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Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metab 2024; 36:240-262. [PMID: 38280383 PMCID: PMC10871592 DOI: 10.1016/j.cmet.2024.01.002] [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: 10/06/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
Metabolic health is characterized by optimal blood glucose, lipids, cholesterol, blood pressure, and adiposity. Alterations in these characteristics may lead to the development of type 2 diabetes mellitus or dyslipidemia. Recent evidence suggests that female reproductive characteristics may be overlooked as risk factors that contribute to later metabolic dysfunction. These reproductive traits include the age at menarche, menstrual irregularity, the development of polycystic ovary syndrome, gestational weight change, gestational dysglycemia and dyslipidemia, and the severity and timing of menopausal symptoms. These risk factors may themselves be markers of future dysfunction or may be explained by shared underlying etiologies that promote long-term disease development. Disentangling underlying relationships and identifying potentially modifiable characteristics have an important bearing on therapeutic lifestyle modifications that could ease long-term metabolic burden. Further research that better characterizes associations between reproductive characteristics and metabolic health, clarifies underlying etiologies, and identifies indicators for clinical application is warranted in the prevention and management of metabolic dysfunction.
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Affiliation(s)
- Amy R Nichols
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Su H, Jiang C, Zhang W, Zhu F, Jin Y, Cheng K, Lam T, Xu L. Parity and incident type 2 diabetes in older Chinese women: Guangzhou Biobank Cohort Study. Sci Rep 2023; 13:9504. [PMID: 37308533 DOI: 10.1038/s41598-023-36786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/14/2023] Open
Abstract
This study examined the association between parity and incident type 2 diabetes in older Chinese women and estimated the mediation effect of adiposity indicators. A total of 11,473 women without diabetes at baseline from 2003 to 2008 were followed up until 2012. We used Cox proportional hazards regression to assess the association between parity and incident type 2 diabetes, and mediation analysis to estimate the mediation effect of adiposity indicators. Compared to women with one parity, the hazard ratio (HR) (95% confidence interval (CI)) for incident type 2 diabetes was 0.85 (0.44-1.63), 1.20 (1.11-1.30), 1.28 (1.16-1.41) and 1.27 (1.14-1.42) for women with parity of 0, 2, 3, and ≥ 4, respectively. The proportion of indirect effect (95% CI) mediated by body mass index, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage was 26.5% (19.2-52.2%), 54.5% (39.4-108.7%), 25.1% (18.2-49.1%), 35.9% (25.6-74.1%), 50.3% (36.5-98.6%) and 15.1% (- 66.4 to 112.3%), respectively. Compared to women with one parity, women with multiparity (≥ 2) had a higher risk of incident type 2 diabetes and up to half of the association was mediated by abdominal obesity.
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Affiliation(s)
- Huimin Su
- School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Chaoqiang Jiang
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Weisen Zhang
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China.
| | - Feng Zhu
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Yali Jin
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Karkeung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Taihing Lam
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
- School of Public Health, The University of Hong Kong, Hong Kong, 999077, China
| | - Lin Xu
- School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
- School of Public Health, The University of Hong Kong, Hong Kong, 999077, China.
