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      Higher Gravidity and Parity Are Associated with Increased Prevalence of Metabolic Syndrome among Rural Bangladeshi Women

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          Abstract

          Background

          Parity increases the risk for coronary heart disease; however, its association with metabolic syndrome among women in low-income countries is still unknown.

          Objective

          This study investigates the association between parity or gravidity and metabolic syndrome in rural Bangladeshi women.

          Methods

          A cross-sectional study was conducted in 1,219 women aged 15–75 years from rural Bangladesh. Metabolic syndrome was defined according to the standard NCEP-ATP III criteria. Logistic regression was used to estimate the association between parity and gravidity and metabolic syndrome, with adjustment of potential confounding variables.

          Results

          Subjects with the highest gravidity (> = 4) had 1.66 times higher odds of having metabolic syndrome compared to those in the lowest gravidity (0-1) ( P trend = 0.02). A similar association was found between parity and metabolic syndrome ( P trend = 0.04), i.e., subjects in the highest parity (> = 4) had 1.65 times higher odds of having metabolic syndrome compared to those in the lowest parity (0-1). This positive association of parity and gravidity with metabolic syndrome was confined to pre-menopausal women ( P trend <0.01). Among the components of metabolic syndrome only high blood pressure showed positive association with parity and gravidity ( P trend = 0.01 and <0.001). Neither Parity nor gravidity was appreciably associated with other components of metabolic syndrome.

          Conclusions

          Multi parity or gravidity may be a risk factor for metabolic syndrome.

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          Most cited references19

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          Obesity and the metabolic syndrome in developing countries.

          Prevalence of obesity and the metabolic syndrome is rapidly increasing in developing countries, leading to increased morbidity and mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular disease. Literature search was carried out using the terms obesity, insulin resistance, the metabolic syndrome, diabetes, dyslipidemia, nutrition, physical activity, and developing countries, from PubMed from 1966 to June 2008 and from web sites and published documents of the World Health Organization and Food and Agricultural Organization. With improvement in economic situation in developing countries, increasing prevalence of obesity and the metabolic syndrome is seen in adults and particularly in children. The main causes are increasing urbanization, nutrition transition, and reduced physical activity. Furthermore, aggressive community nutrition intervention programs for undernourished children may increase obesity. Some evidence suggests that widely prevalent perinatal undernutrition and childhood catch-up obesity may play a role in adult-onset metabolic syndrome and T2DM. The economic cost of obesity and related diseases in developing countries, having meager health budgets is enormous. To prevent increasing morbidity and mortality due to obesity-related T2DM and cardiovascular disease in developing countries, there is an urgent need to initiate large-scale community intervention programs focusing on increased physical activity and healthier food options, particularly for children. International health agencies and respective government should intensively focus on primordial and primary prevention programs for obesity and the metabolic syndrome in developing countries.
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            Metabolic Syndrome and Incident Diabetes

            OBJECTIVE—Our objective was to perform a quantitative review of prospective studies examining the association between the metabolic syndrome and incident diabetes. RESEARCH DESIGN AND METHODS—Using the title terms “diabetes” and “metabolic syndrome” in PubMed, we searched for articles published since 1998. RESULTS—Based on the results from 16 cohorts, we performed a meta-analysis of estimates of relative risk (RR) and incident diabetes. The random-effects summary RRs were 5.17 (95% CI 3.99–6.69) for the 1999 World Health Organization definition (ten cohorts); 4.45 (2.41–8.22) for the 1999 European Group for the Study of Insulin Resistance definition (four cohorts); 3.53 (2.84–4.39) for the 2001 National Cholesterol Education Program definition (thirteen cohorts); 5.12 (3.26–8.05) for the 2005 American Heart Association/National Heart, Lung, and Blood Institute definition (five cohorts); and 4.42 (3.30–5.92) for the 2005 International Diabetes Federation definition (nine cohorts). The fixed-effects summary RR for the 2004 National Heart, Lung, and Blood Institute/American Heart Association definition was 5.16 (4.43–6.00) (six cohorts). Higher number of abnormal components was strongly related to incident diabetes. Compared with participants without an abnormality, estimates of RR for those with four or more abnormal components ranged from 10.88 to 24.4. Limited evidence suggests fasting glucose alone may be as good as metabolic syndrome for diabetes prediction. CONCLUSIONS—The metabolic syndrome, however defined, has a stronger association with incident diabetes than that previously demonstrated for coronary heart disease. Its clinical value for diabetes prediction remains uncertain.
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              Double burden of noncommunicable and infectious diseases in developing countries.

              On top of the unfinished agenda of infectious diseases in low- and middle-income countries, development, industrialization, urbanization, investment, and aging are drivers of an epidemic of noncommunicable diseases (NCDs). Malnutrition and infection in early life increase the risk of chronic NCDs in later life, and in adult life, combinations of major NCDs and infections, such as diabetes and tuberculosis, can interact adversely. Because intervention against either health problem will affect the other, intervening jointly against noncommunicable and infectious diseases, rather than competing for limited funds, is an important policy consideration requiring new thinking and approaches.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                2 August 2013
                : 8
                : 8
                : e68319
                Affiliations
                [1 ]Health & Disease Research Center for Rural Peoples (HDRCRP), 14/15, Probal Housing Ltd., Mohammadpur, Dhaka, Bangladesh
                [2]2 Graduate School of Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
                [3 ]National Center for Global Health and Medicine (NCGM), Toyama, Shinjuku-ku, Tokyo, Japan
                [4 ]Department of Global Health Policy, University of Tokyo, Tokyo, Japan
                Iran University of Medical Sciences, Islamic Republic of Iran
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: SA SJ MMR. Performed the experiments: SA. Analyzed the data: SA MMR. Contributed reagents/materials/analysis tools: SJ MMI MTK. Wrote the manuscript: SA. Critical comments and Revision of manuscripts: SJ TM NY HA.

                Article
                PONE-D-13-10650
                10.1371/journal.pone.0068319
                3732242
                23936302
                84a8d80b-8024-4edb-8b9f-91fc37ab68d5
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 March 2013
                : 28 May 2013
                Funding
                This work was supported by Grant-in-Aid for Scientific Research (overseas academic) from the Ministry of Education, Culture, Sports, Science and Technology of Japan (22406025, 23406037, 23406016, 23406029, 24406026, 25305034), and Japan Society for the promotion of Science. Current project on diabetes from World Diabetes Foundation, Denmark to Human and Diseases Research Center for Rural Peoples has also supported a part of this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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