Impact of parity on anthropometric measures of obesity controlling by multiple confounders: a cross-sectional study in Chilean women

Effect of Waiting Time for Radioactive Iodine Therapy on Outcome in N1 Stage Papillary Thyroid Cancer

CONTEXT

The waiting time for radioactive iodine therapy (WRAIT) after total thyroidectomy (TT) in patients with papillary thyroid cancer (PTC) and lymph node metastases (N1) has not been sufficiently investigated for risk of adverse outcomes.

OBJECTIVE

This work aimed to estimate the effect of WRAIT on the outcomes of disease persistence and recurrence among patients with N1 PTC and investigate factors predictive of delayed radioactive iodine therapy (RAIT).

METHODS

This retrospective cohort study was conducted in a university hospital. A total of 909 patients with N1 PTC were referred for RAIT between 2014 and 2018. WRAIT is the duration between TT and initial RAIT. The optimal WRAIT threshold determined using recursive partitioning analysis was used to define early and delayed RAIT. The primary end point was tumor persistence/recurrence. We compared the outcomes of patients with early and delayed RAIT using inverse probability weighting based on the propensity score.

RESULTS

The WRAIT threshold that optimally differentiated worse long-term remission/excellent response outcomes was greater than 88 days (51% of our cohort; n = 464). WRAIT exceeding 88 days was associated with an augmented risk of disease persistence/recurrence (odds ratio, 2.47; 95% CI, 1.60-3.82) after adjustment. Predictors of delayed RAIT included residence in lower-income areas, reoperation before the initial RAIT, TT at a nonuniversity-affiliated hospital, multifocality, extrathyroidal extension, N1b disease, and pre-RAIT-stimulated thyroglobulin level less than 1 ng/mL.

CONCLUSION

Delayed RAIT beyond 88 days after TT in patients with N1 PTC independently increased the risk of disease persistence/recurrence. Evaluation of the predictive determinants of prolonged WRAIT may help target at-risk patients and facilitate interventions.

The association of parity number with multimorbidity and polypharmacy among Iranian women in the Azarcohort: a cross-sectional study

OBJECTIVE

We aimed to study the association of parity number with multimorbidity (MM) and polypharmacy among women in the Azar cohort population.

PATIENTS & METHODS

This cross-sectional investigation was based on data from the Azar Cohort Study. Information regarding demographics, personal habits, physical activity level, medical and reproductive history, and anthropometric measurements of 8,290 females (35-70 years) were evaluated. Ordinal logistic and logistic regression analyses were conducted to assess for associations of parity number with multimorbidity (MM), polypharmacy, chronic disease, and abdominal obesity.

RESULTS

More educated participants and people in the fifth quintile of the Wealth Score Index were less likely to have a higher parity number. With increasing parity numbers, the prevalence of MM, polypharmacy, hypertension, cardiovascular disease, fatty liver disease, stroke, rheumatoid diseases, chronic obstructive pulmonary disease, and cancers tended to rise. Moreover, we found that increasing parity numbers (especially when ≥ 5) enhanced the odds of abdominal obesity, waist-to-hip ratio ≥ 0.85, and waist-to-height ratio ≥ 0.5; these significant associations were more obvious in parity numbers ≥ 9 and WHtR ≥ 0.5.

CONCLUSION

The parity number is associated with MM and polypharmacy in Iranian women enrolled in the Azar Cohort Study. Further studies exploring the pathways (biological, social, and environmental) underlying these relationships will provide clues for preventing morbidity and premature mortality among susceptible andhighly parous women.

The relationship of reproductive factors with adiposity and body shape indices changes overtime: findings from a community-based study

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.

Determination of hand grip strength and its correlates during pregnancy: a cross-sectional study

BACKGROUND

Pregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy.

METHODS

The study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression.

RESULT

One hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength.

CONCLUSION

Cardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women.

Double burden of underweight and overweight among Indian adults: spatial patterns and social determinants

OBJECTIVE

The current study explores the spatial patterns of underweight and overweight among adult men and women in districts of India and identifies the micro-geographical locations where the risks of underweight and overweight are simultaneously prevalent, after accounting for demographic and socio-economic factors.

DESIGN

We relied on BMI (weight (kg)/height squared (m2)), a measure of nutritional status among adult individuals, from the 2015-2016 National Family and Health Survey. Underweight was defined as <18·5 kg/m2 and overweight as ≥25·0 kg/m2.

SETTING

We adopted Bayesian structured additive quantile regression to model the underlying spatial structure in underweight and overweight burden.

PARTICIPANTS

Men aged 15-54 years (sample size: 108 092) and women aged 15-49 years (sample size: 642 002).

RESULTS

About 19·7 % of men and 22·9 % of women were underweight, and 19·6 % of men and 20·6 % of women were overweight. Results indicate that malnutrition burden in adults exhibits geographical divides across the country. Districts located in the central, western and eastern regions show higher risks of underweight. There is evidence of substantial spatial clustering of districts with higher risk of overweight in southern and northern India. While finding a little evidence on double burden of malnutrition among population groups, we identified a total of sixty-six double burden districts.

CONCLUSIONS

The current study demonstrates that the geographical burden of overweight in Indian adults is yet to surpass that of underweight, but the coexistence of double burden of underweight and overweight in selected regions presents a new challenge for improving nutritional status and necessitates specialised policy initiatives.

The Prevalence of Overweight and Obesity Among Women in Jordan: A Risk Factor for Developing Chronic Diseases

Objective

The study aimed to investigate the prevalence of obesity among Jordanian women and its association with a wide range of chronic diseases.

Methods

Subjects were enrolled in the present cross-sectional study based on a random drop-off technique at the Obstetrics and Gynecology clinics at Jordan University Hospital. Initially, any female 18 years of age and older was asked to enroll in the study. Relevant data were gathered using a questionnaire composed of 30 questions, and body mass index (BMI) was determined from each participant’s weight and height. The following variables were collected: socio-demographic, chronic diseases, and health status. Each variable’s frequencies were reported, and the 95% confidence interval (95% CI) for each variable was calculated. For association analysis, Chi-square analysis was performed with an odds ratio (OR) and 95% CI. Multinomial logistic regression analysis was applied to a combination of independent variables and a dependent condition with covariate factors.

Results

The age-standardized prevalence of overweight/obese Jordanian women was 70.6% (95% CI 66.0–74.8%). On the other hand, the age-standardized prevalence of only obese women was 36.4 (95% Cl 31.9–41.2%). Furthermore, the association between age and overweight/obesity was significant (p<0.0001). The percentage of overweight and obesity started to be significant in the 30–39 year age group. Moreover, the OR for obesity ranged from 2.7 to 7.0 (p<0.05–0.01) for those women with only elementary education. Besides, high parity was significantly associated with obesity and elementary education. For chronic conditions, the percentages of hypertension, diabetes, hypertriglyceridemia, osteoporosis, and rheumatoid arthritis were significantly correlated with increased BMI in Jordanian women. With age adjustment, however, only hypertension was associated with obese level 3 with OR of 7.2 and 95% CI of 2.1–25.1 (p<0.01).

Conclusion

There is a high prevalence of overweight/obesity among women in Jordan, which was related to high parity and low education level. This high prevalence of obesity increased the incidence of chronic diseases, such as hypertension. Therefore, community-based multiple strategies are required to combat obesity in Jordanian women.