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Jiang Y, Jiang S, Long Q, Yang J, Chen JL, Guo J. Factors Associated with Hemoglobin A1c Level Among Women Without Prior Diabetes Diagnosis in Rural Areas of Central South China: A Cross-Sectional Study. Int J Womens Health 2022; 14:741-755. [PMID: 35698488 PMCID: PMC9188317 DOI: 10.2147/ijwh.s362143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Women in rural areas of China face the unique risk of developing diabetes, but data on the glycemic status among women without prior diabetes diagnosis in rural areas are lacking which may limit the decision-making for diabetes screening or prevention. This study was aimed to describe the glycemic status of women determined by hemoglobin A1c (HbA1c) and explore its associating factors. Methods A cross-sectional survey was conducted among women without prior diabetes diagnosis from two counties of rural areas in Central South China from July to October 2018. On the basis of the life course framework, data on socio-demographic, environmental health, genetic, biological (blood pressure, weight and height, lipids), psychosocial, and healthy behavioral factors were collected on site either through questionnaires or field measurements. The questionnaires included social-demographic sheet, Perceived Stress Scale, Self-efficacy scales for health-related diet and exercise behaviors, and Chinese Diabetes Risk Questionnaire. Generalized linear model analysis was performed to determine the associating factors of glycemic status, which was measured by HbA1c level. Results A total of 647 women were included in the study. The median age of women was 51.00 years (range 35–65 years). The median HbA1c level was 5.1% (interquartile range 4.6%-5.5%, range 4–13.6%), and 8.7% (n=56) of women were identified as elevated glycemic status (HbA1c>6%). Environmental health factors (eg, living in less-developed county [β=0.206, p=0.027]), biological factors (eg, higher body mass index [β=0.201, p=0.036], higher total cholesterol [β=0.097, p=0.040], history of gestational diabetes mellitus [β=0.722, p<0.001]), and psychosocial factors (eg, higher perceived stress [β=0.247, p=0.002]) were associated with higher HbA1c level. Conclusion This study reported 8.7% of elevated glycemic status among women without prior diabetes diagnosis in rural Hunan Province, China. After a comprehensive investigation based on a theoretical framework, living in a less-developed county of rural areas, having larger body mass index, higher total cholesterol, higher perceived stress, and a gestational diabetes mellitus history were identified as associating factors of higher HbA1c level. Professional support regarding weight control, blood lipid control, stress management, and the prevention of gestational diabetes mellitus should be recommended among this population, especially for women from less-developed counties.
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Affiliation(s)
- Yuanyuan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Shan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, People's Republic of China.,Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Jundi Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, People's Republic of China.,School of Nursing, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Jyu-Lin Chen
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, People's Republic of China
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Zhao Y, Wang S, Yang Y, Cao W, Chen K, Wang K. Mediation effect of body mass index on the association between age at menopause and type 2 diabetes mellitus in postmenopausal Chinese women. Menopause 2022; 29:590-598. [DOI: 10.1097/gme.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matsunaga T, Kadomatsu Y, Tsukamoto M, Kubo Y, Okada R, Nagayoshi M, Tamura T, Hishida A, Takezaki T, Shimoshikiryo I, Suzuki S, Nakagawa H, Takashima N, Saito Y, Kuriki K, Arisawa K, Katsuura-Kamano S, Kuriyama N, Matsui D, Mikami H, Nakamura Y, Oze I, Ito H, Murata M, Ikezaki H, Nishida Y, Shimanoe C, Takeuchi K, Wakai K. Associations of breastfeeding history with metabolic syndrome and cardiovascular risk factors in community-dwelling parous women: The Japan Multi-Institutional Collaborative Cohort Study. PLoS One 2022; 17:e0262252. [PMID: 35045125 PMCID: PMC8769371 DOI: 10.1371/journal.pone.0262252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the associations between breastfeeding and the prevalence of metabolic syndrome in community-dwelling parous women and to clarify whether the associations depend on age. METHODS The present cross-sectional study included 11,118 women, aged 35-69 years. Participants' longest breastfeeding duration for one child and their number of breastfed children were assessed using a self-administered questionnaire, and their total breastfeeding duration was approximated as a product of the number of breastfed children and the longest breastfeeding duration. The longest and the total breastfeeding durations were categorized into none and tertiles above 0 months. Metabolic syndrome and cardiovascular risk factors (obesity, hypertension, dyslipidemia, and hyperglycemia) were defined as primary and secondary outcomes, respectively. Associations between breastfeeding history and metabolic syndrome or each cardiovascular risk factor were assessed using multivariable unconditional logistic regression analysis. RESULTS Among a total of 11,118 women, 10,432 (93.8%) had ever breastfed, and 1,236 (11.1%) had metabolic syndrome. In participants aged <55 years, an inverse dose-response relationship was found between the number of breastfed children and the prevalence of metabolic syndrome; multivariable-adjusted odds ratios for 1, 2, 3, and ≥4 breastfed children were 0.60 (95% confidence interval [CI]: 0.31 to 1.17), 0.50 (95% CI: 0.29 to 0.87), 0.44 (95% CI: 0.24 to 0.84), and 0.35 (95% CI: 0.14 to 0.89), respectively. The longest and total breastfeeding durations of longer than 0 months were also associated with lower odds of metabolic syndrome relative to no breastfeeding history in participants aged <55 years. In contrast, all measures of breastfeeding history were not significantly associated with metabolic syndrome and cardiovascular risk factors in participants aged ≥55 years old. CONCLUSIONS Breastfeeding history may be related to lower prevalence of metabolic syndrome in middle-aged parous women.
