Disparities and spatial variations of high salt intake in Iran: a subnational study of districts based on the small area estimation method

Salt Contents in Fermented Dairy Products: A Strategic Blueprint for Healthier Intake

This study aimed to estimate the quantity and trends of salt intake from industrial fermented dairy products, develop strategies to reduce salt content, and inform policymakers on promoting public health through healthier dairy options. A cross-sectional study was conducted on fermented dairy products. Seventy-nine random samples were selected, and the salt (NaCl %) content was determined by potentiometric titration after sample preparation and homogenization; also samples were analyzed for their moisture (oven drying method). Data analysis involved descriptive statistics and one-sample t-test. A comprehensive literature review on salt reduction strategies was also performed proposing a model for an optimized low-salt fermented dairy product. This study found high salt content in many fermented dairy products. Brined cheese had the highest salt level (7.57 g/100 g), while pizza processed cheese had the lowest (1.03 g/100 g). Probiotic yogurts contained less salt (0.29 g/100 g) than regular ones. Other products like doogh (1.04 g/100 g), kefir (0.63 g/100 g), and kashk (2.78 g/100 g) also contributed significantly to salt intake. Most products exceeded recommended salt limits. Consuming just one serving of these products often accounted for a substantial portion of the daily recommended salt intake (WHO: 5 g/day). This research emphasizes the need for reducing salt in fermented dairy products to improve public health. This study highlights the excessive salt content in many fermented dairy products, surpassing recommended daily intake levels. Therefore, to address this public health concern, a multi-faceted approach is necessary. For this purpose, Policymakers should implement stringent monitoring, enforce food labeling, and develop legislation to reduce salt content. Furthermore, the food industry must innovate to reduce salt while maintaining product quality and taste. On the other hand, consumer education and awareness campaigns are crucial for informed choices. Additionally, further research is needed to understand consumer perceptions and the long-term impact of salt-sustainable reduction strategies on dietary habits and public health.

'Inequalities in prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment in 429 districts of Iran; a population-based STEPS 2016 small area spatial estimation model'

Purpose

While many studies have reported hypertension (HTN) and pre-hypertension (PHTN) in large geographic locations of Iran, information regarding district levels is missing. We aimed to examine inequalities in the prevalence of hypertension, prehypertension, anti-hypertensive coverage, awareness, and effective treatment of adults in districts of Iran.

Methods

We used 27,165 participants' data from the STEPS 2016 study in Iran. A small area estimation model was carried out to predict HTN in the 429 districts of Iran. HTN and PHTN were defined based on the American Heart Association Guideline. Awareness of being hypertensive, treatment coverage, and effective treatment were also estimated.

Results

HTN's crude prevalence was estimated to be in the range of 11.5-42.2% in districts. About PHTN, it was estimated to be 19.9-56.1%. Moreover, for awareness, treatment coverage, and effective treatment crude estimates ranged from 24.3 to 79.9%, 9.1 - 64.6%, and 19.5 - 68.3%, respectively, indicating inequalities in the distribution of aforementioned variables in 429 districts of Iran. Overall, better conditions were detected in central geographical locations and in females.

Conclusion

The inequality of increased blood pressure disorder and related measures are high in districts of Iran and pave the way for policymakers and local health organizers to use the findings of this study to address the inequity of existing resources and improve HTN control.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01186-5.

The levels and trends of metabolic risk factors in the elderly population at the national and sub-national scale in Iran from 1990 to 2016

Purpose

Describing the trends of metabolic risk factors (MRFs) in the elderly population.

Methods

We used modeled data from previous comprehensive systematic reviews for MRFs among adults aged ≥ 60 years. Two stages of age-specific Spatio-temporal modeling and Gaussian process regression were used to estimate the mean of MRFs. We used crosswalk modeling to estimate the prevalence of elevated and raised Total cholesterol (TC), overweight/obesity and obesity, hypertension, and diabetes. Estimates were analyzed based on combinations of sex, age, year, and province from 1990 to 2016.

Results

Comparing prevalence estimates from 2016 with those of 1990, in the elderly population, the age-standardized prevalence of overweight/obesity, obesity, diabetes, and hypertension increased, conversely, the prevalence of hypercholesteremia decreased. The prevalence of hypertension increased about 141.5% and 129.9% in men and women respectively. The age-standardized prevalence of diabetes increased about 109.5% in females, and 116.0% in males. Prevalence of elevated TC at the national level decreased to 67.4% (64.1-70.4) in women and to 51.1% (47.5-54.8) in men. These findings were almost shown across provinces. In general, the northern and western provinces had the highest prevalence of overweight/obesity in women in 2016.

