggest that lifestyle factors accompanying having offspring, rather than the physical process of pregnancy experienced only by females, contribute to these associations and underscore the importance of studying such factors, particularly in the context of sex.
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Affiliation(s)
- Kaida Ning
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, 90033, USA
- Molecular and Computational Biology Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Lu Zhao
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, 90033, USA
| | - Meredith Franklin
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, United States
| | - Will Matloff
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, 90033, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ishaan Batta
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, 90033, USA
| | - Nibal Arzouni
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, 90033, USA
- Molecular and Computational Biology Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Fengzhu Sun
- Molecular and Computational Biology Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, 90033, USA.
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Schott W, Aurino E, Penny ME, Behrman JR. Time use and sexual maturity-related indicators differentially predict youth body mass indices, Peruvian girls versus boys. Ann N Y Acad Sci 2019; 1468:55-73. [PMID: 31872895 DOI: 10.1111/nyas.14292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Abstract
Rapid development in Latin America has been accompanied by lifestyle shifts, including changes in time use and social environments. Overweight/obesity has also emerged as a public health challenge. We examined whether lifestyle changes and sexual maturity-related indicators (early pubertal development and having a child) predict increases in adiposity among Peruvian youth. Using longitudinal data from Young Lives, we examined changes in adiposity between ages 8 and 15 years old for the younger cohort and ages 15 and 22 years old for the older cohort. Boys and girls in both cohorts demonstrated substantial increases in age-adjusted adiposity measures, but predictors were different for boys versus girls. For boys, increases in time spent in work and domestic chores predicted increases in adiposity body mass index and BMI-for-age Z-score and increases in time spent sleeping were associated with decreases in adiposity (waist circumference and waist-to-height ratio). For girls, sexual maturity-related indicators (early menarche and childbearing) predicted increases in adiposity, regardless of time use. Potential mechanisms for these results may include diet, physical activity, wealth, and urban-rural residence. Time use among youth was associated with diet quality and physical activity, but in different ways for boys versus girls. Strategies for dealing with rising overweight and obesity should incorporate sex-based specificities.
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Affiliation(s)
- Whitney Schott
- Population Studies Center, University of Pennsylvania, Pennsylvania, Philadelphia
| | - Elisabetta Aurino
- Department of Management and Centre for Health Economics and Policy Innovations, Imperial College London and Young Lives, University of Oxford, Oxford, United Kingdom
| | - Mary E Penny
- Instituto de Investigación Nutricional, Lima, Peru
| | - Jere R Behrman
- Population Studies Center, University of Pennsylvania, Pennsylvania, Philadelphia.,Economics Department, University of Pennsylvania, Pennsylvania, Philadelphia
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Sun K, Lin D, Qiling F, Li F, Qi Y, Feng W, Ren M, Yan L, Liu D. Number of parity is associated with low-grade albuminuria in middle-aged and elderly Chinese women. BMC WOMENS HEALTH 2019; 19:117. [PMID: 31590639 PMCID: PMC6781324 DOI: 10.1186/s12905-019-0814-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/06/2019] [Indexed: 01/13/2023]
Abstract
Background Women with a higher number of pregnancies have a higher risk of developing cardiovascular diseases. Subtle fluctuations in albumin excretion could be related to pathophysiologic changes in the vascular system. We aimed to investigate the possible association of parity with low-grade albuminuria. Methods We conducted a community-based study in 6495 women aged 40 years or older. Low-grade albuminuria was defined according to the highest quartile of urine albumin-to-creatinine ratio in participants free of micro- or macro-albuminuria. Results Parous women with a higher number of pregnancies had increased age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), fasting plasma glucose (FPG), and fasting insulin, as well as decreased high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR) levels, and proportion of menopause. The prevalence of low-grade albuminuria in parous women gradually increased with parity number. Compared with women with one childbirth, those with more than two childbirths were independently associated with a higher prevalent low-grade albuminuria (odds ratios [ORs] 1.41, 95% confidence interval [CI], 1.09–1.81) after multiple adjustments. In subgroup analysis after multiple adjustments, significant relation between parity number and prevalent low-grade albuminuria was detected in subjects age 55 years or older. Conclusion Number of parity is associated with prevalent low-grade albuminuria in middle-aged and elderly Chinese women without micro- or macro-albuminuria.
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Affiliation(s)
- Kan Sun
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Diaozhu Lin
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Feng Qiling
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Feng Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yiqin Qi
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Wanting Feng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Meng Ren
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.
| | - Dan Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.
