Our study investigated trends in osteoporosis management in Xiamen from 2012 to 2021, revealing improvements in screening and treatment, although medication use remained low. Additionally, we identified factors that may influence medication use and emphasized the importance of effective osteoporosis management strategies. Purpose The goal of the current study is to explore trends in assessment, diagnosis after fragility fractures, and osteoporosis treatment among hospitalized patients in Xiamen, China, between 2012 and 2021. Methods We conducted a retrospective cross-sectional study, using the Cochran-Armitage trend test to describe trends. Logistic regression was performed to identify the influencing factors of anti-osteoporosis medication (AOM) treatment. We performed a sensitivity analysis to verify the robustness of our findings. Results From 2012 to 2021, the rates of dual-energy X-ray absorptiometry (DXA) scans and bone turnover marker (BTM) examinations increased from 0 to 37% and 36.5%, respectively. 29.3% of patients with fragility fractures were diagnosed with osteoporosis. The use rate of AOM was only 22.7%. There was an upward trend in the prescription of bisphosphonates, increasing from 1% in 2012 to 16.8% in 2021. The use of calcitonin ranged from 4.1% (2014) to 32.7% (2021). Calcium and vitamin D supplementation prescribing increased significantly from 5.6% in 2012 to 78.7% in 2021. Logistic regression analysis showed that old age, female sex, history of fractures, DXA scans, and osteoporosis diagnosis were significantly associated with increased AOM use. Tobacco use, hypertension, diabetes, congestive heart failure, cerebral vascular accidents, and severe liver diseases were associated with a reduced likelihood of AOM treatment. Conclusions Although assessment, diagnosis after fragility fractures, and osteoporosis treatment have increased over the past decade, there are still deficiencies in the management of osteoporosis. In the future, it will be necessary to further strengthen management of osteoporosis.

Objective: This study was undertaken to investigate the relationship between amino acids (AAs) and nonalcoholic fatty liver disease (NAFLD), and how AAs changed following long-term exercise training under different exercise intensities. Methods: NAFLD participants (n = 220) were recruited and randomly assigned to control, moderate exercise and vigorous exercise groups with a 6-month follow-up. Clinical characteristics were carefully calculated and plasma AAs concentrations were determined using a validated ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method. Results: At baseline, AAs concentrations were closely associated with clinical characteristics in NAFLD, particularly, the sum of branched chain amino acids (BCAAs) positively associated with intrahepatic triglyceride (IHTG) content (r = 0.18, p = 0.007). After 6-month exercise intervention, several AAs concentrations altered, and different exercise intensities exerted inverse effects on histidine, serine, glutamine, valine, tyrosine, and tryptophan concentrations changes, particularly, moderate exercise was much more efficient on decreasing BCAAs than vigorous exercise with a significant difference (p = 0.0008). Conclusion: Several AAs was closely associated with IHTG content in NAFLD patients, and 6-month moderate exercise more strongly reduced AAs concentrations, particularly BCAAs, compared to vigorous exercise. These findings suggest that exercise intensity optimization could enhance the metabolic benefits of exercise therapy in NAFLD.

Purpose:Nutrient intake for pregnant women with gestational diabetes mellitus (GDM) is important to ensure satisfactory birth outcomes. This study aims to explore the dietary profiles of patients with GDM, compare the results with the Chinese dietary guidelines or Dietary Reference Intakes (DRIs) from China and investigate the relationship between maternal dietary intake and pregnancy outcomes.Patients and Methods:A total of 221 patients with GDM in the second trimester were included in the cohort. Dietary intake data were collected using a 24-hour recall method for three consecutive days. The pregnancy outcomes of these participants were subsequently monitored. Both univariate logistic regression and multivariate logistic regression analyses were conducted to explore the associations between dietary intake variables or general characteristics variables and adverse pregnancy outcomes.Results:Participants with adverse pregnancy outcomes showed a lower intake of iodine and vitamin D, a lower percentage of dietary energy intake from carbohydrates and a higher percentage of dietary energy intake from fats, compared to participants without adverse pregnancy outcomes. The gestational weight gain and family history of diabetes were associated with an increased risk of adverse pregnancy outcomes. Conversely, regular exercise, the intake of iodine and Vitamin D, and the percentage of dietary energy intake from carbohydrates were associated with a decreased risk.Conclusion:The daily diet of pregnant women with GDM in China did not meet the dietary guidelines or DRIs. The low intake of Vitamin D and iodine, the low dietary carbohydrate ratio, family history of diabetes, lack of exercise, and high gestational weight gain were associated with increased risk of adverse pregnancy outcomes in pregnant women with GDM.

