Trends in Overweight, Obesity and Central Fat Accumulation among Tehranian Adults between 1998–1999 and 2001–2002: Tehran Lipid and Glucose Study

Association of quality and quantity of macronutrients intake with obesity, new anthropometric indices, lipid accumulation, and blood lipid risk index in Tehranian women

Background

This study examines the association between micronutrient intake, anthropometric indices, lipid accumulation, and blood lipid risk index among Tehranian women.

Methods

A cross-sectional study was conducted on 556 Tehranian women. Dietary intake was measured using a Food Frequency Questionnaire. Biochemical assessment and anthropometric indices were measured, and demographic information and physical activity were collected.

Results

Participants with the highest intake of carbohydrates were more prone to obesity. Conversely, those in the top tertile for protein intake had a lower likelihood of obesity and higher levels of lipid accumulation product (LAP). The highest fat consumers had a 63% decreased chance of having a high Castelli's Risk Index 1 (CRI-1). A higher glycemic index (GI) and glycemic load (GL) were linked to an increased probability of a high atherogenic coefficient (AC). Women in the top tertile of GL were significantly more likely to be obese and had lower odds for high LAP. Participants in the top tertile of aromatic amino acids/branched chain amino acids (AAA/BCAA) had significantly lower chances of high CRI-1 and a high atherogenic index of plasma (AIP). Those in the highest tertile of monounsaturated fatty acids/polyunsaturated fatty acids (MUFA/PUFA) had lower odds of obesity and high AIP.

Conclusions

The amount of carbohydrate (g) and protein intake (%), dietary GL, and the ratio of MUFA to PUFA were associated with obesity. The amount of fat intake (g) and AAA/BCAA indices were associated with CRI-1. LAP decreased with an increase in GL. AC increased with an increase in GI and GL. AAA/BCAA and MUFA/PUFA were associated with AIP.

Prevalence of overweight and obesity among Iranian population: a systematic review and meta-analysis

BACKGROUND

Obesity is a major risk factor for chronic diseases. Politicians and practitioners should be aware of the dramatic increase in obesity and its subsequent complications to prevent associated health risks. This systematic review aimed to provide better insight into the prevalence of overweight and obesity in the Iranian population.

METHOD

An evaluation was conducted on all published observational studies from both national (SID, Irandoc, Iranmedex) and international (Web of Knowledge, PubMed, Scopus) sources, which reported the prevalence of overweight/obesity among normal population samples, between January 2012 and December 2021.

RESULT

A total of 152 eligible studies were included in this meta-analysis. Of the 152 selected studies, 74 reported the prevalence of overweight/obesity in patients aged ≤ 18 years, and 61 studies in adults. In the rest of the articles (17 studies), the results were reported for a combination of these age groups. The prevalence of overweight and obesity in Iran was estimated at 20.1 (95% CI 17.92-22.30) and 13.44 (95% CI 11.76-15.22), respectively. This percentage (95% CI) was 11.71 (10.98-12.46) for overweight and 8.08 (7.02-9.22) for obesity in those aged ≤ 18 years, and 35.26 (32.61-37.99) for overweight and 21.38 (19.61-23.20) for obesity in those aged > 18 years. The overall prevalence of overweight and obesity in the entire population was 35.09% (95% CI 31.31-38.98).

CONCLUSION

As obesity is on the rise in Iran, we should seek both weight loss strategies and ways to control comorbidities associated with high BMI.

Dietary patterns derived using principal component analysis and associations with sociodemographic characteristics and overweight and obesity: A cross-sectional analysis of Iranian adults

Introduction

This study examined the cross-sectional association between household dietary patterns and sociodemographic characteristics and BMI in a nationally representative sample of Iranian adults.

Methods

Data on 6,833 households (n = 17,824 adults) from the National Comprehensive Study on Household Food Consumption Pattern and Nutritional Status 2001-2003 were used. Principal component analysis (PCA) was used to extract dietary patterns from three household 24-h dietary recalls. Linear regression analyses were used to examine associations between dietary patterns and sociodemographic characteristics and BMI.

Results

Three dietary patterns were identified: the first was characterized by high citrus fruit intake, the second by high hydrogenated fats intake and the third by high non-leafy vegetables intake. The first and third patterns were associated with household heads with higher education and living in urban areas, while the second was associated with household heads with lower education and living in rural areas. All dietary patterns were positively associated with BMI. The strongest association was found with the first dietary pattern (β: 0.49, 95% CI: 0.43, 0.55).