The association between parity and metabolic syndrome and its components in normal-weight postmenopausal women in China

BACKGROUND

Studies analyzing the association between parity and normal-weight metabolic syndrome (MetS) in postmenopausal women of normal weight remain limited, this study aimed to explore the association between parity and MetS among Chinese normal-weight postmenopausal women.

METHODS

In total, 776 normal-weight undiagnosed type 2 diabetes postmenopausal women who visited the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University for a routine health check-up between 1 January 2017 and 31 December 2019 were included in the cross-sectional study. All individuals had fully completed information records encompassing standardized electronic medical records, physical examinations, and biochemical measurements. Metabolic health was defined as fewer than 2 parameters of the MetS were present, in combination with normal weight. Continuous variables which were normally distributed were expressed as means and standard deviation. Comparisons among normally distributed continuous variables were made using one-way ANOVA while that among non-normal distribution parameters were made using Kruskal-Wallis. The association between parity and MetS was analyzed using multivariate logistic regression. All of the analyses were performed with SPSS statistical software (Version 23.0, SPSS, Inc., Chicago, IL, USA) and the statistical software package EmpowerStats ( http://www.empowerstats.com , X&Y Solutions, Inc., Boston, MA).

RESULTS

After adjusting for potential confounding factors including hip circumference, parity was failed to show a significantly relationship with MetS in normal-weight women(P=0.054). Women with a higher parity (≥3) had an increased OR of abdominal obesity, while the OR (95% CI) of the parity 3 group was 2.06 (1.13, 3.77) and that of the parity ≥4 group was 3.08(1.42, 6.66) the P for trend was 0.002 after adjusting for potential confounding factors. No significant differences were detected for other metabolic disorders including high levels of triglycerides (TG), blood pressure, fasting plasma glucose (FPG), and decreased high-density lipoprotein cholesterol (HDL-C) in different parity groups.

CONCLUSIONS

Higher parity was not associated with a higher risk of MetS in normal weight Chinese postmenopausal women. As for the components of MetS, only waist circumference was associated with multiparity even after controlling for hip circumference.

Association between parity and obesity: a cross sectional study on 6,447 Iranian females

Background

The aim of this study was to determine the relationship between parity and obesity in Iranian women.

Methods

In a cross-sectional study, a total of 6447 urban women aged 40-65 were studied. Parity(number of full-term births), age at menarche, menopausal status, age, height, weight, marital status, education level and occupation were gathered by a checklist. Body Mass Index (BMI) was calculated. Statistical associations between parity and obesity using multiple logistic regression model were examined.

Results

The mean age of the enrolled women was 48.40 ± 6.13 years. The mean BMI was 27.55 ± 4.47 kg/m². Of the total participants enrolled, 3517 (54.55%) had < 3 parities, while 2930 (45.44%) had ≥ 3 parities. The prevalence of obesity (BMI ≥ 30 kg/m²) and overweight (30 > BMI ≥ 25) was 27.50 % (95% CI 26.85-28.15) and 43.70% (95% CI 42.98-44.42), respectively. After adjustment for potential confounders, women with ≥ 3 parities were at higher risk of being obese (OR 1.19, 95% CI 1.05-1.35).

Conclusion

There was a statistically significant positive association between higher parity and obesity. It is recommended that health policymakers plan appropriate weight loss programs for postpartum.

Levels and determinants of malnutrition among India's urban poor women: An analysis of Demographic Health Surveys 2006 and 2016

A quarter of 400 million urban Indian residents are poor. Urban poor women are as undernourished as or worse than rural women but urban averages mask this disparity. We present the spectrum of malnutrition and their determinants for more than 26,000 urban women who gave birth within 5 years from the last two rounds of Demographic Health Survey 2006 and 2016. Among urban mothers in the lowest quartile by wealth index (urban poor), 12.8% (95% CI [11.3%, 14.5%]) were short or with height < 145 cm; 20.6% (95% CI [19%, 22.3%]) were thin or with body mass index < 18.5 kg/m² ; 57.4% (95% CI [55.5%, 59.3%]) had any anaemia (haemoglobin < 12 g/dL), whereas 32.4% (95% CI [30.5%, 34.3%]) had moderate to severe anaemia; and 21.1% (95% CI [19.3%, 23%]) were obese (body mass index ≥ 25 kg/m² ). Decadal gains were significant for thinness reduction (17p.p.) but obesity increased by 12 p.p. Belonging to a tribal household increased odds of thinness by 1.5 (95% CI [1.06, 2.18]) times among urban poor mothers compared with other socially vulnerable groups. Secondary education reduced odds of thinness (0.61; 95% CI [0.48, 0.77]) and higher education of short stature (0.41; 95% CI [0.18, 0.940]). Consuming milk/milk products, pulses/beans/eggs/meats, and dark green leafy vegetables daily reduced the odds of short stature (0.52; 95% CI [0.35, 0.78]) and thinness (0.72; 95% CI [0.54, 0.98]). Urban poor mothers should be screened for nutritional risks due to the high prevalence of all forms of malnutrition and counselled or treated as per risk.

Associations of Pregnancy History with BMI and Weight Gain in 45-54-Year-Old Women

BACKGROUND

Midlife women have a higher risk of cardiometabolic disease than younger women, but the lifelong biological/lifestyle factors responsible for this increase are unclear.

OBJECTIVES

We investigated whether pregnancy history is a risk factor for midlife overweight/obesity and evaluated potential hormonal mechanisms.

METHODS

The Baltimore Midlife Women's Health Study, a prospective cohort, recruited 772 women aged 45-54 y. Women reported pregnancy characteristics via questionnaires, trained staff measured weight/height to calculate midlife BMI, and serum hormones were assessed by ELISA. Logistic regression models assessed associations of pregnancy history with risk of midlife overweight/obesity and BMI gain since age 18. We additionally explored whether associations differed by menopausal status, and whether midlife hormones mediated relationships of pregnancy history and midlife BMI.

RESULTS

These premenopausal or perimenopausal women were 66% Caucasian/White and 30% African American/Black, with a median of 2 live births (range: 0-11) and median age at first birth of 27 y (range: 12-46 y). Women with 0 and ≥2 live births had lower odds of overweight/obesity than those with 1 birth (OR = 0.47; 95% CI: 0.23, 0.96; P = 0.04, and OR = 0.58; 95% CI: 0.35, 0.95; P = 0.03, respectively). Women with ≥2 live births also had lower odds of BMI gain than those with 1 birth (OR = 0.66; 95% CI: 0.41, 1.06; P = 0.08). Furthermore, women who were older at their first birth had lower odds of overweight/obesity (OR = 0.96; 95% CI: 0.92, 1.00; P = 0.03) and BMI gain (OR = 0.97; 95% CI: 0.93, 1.00; P = 0.06). Number of pregnancies and age at last pregnancy were not associated with midlife overweight/obesity or BMI gain. Associations did not differ by menopausal status and were not explained by midlife hormones.

CONCLUSIONS

Earlier childbirth and having 1 child increased women's risk of midlife overweight/obesity and BMI gain since age 18. Additional studies should focus on women's childbearing years as a critical determinant of midlife metabolic health.