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Affiliation(s)
- Takashi Matsunaga
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuka Kadomatsu
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mineko Tsukamoto
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshiro Takezaki
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Ippei Shimoshikiryo
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hiroko Nakagawa
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Yoshino Saito
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
- Department of Nursing, Faculty of Health Science, Aino University, Ibaraki, Osaka, Japan
| | - Kiyonori Kuriki
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Shizuoka, Japan
| | - Kokichi Arisawa
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Sakurako Katsuura-Kamano
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Daisuke Matsui
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Haruo Mikami
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Chiba, Japan
| | - Yohko Nakamura
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Chiba, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Hiroaki Ikezaki
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Yuichiro Nishida
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Chisato Shimanoe
- Department of Pharmacy, Saga University Hospital, Saga, Saga, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Mishra SR, Waller M, Chung HF, Mishra GD. Association between reproductive lifespan and risk of incident type 2 diabetes and hypertension in postmenopausal women: findings from a 20-year prospective study. Maturitas 2022; 159:52-61. [DOI: 10.1016/j.maturitas.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
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Mishra SR, Waller M, Chung HF, Mishra GD. Epidemiological studies of the association between reproductive lifespan characteristics and risk of Type 2 diabetes and hypertension: A systematic review. Maturitas 2021; 155:14-23. [PMID: 34876245 DOI: 10.1016/j.maturitas.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/16/2021] [Accepted: 09/19/2021] [Indexed: 12/23/2022]
Abstract
Some reproductive factors are found to be associated with metabolic outcomes in women; however, little is known about reproductive lifespan characteristics and the mutual effect of age at menarche and age at menopause on cardiovascular risk. This systematic review evaluated reproductive lifespan characteristics and describes the mutual effect of age at menarche and age at menopause on the risk of type 2 diabetes (T2DM) and hypertension at midlife. PubMed, EMBASE, and Web of Science were screened for studies published up to September 1, 2020. The individual effect estimates were reviewed and synthesized without meta-analysis due to methodological and clinical or conceptual diversity in reported studies. Of the 3033 identified studies, 20 were included in the final synthesis: 6 reported reproductive life span; 12 reported age at menarche, and 7 reported age at menopause. Synthesis of two cohorts, with a median follow-up of 9-11 years, showed that a shorter reproductive lifespan was positively associated with T2DM, yielding 6-15% higher risk of T2DM for a one-year decrease in reproductive lifespan. A few studies also demonstrated that women who experienced early menarche (four of six studies) and early menopause (two of five studies) were positively associated with risk of T2DM. The association between reproductive lifespan and hypertension was unclear due to the limited availability of studies. Our findings suggest that a shorter reproductive lifespan is associated with T2DM risk in postmenopausal women, especially those with early menarche and early menopause. Large cohort studies are needed to assess the association between reproductive lifespan and incident hypertension in midlife.
