Short-term results of a community-based program on promoting healthy lifestyle for prevention and control of chronic diseases in a developing country setting: Isfahan Healthy Heart Program

The objective of the study is to investigate the effect of a comprehensive community trial on behavioral modification after 2 years of intervention. The interventions of this 6-year, comprehensive community-based study target the whole population, of nearly 2 180 000, living in 2 cities in Iran and are compared with another Iranian city considered as reference. Educational, environmental, and legislative interventions are being conducted at the population level. From the baseline to the second year of evaluation of this study, the consumption of hydrogenated fat decreased significantly in the intervention community, but it remained nearly constant in the reference area. Meanwhile, the consumption of liquid oil increased in the intervention community, whereas it decreased in the reference area. The prevalence of current smoking and attempt to smoke decreased, respectively, in men and youths living in the intervention area but increased or remained constant in the reference area; however, no favorable change was seen for smoking among women. Leisure time physical activity increased in women and declined in men of both communities; the slopes of these changes were greater in the intervention area. Although the consumption of salty/fat snacks slightly decreased in the school students of the intervention area, it had a sharp increase in the reference area. This program succeeded in improving some aspects of lifestyle in its different target groups. The authors suggest that the synergy of activities intensified the dose of interventions and led to this improvement.

Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran

OBJECTIVE

To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities.

METHODS

Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak). Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area. The scores for all behaviours were then added to derive an overall lifestyle score.

FINDINGS

After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus -1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus -2.0%, respectively; P < 0.001). Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women. Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (-68 metabolic equivalent task (MET) minutes per week versus -114 MET minutes per week, respectively; P < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas. A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values.

CONCLUSION

The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.

Short- and long-term relationships of serum ghrelin with changes in body composition and the metabolic syndrome in prepubescent obese children following two different weight loss programmes

OBJECTIVES

Ghrelin has been proposed to be a regulator of energy balance, and its dysregulation may be important in obesity. The aims of this study were (i) to compare short- and long-term changes in circulating ghrelin concentration after increasing energy expenditure vs. its changes after decreasing energy intake, (ii) to determine factors associated with changes in ghrelin level, and (iii) to assess relationships of ghrelin concentration with metabolic syndrome (MetS) in prepubescent obese children.

DESIGN

Randomized controlled trial.

PATIENTS

About 100 obese children aged 7-9 years.

MEASUREMENTS

After baseline testing, children were randomly assigned to two interventional groups, either receiving dietary recommendations or engaging in physical training classes for 6 months. Ghrelin, insulin, leptin, fasting blood sugar, lipid profile and anthropometric indexes, as well as energy intake and expenditure were measured.

RESULTS

Of the participants, 92 completed the 6-month trial, and 87 returned for the 1-year follow-up. Except ghrelin level, other biochemical variables had no significant change at 12- vs. 6-month follow-up. In both groups, ghrelin showed a progressive increase in the periods of time with significant reduction of overweight and negative energy balance; while after the end of the trial, when children regained weight, it decreased toward baseline levels. Baseline ghrelin had strong negative correlation with measures of central obesity. The odds of having the MetS were 12% lower in the middle and 37% lower in the highest tertile of ghrelin level. As the number of MetS components increased, there was a progressive decrease in ghrelin and quantitative insulin sensitivity check index (QUICKI), with a progressive increase in serum insulin, HOMA-R and leptin levels.

CONCLUSIONS

Ghrelin increases in response to overweight reduction and negative energy balance resulting from either an exercise intervention or reduction in food intake in prepubescent obese children. It is unlikely to regulate long-term energy balance in young obese children.

Clustering of coronary artery disease risk factors in patients with type 2 diabetes and impaired glucose tolerance

A cross-sectional study in Isfahan city, Islamic Republic of Iran, compared the frequency of coronary artery disease risk factors in known and newly diagnosed diabetic patients and individuals with impaired glucose tolerance (IGT) with normal individuals. The prevalence of known cases of diabetes, new cases of diabetes and cases with IGT in the general population sample of 3940 were 4.3%, 1.1%, and 6.2% respectively. The frequency of dyslipidaemia was significantly different comparing diabetics and normal individuals. There was a significantly higher prevalence of risk factors (i.e. increased body mass index or waist circumference accompanied by dyslipidaemia) in the female population. The study highlights the importance of defining strategies for prevention and early diagnosis of diabetes in the community.

Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart Program

OBJECTIVES

To determine the gender-specific prevalence of the metabolic syndrome (Met S) in a representative sample of Iranian adults, and to identify some possible related lifestyle factors.

