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Table 1 shows the baseline characteristics of participants stratified by parity. The study population consisted of women with parity of zero (9.1%), one (72.9%), two (13.0%), and three or more (5.0%). There was a significant increase in age with parity (P < 0.001). Multiple lifestyle factors, including current smoking, alcohol use, and physical activity, exhibited a significant difference across the parity groups (all with P < 0.001). Higher proportion of postmenopausal status and use of contraceptive drugs was associated with increasing parity (both with P < 0.001). Socioeconomic status, measured using education level and mean equivalent household income, also demonstrated a statistical difference among the parity groups (both with P < 0.001).
Table 1. Baseline characteristics of participants stratified by parity
Characteristics Overall Parity group P value 0 1 2 ≥ 3 Number, n (%) 5,674 513 (9.1) 4,138 (72.9) 739 (13.0) 284 (5.0) Age, year 45.4 ± 12.7 28.2 ± 6.2 43.7 ± 9.7 58.5 ± 8.8 67.3 ± 8.0 < 0.001 Age at menopause, year 49.8 ± 4.0 44.4 ± 7.3 49.5 ± 4.0 50.3 ± 3.7 50.0 ± 4.3 < 0.001 Postmenopause, n (%) 1,844 (32.5) 5 (1.0) 1,024 (24.8) 564 (76.3) 251 (88.4) < 0.001 Married, n (%) 5,311 (93.6) 292 (56.9) 4,042 (97.7) 714 (96.6) 263 (92.6) < 0.001 Current smoking, n (%) 120 (2.1) 5 (1.0) 75 (1.8) 24 (3.3) 16 (5.6) < 0.001 Alcohol use, n (%) 203 (3.6) 29 (5.7) 154 (3.7) 19 (2.6) 1 (0.4) < 0.001 Antihypertensive medication, n (%) 659 (11.6) 2 (0.4) 336 (8.1) 214 (29.0) 107 (37.7) < 0.001 Insulin or oral hypoglycemic drug, n (%) 206 (3.6) 1 (0.2) 109 (2.6) 70 (9.5) 26 (9.2) < 0.001 Antilipemic agent, n (%) 81 (1.4) 0 45 (1.1) 19 (2.6) 17 (6.0) < 0.001 Oral contraceptives, n (%) 148 (2.6) 4 (0.8) 91 (2.2) 33 (4.5) 20 (7.0) < 0.001 Estrogen replacement therapy, n (%) 35 (0.6) 1 (0.2) 27 (0.7) 5 (0.7) 2 (0.7) 0.647 Physical activity, n (%) < 0.001 Inactive 2,017 (35.6) 178 (34.7) 1,513 (36.6) 238 (32.2) 88 (31.0) Moderate active 1,062 (18.7) 103 (20.1) 829 (20.0) 86 (11.6) 44 (15.5) Active 2,595 (45.7) 232 (45.2) 1,796 (43.4) 415 (56.2) 152 (53.5) Education level, n (%) < 0.001 Illiteracy/primary school 319 (5.6) 1 (0.2) 86 (2.1) 148 (20.0) 84 (29.6) Middle/high school 2,705 (47.7) 73 (14.2) 1,960 (47.4) 501 (67.8) 171 (60.2) College or above 2,650 (46.7) 439 (85.6) 2,092 (50.5) 90 (12.2) 29 (10.2) Income, ¥/month, n (%) < 0.001 ≤ 3,000 3,194 (56.3) 159 (31.0) 2,221 (53.7) 584 (79.0) 230 (81.0) 3,001–5,000 2,153 (38.0) 304 (59.3) 1,667 (40.3) 134 (18.1) 48 (16.9) > 5,000 327 (5.7) 50 (9.7) 250 (6.0) 21 (2.9) 6 (2.1) -
Figure 2 shows the prevalence of MetS and its components according to parity. Among the parity groups, nulliparous women had the lowest prevalence, and those with parity of three or more had the highest prevalence of abdominal obesity (81%), elevated fasting glucose levels (21%), high blood pressure (75%), elevated triglyceride levels (43%), and MetS (44%). The prevalence of MetS and its components appeared to increase progressively with parity (all with P < 0.001, Figure 2). However, a similar pattern was not observed for low HDL cholesterol levels (P = 0.119), where nulliparous women had the highest prevalence of 11.7%. Overall, an elevated fasting glucose level was the least prevalent component in our study cohort, and abdominal obesity was the most prevalent component.