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Yu W, Wang X, Hu X, Deng H, Yang L, Liang H, Si Q, Chen X, Li Q, Gu X, Shen F. PREVIOUS DELIVERY OF MACROSOMIA IS ASSOCIATED WITH MATERNAL ADIPOSITY IN LATER LIFE IN CHINESE PAROUS WOMEN WITH NORMAL WEIGHT BEFORE AND/OR AFTER PREGNANCY. Endocr Pract 2019; 25:1176-1183. [PMID: 31414910 DOI: 10.4158/ep-2019-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Obesity has become a major worldwide health challenge. Macrosomic infants are more likely to experience type 2 diabetes mellitus, obesity and hypertension in adulthood. However, whether macrosomia increases the risk of maternal adiposity later in life is still unknown. Methods: One thousand nine hundred eighty-six unrelated parous women of Chinese Han ancestry aged from 40 to 76 years were enrolled. Self-reported information about reproductive status, including age at menarche, number of children, previous delivery of macrosomic infants, and body weight before and after pregnancy were obtained from personal interview by trained interviewers using a standard questionnaire. Macrosomia was defined as birth weight greater than 4,000 g. Adiposity indexes were measured or calculated. Results: Prior delivery of macrosomia was associated with an increased risk of having obesity in parous women with normal weight before pregnancy (odds ratio [OR] = 1.840; 95% confidence interval [CI] 1.028, 3.294; P = .040), as well as a higher risk of overweight/obesity in parous women with normal weight after pregnancy (OR = 1.777; 95% CI 1.131, 2.794; P = .013). In addition, previous delivery of macrosomia was related with 1.919 (95% CI 1.207, 3.050; P = .006) times higher risk of overweight/obesity in parous women with normal weight before and after pregnancy. Conclusion: The present study suggests that prior delivery of macrosomia may be an independent risk factor for adiposity later in life in parous women with normal weight before and/or after pregnancy. Abbreviations: BMI = body mass index; CI = confidence interval; OR = odds ratio; WC = waist circumference; WHR = waist-to-hip ratio; WHtR = waist-to-height ratio.
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Cortés YI, Catov JM, Brooks M, El Khoudary SR, Thurston RC, Matthews KA, Isasi CR, Jackson EA, Barinas-Mitchell E. Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN. Atherosclerosis 2019; 289:27-35. [PMID: 31446211 DOI: 10.1016/j.atherosclerosis.2019.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 06/10/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Reproductive factors are associated with later life CVD in women (e.g., age at first birth, preeclampsia, gestational diabetes), but studies have focused largely on premenopausal women. We examined the relationship of reproductive factors with subclinical CVD burden in late midlife women. METHODS We included 964 parous women from the Study of Women's Health Across the Nation (SWAN), who completed a reproductive history questionnaire at the 13th SWAN visit (2011-2012), and a carotid ultrasound and brachial-ankle pulse wave velocity (baPWV) assessment. The primary outcomes were carotid intima-media thickness, plaque, and baPWV; our secondary outcome was a composite subclinical CVD index created using these measures. Linear and logistic regression was performed to examine associations with individual subclinical CVD measures, and multinomial logistic regression was used in analyses of the composite index. Models adjusted for socio-demographics and cardiovascular risk factors. RESULTS Mean age at subclinical CVD assessment was 60.2 years (SD ± 2.7). History of gestational hypertension/preeclampsia was associated with greater carotid IMT (β: 0.038, p = 0.004). Earlier age at first birth was associated with subclinical CVD, but not when accounting for CVD risk factors. History of gestational diabetes was associated with greater baPWV, but not related to our composite index. CONCLUSIONS Pregnancy history is an important marker of subclinical CVD in late midlife and may impact the vasculature through distinct pathways. Future studies are necessary to evaluate racial/ethnic differences in the observed associations and to assess the benefit of a composite subclinical CVD index for earlier CVD risk modification in midlife women.