Association Between Antenatal and Postpartum Depression and Anxiety with Weight Retention 1 Year After Childbirth: A Longitudinal Study

This was an observational, longitudinal study investigated the association between anxiety and depression in trimesters of pregnancy and early postpartum with weight retention 1 year after childbirth. Sixty-two pregnant women aged 18-35 years with a BMI of 35 or higher and 245 pregnant women with normal BMI (BMI 18.5-24.9 kg/m²) were recruited at their initial prenatal visit in the health centers. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Anxiety Inventory (BAI-II) were completed in five time points, the first, second, third trimester of pregnancy, 6-8 weeks and 12 months after delivery. Pre-pregnancy weight and weight retention at 1 year postpartum was measured. A significant relationship was found between first trimester (adjusted mean difference: aMD 3.416; 95% CI 1.392-5.441) and postpartum (aMD 3.042; 95% CI 0.538-5.547) depression as well as first trimester's anxiety (aMD 3.050; 95% CI 0.631-5.470) with weight retention at 1 year after childbirth.

Parity and Overweight/Obesity in Peruvian Women

Introduction

The rise in noncommunicable diseases and their risk factors in developing countries may have changed or intensified the effect of parity on obesity. We aimed to assess this association in Peruvian women using data from a nationally representative survey.

Methods

We used data from Peru’s Demographic and Health Survey, 2012. Parity was defined as the number of children ever born to a woman. We defined overweight as having a body mass index (BMI, kg/m²) of 25.0 to 29.9 and obesity as a BMI ≥30.0. Generalized linear models were used to evaluate the association between parity and BMI and BMI categories, by area of residence and age, adjusting for confounders.

Results

Data from 16,082 women were analyzed. Mean parity was 2.25 (95% confidence interval [CI], 2.17–2.33) among rural women and 1.40 (95% CI, 1.36–1.43) among urban women. Mean BMI was 26.0 (standard deviation, 4.6). We found evidence of an association between parity and BMI, particularly in younger women; BMI was up to 4 units higher in rural areas and 2 units higher in urban areas. An association between parity and BMI categories was observed in rural areas as a gradient, being highest in younger women.

Conclusion

We found a positive association between parity and overweight/obesity. This relationship was stronger in rural areas and among younger mothers.

Age at First Childbirth and Hypertension in Postmenopausal Women

Whether age at first childbirth has an effect on hypertension incidence is unclear. The objectives of this study were to examine the relationship between age at first childbirth and hypertension and to examine whether degree of obesity, measured as body mass index, mediates age at first childbirth-related hypertension in postmenopausal women. This study analyzed 4779 postmenopausal women data from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Logistic regression analyses were used to investigate relationship between age at first childbirth and hypertension. Mediation analysis was performed to examine the contribution of body mass index to age at first childbirth-related hypertension. Mean of participants’ age at first childbirth and current age were 23.8 and 63.4 years, respectively. The prevalence of hypertension was 51.1%. Age at first childbirth was significantly associated with the prevalence of hypertension (odds ratio, 0.963; 95% confidence interval, 0.930–0.998; P =0.036). Women with age at first childbirth ≤19 years had significantly higher risk of hypertension (odds ratio, 1.61; 95% confidence interval, 1.17–2.23; P =0.004) compared with those >19 years. Multivariable-adjusted prevalence of hypertension was significantly lower in women who delivered the first infant at 20 to 24 (45.5%), 25 to 29 (46.1%), and ≥30 (39.9%) years compared with those at ≤19 years (58.4%). Body mass index completely mediated age at first childbirth–hypertension relationship (indirect effect: odds ratio, 0.992; 95% confidence interval, 0.987–0.998; P =0.008). Age at first childbirth was significantly associated with hypertension in postmenopausal women. Body mass index mediated the effects of age at first childbirth on hypertension.

Adiposity in relation to age at menarche and other reproductive factors among 300 000 Chinese women: findings from China Kadoorie Biobank study

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.

Socio-demographic trends in overweight and obesity among parous and nulliparous women in Ghana

Background

Overweight and obesity are among the leading threats to global health because of their association with increased risk of morbidity and mortality. Much of the research on overweight and obesity among women largely generalize without due cognisance to differences in their reproductive history. This study explored differences in trends in overweight/obesity, and associated factors between parous and nulliparous women in Ghana.

Methods

Anthropometric measurements from three nationally representative Ghana Demographic and Health Surveys (2003, 2008 and 2014) were analysed using descriptive statistics and multivariate binary logistic regression.

Results

Over all, overweight/obesity increased between 2003 and 2014, with disproportionately higher rates among parous women (from about 30 % in 2003 to about 48 % in 2014) than nulliparous women (from about 15 % in 2003 to about 24 % in 2014). Age, wealth quintile and marital status were associated with overweight/obesity similarly in both women groups. However, there were variations in the association between parous and nulliparious women by educational level, type of locality, occupation and ethnicity.

Conclusion

The trend of overweight/obesity in Ghana warrants urgent national level public health attention to help curb the situation. Such interventions should be tailored bearing in mind the peculiar differences in associated factors between parous and nulliparous women.

Association between parity and obesity patterns in a middle-aged and older Chinese population: a cross-sectional analysis in the Tongji-Dongfeng cohort study

Background

Higher parity has been implicated as a risk factor for obesity of women. The objective of the study was to examine whether parity was associated with general obesity or abdominal obesity, or both, among middle-aged and older Chinese women.

Methods

A total of 12,829 Chinese women (mean age: 64.8 years) with at least one live birth were selected from the Dongfeng–Tongji Cohort Study (phase II). We used body mass index to assess general obesity, and waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and waist circumference (WC) to assess abdominal obesity. We used multivariate linear and logistic regression models to investigate the association between parity and obesity.

Results

The values of all four obesity measures increased with the greater number of live births (P for trend <0.001). After adjustment for potential confounders, women with four or more children had 1.72 times (95 % confidence interval [CI], 1.41–2.10) higher risk of general obesity, and 1.93 (95 % CI, 1.57–2.37), 2.09 (95 % CI, 1.65–3.64) and 1.58 (95 % CI, 1.28–1.94) times risk of abdominal obesity assessed by WHR, WHtR and WC, respectively. Furthermore, we observed an ascending gradient between parity and the three abdominal obesity measures.

Conclusions

Parity was positively associated with risk of obesity, especially abdominal obesity, in the long term among Chinese women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12986-016-0133-7) contains supplementary material, which is available to authorized users.

Effect of Maternal Age at Childbirth on Obesity in Postmenopausal Women: A Nationwide Population-Based Study in Korea

The object of this study was to assess the obesity in postmenopausal women, according to age at childbirth.We analyzed the association between age at first childbirth, age at last childbirth, parity, and subject obesity status (general obesity; BMI >25 kg/m, nongeneral obesity; BMI ≤25 kg/m, abdominal obesity; waist circumference >85 cm, nonabdominal obesity; waist circumference ≤85 cm), using data from a nationwide population-based survey, the 2010 to 2012 Korean National Health and Nutrition Examination Survey. Data from a total of 4382 postmenopausal women were analyzed using multivariate regression analysis with complex survey design sampling. And, the subjects were subdivided into groups according to obesity or not. Age, smoking, alcohol consumption, exercise, education, income level, number of pregnancies, oral contraceptive uses, breast feeding experience were adjusted as the confounders.The prevalence of general obesity among Korean postmenopausal women was 37.08%. Women with general obesity and abdominal obesity were significantly younger at first childbirth compared with women with nongeneral obesity and no abdominal obesity (23.89 ± 0.1 vs. 23.22 ± 0.1, P <0.001). Age at first childbirth was inversely associated with obesity, while age at last childbirth was not associated with obesity or abdominal obesity. Women with a higher number of pregnancies were also more likely to have obesity and abdominal obesity. Age at first childbirth remained significantly associated with obesity, after adjusting for confounding factors.Obesity in postmenopausal women is associated with first childbirth at a young age, and higher parity. Further research is needed to clarify the association between obesity and reproductive characteristics.