Discussion

While all three dietary patterns were positively associated with BMI, the sociodemographic characteristics of Iranian adults who consumed them differed. These findings inform the design of population-level dietary interventions to address rising obesity rates in Iran.

The sociocultural mechanism of obesity: The influence of gender role attitudes on obesity and the gender gap

Worldwide, women are more likely to be obese than men, but research on the mechanism of the gender gap in obesity is relatively lacking. This article uses five rounds of Chinese General Social Survey (CGSS) data from 2010 to 2017 to empirically test the impact of gender role attitudes on obesity and the gender gap and to explore the mechanism. The main results show that the traditional gender role attitude will improve the probability of obesity in women, but it will not positively impact obesity in men. Using the proportion of "March 8th red flag bearer" at the provincial level as an instrumental variable to alleviate the possible estimation errors caused by omitted variables, the results show that the lower the proportion of red flag bearers, the higher the probability of obesity of women, and still will not improve the probability of obesity of men. The robustness test based on the generalized propensity score method (GPSM) supports the above results. The mechanism analysis shows that economic status and market participation are two essential mechanisms of gender role attitudes and female obesity. Traditional gender role attitudes increase the risk of women's obesity by reducing their economic status and labour market participation.

Prevalence and Incidence Rate of Diabetes, Pre-diabetes, Uncontrolled Diabetes, and Their Predictors in the Adult Population in Southeastern Iran: Findings From KERCADR Study

Background: Diabetes mellitus is among the most serious health challenges worldwide. We assessed the prevalence of pre-diabetes (pre-DM) and diabetes (DM), the effectiveness of diabetes management, the 5-year incidence rate, and associated variables in the adult population in southeastern Iran. Methods: In a random cluster household survey (2014-2018), 9,959 adult individuals aged 15-80 years were assessed for coronary artery disease risk factors, including diabetes mellitus in Kerman (KERCADRS, phase 2). Among these people, 2,820 persons had also participated in phase 1 of the study 5 years earlier (2009-2011). Univariable and multivariable survey logistic regression models were used to identify the potential predictors of diabetes and pre-diabetes. Results: The prevalence of pre-DM was 12% (males 13.2% vs. females 11.1%), steadily increasing from 7.1% in the 15-24 years group to 18.4% in the 55-64 years group. The prevalence of DM was 10.2% (male and female, 7.9 and 10.8%, respectively), of which 1.9% were undiagnosed. DM was diagnosed in 10.6% of educated and 15.1% of illiterate people. The prevalence of diagnosed DM was lower in smokers (5.2 vs. 8.7%) and dependent opium users (5.4 vs. 8.8%). The prevalence of uncontrolled DM (HbA1c > 7%) was 48.8%, increasing with age. The frequency of uncontrolled DM among people without and with treatment was 32 and 55.9%, respectively. Illiterate people had worse uncontrolled DM (55.6 vs. 39.6%). The 5-year incidence rate (persons/100 person-years) was 1.5 for pre-DM and 1.2 for DM, respectively. The lowest and the highest incidence rate of DM belonged to the 15-34 years old group (0.5) and dependent opium users (2.4). The incidence rate was found to have a direct relationship with BMI and a reverse relationship with physical activity. Conclusion: Pre-DM and DM affected 22.2% of the population. One-third of patients with diabetes had undiagnosed DM, and in 55.9% of people with diagnosed DM, treatment had been ineffective. Appropriate health interventions are needed to reduce the prevalence and health consequences of diabetes in the region.

Prevalence of overweight and obesity in Iranian population: A population-based study in northwestern of Iran

BACKGROUND

Overweight and obesity and its problems are the most important health and nutrition issues of adolescents in developed and developing countries. This study aimed to determine prevalence of overweight and obesity among studied population.

DESIGN AND METHODS

This Persian Cohort Study is a population-based study of 10,000 men and women, aged 35-70 years in northwest of Iran. Anthropometric parameters such as height, weight, waist circumference and hip circumference were measured by interviewers. Body Mass Index (BMI) and waist-to-hip ratio (WHR) were used to assess the overweight and obesity.