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As depicted in Figure 3, there was no association between parity and low HDL cholesterol levels. Regarding the other four components and MetS, there was an increasing trend of ORs
among the parity groups. Compared with women with parity of one, nulliparous women had significantly decreased ORs in all models. Women with parity of two had statistically significant odds of abdominal obesity (OR = 1.45, 95% CI: 1.17–1.81, P < 0.001), high blood pressure (OR = 1.26, 95% CI: 1.03–1.54, P = 0.025), elevated fasting glucose levels (OR = 1.36, 95% CI: 1.03–1.79, P = 0.029), and MetS (OR = 1.39, 95% CI: 1.13–1.73, P = 0.002), and those with parity of three or more had statistically significant odds of elevated triglyceride levels (OR = 1.42, 95% CI: 1.04–1.94, P = 0.027) and MetS (OR = 1.50, 95% CI: 1.10–2.05, P = 0.011) after complete adjustment for age, postmenopausal status, marital status, current smoking, alcohol use, oral contraceptive use, physical activity, education level, and income (Supplementary Table S1 available in www.besjournal.com). Figure 3. The associations between parity and metabolic syndrome and its components. Model 1: unadjusted. Model 2: adjusted for age. Model 3: adjusted for age, postmenopausal status, marital status, current smoking, alcohol use, oral contraceptive use, physical activity, education level, and income.
Table S1. Adjusted ORs for the associations between parity and the metabolic syndrome and its components
Parity Abdominal obesity Elevated triglycerides Elevated fasting glucose Low HDL cholesterol High blood pressure Metabolic syndrome OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P Model 1 0 0.34
(0.28—0.41)< 0.001 0.47
(0.36—0.63)< 0.001 0.16
(0.07—0.37)< 0.001 1.27
(0.95—1.69)0.109 0.33
(0.25—0.43)< 0.001 0.35
(0.24—0.51)< 0.001 1 1 1 1 1 1 1 2 2.82
(2.34—3.39)< 0.001 2.00
(1.69—2.37)< 0.001 3.27
(2.63—4.08)< 0.001 1.19
(0.93—1.54)0.171 3.61
(3.07—4.25)< 0.001 3.01
(2.53—3.58)< 0.001 ≥ 3 3.16
(2.34—4.27)< 0.001 2.81
(2.19—3.59)< 0.001 3.80
(2.79—5.17)< 0.001 0.76
(0.48—1.21)0.246 6.47
(4.90—8.54)< 0.001 4.37
(3.41—5.61)< 0.001 Model 2 0 0.34
(0.28—0.42)< 0.001 0.48
(0.36—0.64)< 0.001 0.17
(0.08—0.39)< 0.001 1.28
(0.96—1.71)0.097 0.35
(0.27—0.45)< 0.001 0.37
(0.25—0.54)< 0.001 1 1 1 1 1 1 1 2 2.14
(1.74—2.63)< 0.001 1.62
(1.33—1.98)< 0.001 1.91
(1.45—2.51)< 0.001 1.07
(0.80—1.44)0.634 2.01
(1.67—2.42)< 0.001 1.84
(1.49—2.27)< 0.001 ≥ 3 1.83
(1.29—2.61)< 0.001 1.94
(1.43—2.63)< 0.001 1.57
(1.06—2.32)0.023 0.64
(0.37—1.08)0.093 2.03
(1.45—2.82)< 0.001 1.89
(1.38—2.56)< 0.001 Model 3 0 0.50
(0.40—0.63)< 0.001 0.72
(0.53—1.00)0.048 0.24
(0.10—0.57)0.001 1.09
(0.78—1.53)0.619 0.52
(0.38—0.70)< 0.001 0.45
(0.30—0.68)< 0.001 1 1 1 1 1 1 1 2 1.45
(1.17—1.81)< 0.001 1.15
(0.93—1.41)0.196 1.36
(1.03—1.79)0.029 1.11
(0.81—1.53)0.507 1.26
(1.03—1.54)0.025 1.39
(1.13—1.73)0.002 ≥ 3 1.30
(0.90—1.87)0.167 1.42
(1.04—1.94)0.027 1.20
(0.81—1.77)0.362 0.62
(0.36—1.07)0.084 1.37
(0.97—1.94)0.071 1.50
(1.10—2.05)0.011 Note. Model 1: unadjusted. Model 2: adjusted for age. Model 3: adjusted for age, postmenopause, marital status, current smoking, alcohol use, oral contraceptives, physical activity, education level and income. -
As shown in Table 2, subgroup analyses for the associations between parity and MetS and its components were performed according to BMI and age. BMI was subdivided by 25, age was subdivided by the median, and parity was included as a categorical variable.