Understanding rural-urban differences in risk factors for breast cancer in an Indian population

PURPOSE

Although cancer registry data indicate that there are large differences in breast cancer (BC) rates between rural and urban regions of India, the reasons for these differences are not well understood.

METHODS

We conducted a hospital based case-control study (1,637 breast cancer cases; 1,515 visitor controls) in Mumbai, India, during the years 2009-2013. Extensive questionnaire data, anthropometry measurement and blood samples were collected on all participants. Using logistic regression models, we estimated risk based on odds ratio (OR) and 95 % confidence intervals (CI) for various reproductive and anthropometric measures, stratified by rural-urban status depending upon residence in first 20 years of life.

RESULTS

Waist-to-hip ratio of ≥0.95 compared to ratio ≤0.84 was strongly associated with risk of BC in both rural and urban populations (ORurban = 4.10, 95 % CI 3.03-5.56; ORrural = 3.01, 95 % CI 1.85-4.90). First full-term pregnancy after the age of 25 compared to first full-term pregnancy below 20 years of age was associated with risk of BC in both urban and rural women (ORurban = 1.78, 95 % CI 1.32-2.41; ORrural = 2.24, 95 % CI 1.13-4.43). The prevalence of age at first full-term pregnancy was significantly lower in rural (mean age at first full-term pregnancy = 19.39 years) versus urban women (mean age at first full-term pregnancy = 22.62 years), whereas mean waist circumference was much higher in urban women (82.13 cm) compared to rural women (79.26 cm). We did not observe any association between breast feeding and risk of BC.

CONCLUSIONS

Differences in the prevalence of central adiposity and age at first full-term pregnancy between rural and urban women from India may explain some differences in breast cancer rates between these two populations.

Women's reproductive health factors and body adiposity: findings from the UK Biobank

OBJECTIVE

To conduct a comprehensive examination of the association between women's reproductive health factors and measures of body adiposity in a contemporary Western population.

METHODS

A cross-sectional analysis of 502 664 individuals from the UK Biobank was conducted. Multivariable linear regression models were used to examine the association of age at menarche, age at first birth, parity and age at menopause with measures of general and central body adiposity, adjusted for age, smoking and socioeconomic status. The association between number of children and body adiposity in men was also assessed.

RESULTS

Age at menarche was inversely associated with body mass index (BMI); adjusted mean BMI was 29.0 kg m(-2) in women with menarche before the age of 12 years, compared with 26.5 kg m(-2) in those who had menarche after 14 years of age. Age at first birth was linearly and inversely associated with BMI: 0.16 kg m(-2) lower BMI per year increase in age of first birth. Each additional live birth or child fathered was associated with a 0.22 kg m(-2) higher BMI in women and a 0.14 kg m(-2) higher BMI in men. There was no evidence for an association between age at menopause and BMI. Corresponding associations for other markers of general or abdominal adiposity were similar to those for BMI. Findings were broadly similar in analyses stratified by age, smoking status, socioeconomic status, ethnic background, and history of diabetes or cardiovascular disease.

CONCLUSIONS

In women from a contemporary Western population, earlier age at menarche and age at first birth, and higher number of total live births were associated with higher levels of body adiposity. Prospective evaluations of the association between reproductive health factors, adiposity and the onset of cardiometabolic diseases are needed to assess causality, and to explore the mechanisms involved.

Relationship between maternal obesity and prenatal, metabolic syndrome, obstetrical and perinatal complications of pregnancy in Indiana, 2008-2010

BACKGROUND

Obesity is a serious medical condition affecting more than 30% of Indiana, and 25% of Unites States pregnant women. Obesity is related to maternal complications, and significantly impacts the health of pregnant women. The objective of this study was to describe the relationship between maternal complications and pre-pregnancy maternal weight.

METHODS

Using logistic regression models, we analyzed 2008 to 2010 birth certificate data, for 255,773 live births abstracted from the Indiana Vital Statistics registry. We examined the risk of reproductive factors, obstetrical complications and perinatal (intrapartum) complications for underweight, healthy weight, overweight and obese women for this population.

RESULTS

Women who received prenatal care were more likely to be obese [adjusted odds ratio (AOR) = 1.82 (1.56-2.13)]. While women with parity of zero (0) were less likely to be obese [AOR = 0.89, 95% CI (0.86-0.91)]. Women giving birth to twins [AOR = 1.25, 95% CI (1.17- 1.33)], women delivering by Caesarian section [AOR = 2.31, 95% CI ( 2.26-2.37)], and women who previously had a Caesarian section [AOR = 1.95, 95% CI (1.88-2.02)] were more likely to be obese. There was evidence of metabolic like complication in this population, due to obesity. Obesity was significantly associated with obstetrical conditions of the metabolic syndrome, including pre-pregnancy diabetes, gestational diabetes, pre-pregnancy hypertension, pregnancy-induced hypertension and eclampsia [AOR = 5.12, 95% CI (4.47-5.85); AOR = 3.87, 95% CI (3.68-4.08); AOR = 7.66, 95% CI (6.77-8.65); AOR = 3.23, 95% CI (3.07-3.39); and AOR = 1.77, 95% CI (1.31-2.40), respectively. Maternal obesity modestly increased the risk of induction, epidural, post-delivery bleeding, and prolonged labor [AOR = 1.26, 95% CI (1.23-1.29); AOR = 1.15, 95% CI (1.13-1.18); AOR = 1.20, 95% CI (1.12-1.28); and AOR = 1.44, 95% CI (1.30-1.61)], respectively. Obese women were less likely to have blood transfusions [AOR = .74, 95% CI (0.58-96)], vaginal tears [AOR = 0.51, 95% CI (0.44-0.59)], or infections [AOR = 86, 95% CI (0.80-0.93)].

CONCLUSIONS

Our results suggest that maternal obesity in Indiana, like other populations in the USA, is associated with high risks of maternal complications for pregnant women. Pre-pregnancy obesity prevention efforts should focus on targeting children, adolescent and young women, if the goal to reduce the risk of maternal complications related to obesity, is to be reached.

Parity and risk of metabolic syndrome among Chinese women

BACKGROUND

Studies regarding the effects of parity on metabolic syndrome in later life have produced conflicting results. The purpose of this study was to explore the association between parity and the risk of metabolic syndrome and its components in a population of Chinese women.

METHODS

A cross-sectional study was performed in a total of 13,358 women (mean age 61.5 years) with at least one live birth from the Dongfeng-Tongji cohort study. Each woman completed baseline questionnaires and received baseline examination, including a physical examination and laboratory tests. Participants were categorized into four groups according to parity (one, two, three, four or more live births). The metabolic syndrome was defined according to the International Diabetes Foundation criteria. Logistic regression was conducted to examine the association between parity and metabolic syndrome, with adjustment of potential confounders.

RESULTS

In this study sample, the prevalence of metabolic syndrome was 38.6% (5,156 of 13,358). After adjusting for demographic, lifestyle, and reproduction-related factors, women with two, three, or four or more live births had 1.18 times (95% confidence interval [CI], 1.05-1.32), 1.44 times (95% CI, 1.24-1.67), and 1.52 times (95% CI, 1.26-1.83), respectively, higher odds of having metabolic syndrome compared with those with one live birth. Furthermore, parity showed a positive association with waist circumference and a negative association with high-density lipoprotein cholesterol.