RESULTS

The mean age of all participants was 49.1±8.7 and 56.1% of them were female.  The mean height of participants was 162.5±9.4 kg in range 126-196 and the mean weight of them was 78.5±13.1 cm in range 40-164. According to BMI, 42.7% of all participants had overweight and 45% had obesity. According to the WHR, 71.8% of male and 97.9% of female had high WHR (abdominal obesity).

CONCLUSIONS

Results showed that the rate of overweight and obesity in studied people was more than country rate. So programing for raising their Quality of Life (QoL) and life style and also change their poor nutritional habits is essential in area healthy people.

Dietary diversity and food security status among heart failure patients in the north of Iran

Background

Dietary diversity score (DDS) is an indicator for assessing nutritional adequacy. Food security is another important measure in nutrition field which can be associated with several cardiovascular risk factors. Considering the importance of nutrition in heart failure (HF) patients, this study was designed to evaluate the DDS and food security of patients with HF.

Methods

A total of 200 HF patients were enrolled. DDS was evaluated using valid and reliable food frequency questionnaire and was calculated by scoring food intakes as 5 main groups. Household food insecurity access scale was applied to assess food security status. Data were analyzed using descriptive statistics, Chi-square and Kruskal-Wallis tests and multiple logistic regression models.

Results

The mean age of patients was 65 (standard deviation: 12) years and 59% of patients were male. Median of DDS was 1.96 (range: 0.29 to 6.12). Adjusted odds of greater DDS (> = median of 2) was 2.58 times higher for patients without hypertension than for patients with hypertension (95%CI: 1.31–5.08, P = 0.006). Also, odds of greater DDS were more in ex-smokers’ patients when compared to non-smokers (adjusted odds ratio (AOR): 2.70, 95%CI: 1.27–5.75, P = 0.010), patients with supplement use (AOR: 2.42, 95%CI: 1.16–5.05, P = 0.019), patients with lower total cholesterol level (AOR: 1.01, 95%CI: 1.00–1.02, P = 0.051), and patients with higher ejection fraction (AOR: 1.03, 95%CI: 1.00–1.05, with borderline.

P = 0.073). About 57% of patients had experienced degrees of food insecurity as mild (26%), moderate (16%) and severe (15%). On the other hand, women (AOR: 1.90, 95%CI: 0.90–3.71, with borderline P = 0.061) and patients with middle (AOR: 3.48, 95%CI: 1.79–6.76, P < 0.001) or high (AOR: 20.32, 95%CI: 2.56–161.19, P = 0.004) socio-economic status were more likely to be food secure or mild insecure. Also, no relation between DDS and food security was found (r = − 0.08, P = 0.262).

Conclusion

This study found that HF patients had a low DDS and more than half of the patients were food insecure to some extents.

Food insecurity status and associated factors among rural households in the north of Iran

BACKGROUND

Iran has been experiencing an accelerated change in the nutrition and health of its people, which has led to considerable variations in the country's nutritional status. Little is known about the food insecurity status in the north of Iran.

AIM

The present study aimed to investigate the food insecurity status and factors associated with it in a rural area in the north of Iran.

METHODS

This cross-sectional study was conducted among 573 rural households in Guilan Province in the north of Iran. The food insecurity status of the households was measured using the Household Food Insecurity Access Scale. Data on the demographic characteristics of the households and their depression status were collected by interviewing the heads of the households. The socioeconomic status index of the households was constructed using factor analysis, and a multivariate ordinal logistic regression model was used to estimate the adjusted odds ratio of the independent predictors of food insecurity.

RESULTS

The results indicated that approximately half of the households (50.8%) had experienced mild (43.2%), moderate (6.5%) or severe (1.1%) food insecurity. The multivariate model showed that sex, age, depression status of the head of the household and having a patient with a chronic condition in the household were independently associated with food security status.

CONCLUSIONS

This study showed that food insecurity was highly prevalent among rural households in the north of Iran. The study concludes that interventions with the aim of reducing the prevalence of food insecurity, depression and chronic diseases in the area can be effective in improving the nutritional status of the households.

The association between dietary glycemic index and load and risk of gestational diabetes mellitus: A prospective study

AIMS

This study aimed to investigate the association between dietary GI and GL and risk of GDM in a group of pregnant women in Iran.