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Affiliation(s)
- Shiva R Mishra
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia.
| | - Michael Waller
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| | - Hsin-Fang Chung
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| | - Gita D Mishra
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
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Huo Y, Cheng L, Wang C, Deng Y, Hu R, Shi L, Wan Q, Chen L, Zeng T, Yu X, Tang X, Yan L, Qin G, Chen G, Gao Z, Wang G, Shen F, Luo Z, Qin Y, Chen L, Li Q, Ye Z, Zhang Y, Bi Y, Lu J, Li M, Xu M, Xu Y, Wang T, Zhao Z, Chen Y, Qi H, Zhu Y, Hu C, Su Q, Liu C, Wang Y, Wu S, Yang T, Deng H, Zhao J, Mu Y, Ning G, Wang W, Lin A. Associations between parity, pregnancy loss, and breastfeeding duration and risk of maternal type 2 diabetes: An observational cohort study. J Diabetes 2021; 13:857-867. [PMID: 33710784 DOI: 10.1111/1753-0407.13176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/18/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Parity, pregnancy loss, and breastfeeding duration were found to be associated with diabetes. However, the results are inconsistent. Also, no epidemiological studies have examined the association of these reproductive factors with diabetes in the same large population. We aim to investigate the associations between parity, pregnancy loss, breastfeeding duration, and the risk of maternal diabetes in middle-aged and elderly Chinese females. METHODS We included 131 174 females aged ≥40 years from the REACTION study (Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study). Multivariable linear regression and logistic regression were used to assess the association between parity, pregnancy loss, and breastfeeding duration and type 2 diabetes. RESULTS The number of parities and breastfeeding duration were positively related to fasting plasma glucose, 2-hour postload glucose, glycosylated hemoglobin, and homeostatic model assessment of insulin resistance. Compared with those with one birth, nulliparous women or women with 2 or ≥3 births had a significantly increased risk of diabetes. The odds ratios (OR) and 95% confidence intervals (CI) were 1.27 (1.10-1.48), 1.17 (1.12-1.22), and 1.28 (1.21-1.35), respectively. Compared with women without pregnancy loss, those who underwent 2 (OR 1.09; 95% CI, 1.04-1.14) or ≥3 pregnancy losses (OR 1.11; 95% CI, 1.04-1.18) had an increased risk of diabetes. Moreover, women with a breastfeeding duration ≥0 to 6 months (OR 0.82; 95% CI, 0.75-0.90) and ≥6 to 12 months (OR 0.94; 95% CI, 0.89-0.99) had a significantly lower risk of diabetes. CONCLUSIONS Nulliparous women or women with multiparity or more than one pregnancy loss have an increased risk of diabetes in later life, while women who breastfeed more than 0 to 12 months have a lower risk of diabetes.
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Affiliation(s)
- Yanan Huo
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Lihong Cheng
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Chenxiu Wang
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ying Deng
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Qin Wan
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianshu Zeng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xulei Tang
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital, Dalian, China
| | - Guixia Wang
- The First Hospital of Jilin University, Changchun, China
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading District, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Hongyan Qi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yuanyue Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Chunyan Hu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Qing Su
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Chao Liu
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Youmin Wang
- Karamay Municipal People's Hospital, Xinjiang, China
| | - Shengli Wu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Yang
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huacong Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiajun Zhao
- Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Yiming Mu
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Anhua Lin
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
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9
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Moazzeni SS, Hizomi Arani R, Asgari S, Azizi F, Hadaegh F. The association of parity/live birth number with incident type 2 diabetes among women: over 15 years of follow-up in The Tehran Lipid and Glucose Study. BMC WOMENS HEALTH 2021; 21:378. [PMID: 34715851 PMCID: PMC8556972 DOI: 10.1186/s12905-021-01519-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022]