CONCLUSIONS

Multiparity was associated with increasing risk of metabolic syndrome independent of main covariates in this population of Chinese women. The findings suggested that multiparity may be a risk factor for metabolic syndrome.

Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states

OBJECTIVE

To test whether there is an association between abortion legislation and maternal mortality outcomes after controlling for other factors thought to influence maternal health.

DESIGN

Population-based natural experiment.

SETTING AND DATA SOURCES

Official maternal mortality data from 32 federal states of Mexico between 2002 and 2011.

MAIN OUTCOMES

Maternal mortality ratio (MMR), MMR with any abortive outcome (MMRAO) and induced abortion mortality ratio (iAMR).

INDEPENDENT VARIABLES

Abortion legislation grouped as less (n=18) or more permissive (n=14); constitutional amendment protecting the unborn (n=17); skilled attendance at birth; all-abortion hospitalisation ratio; low birth weight rate; contraceptive use; total fertility rates (TFR); clean water; sanitation; female literacy rate and intimate-partner violence.

MAIN RESULTS

Over the 10-year period, states with less permissive abortion legislation exhibited lower MMR (38.3 vs 49.6; p<0.001), MMRAO (2.7 vs 3.7; p<0.001) and iAMR (0.9 vs 1.7; p<0.001) than more permissive states. Multivariate regression models estimating effect sizes (β-coefficients) for mortality outcomes showed independent associations (p values between 0.001 and 0.055) with female literacy (β=-0.061 to -1.100), skilled attendance at birth (β=-0.032 to -0.427), low birth weight (β=0.149 to 2.166), all-abortion hospitalisation ratio (β=-0.566 to -0.962), clean water (β=-0.048 to -0.730), sanitation (β=-0.052 to -0.758) and intimate-partner violence (β=0.085 to 0.755). TFR showed an inverse association with MMR (β=-14.329) and MMRAO (β=-1.750) and a direct association with iAMR (β=1.383). Altogether, these factors accounted for (R(2)) 51-88% of the variance among states in overall mortality rates. No statistically independent effect was observed for abortion legislation, constitutional amendment or other covariates.

CONCLUSIONS

Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states.

Impact of parity on obesity: a cross-sectional study in Iranian women

OBJECTIVE

The aim of the present study was to analyze whether or not parity influenced the prevalence of obesity in both pre- and postmenopausal women.

SUBJECTS AND METHODS

A cross-sectional study was conducted on characteristics of urban women regarding parity. A total of 1,620 women aged 45-63 years were selected using cluster sampling. A face-to-face household interview was conducted by trained, skillful personnel. A risk factor questionnaire was used to obtain information on reproductive history and sociodemographic factors. Statistical associations between parity and obesity using logistic regression were then investigated.

RESULTS

The mean BMI was 29.1 ± 5.1, and 96.8% of the sample population were parous, with a median of 4 births. Of the total women enrolled, 216 (13.3%) had <3 parities, while 1,404 (86.7%) had ≥3 parities. The prevalence of obesity (BMI ≥30) was 38.3%, diagnosed at a mean age of 51.4 ± 5.2 years. After adjustment for a range of potential confounders (age, marital status, employment, education, smoking status, abortion history, savings situation and menopausal status), women with ≥3 parities were at higher risk of being obese (OR 1.74, 95% CI 1.24-2.45; p = 0.001).

CONCLUSION

A positive association was observed between the number of parities and obesity. The findings of this study suggest that the BMI is associated with high parity in Babolian women. Health policymakers should work with health providers to develop appropriate postpartum weight loss interventions.

A proposal for a primary screening tool: 'Keep your waist circumference to less than half your height'

BACKGROUND

There is now overwhelming scientific evidence that central obesity, as opposed to total obesity assessed by body mass index (BMI), is associated with the most health risks and that the waist-to-height ratio (WHtR) is a simple proxy for this central fat distribution. This Opinion reviews the evidence for the use of WHtR to predict mortality and for its association with morbidity. A boundary value of WHtR of 0.5 has been proposed and become widely used. This translates into the simple screening message 'Keep your waist to less than half your height'. Not only does this message appear to be suitable for all ethnic groups, it also works well with children.

DISCUSSION

Ignoring this simple message and continuing to use BMI as a sole indicator of risk would mean that 10% of the whole UK population, and more than 25% of the UK population who are judged to be normal weight using BMI, are misclassified and might not be alerted to the need to take care or to take action.

SUMMARY

Accepting that a boundary value whereby WHtR should be less than 0.5 not only lends itself to the simple message 'Keep your waist to less than half your height' but it also provides a very cheap primary screening method for increased health risks: A piece of string, measuring exactly half a person's height should fit around that person's waist.

Association between parity and obesity in Mexican and Mexican-American women: findings from the Ella binational breast cancer study

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m(2), waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m(2)) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.

A double burden of overall or central adiposity and anemia or iron deficiency is prevalent but with little socioeconomic patterning among Moroccan and Tunisian urban women

In North Africa, overnutrition has dramatically increased with the nutrition transition while micronutrient deficiencies persist, resulting in clustering of opposite types of malnutrition that can present a unique difficulty for public health interventions. We assessed the magnitude of the double burden of malnutrition among urban Moroccan and Tunisian women, as defined by the coexistence of overall or central adiposity and anemia or iron deficiency (ID), and explored the sociodemographic patterning of individual double burden. In cross-sectional surveys representative of the region around the capital city, we randomly selected 811 and 1689 nonpregnant women aged 20-49 y in Morocco and Tunisia, respectively. Four double burdens were analyzed: overweight (body mass index ≥25 kg/m(2)) or increased risk abdominal obesity (waist circumference ≥80 cm) and anemia (blood hemoglobin <120 g/L) or ID (C-reactive protein-corrected serum ferritin <15 μg/L). Adjusted associations with 9 sociodemographic factors were estimated by logistic regression. The prevalence of overweight and ID was 67.0% and 45.2% in Morocco, respectively, and 69.5% and 27.0% in Tunisia, respectively, illustrating the population-level double burden. The coexistence of overall or central adiposity with ID was found in 29.8% and 30.1% of women in Morocco, respectively, and in 18.2% and 18.3% of women in Tunisia, respectively, quite evenly distributed across age, economic, or education groups. Generally, the rare, associated sociodemographic factors varied across the 4 subject-level double burdens and the 2 countries and differed from those usually associated with adiposity, anemia, or ID. Any double burden combining adiposity and anemia or ID should therefore be taken into consideration in all women. This trial was registered at clinicaltrials.gov as NCT01844349.

Fundal height growth curve for underweight and overweight and obese pregnant women in Thai population

Objectives. To develop fundal height growth curves for underweight and overweight and obese pregnant women based on gestational age from last menstrual period and/or ultrasound. Methods. A retrospective study was conducted at four hospitals in the northern part of Thailand between January 2009 and March 2011. Fundal height, gestational age, height, and prepregnancy weight were extracted from antenatal care and delivery records. Fundal height growth curves were presented as smoothed function of the 10th, 50th, and 90th percentiles between 20 and 40 weeks of gestation, derived from multilevel models. Results. Fundal height growth curve of the underweight was derived from 1,486 measurements (208 women) and the overweight and obese curve was derived from 1,281 measurements (169 women). The 50th percentile line of the underweight was 0.1-0.4 cm below the normal weight at weeks 23-31 and 0.5-0.8 cm at weeks 32-40. The overweight and obese line was 0.1-0.4 cm above the normal weight at weeks 22-29 and 0.6-0.8 cm at weeks 30-40. Conclusions. Fundal height growth curves of the underweight and overweight and obese pregnant women were different from the normal weight. In monitoring or screening for abnormal intrauterine growth in these women, fundal height growth curves specifically developed for such women should be applied.