Table 2. Subgroup analyses for the association between parity and five components and metabolic syndrome according to BMI and age
Variables BMI* Age# ≤ 25 kg/m2 > 25 kg/m2 P-interaction ≤ 45 > 45 P-interaction Abdominal obesity 0.152 0.442 0 0.48 (0.37–0.64) 1.10 (0.45–2.70) 0.53 (0.41–0.69) 0.86 (0.30–2.46) 1 1 1 1 1 2 1.32 (1.02–1.72) 2.41 (1.19–4.89) 1.03 (0.61–1.75) 1.58 (1.26–1.99) ≥ 3 0.88 (0.56–1.38) 2.59 (0.97–6.92) 1.63 (0.27–9.88) 1.50 (1.07–2.09) Elevated triglycerides < 0.001 0.155 0 0.58 (0.37–0.91) 1.44 (0.85–2.44) 0.87 (0.60–1.26) 1.10 (0.34–3.51) 1 1 1 1 1 2 1.33 (0.98–1.81) 0.93 (0.70–1.25) 2.10 (1.15–3.83) 1.10 (0.90–1.34) ≥ 3 1.43 (0.88–2.32) 1.23 (0.81–1.87) 3.84 (0.63–23.45) 1.45 (1.15–1.91) Elevated fasting glucose 0.595 0.991 0 NA 0.64 (0.25–1.61) 0.46 (0.18–1.21) NA 1 1 1 1 1 2 1.23 (0.78–1.93) 1.34 (0.94–1.91) 1.82 (0.61–5.38) 1.08 (0.81–1.43) ≥ 3 0.91 (0.47–1.78) 1.23 (0.76–2.01) NA 0.73 (0.48–1.12) Low HDL cholesterol 0.034 0.359 0 1.29 (0.85–1.94) 1.19 (0.64–2.21) 1.01 (0.70–1.47) 2.69 (0.74–9.82) 1 1 1 1 1 2 1.35 (0.85–2.14) 0.89 (0.57–1.38) 0.88 (0.37–2.09) 1.34 (0.98–1.85) ≥ 3 0.54 (0.22–1.35) 0.60 (0.30–1.19) NA 0.81 (0.49–1.35) High blood pressure 0.078 0.523 0 0.48 (0.33–0.71) 0.81 (0.48–1.37) 0.69 (0.48–0.98) 1.13 (0.40–3.16) 1 1 1 1 1 2 1.22 (0.92–1.60) 1.21 (0.88–1.68) 1.33 (0.71–2.47) 1.66 (1.37–2.02) ≥ 3 0.96 (0.60–1.53) 1.73 (1.01–3.00) 5.88 (0.96–36.06) 2.54 (1.88–3.44) Metabolic syndrome < 0.001 0.497 0 0.35 (0.16–0.79) 0.89 (0.51–1.55) 0.65 (0.39–1.08) 1.01 (0.28–3.65) 1 1 1 1 1 2 1.28 (0.89–1.83) 1.17 (0.88–1.57) 1.93 (0.92–4.05) 1.45 (1.19–1.78) ≥ 3 0.90 (0.52–1.54) 1.53 (1.01–2.31) 6.48 (1.06–39.73) 1.90 (1.44–2.51) Note. *Adjusted for age, postmenopause, marital status, current smoking, alcohol use, oral contraceptives, physical activity, education level and income.