Abstract
Background Childbearing may increase the future risk of developing type 2 diabetes mellitus (T2DM) in mothers. However, the issue is not clear completely and not investigated in the Middle East, a region with a high burden of T2DM. In the current study, we examined the association of parity/live birth number with incident T2DM among Iranian women. Methods The study population included 2552 women aged 30–65 years recruited in 1999–2001 and were followed for incident T2DM by 3-year intervals. Multivariable Cox proportional hazard models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the parity/live birth number for incident T2DM. Parity number was defined as the number of live childbirth (number of live birth) plus the number of stillbirth (defined as birth of an infant that died after the 20th week of pregnancy in the uterus). Results During a median follow-up of 15.4 years, 557 incident T2DM cases have occurred. After adjustment for potential T2DM risk factors and reproductive factors, each additional parity caused a 9% higher risk for incident T2DM. Moreover, compared to women with one parity, those with 3 and ≥ 4 parity had HRs of 1.73 [95% CI: 1.06–2.83] and 2.23 [1.36–3.65], respectively. After further adjustment for body mass index (BMI) and waist circumference, although the HRs were attenuated prominently, parity ≥ 4 was associated with significantly higher risk (HR: 1.72 [1.05–2.83]); even after further adjustment for triglycerides (TG)/ high-density lipoprotein cholesterol (HDL-C), the risk remained marginally significant (HR: 1.64 [1.00–2.70; P value: 0.051]). For the number of live birth, the results were also similar. Moreover, in a sensitivity analysis, when we considered BMI change during follow-up as another covariate, generally, the effect sizes did not change; the trend of HRs across categories of parity number remained marginally significant (P value: 0.064). Conclusions During a long-term follow-up, after adjustment for potential T2DM risk factors, reproductive factors, obesity indices, and TG/HDL-C (insulin resistance surrogate), we demonstrated that higher parity/live birth numbers could be associated with increased risk of T2DM development among Iranian women. Moreover, even after further adjustment for BMI change, the suggestive higher risk was still found. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01519-7.
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Affiliation(s)
- Seyyed Saeed Moazzeni
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhane Hizomi Arani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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10
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Nakamura K, Sawada N, Kitamura K, Watanabe Y, Tsugane S. Menstrual and reproductive factors and limitations in activities of daily living: A case-control study within the Japan Public Health Center-based Prospective Study. J Obstet Gynaecol Res 2021; 47:3903-3912. [PMID: 34482606 DOI: 10.1111/jog.14959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
AIM Although menstrual/reproductive factors are known to be associated with physical disability, little is known about these associations in relation to activities of daily living (ADL). This study aimed to clarify associations between menstrual/reproductive factors and ADL limitations in peri- and postmenopausal women. STUDY DESIGN A nested case-control study of the Japan Public Health Center-based Prospective (JPHC) Study. METHODS The main outcome measure was self-reported ADL levels in the 10-year follow-up questionnaire survey of the JPHC Study conducted between 2000 and 2004 (N = 36 460). Women who "live inside almost independently, but go out with assistance" or had a lower level of activity were considered to have ADL limitations ("cases"), and all others served as controls. Candidate menstrual/reproductive predictors were as follows: menarcheal age, menopausal status, menopausal age, regularity of menses, menstrual cycle, number of pregnancies, age at first pregnancy, number of deliveries, age at first delivery, and breast feeding. Multiple logistic regression analyses were conducted, and odds ratios adjusted for age and past lifestyle were calculated. RESULTS Mean ages of cases (N = 592) and controls (N = 38 656) were 68.3 (SD = 7.6) and 61.1 (SD = 7.7) years, respectively. With respect to menopausal age, groups aged <45 and ≥55 years had significantly higher adjusted ORs (1.44, 95% CI: 1.09-1.90 and 1.55, 95%CI: 1.09-2.18, respectively) than the reference group (50-54 years). Multiparous women had significantly lower ORs than nulliparous women. CONCLUSION Our findings suggest that menopausal age and parity may predict future ADL limitations in women.