Excess weight and abdominal obesity in postmenopausal Brazilian women: a population-based study

Background

The menopause is associated with a tendency to gain weight. Several alterations in fat deposits occur, leading to changes in the distribution of body fat. There are strong indications that, in middle age, obesity is associated with increased mortality. This study set out to determine the factors associated with the prevalence of overweight and abdominal obesity in postmenopausal women in a population-based study in Brazil.

Methods

The sample included 456 women, aged 45–69 years, residing in the urban area of Maringa, Parana. Systematic sampling, with a probability proportional to the size of the census sector, was performed. Behavioral, economic, and sociodemographic data were collected, and body mass index (BMI) and waist circumference (WC) were determined.

Results

According to BMI criteria (≥25.0 kg/m²), 72.6% of the women were overweight, and according to WC (≥88 cm), 63.6% had abdominal obesity. Based on logistic regression analysis, the factors that were most closely associated with overweight were: having three or more children (odds ratio (OR): 1.78; 95% confidence interval (CI): 1.06–3.00); and not taking hormone replacement therapy (OR: 1.69; 95% CI: 1.06–2.63). The prevalence of abdominal obesity was positively associated with greater parity (OR: 1.34, 95% CI: 1.05–1.72) and age older than 65 years (OR: 1.50; 95% CI: 1.03–2.19).

Conclusions

This study found that the prevalences of overweight and abdominal obesity were higher for postmenopausal women who had three or more children. Age over 65 years was also a risk factor for abdominal obesity and no use of hormonal replacement therapy was a risk factor for overweight.

Overweight patients achieve ideal body weight following curative gastrectomy resulting in better long-term prognosis

BACKGROUND

The relationship between body mass index (BMI) and long-term outcome in gastric cancer patients following radical gastrectomy continues to be debated. We investigated the association between BMI, clinicopathological features, and prognosis in Chinese gastric carcinoma patients.

METHODS

A retrospective consecutive cohort study was performed on 1,296 patients who underwent gastrectomy with curative intent at the Tianjin Cancer Institute Hospital between 1999 and 2004. The clinicopathological characteristics, overall 5-year survival rate (OS), and preoperative and six-month postoperative BMIs of both overweight (BMI ≥ 25 kg/m(2); H-BMI; n = 364) and non-overweight (BMI <25 kg/m(2); N-BMI; n = 932) patients were compared.

RESULTS

Among these patients, 364 (28.1 %) were overweight. The OS was significantly higher in the H-BMI than N-BMI group (33.2 vs. 24.1 %, respectively; p < 0.001). Preoperative and six-month postoperative BMIs were 27.1 ± 2.0 and 24.8 ± 2.0 kg/m(2), respectively, in the H-BMI group (p < 0.001), whereas they were 21.7 ± 2.2 and 20.7 ± 2.2 kg/m(2), respectively, in the N-BMI group (p = 0.007). There was significantly better differentiation (p = 0.034), less distant metastases (p = 0.006), and a lower metastatic lymph node ratio (p = 0.014) observed in the H-BMI groups. Multivariate analyses indicated age, BMI, pathological tumor depth, distant metastases, metastatic lymph node ratio, and tumor size as independent prognostic factors.

CONCLUSIONS

Our findings suggest that overweight patients were less likely to have tumors with aggressive features and can achieve ideal body weight following curative gastrectomy, possibly resulting in better long-term prognosis.

Weight and body fat changes in postpartum depot-medroxyprogesterone acetate users

BACKGROUND

Although postpartum depot-medroxyprogesterone acetate (DMPA) recipients often cite weight gain as the reason for discontinuing DMPA, little is known about body composition changes in postpartum DMPA recipients.

STUDY DESIGN

Women who used DMPA during the postpartum year were measured on several anthropometric dimensions of body composition and compared with women who elected surgical sterilization with bilateral partial salpingectomy (BPS).

RESULTS

After 1 year, DMPA recipients did not differ from the BPS group in weight or percent body fat changes. Almost half the women using DMPA returned to pregravid weight; nearly half gained weight. Higher pre-pregnancy body mass index was associated with weight gain among DMPA recipients.

CONCLUSIONS

DMPA recipients who were overweight or obese before pregnancy may have greater risk for weight gain in the first year postpartum. However, when counseling women, the risk for DMPA-related weight gain should be balanced against the potential for increased weight from subsequent pregnancies.

The current state of Indigenous and Aboriginal women with diabetes in pregnancy: a systematic review

To undertake a systematic review of diabetes in pregnancy (DIP), determining prevalence and impact on maternal and child health outcomes for Indigenous and Aboriginal women.

METHOD

Electronic searches of MEDLINE, Embase, CINAHL, ERIC, DARE, CDSR, PsycINFO, Austhealth and HealthInfoNet were undertaken. Changes in diagnostic criteria for DIP and variability in methodology meant a qualitative synthesis of the data was undertaken.

RESULTS

From the 142 potential studies, 42 peer reviewed journal articles met the inclusion criteria. GDM prevalence in 65% of studies was greater for Indigenous and Aboriginal women than the comparison groups; Pacific Islander 8.1%, Canadian Aboriginal 11.5%, American Indian 7.9%, Australian Aboriginal 8.4% compared with 2-5% worldwide. Of studies reporting high birth weight (>4000 g) and DIP, 75% had a higher than expected prevalence, 86% had higher macrosomia prevalence and 63% had higher stillbirth rates. Studies with Alaskan, Australian Aboriginal and Pacific Islander women had GDM prevalence both greater and less than comparison groups.

CONCLUSION

Correcting the health disparity for Indigenous and Aboriginal women with DIP is a health priority. DIP prevalence is not the same for all Indigenous and Aboriginal women. Inconsistent study design without robust data is interfering with accurate prevalence of DIP. New international consensus guidelines provide opportunities for high quality studies of DIP for Indigenous and Aboriginal women.

The influence of a behavior modification interventional program on body mass index in obese adolescents

BACKGROUND/PURPOSE

The prevalence of obesity and overweight among children and adolescents is increasing rapidly. The present research was performed to determine the influence of a ''behavior modification'' program on body mass index (BMI) in obese public high school students in Iran.

METHODS

In this study, 152 adolescence and their parents were selected from 12 high schools of Khorram Abad from 2004 to 2006, and they were randomly assigned to either the intervention or the control groups. The "behavior modification" interventional program consisted of nutritional education, modifying dietary habits, teaching exercise programs, teaching nutritional facts to the parents, and performing exercises 3 days a week. The height and weight as well as waist, hip, and wrist circumferences of the participants were measured before and after implementing the interventional program. BMI and waist to hip ratio (WHR) were calculated. The adolescents and parents completed a nutrition knowledge questionnaire. Adolescents also completed the Beck's Depression Questionnaire.