METHODS

A number of 812 pregnant women were recruited in their first trimester in a prospective study. A validated 117-item semi-quantitative food frequency questionnaire was used to assess usual dietary intakes of participants at study baseline. Dietary GI and GL were calculated based on earlier publications. GDM was diagnosed based on the results of a fasting plasma glucose concentration and a 50-g, 1-h oral glucose tolerance test at 24-28 weeks of gestation. Cox proportional hazards model was used to compute relative risks (RRs) and 95% confidence intervals (CI) for GDM.

RESULTS

Mean ± SD of age and BMI of study participants was 29.4 ± 4.84 y and 25.14 ± 4.08 kg/m², respectively at study baseline. Mean ± SD of dietary GI was 58 ± 7 and that of dietary GL was 176 ± 42. Overall, 28.4% (n = 231) of study population developed GDM at weeks 24-28 of pregnancy. After adjustment for potential confounding variables, we found that women in the highest tertile of dietary GL were 43% more likely to develop GDM than those in the lowest tertile (95% CI: 1.01, 2.00; P-trend = 0.03). However, no significant association was seen between dietary GI (RR for the highest tertile compared to the lowest: 0.85; 95% CI: 0.61, 1.20; P-trend = 0.37), and risk of GDM.

CONCLUSIONS

We found that women with the highest dietary GL were at a greater risk of developing GDM during pregnancy. No significant association was seen between dietary GI and risk of GDM.

The prevalence of metabolic syndrome in cardiovascular patients in Iran: a systematic review and meta-analysis

BACKGROUND

Cardiovascular disease is the cause of more than 50% of mortalities globally, and this rate has grown by 8.6% since the 60 s. One of the risk factors associated with cardiovascular disease and its resulting mortality rate is the metabolic syndrome. Different studies have reported inconsistent rates for the metabolic syndrome. However, no comprehensive study has been conducted to combine the results of existing studies. Thus, the present study was performed with the aim of determining the prevalence of metabolic syndrome among cardiovascular patients in Iran through a systematic review and meta-analysis.

METHOD

In this review study, the Scientific Information Database, Google Scholar, Science Direct, Scopus, PubMed, and Web of Science (ISI), databases were searched from January 2005 and until May 2020, to identify and extract related articles. To conduct the analysis, a random effects model was used, and the heterogeneity of the studies was examined using the I² index. Data analysis was performed within Comprehensive Meta-Analysis (version 2) software.

RESULTS

The prevalence of metabolic syndrome in cardiovascular patients in Iran in the 27 papers examined with a sample size of 44,735 patients was 34.2% (95% CI: 26.8-42.6%). A sensitivity analysis was performed to ensure the stability of the results, these results show that by omitting the prevalence from each study, the overall prevalence (34.2%) does not change significantly. the highest prevalence of metabolic syndrome in studies conducted in the period between 2015 and 2020, and this was reported as 55.3 (95% CI: 47.9-62.3) and the highest prevalence of metabolic syndrome in studies conducted in the methods of diagnosis IDF, and the rate was reported as 48 (95% CI: 36.5-59.8). based on meta-regression as the year of research increased, the prevalence of metabolic syndrome in cardiovascular patients in Iran also increased. However, with the increase in sample size, this prevalence decreased (p < 0.05).

CONCLUSIONS

The results of this study indicate that metabolic syndrome is high in cardiovascular patients in Iran. Accordingly, by understanding its etiology and supervision at all levels, suitable solutions could be offered by providing feedback to hospitals.

Association of physical activity, body mass index and reproductive history with breast cancer by menopausal status in Iranian women

BACKGROUND

The incidence rate of breast cancer (BC) is increasing in low- and middle-income countries (LMICs), including Iran. We investigated the association between BC risk and physical activity (PA), body mass index (BMI), and reproductive history among Iranian women.

METHODS

We conducted a large hospital-based case-control study and compared 958 BC cases with 967 controls at the Cancer Institute of Iran during 2011-2016. We used multiple logistic regression models and adjusted for potential confounders to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for the associations between BC and different risk factors, including low physical activity.