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Affiliation(s)
- Yamnia I Cortés
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Janet M Catov
- Departments of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA, USA; Department of Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - Maria Brooks
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Rebecca C Thurston
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Karen A Matthews
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth A Jackson
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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22
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Early Menstrual Factors Are Associated with Adulthood Cardio-Metabolic Health in a Survey of Mexican Teachers. Matern Child Health J 2019; 23:356-368. [PMID: 30701414 DOI: 10.1007/s10995-018-2650-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives To evaluate whether age at menarche and time to menstrual regularity were related to cardio-metabolic risk factors in Mexican women. Methods The study population comprised 54,921 women from the 2008-2010 wave of the Mexican Teacher's Cohort. A modified Poisson approach was used; exposures were age at menarche and time to menstrual regularity (< 1 year vs. ≥1 year), and outcomes were prevalent obesity, type 2 diabetes, high blood pressure, and high cholesterol. Results Mean (SD) age of women was 42.1 (7.6) years, and mean (SD) menarcheal age was 12.5 (1.5) years. Compared to women with menarche age 13 years, those with menarche < 9 years had a 65% (95% CI 43-90%); 27% (95% CI 4-55%); and 23% (95% CI 1-49%) higher prevalence of obesity, high blood pressure, and high cholesterol, respectively. For diabetes, there was a U-shaped association; compared to menarche age 13 years, those with menarche < 9 years had an 89% higher prevalence of diabetes (95% CI 39-156%), and those with menarche ≥ 17 years had a 65% higher prevalence (95% CI 16-134%). Among women with regular cycles (n = 43,113), a longer time to menstrual regularity was associated with diabetes (PR = 1.11 with 95% CI 1.02-1.22), high blood pressure (PR = 1.11 with 95% CI 1.06-1.17), and high cholesterol (PR = 1.09 with 95% CI 1.04-1.14). Conclusions for practice Mexican women with earlier and later ages at menarche and/or longer time to menstrual regularity may have higher risk of cardio-metabolic disease in adulthood.
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23
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Number of Offspring and Cardiovascular Disease Risk in Men and Women: The Role of Shared Lifestyle Characteristics. Epidemiology 2018; 28:880-888. [PMID: 28696997 PMCID: PMC5625954 DOI: 10.1097/ede.0000000000000712] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Previous studies of the number of offspring and cardiovascular disease (CVD) report conflicting findings. We re-examined this association in both sexes to clarify the role of the cardiometabolic changes that women experience during pregnancy versus shared lifestyle characteristics. Methods: We studied 180,626 women and 133,259 men participating in the UK Biobank cohort who were free of CVD at baseline. CVD events were obtained from hospital and death registers. Analyses were conducted using Cox proportional hazards regression. Results: The incidence rates of overall CVD were six per 1000 person-years for women and nine per 1000 person-years for men. Number of children showed an association with risk of CVD among women; the adjusted HR (95% CI) was 1.2 (1.1, 1.3) for one, 1.1 (1.0, 1.2) for two, 1.2 (1.1, 1.3) for three, and 1.2 (1.1, 1.4) for four or more as compared to none. Number of children was also associated with CVD among men; the adjusted HR (95% CI) was 1.1 (1.0, 1.2) for one, 1.0 (0.96, 1.1) for two, 1.1 (1.0, 1.2) for three, and 1.1 (1.0, 1.3) for four or more as compared to none. There was no evidence of heterogeneity in the associations between sexes (Pinteraction = 0.80). Number of offspring also showed similar associations with ischemic heart disease and hypertensive disorders in both sexes. Conclusions: We observed similar associations between number of offspring and CVD in both sexes. The association among women might therefore be largely explained by unobserved behavioral and lifestyle characteristics.
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24
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Association of age at menarche with obesity and hypertension among southwestern Chinese women: a new finding. Menopause 2018; 25:546-553. [DOI: 10.1097/gme.0000000000001027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
PURPOSE OF THE REVIEW To review the latest evidence on sex differences in the burden and complications of diabetes and discuss the potential explanations for the sex differences described. RECENT FINDINGS Diabetes is a strong risk factor for vascular disease, with compelling evidence that the relative risks of vascular diseases conferred by diabetes are considerably greater in women than men. The mechanisms underpinning women's excess relative risk of vascular disease from diabetes are unknown. Sex differences in the health care provided for the prevention, management, and treatment of diabetes and its complications could contribute to women's greater excess relative risks of diabetes complications. However, since the excess risk of vascular disease is not seen for other major vascular risk factors, inherent biological factors may be more likely to be involved. In addition to other cardiometabolic pathways, the sex dimorphism in body composition and fat distribution may be particularly important in explaining women's greater excess risk of the vascular complications of diabetes. There is strong evidence to suggest that diabetes is a stronger risk factor for vascular disease in women than men. Although several mechanisms may be involved, further research is needed to provide new and deeper insights into the mechanisms underpinning sex differences in the association between diabetes and vascular diseases. Such research will inform patients, health care professionals, and policy makers to ensure that women are not disproportionately affected by diabetes, and will help to reduce the burden in both sexes.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK.