RESULTS

Adolescent's mean weight, BMI, and waist and hip circumferences decreased significantly after implementing the interventional program, in the intervention group (p≤0.001). In addition, the students' and parents' nutrition knowledge increased in the intervention group after implementing the interventional program (p<0.046). The symptoms of depression decreased and the frequency of students without symptoms of depression increased in the case group, but it did not reveal a statistically significant difference between case and control groups.

CONCLUSION

The ''behavior modification'' interventional program is effective in reducing BMI in obese students, and therefore, school principals and planners can play an important role in controlling obesity by implementing this program via the students, their parents, and the school staff.

Association of number of live births with left ventricular structure and function. The Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Pregnancy is associated with marked maternal cardiovascular/hemodynamic changes. A greater number of pregnancies may be associated with long-term subclinical changes in left ventricular (LV) remodeling.

METHODS

Among 2,234 white, black, Hispanic, and Chinese women (mean age 62 years) in the MESA, we used linear regression to relate live births and cardiac magnetic resonance imaging LV measures. Covariates included age, ethnicity, height, income, education, birth country, smoking, menopause, and oral contraceptive duration. Models were additionally adjusted for potential mediators: systolic blood pressure, antihypertensive use, total/high-density lipoprotein cholesterol, triglycerides, diabetes, and body mass index. We performed sensitivity analyses excluding 763 women in the lowest socioeconomic group: annual income <$25,000 and lower high school level of education.

RESULTS

With each live birth, LV mass increased 1.26 g; LV end-diastolic volume, 0.74 mL; and LV end-systolic volume, 0.45 mL; LV ejection fraction decreased 0.18% (P trend <0.05). Changes were most notable for the category of women with ≥5 pregnancies. Upon adjustment for potential biologic mediators, live births remained positively associated with LV mass and end-systolic volume. Live births remained significantly associated with LV end-systolic, end-diastolic volumes, and LV mass (P trend ≤0.02) after excluding women in the lowest socioeconomic group.

CONCLUSIONS

Number of live births is associated with key LV structural and functional measures in middle to older ages, even after adjustment for sociodemographic factors and cardiovascular disease risk factors. Hemodynamic changes during pregnancy may be associated with cardiac structure/function beyond childbearing years.

Body mass index and its correlation to metabolic and hormone parameters in postmenopausal Spanish women

OBJECTIVE

To assess body weight composition in postmenopausal women and determine correlations with metabolic and hormonal parameters.

METHODS

Medical records of 574 postmenopausal Caucasian Spanish women first time attending a menopause clinic were retrospectively reviewed. Retrieved information included general demographic data, type of menopause, time since menopause onset and baseline hormonal and metabolic parameters. A body mass index (BMI) value of >28.8 kg/m(2) was used to define obesity. The metabolic syndrome (METS) was diagnosed with three or more criteria: fasting glycemia ≥ 100 mg/dL, high density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides (TG) ≥ 150 mg/dL, blood pressure ≥ 130/85 mmHg and obesity (as defined above).

RESULTS

Mean age of the whole cohort was 49.9 ± 6.1 years, with 66% having a natural menopause. A 38.9% and 23.1% of all women were obese or had the METS, respectively. Obese women were older, had a higher parity, smoked less, had more time since menopause onset and a higher rate of surgical menopause as compared to non-obese ones (p = 0.001). BMI values positively correlated with age, time since menopause, parity, and glucose, TG and systolic blood pressure levels; displaying an inverse correlation with HDL-C and SHBG levels. SHBG levels inversely correlated with glucose, TG, HDL-C and systolic blood pressure levels.

CONCLUSION

In this Spanish postmenopausal population BMI significantly increased with age, time since menopause and parity displaying significant correlations with hormonal and metabolic parameters.

Prevalência e fatores associados à obesidade em mulheres usuárias de serviços de pronto-atendimento do Sistema Único de Saúde no sul do Brasil

A obesidade é uma das principais epidemias modernas, sendo importante problema de saúde pública e estando associado a um aumento de doenças crônicas. O objetivo deste estudo é investigar a prevalência de sobrepeso e obesidade e seus fatores associados em mulheres de 20 a 59 anos, usuárias de serviços de pronto atendimento do Sistema Único de Saúde. Realizou-se entrevista padronizada e foram tomadas as medidas antropométricas em 440 mulheres. O modelo de Poisson foi usado para avaliar a associação entre obesidade e características selecionadas. A prevalência de sobrepeso e obesidade (64,3%) e de obesidade central (44,1%) em usuárias de serviços de pronto atendimento é maior do que a encontrada na população geral e está associada a um aumento do número de agravos à saúde. Atividade física insuficiente (RP=1,44; IC 95% 1,24-1,66), história de três ou mais gestações (RP=1,45; IC 95% 1,05-2,00), idade maior que 50 anos (RP=1,34; IC 95% 1,00-1,82) e obesidade central estão associadas a uma prevalência maior de obesidade. A implantação de políticas de saúde voltadas para a prevenção da obesidade certamente terá um impacto importante na prevenção primária de doenças crônicas na população feminina.

Relationship between adiposity and admixture in African-American and Hispanic-American women

Objective

To investigate whether differences in admixture in African American (AFA) and Hispanic American (HA) adult women are associated with adiposity and adipose distribution.

Design

The proportion of European, sub– Saharan African and Amerindian admixture was estimated for AFA and HA women in the Women's Heath Initiative using 92 ancestry informative markers. Analyses assessed the relationship between admixture and adiposity indices.

Subjects

11712 AFA and 5088 HA self– identified post– menopausal women.

Results

There was a significant positive association between body mass index (BMI) and African admixture when BMI was considered as a continuous variable, and age, education, physical activity, parity, family income and smoking were included covariates (p < 10^{− 4}). A dichotomous model (upper and lower BMI quartiles) showed that African admixture was associated with a high odds ratio [OR = 3.27 (for 100% admixture compared to 0% admixture), 95% confidence interval (CI) 2.08 – 5.15]. For HA there was no association between BMI and admixture. In contrast, when waist to hip ratio (WHR) was used as a measure of adipose distribution, there was no significant association between WHR and admixture in AFA but there was a strong association in HA (p<10^{− 4}; OR Amerindian admixture = 5.93, CI = 3.52 – 9.97).

Conclusion

These studies show that 1) African admixture is associated with BMI in AFA women; 2) Amerindian admixture is associated with WHR but not BMI in HA women; and 3) it may be important to consider different measurements of adiposity and adipose distribution in different ethnic population groups.

Epidemiology of underweight and overweight-obesity among term pregnant Sudanese women

BACKGROUND

The increasing prevalence of obesity in young women is a major public health concern. Few data are available concerning the epidemiology of malnutrition especially obesity among pregnant women in the developing countries. A cross sectional study was conducted at Khartoum hospital during February-April 2008, to investigate prevalence of underweight, obesity, and to identify contemporary socio-demographic predictors for obesity among term pregnant women in Khartoum Hospital, Sudan. After taking an informed consent, a structured questionnaire was administered to each woman to gather information on educational level, age and parity. Maternal weight and height were measured and expressed as body mass index (BMI - weight (kg)/height (m) 2).