Conclusion

The rising prevalence of most MRFs, as well as the greater prevalence and mean of all MRFs in women, necessitate effective public health policies to reduce the burden of non-communicable diseases and run preventive programs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01297-z.

Metabolic risk factors attributed burden in Iran at national and subnational levels, 1990 to 2019

Introduction

Metabolic risk factors (MRFs) predispose populations to a variety of chronic diseases with a huge burden globally. With the increasing burden of these risk factors in Iran, in this study, we aimed to report the estimated burden attributed to MRFs at national and subnational scales in Iran, from 1990 to 2019.

Methods

Based on the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, data of deaths and disability-adjusted life years (DALYs) attributable to four top MRFs in Iran including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body mass index (BMI), and high low-density lipoprotein (LDL) for the 1990-2019 period, were extracted. The socio-demographic index (SDI) was used to report the data based on the corresponding socio-economic stratifications. The results were reported in national and subnational 31 provinces of Iran to discover disparities regarding the attributable burden to MRFs. Furthermore, we reported the causes of diseases to which the attributable burden to MRFs was related.

Results

Overall, the age-standardized high LDL, high SBP, high BMI, and high FPG-attributed death rate changed by -45.1, -35.6, +2.8, and +19.9% from 1990 to 2019, respectively. High SBP was the leading risk factor regarding attributed age-standardized death rates reaching 157.8 (95% uncertainty interval: 135.3-179.1) and DALY rates reaching 2973.4 (2652.2-3280.2) per 100,000 person-years, in 2019. All rates increased with aging, and men had higher rates except for the +70 years age group. At the subnational level, provinces in the middle SDI quintile had the highest death and DALY rates regarding all four MRFs. Total deaths, DALYs, YLLs and YLDs number by the causes of diseases linked to MRFs increased over the study period. Cardiovascular diseases, diabetes mellitus, and kidney diseases were the main causes of burden of disease attributable to MRFs.

Conclusion

Herein, we found divergent patterns regarding the burden of MRFs as well as disparities in different regions, sex, and age groups for each risk factor and related causes. This could provide policymakers with a clearer vision toward more appropriate decision-making and resource allocation to prevent the burden of MRFs in Iran.

Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis

BACKGROUND

We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures.

METHODS

Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran.

RESULTS

All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%-47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%-64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively.

CONCLUSIONS

The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.

Strategies to improve the quality of wheat- flour- bread chain in Iran: the perspective of different stakeholders

Objective

Bread constitutes a significant energy source and provides protein and some essential micronutrients to a large population worldwide, including Iran. So, its quality characteristics are important for health. This study aimed to identify the views and experiences of various stakeholders involved in the wheat- flour- bread chain about factors affecting the quality of this chain and strategies for its improvement in Iran.

Results

Main suggested strategies in the field of raw materials were managing and planning for the production of high-quality wheat, measuring the quality factors of grain before purchasing by the government, allocating wheat quotas to flour mills based on the quality of the flour produced, and aerating and storing flour in silos to reduce its moisture. Holding training courses for bakery workers, improving the economic situation of bakers, and standardizing bread-making devices were the most important strategies in the bakery field. Assigning a specific unified management apparatus to deal with bread issues was also an effective and essential strategy. Findings show the need to implement strategies in various fields to improve wheat- flour- bread chain quality. This study provides helpful information to guide policy decisions and planning to enhance bread quality and promote public health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06225-7.

Effect of Dietary Salt Intake on Risk of Gastric Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies

Aim: The effect of dietary salt intake on the risk of gastric cancer is not clear. A meta-analysis was performed to estimate the association between dietary salt intake and the risk of gastric cancer. Methods: Three major databases were searched to retrieve case-control studies published in English before 1 July 2022. Random effects model analysis was used to obtain the pooled odds ratios (ORs) and 95% confidence intervals (CIs) of the association between dietary salt intake and risk of gastric cancer. Subgroup analyses were used to identify possible sources of heterogeneity. Results: Thirty-eight case-control studies were included in this meta-analysis (total population: n = 37,225). The pooled ORs showed a significantly positive association between high salt intake and gastric cancer compared with low salt intake (OR = 1.55, 95% CI (1.45, 1.64); p < 0.001). In subgroup meta-analysis for geographic region, estimation method for dietary salt intake and the source of controls, this association was not changed. Conclusion: Higher dietary salt intake increased the risk of gastric cancer. This study has implications for the prevention of gastric cancer.