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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26
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Peters SA, Woodward M. Women's reproductive factors and incident cardiovascular disease in the UK Biobank. Heart 2018; 104:1069-1075. [PMID: 29335253 DOI: 10.1136/heartjnl-2017-312289] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Studies have suggested that women's reproductive factors are associated with the risk of cardiovascular disease (CVD); however, findings are mixed. We assessed the relationship between reproductive factors and incident CVD in the UK Biobank. METHODS Between 2006 and 2010, the UK Biobank recruited over 500 000 participants aged 40-69 years across the UK. During 7 years of follow-up, 9054 incident cases of CVD (34% women), 5782 cases of coronary heart disease (CHD) (28% women), and 3489 cases of stroke (43% women) were recorded among 267 440 women and 215 088 men without a history of CVD at baseline. Cox regression models yielded adjusted hazard ratios (HRs) for CVD, CHD and stroke associated with reproductive factors. RESULTS Adjusted HRs (95% CI) for CVD were 1.10 (1.01 to 1.30) for early menarche (<12 years), 0.97 (0.96 to 0.98) for each year increase in age at first birth, 1.04 (1.00 to 1.09) for each miscarriage, 1.14 (1.02 to 1.28) for each stillbirth, and 1.33 (1.19 to 1.49) for early menopause (<47 years). Hysterectomy without oophorectomy or with previous oophorectomy had adjusted HRs of 1.16 (1.06 to 1.28) and 2.30 (1.20 to 4.43) for CVD. Each additional child was associated with a HR for CVD of 1.03 (1.00 to 1.06) in women and 1.03 (1.02 to 1.05) in men. CONCLUSIONS Early menarche, early menopause, earlier age at first birth, and a history of miscarriage, stillbirth or hysterectomy were each independently associated with a higher risk of CVD in later life. The relationship between the number of children and incident CVD was similar for men and women.
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Affiliation(s)
- Sanne Ae Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Epidemiology, John Hopkins University, Baltimore, Maryland, USA
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Abstract
PURPOSE OF REVIEW Migraine is a common and highly disabling condition that is particularly prevalent among women and especially women of reproductive age. The tremendous rise in adiposity in the Western world has led to an epidemic of obesity in women. The particular effects of obesity on women with migraine of various ages are the focus of this review. RECENT FINDINGS Conflicting findings from various studies with different approaches and populations have made challenging definitive conclusions about associations between migraine and obesity. While the association between obesity and migraine frequency has been consistently demonstrated and obesity is considered a risk factor for progression from episodic to chronic migraine, the association between obesity and migraine prevalence is still somewhat debated and appears to be dependent on gender and age, with the most consistent effects observed in women younger than 55 years of age. Association between migraine and obesity is most commonly observed in women of reproductive age. The multimodal changes associated with age and hormonal change in women likely play a role in this relationship, as obesity does not appear to be related to migraine in women over 55 years of age. Future studies focusing on the migraine-obesity relationship in women should examine the effects of age, endogenous hormonal state, and exogenous hormones on migraine and obesity.
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Affiliation(s)
- Jelena M Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA.
- Montefiore Headache Center, Bronx, NY, USA.
| | - Julio R Vieira
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA
- Health Quest Neurology, Kingston, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA
- Montefiore Headache Center, Bronx, NY, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
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Yang L, Li L, Millwood IY, Lewington S, Guo Y, Sherliker P, Peters SAE, Bian Z, Wu X, Yu M, Liu H, Wang H, Mao E, Chen J, Woodward M, Peto R, Chen Z. Adiposity in relation to age at menarche and other reproductive factors among 300 000 Chinese women: findings from China Kadoorie Biobank study. Int J Epidemiol 2017; 46:502-512. [PMID: 27524817 PMCID: PMC5837303 DOI: 10.1093/ije/dyw165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 01/08/2023] Open
Abstract
Background Adiposity is increasing rapidly in China but little is known about the relevance to it of women's reproductive factors, which differ inter-generationally and from that in the West. We assess associations of adiposity with life-course reproductive factors in Chinese women. Methods In 2004-08, the nationwide China Kadoorie Biobank recruited 303 000 women aged 30-79 (mean 50) years from 10 diverse regions. Multivariable linear regression was used to examine associations of reproductive factors (e.g. age at menarche/first birth/menopause, parity, breastfeeding and reproductive years) with measures of general [e.g. body mass index (BMI)] and central [e.g. waist circumference (WC)] adiposity in adulthood. Results Overall, the mean BMI was 23.7 (standard deviation 3.3) kg/m 2 , mean age at menarche was 15 (2) years and nearly all had given birth (99%) and breastfed children (98%). Adiposity was associated inversely with age at menarche and at first birth, with 0.19 and 0.05 kg/m 2 lower BMI and 0.38 and 0.12 cm lower WC per 1-year delay respectively ( P < 0.001). Among 128 259 post-menopausal women, adiposity was associated positively with age at menopause and reproductive years, with 0.05 and 0.07 kg/m 2 higher BMI and 0.12 and 0.17 cm higher WC per 1-year increase, respectively ( P < 0.001). The proportion with overweight/obesity had similar associations with these reproductive factors. Adiposity had a non-linear positive association with parity, but no association with breastfeeding duration. Conclusion Among Chinese women, earlier age at menarche and at first birth, later age at menopause and longer reproductive years were independently associated with increased adiposity late in life.
