Supplementary Materials for "Familial associations of the metabolic syndrome and its interrelated traits in Southwestern Indigenous Americans". METS_Supplementary_material_final_rev.docx

<b>Context: </b>Metabolic syndrome (MetS) risk factors emerge in childhood. The precursors may include familial association through genetic inheritance or cohabitation.<b>Objective: </b>Examine cross-sectional associations of MetS components between spouses and between parents and their 5–19-year-old offspring.<b>Methods:</b> Data were obtained from 1,255 mother-father-offspring triads enrolled in a longitudinal study in an Indigenous community in Arizona (1965-2007). Parent-offspring measures of waist circumference, triglycerides, high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting glucose were used for MetS diagnosis. Parental MetS and its components were defined according to the modified criteria of Adult Treatment Panel III. Additional offspring measures included HbA1c, fasting insulin, HOMA-IR, and type 2 diabetes (T2D).<b>Results:</b>Parental MetS components associated significantly with higher risk of diabetes and with higher central adiposity, triglycerides, SBP, fasting glucose and insulin, HOMA-IR, and with lower HDL-C in the offspring. These associations were stronger during adolescence and more pronounced between maternal-offspring dyads. For instance, offspring of mothers with hyperglycemia had 10.3 mg/dL higher fasting glucose at ages 12-19 years (vs 2.61 mg/dL higher fasting glucose at ages 05-11 years) than offspring of mothers with normal glucose levels<i>.</i> Parental diabetes partially explained some of these associations. We also found significant spousal concordance in metabolic risk attributes.<b>Conclusions: </b>Parental MetS characteristics were significantly associated with T2D and<b> </b>cardiometabolic risk factors in offspring.<b> </b>Associations were stronger during adolescence and between maternal-offspring pairs. These findings strongly support the need for family-based interventions directed at modifying health behaviors in high-risk population groups.