#Adjusted for postmenopause, marital status, current smoking, alcohol use, oral contraceptives, physical activity, education level and income. NA: not available.After comparison of all the associations depicted between Figure 3 and Table 2, it appeared that BMI subgroups had no effects on the associations between parity and low HDL cholesterol levels, which showed no significant differences. BMI subgroups partially modified the associations between parity and other four components and MetS. Regarding MetS (Table 2), there were no more associations among women with parity of zero and BMI > 25 kg/m2 and among those with parity of two or with parity of three or more and BMI ≤ 25 kg/m2.
Similar to the above-described results, age subgroups had no effects on the associations between parity and low HDL cholesterol levels, whereas they partially modified the associations between parity and other four components and MetS. Regarding MetS (Table 2), the associations remained significant only among women with parity of three or more and among those with parity of two and age > 45 years.
doi: 10.3967/bes2020.002
Effect of Body Mass Index on the Associations between Parity and Metabolic Syndrome and its Components among Northern Chinese Women
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Abstract:
Objectives The aims of this study were to assess the associations between parity and metabolic syndrome (MetS) and its components and to evaluate the effects of body mass index (BMI) on these associations. Methods A total of 5,674 women were enrolled from Jidong and Kailuan communities (Tangshan, Hebei) in Northern China. All participants completed standardized questionnaires, physical examination, and biochemical measurements. Logistic regression analysis was used to test the associations. Results Compared with women with parity of one, nulliparous women had decreased odds ratios (ORs ); those with parity of two had odds of abdominal obesity [OR = 1.45, 95% confidence interval (CI) 1.17–1.81, P < 0.001], high blood pressure (OR = 1.26, 95% CI: 1.03–1.54, P = 0.025), elevated fasting glucose levels (OR = 1.36, 95% CI: 1.03–1.79, P = 0.029), and MetS (OR = 1.39, 95% CI: 1.13–1.73, P = 0.002); and those with parity of three or more had increased odds of elevated triglyceride levels (OR = 1.42, 95% CI: 1.04–1.94, P = 0.027) and MetS (OR = 1.50, 95% CI: 1.10–2.05, P = 0.011) after complete adjustment for confounders. Furthermore, BMI and age subgroups partially modified the associations between parity and MetS and its components. Conclusions Parity is positively associated with MetS and select components in women. BMI is an important modifier involved in the associations between parity and MetS. -
Key words:
- Parity /
- Metabolic syndrome /
- BMI /
- Risk factor /
- Association
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Figure 3. The associations between parity and metabolic syndrome and its components. Model 1: unadjusted. Model 2: adjusted for age. Model 3: adjusted for age, postmenopausal status, marital status, current smoking, alcohol use, oral contraceptive use, physical activity, education level, and income.