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Affiliation(s)
- Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Kaori Kitamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yumi Watanabe
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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11
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Sun X, Zhang R, Wang L, Shen X, Lu Y, An J, Wang L, Wang Y, Luo X, Zhu H, Zhang X. Association Between Parity and the Age at Menopause and Menopausal Syndrome in Northwest China. Asia Pac J Public Health 2020; 33:60-66. [PMID: 32975428 DOI: 10.1177/1010539520960987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study evaluated the relationships between parity and the age at menopause and menopausal syndrome among Chinese women in Gansu. A total of 7236 women aged 40 to 55 years met study eligibility criteria. The modified Kupperman Menopausal Index scale was used to assess the severity of menopausal syndrome. Cox regression was applied to estimate hazard ratio and 95% confidence interval, and logistic regression was performed to calculate odds ratio and confidence interval. The mean age at menopause was 47.91 ± 3.31 years. There is no relationship between parity and age at menopause. Women with nulliparity or multiparity seemed to have higher risks of moderate and severe menopausal syndrome. The potential beneficial effects of one or two births on menopausal syndrome were also observed by applying the multivariable logistic regression analysis, particularly in urogenital symptoms. Women with nulliparity and multiparity appeared to be at the higher risks of menopause syndrome.
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Affiliation(s)
- Xiaoyan Sun
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - Rui Zhang
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Lirong Wang
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | | | - Yongbin Lu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - Junxia An
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
| | - Liyan Wang
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, Gansu, China
| | - Yiqing Wang
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, Gansu, China
| | - Xiaorong Luo
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Haiying Zhu
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xuehong Zhang
- The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, Gansu, China
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12
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Cheng TS, Day FR, Lakshman R, Ong KK. Association of puberty timing with type 2 diabetes: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003017. [PMID: 31905226 PMCID: PMC6944335 DOI: 10.1371/journal.pmed.1003017] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/10/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Emerging studies have investigated the association between puberty timing, particularly age at menarche (AAM), and type 2 diabetes. However, whether this association is independent of adiposity is unclear. We aimed to systematically review published evidence on the association between puberty timing and type 2 diabetes (T2D) or impaired glucose tolerance (IGT), with and without adjustment for adiposity, and to estimate the potential contribution of puberty timing to the burden of T2D in the United Kingdom (UK). METHODS AND FINDINGS We searched PubMed, Medline, and Embase databases for publications until February 2019 on the timing of any secondary sexual characteristic in boys or girls in relation to T2D/IGT. Inverse-variance-weighted random-effects meta-analysis was used to pool reported estimates, and meta-regression was used to explore sources of heterogeneity. Twenty-eight observational studies were identified. All assessed AAM in women (combined N = 1,228,306); only 1 study additionally included men. In models without adjustment for adult adiposity, T2D/IGT risk was lower per year later AAM (relative risk [RR] = 0.91, 95% CI 0.89-0.93, p < 0.001, 11 estimates, n = 833,529, I2 = 85.4%) and higher for early versus later menarche (RR = 1.39, 95% CI 1.25-1.55, p < 0.001, 23 estimates, n = 1,185,444, I2 = 87.8%). Associations were weaker but still evident in models adjusted for adiposity (AAM: RR = 0.97 per year, 95% CI 0.95-0.98, p < 0.001, 12 estimates, n = 852,268, I2 = 51.8%; early menarche: RR = 1.19, 95% CI 1.11-1.28, p < 0.001, 21 estimates, n = 890,583, I2 = 68.1%). Associations were stronger among white than Asian women, and in populations with earlier average AAM. The estimated population attributable risk of T2D in white UK women due to early menarche unadjusted and adjusted for adiposity was 12.6% (95% CI 11.0-14.3) and 5.1% (95% CI 3.6-6.7), respectively. Findings in this study are limited by residual and unmeasured confounding, and self-reported AAM. CONCLUSIONS Earlier AAM is consistently associated with higher T2D/IGT risk, independent of adiposity. More importantly, this research has identified that a substantial proportion of T2D in women is related to early menarche, which would be expected to increase in light of global secular trends towards earlier puberty timing. These findings highlight the need to identify the underlying mechanisms linking early menarche to T2D/IGT risk.
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Affiliation(s)
- Tuck Seng Cheng
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Felix R. Day
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Rajalakshmi Lakshman
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Ken K. Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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