AIM:The prevalence of the coexistence of low muscle mass and obesity is increasing, particularly with a rising trend observed in patients diagnosed with type 2 diabetes mellitus (T2DM). However, the association between the coexistence of low muscle mass and obesity and diabetic complications remains unclear. This study aimed to investigate these associations in patients with T2D. MATERIALS AND METHODS:A retrospective study was conducted, including 2387 hospitalized patients with T2DM. Data on demographic characteristics, biochemical parameters, diabetic complications and body composition was from electronic health records. The participants were categorized as control, low muscle mass, obesity and the coexistence of the low muscle mass and obesity groups according to the body compositions evaluated by dual-energy X-ray absorptiometry. Multiple logistic regression models were applied to assess the associations between the pattern of body composition and complications of diabetes. RESULTS:After adjustment for potential confounders, compared with patients in the control group, the odds ratios [95% confidence intervals (CIs)] of macrovascular complications of diabetes were 0.62 (95% CI, 0.27-1.39) for those in the low muscle mass group, 1.12 (95% CI, 0.59-2.11) in the obesity group, and 2.43 (95% CI, 1.16-5.07) in the coexistence of the low muscle mass and obesity group, respectively; the odds ratios (95% CIs) of microvascular complications of diabetes were 0.86 (95% CI, 0.52-1.43) for those in the low muscle mass group, 0.82 (95% CI, 0.53-1.26) in the obesity group, and 1.21 (95% CI, 0.69-2.15) in the coexistence of the low muscle mass and obesity group, respectively. CONCLUSION:According to our findings, the coexistence of low muscle mass and obesity, rather than low muscle mass or obesity alone, was significantly associated with a higher prevalence of macrovascular complications in hospitalized patients with T2DM. This association was not observed for diabetic microvascular complications.

Abstract Objective: The prevalence of Sarcopenic obesity (SO) is increasing, particularly with a rising trend observed in patients diagnosed with Type 2 diabetes (T2D). However, the association between SO and diabetic complications remains unclear when compared to sarcopenia or obesity alone. This study aimed to investigate the associations between sarcopenia, obesity, SO, and diabetes complications in patients with T2D. Methods: A retrospective study was conducted including 2387 hospitalized patients with T2D. Data associated with demographic characteristics, biochemical parameters, diabetic complications, and body composition from electronic health records were collected. The participants were categorized as normal (nonsarcopenia nonobesity), sarcopenia, obesity, and SO groups according to the body compositions evaluated by dual-energy X-ray absorptiometry. Multiple logistic regression models were applied to assess the associations between body composition and complications of diabetes. Results: After adjustment for potential confounders, compared with patients in normal group, the odds ratios (95% CIs) of macrovascular complications of diabetes were 0.64 (95% CI, 0.29-1.42) for those in sarcopenia group, 1.05 (95% CI, 0.56-1.97) in obesity group, and 2.45 (95% CI, 1.18-5.09) in SO group, respectively; the odds ratios (95% CIs) of microvascular complications of diabetes was 0.95 (95% CI, 0.58-1.55) for those in sarcopenia group, 0.80 (95% CI, 0.53-1.22) in obesity group, and 1.21 (95% CI, 0.69-2.11) in SO group, respectively. Conclusion: According to our findings, SO, rather than sarcopenia or obesity alone, was significantly associated with a higher prevalence of macrovascular complications, in hospitalized patients with T2DM. This association was not observed for diabetic microvascular complications.