Table 1. Baseline characteristics of participants stratified by parity
Characteristics Overall Parity group P value 0 1 2 ≥ 3 Number, n (%) 5,674 513 (9.1) 4,138 (72.9) 739 (13.0) 284 (5.0) Age, year 45.4 ± 12.7 28.2 ± 6.2 43.7 ± 9.7 58.5 ± 8.8 67.3 ± 8.0 < 0.001 Age at menopause, year 49.8 ± 4.0 44.4 ± 7.3 49.5 ± 4.0 50.3 ± 3.7 50.0 ± 4.3 < 0.001 Postmenopause, n (%) 1,844 (32.5) 5 (1.0) 1,024 (24.8) 564 (76.3) 251 (88.4) < 0.001 Married, n (%) 5,311 (93.6) 292 (56.9) 4,042 (97.7) 714 (96.6) 263 (92.6) < 0.001 Current smoking, n (%) 120 (2.1) 5 (1.0) 75 (1.8) 24 (3.3) 16 (5.6) < 0.001 Alcohol use, n (%) 203 (3.6) 29 (5.7) 154 (3.7) 19 (2.6) 1 (0.4) < 0.001 Antihypertensive medication, n (%) 659 (11.6) 2 (0.4) 336 (8.1) 214 (29.0) 107 (37.7) < 0.001 Insulin or oral hypoglycemic drug, n (%) 206 (3.6) 1 (0.2) 109 (2.6) 70 (9.5) 26 (9.2) < 0.001 Antilipemic agent, n (%) 81 (1.4) 0 45 (1.1) 19 (2.6) 17 (6.0) < 0.001 Oral contraceptives, n (%) 148 (2.6) 4 (0.8) 91 (2.2) 33 (4.5) 20 (7.0) < 0.001 Estrogen replacement therapy, n (%) 35 (0.6) 1 (0.2) 27 (0.7) 5 (0.7) 2 (0.7) 0.647 Physical activity, n (%) < 0.001 Inactive 2,017 (35.6) 178 (34.7) 1,513 (36.6) 238 (32.2) 88 (31.0) Moderate active 1,062 (18.7) 103 (20.1) 829 (20.0) 86 (11.6) 44 (15.5) Active 2,595 (45.7) 232 (45.2) 1,796 (43.4) 415 (56.2) 152 (53.5) Education level, n (%) < 0.001 Illiteracy/primary school 319 (5.6) 1 (0.2) 86 (2.1) 148 (20.0) 84 (29.6) Middle/high school 2,705 (47.7) 73 (14.2) 1,960 (47.4) 501 (67.8) 171 (60.2) College or above 2,650 (46.7) 439 (85.6) 2,092 (50.5) 90 (12.2) 29 (10.2) Income, ¥/month, n (%) < 0.001 ≤ 3,000 3,194 (56.3) 159 (31.0) 2,221 (53.7) 584 (79.0) 230 (81.0) 3,001–5,000 2,153 (38.0) 304 (59.3) 1,667 (40.3) 134 (18.1) 48 (16.9) > 5,000 327 (5.7) 50 (9.7) 250 (6.0) 21 (2.9) 6 (2.1) S1. Adjusted ORs for the associations between parity and the metabolic syndrome and its components
Parity Abdominal obesity Elevated triglycerides Elevated fasting glucose Low HDL cholesterol High blood pressure Metabolic syndrome OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P OR
(95% CI)P Model 1 0 0.34
(0.28—0.41)< 0.001 0.47
(0.36—0.63)< 0.001 0.16
(0.07—0.37)< 0.001 1.27
(0.95—1.69)0.109 0.33
(0.25—0.43)< 0.001 0.35
(0.24—0.51)< 0.001 1 1 1 1 1 1 1 2 2.82
(2.34—3.39)< 0.001 2.00
(1.69—2.37)< 0.001 3.27
(2.63—4.08)< 0.001 1.19
(0.93—1.54)0.171 3.61
(3.07—4.25)< 0.001 3.01
(2.53—3.58)< 0.001 ≥ 3 3.16
(2.34—4.27)< 0.001 2.81
(2.19—3.59)< 0.001 3.80
(2.79—5.17)< 0.001 0.76
(0.48—1.21)0.246 6.47
(4.90—8.54)< 0.001 4.37
(3.41—5.61)< 0.001 Model 2 0 0.34
(0.28—0.42)< 0.001 0.48
(0.36—0.64)< 0.001 0.17
(0.08—0.39)< 0.001 1.28
(0.96—1.71)0.097 0.35
(0.27—0.45)< 0.001 0.37
(0.25—0.54)< 0.001 1 1 1 1 1 1 1 2 2.14
(1.74—2.63)< 0.001 1.62
