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Parenthood and the risk of diabetes in men and women: a 7 year prospective study of 0.5 million individuals.

Peters SA, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Bragg F, Zhou X, Ge P, Chen B, Gao Y, Li Y, Chen J, Li L, Woodward M, Chen Z, China Kadoorie Biobank Collaboration Gro - Diabetologia (2016)

Bottom Line: It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing.In both sexes, the findings were broadly similar in different population subgroups.The similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.

View Article: PubMed Central - PubMed

Affiliation: The George Institute for Global Health, University of Oxford, 34 Broad Street, Oxford, OX1 3BD, UK.

ABSTRACT

Aims/hypothesis: In women, higher parity has been associated with increased risk of diabetes later in life. It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing. We assessed the association between number of children and diabetes risk separately in women and men.

Methods: Between 2004 and 2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 (mean 51 years) from ten diverse regions across China. During 7 years of follow-up, 8,840 incident cases of diabetes were recorded among 463,347 participants without prior cardiovascular diseases or diabetes. Multivariable Cox regression yielded sex-specific HRs and 95% CIs for incident diabetes by number of children.

Results: Overall, ∼98% of all participants had children. In women, there was a J-shaped association between number of children and risk of diabetes. Compared with women with one child, the adjusted HRs for diabetes were 1.39 (95% CI 1.11, 1.73) for childless women, 1.12 (95% CI 1.07, 1.18) for those with two children, 1.23 (95% CI 1.16, 1.31) for those with three children, and 1.32 (95% CI 1.21, 1.44) for those with four or more children. In men, there was a similar association with risk of diabetes; the corresponding HRs were 1.28 (95% CI 1.02, 1.60), 1.19 (95% CI 1.12, 1.26), 1.32 (95% CI 1.21, 1.44) and 1.41 (95% CI 1.24, 1.60), respectively. In both sexes, the findings were broadly similar in different population subgroups.

Conclusions/interpretation: The similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.

No MeSH data available.


Related in: MedlinePlus

Adjusted HRs for incident diabetes associated with number of live births. Analyses are stratified by age and region (white squares, model I), and additionally adjusted for level of attained education, household income, smoking status, alcohol use, systolic blood pressure, history of hypertension, physical activity and BMI (black squares, model III). Conventions are the same as in Fig. 1
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Fig3: Adjusted HRs for incident diabetes associated with number of live births. Analyses are stratified by age and region (white squares, model I), and additionally adjusted for level of attained education, household income, smoking status, alcohol use, systolic blood pressure, history of hypertension, physical activity and BMI (black squares, model III). Conventions are the same as in Fig. 1

Mentions: During a median of 7.2 years (interquartile range 6.3–8.1) of follow-up, 8,840 (5,579 women and 3,261 men) incident cases of diabetes were recorded. Overall, childless women had a 27% (adjusted HR 1.27 [95% CI 1.01, 1.59]) excess risk of diabetes compared with women with children in the age- and region-stratified model, which attenuated slightly (HR 1.22 [95% CI 0.97, 1.52]) after further adjustment for socioeconomic and lifestyle factors (Table 3). In women with at least one child, there was a log-linear association between the number of children and the risk of diabetes (Table 3, Fig. 1). In analyses stratified by age and region, women with two, three, or four or more children were at a 17%, 30% and 45% increased risk of diabetes compared with women with one child (p < 0.001 for trend). Further adjustment for socioeconomic and lifestyle factors only slightly attenuated the relationship, with adjusted HRs of 1.12 (95% CI 1.07, 1.18), 1.23 (95% CI 1.16, 1.31) and 1.32 (95% CI 1.21, 1.44), respectively, for two, three and four or more children (p < 0.001 for trend). In analyses restricted to women with children, each additional child was associated with a 4% increased risk of diabetes (HR 1.04 [95% CI 1.02, 1.06]), rising to 1.06 (95% CI 1.03, 1.09) in analyses restricted to women with up to ten children (electronic supplementary material [ESM] Table 1), with limited evidence for material differences between population subgroups (Fig. 2). However, there was some indication that the magnitude of the effect was stronger in women with a history of hypertension compared with those without (p = 0.03 for heterogeneity). Findings for the association between the number of live births and the risk of diabetes were similar (Fig. 3).Table 3


Parenthood and the risk of diabetes in men and women: a 7 year prospective study of 0.5 million individuals.