Abstract Background Advanced maternal age (AMA; ≥35 years) is considered to be a major risk factor for adverse pregnancy outcomes. Along with the global trend of delayed childbearing, and in particular, the implementation of China’s second and third-child policy leading to a dramatic increase of AMA in recent years, the association between maternal age and pregnancy outcomes requires more investigation. Methods A population-based retrospective study was performed. Data were derived from the Medical Birth Registry of Xiamen from 2011 to 2018. Univariate and multivariate logistic regression was used to evaluate the effects of maternal age on pregnancy outcomes. Results A total of 63,137 women categorized into different age groups (< 25 years, 25–29 years, 30–34 years, and ≥ 35 years) were included in this study. Compared with the mothers aged 25–29 years, the univariate regression analysis showed that mothers aged < 25 years had lower risks of gestational diabetes mellitus (GDM) and cesarean. AMA was associated with higher risks of GDM, hypertension, cesarean, preterm birth, low-birth weight (LBW), large-for-gestational-age (LGA), macrosomia, and stillbirth (all P < 0.01). After adjustment for potential confounding factors, increased risks of GDM, hypertension, cesarean, preterm birth, and LBW remained significantly associated with AMA (all P < 0.05), whereas AMA mothers showed a lower risk of macrosomia than their younger counterparts. Additionally, no significant differences were detected in terms of Apgar score < 7. Conclusion AMA was associated with adverse pregnancy outcomes including increased risks of GDM, hypertension, cesarean, preterm birth, and LBW. This study confirmed the relationship between AMA and certain adverse maternal and fetal outcomes and emphasizes the necessity for women to be cautious about the age at which they become pregnant.

Objective Studies have shown that sex differences in lean mass, concentrations of sex hormones, and lifestyles influence cle health and glucose metabolism. We evaluated the sex-specific association between low muscle mass and glucose fluctuations in hospitalized patients with type 2 diabetes mellitus (T2DM) receiving continuous subcutaneous insulin infusion (CSII) therapy. Methods A total of 1084 participants were included. Body composition was determined by dual-energy X-ray absorptiometry. Intraday blood glucose fluctuation was estimated by the Largest amplitude of glycemic excursions (LAGE) and standard deviation of blood glucose (SDBG). Results The prevalence of low muscle mass was higher in males than in females (p<0.001). There was a significant sex-specific interaction between the status of low muscle mass and glucose fluctuations (LAGE and SDBG) (p for interaction=0.025 and 0.036 for SDBG and LAGE, respectively). Among males, low muscle mass was significantly associated with a higher LAGE and SDBG (difference in LAGE: 2.26 [95% CI: 1.01 to 3.51], p < 0.001; difference in SDBG: 0.45 [95% CI: 0.25 to 0.65], p < 0.001) after adjustment for HbA1c, diabetes duration, hyperlipidemia, diabetic peripheral neuropathy, diabetic nephropathy, and cardiovascular disease. These associations remained significant after further adjustment for age and C-peptide. Among females, low muscle mass was not associated with LAGE or SDBG after adjustment for all covariates. Conclusion The prevalence of low muscle mass was higher in males than in females. Low muscle mass was significantly associated with higher LAGE and SDBG among males, but not females.

The severity of liver fibrosis is an important predictor of death in patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). However, there is still no definite conclusion on the relationship between triiodothyronine (T3) and the severity of liver fibrosis. Thus, the aim of this study was to analyze the correlation between T3 level and the severity of liver fibrosis. We performed a cross-sectional study of 2072 T2DM patients with normal thyroid function from January 2017 to January 2020. NAFLD fibrosis score (NFS), Fibrosis index based on the 4 factors (FIB-4) and BARD score (BARD) were used to assess the severity of fibrosis in T2DM patients, and linear regression analyses were used to determine the factors independently associated with liver fibrosis. Further experiments were performed to assess the impact of low T3 on fibrosis progression in mice model and explore possible mechanisms. Free triiodothyronine (fT3) levels had significantly inverse correlations with NFS and FIB-4, and BARD in T2DM patients (P < 0.05). In multiple linear regression analyses, decreased fT3 level was an independent risk factor for the severity of liver fibrosis of T2DM patients (P < 0.01). Findings from in-vivo experiment using mice model proved that hypothyroidism mice had more severe of liver fibrosis than those mice with normal thyroid function. We also found that T3 could inhibit the profibrotic TREM2+CD9+ macrophage, which had been identified an important player in the progression of liver fibrosis. The findings from this study proved an inverse correlation between T3 level and the severity of liver fibrosis, and lower fT3 level within the normal range was an independent risk factor for severe liver fibrosis.