(1.33—1.98)< 0.001 1.91
(1.45—2.51)< 0.001 1.07
(0.80—1.44)0.634 2.01
(1.67—2.42)< 0.001 1.84
(1.49—2.27)< 0.001 ≥ 3 1.83
(1.29—2.61)< 0.001 1.94
(1.43—2.63)< 0.001 1.57
(1.06—2.32)0.023 0.64
(0.37—1.08)0.093 2.03
(1.45—2.82)< 0.001 1.89
(1.38—2.56)< 0.001 Model 3 0 0.50
(0.40—0.63)< 0.001 0.72
(0.53—1.00)0.048 0.24
(0.10—0.57)0.001 1.09
(0.78—1.53)0.619 0.52
(0.38—0.70)< 0.001 0.45
(0.30—0.68)< 0.001 1 1 1 1 1 1 1 2 1.45
(1.17—1.81)< 0.001 1.15
(0.93—1.41)0.196 1.36
(1.03—1.79)0.029 1.11
(0.81—1.53)0.507 1.26
(1.03—1.54)0.025 1.39
(1.13—1.73)0.002 ≥ 3 1.30
(0.90—1.87)0.167 1.42
(1.04—1.94)0.027 1.20
(0.81—1.77)0.362 0.62
(0.36—1.07)0.084 1.37
(0.97—1.94)0.071 1.50
(1.10—2.05)0.011 Note. Model 1: unadjusted. Model 2: adjusted for age. Model 3: adjusted for age, postmenopause, marital status, current smoking, alcohol use, oral contraceptives, physical activity, education level and income. Table 2. Subgroup analyses for the association between parity and five components and metabolic syndrome according to BMI and age
Variables BMI* Age# ≤ 25 kg/m2 > 25 kg/m2 P-interaction ≤ 45 > 45 P-interaction Abdominal obesity 0.152 0.442 0 0.48 (0.37–0.64) 1.10 (0.45–2.70) 0.53 (0.41–0.69) 0.86 (0.30–2.46) 1 1 1 1 1 2 1.32 (1.02–1.72) 2.41 (1.19–4.89) 1.03 (0.61–1.75) 1.58 (1.26–1.99) ≥ 3 0.88 (0.56–1.38) 2.59 (0.97–6.92) 1.63 (0.27–9.88) 1.50 (1.07–2.09) Elevated triglycerides < 0.001 0.155 0 0.58 (0.37–0.91) 1.44 (0.85–2.44) 0.87 (0.60–1.26) 1.10 (0.34–3.51) 1 1 1 1 1 2 1.33 (0.98–1.81) 0.93 (0.70–1.25) 2.10 (1.15–3.83) 1.10 (0.90–1.34) ≥ 3 1.43 (0.88–2.32) 1.23 (0.81–1.87) 3.84 (0.63–23.45) 1.45 (1.15–1.91) Elevated fasting glucose 0.595 0.991 0 NA 0.64 (0.25–1.61) 0.46 (0.18–1.21) NA 1 1 1 1 1 2 1.23 (0.78–1.93) 1.34 (0.94–1.91) 1.82 (0.61–5.38) 1.08 (0.81–1.43) ≥ 3 0.91 (0.47–1.78) 1.23 (0.76–2.01) NA 0.73 (0.48–1.12) Low HDL cholesterol 0.034 0.359 0 1.29 (0.85–1.94) 1.19 (0.64–2.21) 1.01 (0.70–1.47) 2.69 (0.74–9.82) 1 1 1 1 1 2 1.35 (0.85–2.14) 0.89 (0.57–1.38) 0.88 (0.37–2.09) 1.34 (0.98–1.85) ≥ 3 0.54 (0.22–1.35) 0.60 (0.30–1.19) NA 0.81 (0.49–1.35) High blood pressure 0.078 0.523 0 0.48 (0.33–0.71) 0.81 (0.48–1.37) 0.69 (0.48–0.98) 1.13 (0.40–3.16) 1 1 1 1 1 2 1.22 (0.92–1.60) 1.21 (0.88–1.68) 1.33 (0.71–2.47) 1.66 (1.37–2.02) ≥ 3 0.96 (0.60–1.53) 1.73 (1.01–3.00) 5.88 (0.96–36.06) 2.54 (1.88–3.44) Metabolic syndrome < 0.001 0.497 0 0.35 (0.16–0.79) 0.89 (0.51–1.55) 0.65 (0.39–1.08) 1.01 (0.28–3.65) 1 1 1 1 1 2 1.28 (0.89–1.83) 1.17 (0.88–1.57) 1.93 (0.92–4.05) 1.45 (1.19–1.78) ≥ 3 0.90 (0.52–1.54) 1.53 (1.01–2.31) 6.48 (1.06–39.73) 1.90 (1.44–2.51) Note. *Adjusted for age, postmenopause, marital status, current smoking, alcohol use, oral contraceptives, physical activity, education level and income.