RESULTS

Women with high levels of physical activity had a lower risk of BC compared to those who were inactive (OR = 0.55, 95%CI: 0.41, 0.75). In premenopausal women, the association was observed only in normal-weight women (OR = 0.31, 95%CI: 0.13, 0.75), while it was limited to obese women in the postmenopausal group (OR = 0.29, 95%CI: 0.12, 0.66). We found a high risk of postmenopausal BC among overweight (OR = 1.69; 95%CI: 1.01, 2.81) and obese women (OR = 1.9; 95%CI: 1.14, 3.14) compared to women with a normal BMI. We observed an inverse association among postmenopausal women who had between three and five children (OR = 0.31, 95%CI 0.14, 0.64) and more than six children (OR = 0.21, 95%CI 0.12, 0.42) compared to nulliparous women.

CONCLUSIONS

Low levels of physical activity, low parity, and being overweight or obese were major risk factors for BC. For the first time, we report a strong association between physical activity and BC risk in Iranian women.

Association of low-carbohydrate diet score with overweight, obesity and cardiovascular disease risk factors: a cross-sectional study in Iranian women

Introduction: This study aimed to determine the association of low-carbohydrate-diet score with overweight, obesity and cardiovascular risk factors among Iranian women. Methods: In healthy Iranian women 20-50 years, demographics, anthropometrics, physical activity, blood pressure, fasting blood glucose, blood lipids, and dietary intake (using a validated food frequency questionnaire) were assessed. Participants were divided into deciles of macronutrient intakes. Women in the lowest decile of carbohydrate intake received a score of 9 and women in the highest decile received a score of 0. For protein and fat intakes, women in the lowest decile received a score of 0 for that macronutrient and those in the highest decile received the score of 9. Macronutrient scores were summed to create the low-carbohydrate diet score and women were grouped into tertiles based on these scores. Continuous and qualitative variables were compared among the low-carbohydrate-diet score by one-way ANOVA and chi-square test, respectively. Logistic regression was used to determine the association of low-carbohydrate-diet score and cardiovascular risk factors. Results: A total of 209 women were included in the study. Socioeconomic status significantly increased from tertile 1 to 3 of the low-carbohydrate diet score (P = 0.02). Total dietary glycemic index (GI) significantly differed among tertiles (tertile 1 GI: 63.1 ±0.50, tertile 2 GI: 61.9 ± 0.5, tertile 3 GI: 59.5 ± 0.5; P < 0.001). The odds ratios for overweight, obesity and cardiovascular risk factors were not significantly different among the tertiles of low-carbohydrate diet score. Conclusion: In Iranian women, diets lower in carbohydrate and higher in protein and fat were not associated with overweight, obesity and cardiovascular risk factors.

Sex specific impact of different obesity phenotypes on the risk of incident hypertension: Tehran lipid and glucose study

Background

To investigate the association between different obesity phenotypes and the risk of incident hypertension among both genders.

Methods

The study population included 3659 Iranians (men = 1540), aged ≥20 years free of hypertension at baseline. Participants were classified into six categories of body mass index (BMI)-metabolic health status, in which unhealthy metabolic status was defined based on the presence of > 1 component of metabolic syndrome (MetS) using the joint interim statement (JIS) criteria or the presence of insulin resistance (IR). The association between different obesity phenotypes and incident hypertension was assessed using multivariate Cox's proportional hazard models adjusted for age, current smoking, low physical activity, diabetes mellitus, family history of premature cardiovascular disease, estimated glomerular filtration rate, phase of recruitment, BMI and systolic blood pressure, considering metabolically healthy normal weight group as the reference.

Results

After a median follow-up of 11.6 years 1122 participants (men = 493) experienced hypertension. Using JIS criteria, a significant higher risk of hypertension was observed among metabolically healthy obese and well as metabolically unhealthy groups among men in the age adjusted model; however, a significant higher risk in the fully adjusted model was seen among women in the metabolically healthy obese [hazard ratio (HR) 95% confidence interval (CI) 1.96(1.16-3.32)] as well as metabolically unhealthy normal weight [1.98(1.37-2.86)], overweight [2.08(1.49-2.90)] and obese [2.06(1.27-3.30)] groups. Using insulin sensitive normal weight group as the reference, among men, being overweight or obese with and without IR was significant predictors of incident hypertension in the age adjusted model; however, among women, insulin resistant overweight [1.46(1.06-2.02)] and obese groups, [1.63(1.01-2.62)] showed significant risk in the fully adjusted model.