目的 分析老年2型糖尿病患者治疗中联合应用六味地黄汤加减方与西格列汀的价值.方法 选取2020年1月—2021年11月在厦门大学附属第一医院门诊及病房治疗的98例老年2型糖尿病患者,随机分为两组.对照组49例患者单用西药治疗(磷酸西格列汀片),观察组49例患者在此基础上联合应用六味地黄汤加减方治疗.比较两组血糖指标、胰岛功能指标、血清炎性因子水平.结果 治疗后,观察组患者空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平均明显低于对照组,差异有统计学意义(P<0.05);观察组胰岛β细胞功能指数(HOMA-β)明显高于对照组,胰岛素抵抗指数(HOMA-IR)明显低于对照组,差异有统计学意义(P<0.05);观察组白细胞介素(IL)-17A、IL-22、干扰素-γ(IFN-γ)水平均明显低于对照组,差异有统计学意义(P<0.05).结论 联合应用六味地黄汤加减方与西格列汀治疗老年2型糖尿病患者能够提高治疗效果,有效控制血糖,下调血清炎性因子水平.

Our aim was to assess effects of breast-feeding (BF) in the association between large-for-gestational age (LGA) and body mass index (BMI) trajectories on childhood overweight from 1 to 4 years old. A total of 1649 healthcare records of mother–child pairs had detailed records of feeding practices and were included in this retrospective cohort study. Data were available in Medical Birth Registry of Xiamen between January 2011 and March 2018. Linear and logistic regression models were used to access the difference between BF and no-BF group. For offspring were LGA and BF was significantly associated with a lower BMI Z-score from 1 to 4 years old after adjustment confounders in Model 1 to 3 [difference in BMI Z-score in Model 1: estimated β: −0.07 [95%CI: −0.13 to −0.01]; Model 2: estimated β: −0.07 (−0.13 to −0.004); Model 3: estimated β: −0.06 (−0.12 to −0.001); P = 0.0221, 0.0371, 0.0471]. A significantly lower risk of childhood overweight was observed in Model 1 [odd ratio (OR): 0.85 (95%CI, 0.73 to 1.00)], P = 0.0475) with adjustment for maternal pre-pregnancy BMI. Furthermore, Model 2 and Model 3 showed LGA-BF infants had a lower risk for childhood overweight then LGA-no-BF infants [OR: 0.87 and 0.87 (95%CI, 0.73 to 1.03; 0.74 to 1.03)], however, there was no statistical significance ( P = 0.1099, and 0.1125)]. BF is inversely related to BMI Z-score and risk for overweight in children were LGA from 1 to 4 years old. Adjustment for maternal pre-pregnancy BMI, the protective association between BF and childhood overweight was more significant.

APS (autoimmune polyglandular syndrome) is defined as the coexistence of at least two kinds of endocrine autoimmune diseases. APS type 3 comprises autoimmune thyroid diseases and other autoimmune diseases but does not involve autoimmune Addison's disease. So far, APS-3 combined with isolated gonadotropin-releasing hormone (GnRH) reduction caused by the suspected autoimmune hypothalamic disease has not been reported. We recently received a 43-year-old woman with a one-year history of Graves' disease (GD) and a four-month history of type 1 diabetes presented with hyperthyroidism and hyperglycemia. After the GnRH stimulation test, she was diagnosed with secondary amenorrhea attributed to suspected autoimmune Hypothalamitis and APS type 3 associated with Graves' disease and Latent Autoimmune Diabetes (LADA). According to this case, the hypothalamus cannot be spared from the general autoimmune process. It is recommended to carry out the GnRH stimulation test when encountering APS patients combined with secondary amenorrhea.

Nonalcoholic fatty liver disease is likely to be associated with increased circulating branched-chain amino acids. We investigated the relationship between changes in branched-chain amino acids levels in the serum and improvement in liver fat content caused by exercise intervention in individuals with nonalcoholic fatty liver disease. The exploratory study included 208 central obesity and nonalcoholic fatty liver disease individuals from an exercise intervention randomized clinical trial for nonalcoholic fatty liver disease. The participants were randomly assigned to control, moderate, and vigorous-moderate exercise groups for 12 months. Changes in total branched-chain amino acids, leucine, isoleucine, and valine levels from baseline to 6 months were calculated. Liver fat content was determined by proton magnetic resonance spectroscopy. Reductions in circulating levels of total branched-chain amino acids, leucine, and valine levels from baseline to 6 months were significantly associated with the improvement of liver fat content at 6 months and 12 months (p < 0.01 for all) after adjustments for age, sex, total energy intake, protein intake, intervention groups, HOMA-IR, BMI, liver fat content, total branched-chain amino acids, leucine, and valine at baseline, respectively. These associations were still significant after further adjustments for changes in HOMA-IR and BMI from baseline to 6 months (p < 0.05 for all). Our findings indicated that reductions in circulating branched-chain amino acids levels were associated with an improvement in liver fat content by exercise intervention among patients with nonalcoholic fatty liver disease, which was independent of changes in BMI or HOMA-IR.