#Adjusted for postmenopause, marital status, current smoking, alcohol use, oral contraceptives, physical activity, education level and income. NA: not available. -
[1] Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation, 2009; 120, 1640−5. doi: 10.1161/CIRCULATIONAHA.109.192644 [2] Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk: A systematic review and meta-analysis. J Am Coll Cardiol, 2010; 56, 1113−32. doi: 10.1016/j.jacc.2010.05.034 [3] McNeill AM, Rosamond WD, Girman CJ, et al. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care, 2005; 28, 385−90. doi: 10.2337/diacare.28.2.385 [4] Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation, 2004; 110, 1245−50. doi: 10.1161/01.CIR.0000140677.20606.0E [5] Gu D, Reynolds K, Wu X, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet, 2005; 365, 1398−405. doi: 10.1016/S0140-6736(05)66375-1 [6] Skilton MR, Sérusclat A, Begg LM, et al. Parity and carotid atherosclerosis in men and women insights into the roles of childbearing and child-Rearing. Stroke, 2009; 40, 1152−7. doi: 10.1161/STROKEAHA.108.535807 [7] Skilton MR, Bonnet F, Begg LM, et al. Childbearing, child-Rearing, cardiovascular risk factors, and progression of carotid intima-media thickness. Stroke, 2010; 41, 1332−7. doi: 10.1161/STROKEAHA.110.579219 [8] Dior UP, Hochner H, Friedlander Y, et al. Association between number of children and mortality of mothers: Results of a 37-year follow-up study. Ann Epidemiol, 2013; 23, 13−8. doi: 10.1016/j.annepidem.2012.10.005 [9] Vladutiu CJ, Siega-Riz AM, Sotres-Alvarez D, et al. Parity and components of the metabolic syndrome among US Hispanics/Latina women: results from the Hispanic community health study/study of Latinos. Circ Cardiovasc Qual Outcomes, 2016; 9, S62−9. doi: 10.1161/CIRCOUTCOMES.115.002464 [10] Lee Y, Lee HN, Kim SJ, et al. Higher parity and risk of metabolic syndrome in Korean postmenopausal women: Korea National Health and Nutrition Examination Survey 2010-2012. J Obstet Gynaecol Res, 2018; 44, 2045−52. doi: 10.1111/jog.13766 [11] Chen S, Li W, Jin C, et al. Resting heart rate trajectory pattern predicts arterial stiffness in a community-based Chinese cohort. Arterioscler Thromb Vasc Biol, 2017; 37, 359−64. doi: 10.1161/ATVBAHA.116.308674 [12] Hao Z, Zhang Y, Li Y, et al. The Association between Ideal Cardiovascular Health Metrics and Extracranial Carotid Artery Stenosis in a Northern Chinese Population: A Cross-Sectional Study. Sci Rep, 2016; 6, 31720. doi: 10.1038/srep31720 [13] Qiu MS, Wang XS, Yao Y, et al. Protocol of Jidong Women Health Cohort Study: Rationale, Design and Baseline Characteristics. Biomed Environ Sci, 2019; 32, 144−52. [14] Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000; 894, 1−253. [15] Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. National Institutes of Health. Obes Res, 1998; 6(suppl 2), 51S−209S. [16] Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 2001; 285, 2486-97. [17] He J, Gu D, Reynolds K, et al. Serum total and lipoprotein cholesterol levels and awareness, treatment, and control of hypercholesterolemia in China. Circulation, 2004; 110, 405−11. doi: 10.1161/01.CIR.0000136583.52681.0D [18] Lv H, Yang X, Zhou Y, et al. Parity and serum lipid levels: a cross-sectional study in Chinese female adults. Sci Rep, 2016; 6, 33831. doi: 10.1038/srep33831 [19] Cohen A, Pieper CF, Brown AJ, et al. Number of children and risk of metabolic syndrome in women. J Womens Health (Larchmt), 2006; 15, 763−73. doi: 10.1089/jwh.2006.15.763 [20] Mousavi E, Gharipour M, Tavassoli A, et al. Multiparity and risk of metabolic syndrome: Isfahan Healthy Heart Program. Metab Syndr Relat Disord, 2009; 7, 519−24. doi: 10.1089/met.2008.0076 [21] Gunderson EP, Jacobs DR Jr, Chiang V, et al. Childbearing is associated with higher incidence of the metabolic syndrome among women of reproductive age controlling for measurements before pregnancy: the CARDIA study. Am J Obstet Gynecol, 2009; 201, 177.e1−9. doi: 10.1016/j.ajog.2009.03.031 [22] Akter S, Jesmin S, Rahman MM, et al. Higher gravidity and parity are associated with increased prevalence of metabolic syndrome among rural Bangladeshi women. PLoS One, 2013; 8, e68319. doi: 10.1371/journal.pone.0068319 [23] Moradi S, Zamani F, Pishgar F, et al. Parity, duration of lactation and prevalence of maternal metabolic syndrome: a cross-sectional study. Eur J Obstet Gynecol Reprod Biol, 2016; 201, 70−4. doi: 10.1016/j.ejogrb.2016.03.038 [24] Sorlie PD, Avilés-Santa LM, Wassertheil-Smoller S, et al. Design and implementation of the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol, 2010; 20, 629−41. doi: 10.1016/j.annepidem.2010.03.015 [25] Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet, 2005; 365, 1415−28. doi: 10.1016/S0140-6736(05)66378-7 [26] Chandra A, Neeland IJ, Berry JD, et al. The relationship of body mass and fat distribution with incident hypertension: Observations from the Dallas Heart Study. J Am Coll Cardiol, 2014; 64, 997−1002. doi: 10.1016/j.jacc.2014.05.057 [27] Smith DE, Lewis CE, Caveny JL, et al. Longitudinal changes in adiposity associated with pregnancy: The CARDIA study. JAMA, 1994; 271, 1747−51. doi: 10.1001/jama.1994.03510460039030 [28] Hill M, Pašková A, Kančeva R, et al. Steroid profiling in pregnancy: a focus on the human fetus. J Steroid Biochem Mol Biol, 2014; 139, 201−22. doi: 10.1016/j.jsbmb.2013.03.008 [29] Arnold AP, Cassis LA, Eghbali M, et al. Sex hormones and sex chromosomes cause sex differences in the development of cardiovascular diseases. Arterioscler Thromb Vasc Biol, 2017; 37, 746−56. doi: 10.1161/ATVBAHA.116.307301 [30] Lawlor DA, Emberson JR, Ebrahim S, et al. Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women’s Heart and Health Study and the British Regional Heart Study. Circulation, 2003; 107, 1260−4. doi: 10.1161/01.CIR.0000053441.43495.1A [31] Raikkonen K, Matthews KA, Kuller LH. Depressive symptoms and stressful life events predict metabolic syndrome among middle-aged women: A comparison of World Health Organization, Adult Treatment Panel III, and International Diabetes Foundation definitions. Diabetes Care, 2007; 30, 872−7. doi: 10.2337/dc06-1857 [32] Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: a guideline from the American Heart Association. J Am Coll Cardiol, 2011; 57, 1404−23. doi: 10.1016/j.jacc.2011.02.005