Peters SA, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Bragg F, Zhou X, Ge P, Chen B, Gao Y, Li Y, Chen J, Li L, Woodward M, Chen Z, China Kadoorie Biobank Collaboration Gro - Diabetologia (2016)

Adjusted HRs for incident diabetes associated with number of live births. Analyses are stratified by age and region (white squares, model I), and additionally adjusted for level of attained education, household income, smoking status, alcohol use, systolic blood pressure, history of hypertension, physical activity and BMI (black squares, model III). Conventions are the same as in Fig. 1
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4930461&req=5

Fig3: Adjusted HRs for incident diabetes associated with number of live births. Analyses are stratified by age and region (white squares, model I), and additionally adjusted for level of attained education, household income, smoking status, alcohol use, systolic blood pressure, history of hypertension, physical activity and BMI (black squares, model III). Conventions are the same as in Fig. 1
Mentions: During a median of 7.2 years (interquartile range 6.3–8.1) of follow-up, 8,840 (5,579 women and 3,261 men) incident cases of diabetes were recorded. Overall, childless women had a 27% (adjusted HR 1.27 [95% CI 1.01, 1.59]) excess risk of diabetes compared with women with children in the age- and region-stratified model, which attenuated slightly (HR 1.22 [95% CI 0.97, 1.52]) after further adjustment for socioeconomic and lifestyle factors (Table 3). In women with at least one child, there was a log-linear association between the number of children and the risk of diabetes (Table 3, Fig. 1). In analyses stratified by age and region, women with two, three, or four or more children were at a 17%, 30% and 45% increased risk of diabetes compared with women with one child (p < 0.001 for trend). Further adjustment for socioeconomic and lifestyle factors only slightly attenuated the relationship, with adjusted HRs of 1.12 (95% CI 1.07, 1.18), 1.23 (95% CI 1.16, 1.31) and 1.32 (95% CI 1.21, 1.44), respectively, for two, three and four or more children (p < 0.001 for trend). In analyses restricted to women with children, each additional child was associated with a 4% increased risk of diabetes (HR 1.04 [95% CI 1.02, 1.06]), rising to 1.06 (95% CI 1.03, 1.09) in analyses restricted to women with up to ten children (electronic supplementary material [ESM] Table 1), with limited evidence for material differences between population subgroups (Fig. 2). However, there was some indication that the magnitude of the effect was stronger in women with a history of hypertension compared with those without (p = 0.03 for heterogeneity). Findings for the association between the number of live births and the risk of diabetes were similar (Fig. 3).Table 3

Bottom Line: It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing.In both sexes, the findings were broadly similar in different population subgroups.The similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.

View Article: PubMed Central - PubMed

Affiliation: The George Institute for Global Health, University of Oxford, 34 Broad Street, Oxford, OX1 3BD, UK.

ABSTRACT

Aims/hypothesis: In women, higher parity has been associated with increased risk of diabetes later in life. It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing. We assessed the association between number of children and diabetes risk separately in women and men.

Methods: Between 2004 and 2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 (mean 51 years) from ten diverse regions across China. During 7 years of follow-up, 8,840 incident cases of diabetes were recorded among 463,347 participants without prior cardiovascular diseases or diabetes. Multivariable Cox regression yielded sex-specific HRs and 95% CIs for incident diabetes by number of children.

Results: Overall, ∼98% of all participants had children. In women, there was a J-shaped association between number of children and risk of diabetes. Compared with women with one child, the adjusted HRs for diabetes were 1.39 (95% CI 1.11, 1.73) for childless women, 1.12 (95% CI 1.07, 1.18) for those with two children, 1.23 (95% CI 1.16, 1.31) for those with three children, and 1.32 (95% CI 1.21, 1.44) for those with four or more children. In men, there was a similar association with risk of diabetes; the corresponding HRs were 1.28 (95% CI 1.02, 1.60), 1.19 (95% CI 1.12, 1.26), 1.32 (95% CI 1.21, 1.44) and 1.41 (95% CI 1.24, 1.60), respectively. In both sexes, the findings were broadly similar in different population subgroups.

Conclusions/interpretation: The similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.

No MeSH data available.


Related in: MedlinePlus