Objective. The current study aimed to explore the relationship between OSAS and hypertension and whether polysomnography (PSG) indices were independently associated with hypertension in patients with type 2 diabetes (T2DM). Methods. This study recruited 316 T2DM patients. Multivariable logistic regression analyses were performed to determine the independent association of apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) with hypertension with adjustment for potential confounders. Results. Among 316 patients, 130 (41.1%) and 204 (64.6%) had hypertension and OSAS, respectively. T2DM patients with hypertension showed significantly increased levels of AHI ((median (interquartile range)): 17.2 (5.7–34.9) vs. 5.7 (2.1–17.3) events/hour, p < 0.001), nonrapid eye movement AHI (NREM-AHI) (17.6 (5.5–36.5) vs. 5.2 (2.2–16.6) events/hour, p < 0.001), ODI (48.4 (21.9–78.0) vs. 22.6 (10.8–48.1) events/hour, p < 0.001), and severities of OSAS and decreased levels of lowest SaO2 ((mean ± standard deviation): 74.0 ± 10.4 vs. 77.3 ± 9.8, p = 0.004). Multivariable logistic regression analysis showed that higher levels of AHI, NREM-AHI, and ODI were significantly associated with increased risks of hypertension, and the adjusted odds ratios (ORs) with 95% CI were 1.026 (1.008–1.044, p = 0.004), 1.026 (1.009–1.044, p = 0.003), and 1.005 (1.001–1.010, p = 0.040), respectively. Compared with non-OSAS, severe OSAS was significantly associated with the risk of hypertension with the adjusted OR (95% CI) of 3.626 (1.609–8.172, p = 0.002), but associations of rapid eye movement AHI (REM-AHI) and lowest SaO2 with hypertension were not statistically significant. Conclusion. Increased AHI, NREM-AHI, ODI, and severities of OSAS were significantly associated with higher risks of hypertension in T2DM patients. Detection and treatment of OSAS are needed to prevent hypertension in T2DM patients.

Objective: To assess the role of neck circumference (NC) in assessing insulin resistance (IR) in polycystic ovary syndrome (PCOS). Design: A cross-sectional study. Setting: University-affiliated hospital. Patient(s): One hundred forty-three women with PCOS were recruited from November 2018 to February 2020. Intervention(s): None. Main Outcome Measure(s): The associations of NC with IR and the cutoff points of NC for IR. Result(s): The prevalence rates of IR were 64.3%. The patients with PCOS with IR had significantly greater values of systolic blood pressure, NC, body mass index, waist-to-hip ratio, waist circumference, fasting blood glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR). Pearson correlation analysis showed body mass index (log-transformed), waist circumference, waist-to-hip ratio, and HOMA-IR (log-transformed) were positively correlated with NC. Multivariable linear regression showed that NC was significantly associated with HOMA-IR (log-transformed), with the standardized regression coefficient of 0.330 with adjustment for potential confounding factors. Furthermore, multivariate logistic regression analyses showed NC was associated significantly with increased risk of IR, with the adjusted odds ratio of 1.423. Additionally, NC was able to identify IR in women with PCOS; the optimal cut-off points was 34.3 cm (Youden index = 0.586). Conclusion(s): Neck circumference is positively associated with IR in women with PCOS. We suggest NC as a novel, simple, practical, and reliable anthropometric measure to be used to predict the risk of IR in patients with PCOS. (C) 2020 by American Society for Reproductive Medicine.