Ideal cardiovascular health status and risk of cardiovascular disease and all-cause mortality: over a decade of follow-up in the Tehran lipid and glucose study

Objective

To quantify the association between ideal cardiovascular health (CVH) metrics and incident cardiovascular disease (CVD) including different subtypes [coronary heart disease (CHD), stroke, and sudden death], and all-cause mortality in an Iranian population.

Methods

The study population included 6,388 participants (2,726 men) aged 48.0 ± 12.4 years free of CVD at baseline. We utilized the American Heart Association’s 2020 impact target criteria of ideal, intermediate, and poor CVH. The multivariate Cox proportional Hazard model, adjusted for age, sex, educational level, marital status, and family history of CVD, was applied to estimate the hazard ratio (HR) of outcomes per one additional metric of ideal CVH metrics. Furthermore, the risk was also calculated for ideal and intermediate categories considering poor category as a reference.

Results

During the median follow-up of 11.26 years, 692 CVD, 589 CHD, 130 stroke, 111 sudden death, and 519 all-cause mortality events were reported. All of the individual ideal CVH metrics were independent predictors except intermediate physical activity level for CVD, BMI &lt; 25 kg/m2, and intermediate physical activity for all-cause mortality. Each additional metrics of ideal CVH decreased the risk by 31 (0.69, 0.65–0.73) for CVD, 32 (0.68, 0.64–0.73) for CHD, 31 (0.69, 0.60–0.80) for stroke, 25 (0.75, 0.64–0.88) for sudden death, and 13% (0.87, 0.81–0.93) for all-cause mortality events. Moreover, intermediate and ideal categories of CVH metrics were associated with lower risk for different CVD outcomes, i.e., 44 (0.56, 0.48–0.65) and 76% (0.24, 0.17–0.35) for CVD; 43 (0.57, 0.47–0.67) and 75% (0.25, 0.16–0.37) for CHD, 58 (0.42, 0.29–0.61) and 86% (0.14, 0.04–0.44) for stroke; 56 (0.44, 0.29–0.66) and 55% (0.45, 0.21–0.99) for sudden death; and 25 (0.75, 0.62–0.90) and 46% (0.54, 0.37–0.80) for all-cause mortality events, respectively. We also assessed the impact of changes in ideal CVH status from phase III to phase IV (2008–2011) on CVD events among 5,666 participants. Accordingly, compared to those remaining in the poor category, all of the changes in ideal CVH categories showed a lower risk for CVD events.

Conclusion

Among the Iranian population, meeting higher ideal CVH metrics is associated with a lower risk of different CVD events and mortality outcomes.

Assessing the effect of socioeconomic factors on prevalence of dyslipidemia among iranian adult population; district level analysis from 2016 STEPS national study using small area estimation

Background

Atherosclerotic Cardiovascular Disease (CVD) is the leading cause of death globally and dyslipidemia plays a critical role in the development of this condition. This study aimed to analyze the potential impact of socioeconomic factors on the prevalence of dyslipidemia at district level in Iran. Understanding these factors is important for development of future risk factor control programs.

Methods

We used the nationwide Iran STEPwise approach to risk factor Surveillance (STEPS) 2016 survey as a representative dataset on the Non-Communicable Diseases (NCDs) risk factors in Iran. To obtain a district level dyslipidemia estimates, we utilized the small area estimation method with a Bayesian spatial hierarchical multilevel regression and multilevel mixed models. The principal component analysis was applied to derive household wealth index. For evaluation of education, successful years of schooling was calculated at district level. Urbanization ratio was defined as the proportion of residents in the urban area to the urban and rural areas for each district.

Results

The highest difference was found for hypercholesterolemia coverage with 9.11 times difference among the lowest and highest prevalence across the country's district for males. Men with lower income, lower urbanization, and lower education levels had lower values of high-density lipoprotein (HDL) cholesterol, and higher level of hypercholesterolemia, and hypertriglyceridemia (P-value < 0.001). Triglyceride levels were directly correlated with all analyzed socioeconomic factors in both females and males (P-value < 0.001).

Conclusion

We demonstrated that there is an inverse relationship between socioeconomic levels and dyslipidemia indices as populations with higher socioeconomic levels consistently had higher mean dyslipidemia levels. Our findings provide an excellent fundamental framework for healthcare administrators and policymakers to set goals and pursue effective preventive strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01027-x.