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Affiliation(s)
- Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
- Department of Public Health, Beijing University, Beijing, China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Sanne AE Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | | | - Min Yu
- Zhejiang CDC, Hangzhou, Zhejiang, China
| | - Huilin Liu
- Hunan CDC NCDs Prevention and Control Department, Changsha, Hunan, China
| | - Hongmei Wang
- Hainan CDC NCDs Prevention and Control Department, Haikou, Hainan, China
| | - Enke Mao
- Maiji CDC, Tianshui, Gansu, China
| | - Junshi Chen
- The George Institute for Global Health, University of Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, Australia
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
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Silveira EA, Ferreira CCDC, Pagotto V, Santos ASEADC, Velasquez-Melendez G. Total and central obesity in elderly associated with a marker of undernutrition in early life - sitting height-to-stature ratio: A nutritional paradox. Am J Hum Biol 2017; 29. [PMID: 28161905 DOI: 10.1002/ajhb.22977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/17/2016] [Accepted: 01/14/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate whether sitting height-to-stature ratio (SHSR) is associated with total and central obesity in the elderly. METHODS This was a cross-sectional study with 133 noninstitutionalized elderly. High SHSR (≥ 1SD above the mean) was used as a marker of undernutrition (MU) in early life. Poisson's multiple regression was used to determine the association between variables. RESULTS The prevalence of high SHSR was 21.0%, total obesity 43.6% and central obesity 50.4%. Elderly with high SHSR presented a statistically significant association with total obesity (PR 1.50; 95% CI 1.04-2.18) and central obesity (PR 1.42; 95% CI 1.03-1.95) after adjustment for sex, age, educational level and income in the multivariate analysis. CONCLUSION The occurrence of total and central obesity in the elderly was associated with a MU in early life. This result indicates that nutritional deficiencies in childhood may increase the risk of obesity in the elderly, a nutritional paradox.
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Affiliation(s)
- Erika Aparecida Silveira
- Post-Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Brazil
| | | | - Valéria Pagotto
- Post-Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Brazil.,Nursing School, Federal University of Goiás, Brazil
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Holowko N, Jones M, Koupil I, Tooth L, Mishra G. Combined effect of education and reproductive history on weight trajectories of young Australian women: A longitudinal study. Obesity (Silver Spring) 2016; 24:2224-31. [PMID: 27571573 DOI: 10.1002/oby.21610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the combined effect of education and reproductive history on weight trajectory. METHODS The association of education with weight trajectory (1996-2012) in relation to reproductive history was analyzed among 9,336 women (born 1973-1978) from the Australian Longitudinal Study on Women's Health using random effects models. RESULTS Compared with women with a university degree/higher, lower-educated women were 2 kg heavier at baseline and gained an additional 0.24 kg/year. Giving birth was associated with an increase in weight which was more pronounced among women having their first birth <26 years of age (2.1 kg, 95% CI: 1.5-2.7), compared with 26 to 32 years or >32 years. While younger first-time mothers had a steeper weight trajectory (∼+0.16 kg/year, 95% CI: 0.1-0.3), this was less steep among lower-educated women. High-educated women with a second birth between 26 and 32 years had 0.9 kg decreased weight after this birth, while low-educated women gained 0.9 kg. CONCLUSIONS While the effect of having children on weight in young adulthood was minimal, women having their first birth <26 years of age had increased risk of weight gain, particularly primiparous women. Educational differences in weight persisted after accounting for reproductive history, suggesting a need to explore alternative mechanisms through which social differences in weight are generated.
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Affiliation(s)
- Natalie Holowko
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Australia.
| | - Mark Jones
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Australia
| | - Ilona Koupil
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Leigh Tooth
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Australia
| | - Gita Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Australia
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