OBJECTIVE:Animal studies and epidemiological studies have shown that there is potential sex-specific sensitivity to the intrauterine environment in relation to the developmental programming of obesity. The objective of this study was to assess the sex-specific association between prenatal antibiotics exposure and body mass index (BMI) in offspring from 1 to 4 years.METHODS:A total of 10,163 mother-child pairs from the Medical Birth Registry in Xiamen, China, were included in this prospective cohort study. Data on prenatal antibiotics exposure were collected from the prescription database.RESULTS:A total of 4909 (48.3%) offspring had prenatal antibiotics exposure. The associations between prenatal antibiotics exposure and offspring's BMI were significantly different among female offspring and male offspring (P for interaction: 0.034 at 1 year of age; 0.033 at 2 years of age; 0.020 at 3 years of age; and 0.021 at 4 years of age). In female offspring, prenatal antibiotic use was significantly associated with a higher BMI Z-score from 1 to 4 years old (difference in BMI Z-score: 0.11 [95% CI: 0.05-0.17] at 1 years of age; 0.10 [95% CI: 0.05-0.16] at 2 years of age; 0.14 [95% CI: 0.09-0.21] at 3 years of age; and 0.13 [95% CI: 0.07-0.19] at 4 years of age) after adjustment for confounder. Prenatal antibiotics use was not associated with offspring BMI Z-score from 1 to 4 years in male offspring.CONCLUSIONS:The association of prenatal antibiotics exposure and BMI Z-score from 1 to 4 years old may differ by sex of offspring.

BackgroundChildhood obesity is associated with adverse outcomes such as metabolic syndrome, diabetes, and cardiovascular diseases in adulthood. Identifying risk factors related to excessive adiposity in early childhood is of great importance for obesity intervention. The results of studies for associations between maternal with gestational diabetes and offspring obesity are conflicting. Nonetheless, the association of maternal glucose across a spectrum of glucose values with childhood adiposity outcomes is less clear.AimTo assess the association of maternal glucose across a spectrum of glucose values with childhood adiposity at age 5 years.MethodsA population-based cohort study was conducted between 2011 and 2018. Using the healthcare records data were from the Medical Birth Registry in Xiamen, China. The primary outcome was offspring obese/obesity. Primary predictors were maternal oral glucose tolerance test values during pregnancy.Results6090 mother–child pairs were analyzed. The mean age of the children at follow-up was 5.2 years. At multiple logistic regression, after adjustment for variables, including maternal pre-pregnancy body mass index (BMI), birth weight of offspring, and insulin therapy, ORs for offspring overweight/obesity were 1.13 (95% CI 0.90 to 1.42) for maternal fasting glucose levels, 1.12 (95% CI 1.04 to 1.22) for 1-hour glucose, and 1.04 (95% CI 0.95 to 1.14) for 2-hour glucose. The adjusted association of offspring BMI Z-score with maternal 1-hour glucose level remained significant. There were no significant associations between BMI Z-score and maternal fasting glucose and 2-hour glucose level. Exploratory sex-specific analyses indicated generally consistent associations for boys and girls.ConclusionMaternal postload 1-hour glucose across a spectrum of glucose values during pregnancy was an independent risk for offspring weight gain at age 5 years, indicating the importance of screen and management of maternal 1-hour glucose level, except for fasting glucose and 2-hour glucose level during pregnancy in order to prevent offspring weight gain in early childhood.

The growth trajectory of Chinese preschoolers still remains unclear. Our objective was to determine whether there was an association between adverse pregnancy outcomes and overweight offspring. We analyzed population-based retrospective cohort data from the Medical Birth Registry of Xiamen, which comprised 33,157 children examined from 1 to 6 years of age. Longitudinal analyses were used to evaluate the growth trajectories of offspring body mass index (BMI). Multivariate logistic regression was used to assess the effects of two adverse pregnancy outcomes, gestational diabetes mellitus (GDM) and being large-for-gestational age (LGA), on childhood overweight. Offspring of mothers with GDM and LGA has a higher annual BMI z-score from 1 to 6 years of age (all P < 0.05). But, a higher annual BMI z-score was only observed in children aged 1–5 years in models 1–3. Overall BMI z-score of offspring aged 1–6 who were born to mothers with GDM and LGA were also higher in models 1–3 (all P < 0.05). Additionally, offspring of mothers with GDM and LGA had a higher risk for overweight in model 1, from 1 to 6 years of age (odds ratio (OR), 1.814; 95% confidence interval (CI), 1.657–1.985; P < 0.0001). However, this association was attenuated after adjusting for maternal pre-pregnancy BMI (OR, 1.270; 95% CI, 0.961–1.679; P = 0.0930). Offspring of mothers with GDM and LGA had a higher BMI z-score and increased risk for overweight. Indeed, intrauterine exposure to maternal GDM and LGA could bias offspring to overweight, whereas maternal pre-pregnancy BMI may play a key role in offspring overweight for children born to mothers with GDM and LGA.