METHODS

As the baseline survey of a community-based interventional program entitled Isfahan Healthy Heart Program, we performed this cross-sectional study on 12,514 adults (> or =19 years) living in urban and rural areas of 3 cities in Iran. We assessed the prevalence of the Met S (according to the ATP III criteria) as well as dietary intake (based on food frequency questionnaire) and physical activity habits of all of the participants. We also evaluated dietary intake at the micronutrient level by using a one-day food record in a sub-sample of 2000 participants.

RESULTS

The age-adjusted prevalence of Met S was 23.3%, with a higher prevalence in women compared to men (35.1% vs. 10.7%, P<0.05) and in urban residents compared to rural residents (24.2% vs. 19.5%, P<0.05). In all age groups and in both urban and rural areas, the Met S affected a significantly larger number of women than men. Among women, abdominal obesity (71.7%) was more prevalent followed by low HDL-C (60.9%) and hypertriglyceridemia (56.6%), whereas among men, the most frequent components were hypertriglyceridemia (49.1%) and low HDL-C (35.1%), respectively. Abdominal obesity was nearly six times as prevalent in women as in men (71.7% vs. 12%, P<0.05) and had a significant association with metabolic disorders even after adjustment for age, sex and the living area. In general, dietary intake had no effect on the prevalence of Met S. The prevalence of Met S in subjects with a sedentary lifestyle was significantly higher than in active subjects of both genders (25.6% vs. 14.4%, respectively, P<0.05).

CONCLUSION

The Met S is highly prevalent in the Iranian population, notably in women living in urban areas. Abdominal obesity and dyslipidemia characterize this syndrome. Implementing community-based strategies for lifestyle change is of great significance.

Association of changes in oxidative and proinflammatory states with changes in vascular function after a lifestyle modification trial among obese children

BACKGROUND

The association of changes in oxidative and proinflammatory states with vascular function after diet and exercise intervention among obese children has not been previously explored.

METHODS

In this 6-week diet and exercise intervention study in 35 obese children, age 12 to 18 years, we evaluated the relationship between changes in anthropometric indices, measures of insulin resistance, C-reactive protein (CRP), oxidized LDL (ox-LDL), and oxidative stress markers with changes in carotid intima-media thickness (C-IMT) and flow mediated dilation (FMD) of the brachial artery.

RESULTS

At the end of the study, body mass index (BMI), waist circumference, and percentage body fat were decreased (P <0.05), but participants remained overweight (BMI > or = 95th percentile). Although FMD improved (P <0.05), the improvement in C-IMT did not reach statistical significance. The changes in BMI, waist circumference, fat mass, ox-LDL, malondialdehyde (MDA), CRP, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) had an inverse correlation with the changes in mean FMD after adjustment for age and sex, with the highest correlations documented for ox-LDL, CRP, and WC. The age- and sex-adjusted changes in ox-LDL, waist circumference, CRP, MDA, and body fat mass had the highest correlations with changes in C-IMT.

CONCLUSIONS

Our findings suggest that a common inflammatory stress condition associated with childhood obesity, notably with abdominal fat deposition, may play a role in the development of the earliest stages of proatherosclerotic inflammatory processes and subsequent vascular dysfunction. These changes might be partially reversible by short-term diet and exercise intervention, even if patients do not reach ideal body weight.

Antihypertensive and antihyperlipidemic effects of Achillea wilhelmsii

Achillea wilhelmsii C. Koch (Asteraceae) is widely found in different parts of Iran. This plant is full of flavonoids and sesquiterpene lactones, which have been shown to be effective in lowering blood lipids and hypertension. We conducted a double-blind placebo controlled clinical trial to study the antihyperlipidemic and antihypertensive effects of Achillea drops. We randomly selected 120 men and women, aged 40-60 years, and divided them in two distinct groups of moderate hyperlipidemic and primary hypertensive subjects. They were treated either with hydroalcoholic extract or with placebo in the form of 15-20 drops twice daily for more than 6 months. Blood pressure and serum lipids (total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol) were measured in the groups for 3 periods of 2 months each. The mean and standard deviation of alternations in these variables between the group taking placebo and that taking drugs was calculated by Student's t-test. The results showed a significant decrease in triglycerides after of 2 months while decreases in triglycerides, total cholesterol and LDL-cholesterol were significant after 4 months. Levels of HDL-cholesterol were significantly increased after 6 months' treatment. A significant decrease was observed in diastolic and systolic blood pressure after 2 and 6 months, respectively (p < 0.05).