FINDINGS

Out of 1690 term pregnant women, 628 (37.1%) were primigravidae, 926 (54.8%) had ≥ secondary educational level (minimum of 8 years) and 1445 (85.5%) were housewives. The mean (SD) of the age and parity were 27.2 (6.3) years and 2.0 (2.1) respectively. Out of these 1690 women, 94(5.5%) were underweight (BMI of ≤ 19.9 Kg/m2), 603 (35.6%) were overweight (BMI of 25 - 29.9 Kg/m2) and 328 (19.4%) were obese (BMI of ≥ 30 Kg/m2).In multivariate analyses, obesity was positively associated with age (OR = 1.2, 95% CI = 1.0-1.1; P< 0.001), and with women's education (OR = 1.8, 95% CI = 1.2-2.7; P = 0.001). Obesity was positively associated with parity in univariate analyses only (OR = 1.1, 95% CI = 1.0-1.2; P = 0.02)

CONCLUSION

The high prevalence of obesity in these pregnant women represents a competing public health problem in Sudan. More research is needed.

Sex differences in obesity associated with total fertility rate

The identification of biological and ecological factors that contribute to obesity may help in combating the spreading obesity crisis. Sex differences in obesity rates are particularly poorly understood. Here we show that the strong female bias in obesity in many countries is associated with high total fertility rate, which is well known to be correlated with factors such as low average income, infant mortality and female education. We also document effects of reduced access to contraception and increased inequality of income among households on obesity rates. These results are consistent with studies that implicate reproduction as a risk factor for obesity in women and that suggest the effects of reproduction interact with socioeconomic and educational factors. We discuss our results in the light of recent research in dietary ecology and the suggestion that insulin resistance during pregnancy is due to historic adaptation to protect the developing foetus during famine. Increased access to contraception and education in countries with high total fertility rate might have the additional benefit of reducing the rates of obesity in women.

Impact of education, income and chronic disease risk factors on mortality of adults: does 'a pauper-rich paradox' exist in Latin American societies?

OBJECTIVES

To test the hypothesis that an inverse association exists between socio-economic position and all-cause mortality in a developing country in Latin America.

STUDY DESIGN

Prospective cohort study carried out in Chile using data from a simple random sample of 920 apparently healthy subjects (weighted population 11,600 aged 30-89 years) followed for 8 years.

METHODS

Education level (0-8 years, 9-12 years and > or = 13 years) and income quartiles were established at the outset of the study, along with behavioural and biological risk factors for chronic diseases: smoking, alcohol use, obesity, diabetes, hypertension, lipids and family history of death by cardiovascular disease. Relative risks of all-cause mortality were estimated using age-adjusted Cox regression models.

RESULTS

During the follow-up period, 46 deaths were observed. Adjusting for age, gender, and behavioural and biological risk factors, the mortality risk for increasing categories of education after controlling for income was 1.0, 0.76 and 0.33 (P for trend<0.01). In contrast, the relative risk for increasing levels of income after controlling for education was 1.0, 0.98, 1.33 and 1.17 (P for trend=0.07).

CONCLUSION

While education level had a protective effect on mortality risk of Chilean adults, income had a slightly unfavourable effect on survival. This finding is described as suggestive of a 'pauper-rich paradox', since the higher income quantiles in this study correspond with the lower income levels in most developed countries. Nevertheless, due to the small number of deaths, additional research is required to assess the validity of these findings.

Correlates of obesity and body image in Colombian women

OBJECTIVE

To examine the sociodemographic correlates of overweight and obesity as well as body shape perception in women from Bogotá, Colombia.

METHODS

The sample (n = 671) represented low-income and middle-income women, aged 21-55 years, living in Bogotá, who had children in the public school system. We measured height and weight to calculate body mass index (BMI, kg/m(2)) and defined two dichotomous outcomes: overweight/obesity (BMI >or=25) and obesity (BMI >or=30). Women reported sociodemographic information and used the Stunkard Figure Rating Scale to identify the silhouette that most closely resembled their body shape (current), what they would like to look like (ideal), and what they considered healthiest (healthiest). We estimated body dissatisfaction by subtracting the ideal from the current scores.

RESULTS

The prevalences of overweight/obesity and obesity, based on measured height and weight, were 41.9% and 11.6%, respectively. Age, being married, and being born in Bogotá were positively associated with overweight/obesity but not with obesity alone, whereas the number of household assets and parity were both positively related to obesity. Women with higher education or who lived in wealthier neighborhoods identified ideal shapes that were thinner than those identified by their less educated or poorer counterparts (p = 0.03 and p = 0.004, respectively). Higher education was also associated with the selection of thinner body shapes as healthiest (p = 0.02). BMI and education were both positively related to body dissatisfaction (p < 0.0001 and p = 0.04, respectively).

CONCLUSIONS

Indicators of higher socioeconomic status (SES) (e.g., having more household assets) are associated with obesity. Perception of slimmer body shapes as ideal and healthiest and higher body dissatisfaction are associated with higher education.

Parity is associated with increased waist circumference and other anthropometric indices of obesity

BACKGROUND

There is growing interest in the effect of childbearing on the development of chronic medical conditions. In the present study we aim at seeing whether parity is associated with increased waist circumference (WC) and other anthropometric indices of obesity, or not, in a sample of Iraqi women.

METHODS

This was a cross sectional study conducted during the period from January 2006 to the end of December 2007. Subjects were women attending two primary health care centers in a rural district population in Basrah (Abu-Al-khasib district), Iraq.

RESULTS

A total of 9135 women with a mean age of 46.4+/-15.5 years were included in the study. The mean weight was 69.9+/-16.9 kg and the mean WC was 92.7+/-15.0 cm with 78.9% of women having WC >or=80 cm. The mean and the standard deviation of other anthropometric variables were 27.0+/-6.25 for body mass index (BMI), 0.57+/-0.09 for waist-to-height ratio (WHtR) and 0.89+/-0.08 for waist-to-hip ratio (WHpR). Body weight, WC, BMI, WHpR, and WHtR progressively and significantly increased with increasing parity (p<0.001). Increasing age and higher number of births were associated with a consistent significant increase in the risk of increasing WC. While the reverse was true with respect to education, the risk of increased WC significantly decreased with the increase in education. The risk of increased WC was higher among housewives compared to employed women. On multiple logistic regression analyses of parity and risk of increasing WC, the number of births remained significantly and independently associated with increased WC after adjustment for a range of potential confounders (age, BMI, employment, education, and marital status). However, when parity was analyzed as a dichotomous variable (parous versus nulliparous), no significant association was found (p>0.05).

CONCLUSION

Parity was associated with increased WC and other anthropometric indices of obesity in a sample of rural Iraqi women attending two primary health care centers.

Prevalence of obesity in a Saudi obstetric population

OBJECTIVE

To estimate the prevalence of obesity and its determinants during the first month of gestation in Saudi women.

METHODS

Retrospective chart review of measured BMI in Al-Hassa, the largest province in Saudi Arabia, in 2007. Data were collected from records of 791 (72.6% of 1,089) pregnant women registered for prenatal care.

RESULTS

Height shows a normal Gaussian distribution, whereas weight is skewed positively (skewness of 0.77). The prevalence of underweight, normal weight, overweight, obesity, and extreme obesity (BMI > 40 kg/m(2)) were 8.5, 39.3, 23.6, 23.9, and 4.7%, respectively. Logistic regression revealed that the most important significant independent predictors of obesity are parity of 4 and more (odds ratio (OR) = 5.8) and urban residence (OR = 4.9).

CONCLUSION

Overweight, obesity, and extreme obesity are common (>52%) among pregnant women in Saudi Arabia. Health education to control body weight before pregnancy is warranted.