Conclusion

We concluded that first, there was significant difference between genders in the associations between obesity phenotypes and incident hypertension. Second, in general, metabolic status defined by MetS components as compared to IR could do better in identifying high risk women for hypertension. Third, women populations who are metabolically healthy obese using MetS definition or those with either > 1 component of metabolic syndrome or overweight/obese ones with IR should be prioritized for implementing urgent preventive strategies against hypertension focusing on lifestyle changes.

Pattern of some risk factors of cardiovascular diseases and liver enzymes among Iranian seafarers

Background: Little information is available on the trend in cardiovascular risk factors and hepatic enzymes in Iranian seafarers. The present study aimed at assessing the pattern of obesity, hypertension, diabetes, elevated serum glutamic oxaloacetate transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) in Iranian seafarers during 2010 to 2014.

Methods: Data on cardiovascular risk factors and hepatic enzymes were extracted from seafarers’ annual health examination of National Iranian Tanker Company (NITC) of 2010, 2012, and 2014. The repeated measure ANOVA was used to compare continuous variables across 3 years. Categorical data were analyzed using Chi-square test. Over weight was defined as BMI (Body Mass Index) >25 kg/m²; obesity was defined as BMI>=30 kg/m²; hypertension was defined as systolic blood pressure (SBP)> 140 mmHg, and diastolic blood pressure (DBP)> 90 mmHg, or a history of antihypertensive drug use. Diabetes (DM) was defined as fasting blood sugar (FBS) > 110 mg/dl, or having a history of oral hypoglycemic agents; and elevated SGOT and SGPT were defined as SGOT > 40 U/L and SGPT > 40 U/L, respectively.

Results: The BMI mean±SD values of Iranian seafarers were 24.81±3.07 kg/m², 25.51±2.96 kg/m², and 25.96 ± 3.02 kg/m² in 2010, 2012, and 2014, respectively. A significant difference was observed in BMI over the study period. The mean of systolic and diastolic blood pressure did not significantly increase over time. The SGOT and SGPT means were not significantly different from 2010 to 2014. The prevalence of overweight increased significantly from 46.7% to 60.9% over the study period; however, the prevalence of obesity, hypertension, elevated SGOT, and elevated SGPT did not change significantly.

Conclusion: The current survey showed that the obesity problem has increased among Iranian seafarers working on tankers, which is a concerning problem because obesity has negative effects on seafarers’ health.

Different Weight Histories and Risk of Incident Coronary Heart Disease and Stroke: Tehran Lipid and Glucose Study

Background

This study aimed to determine the association between different weight histories, including cumulative excess weight, cumulative excess waist circumference (WC), duration of general and central adiposity, current and maximum body mass index, and current and maximum WC, and incident coronary heart disease (CHD) and stroke.

Methods and Results

The study population consisted of 4398 adults aged ≥40 years without CHD or stroke at baseline. Associations between different weight histories and CHD and stroke were determined by multivariable time‐varying Cox regression models after adjustment for age, sex, and time‐varying confounders. Further adjustment was also done for mediators (eg, diabetes mellitus, hypercholesterolemia, and hypertension). During median follow‐up of 13.9 years, 718 incident CHD and 158 stroke events were documented. Multivariable adjusted hazard ratios (HRs) were calculated in the sex and confounder adjusted model for CHD per 1‐SD increase in cumulative excess weight (HR: 1.02; 95% confidence interval [CI], 0.96–1.07), cumulative excess WC (HR: 1.14; 95% CI, 1.04–1.24), duration of general adiposity (HR: 1.00; 95% CI, 0.92–1.08), duration of central adiposity (HR: 1.01; 95% CI, 0.93–1.09), current body mass index (HR: 1.03; 95% CI, 0.99–1.07), current WC (HR: 1.21; 95% CI, 1.11–1.32), maximum body mass index (HR: 1.01; 95% CI, 0.95–1.07), and maximum WC (HR: 1.17; 95% CI, 1.07–1.28). After further adjustment for mediators, current and maximum WC still showed a significant risk (HR: 1.13 [95% CI, 1.03–1.23] and 1.09 [95% CI, 1.00–1.20], respectively). Moreover, in the sex and confounder adjusted model, cumulative excess WC and maximum WC were associated with higher risk of stroke (hazard ratio: 1.21 [95% CI, 0.99–1.48] and 1.25 [95% CI, 1.02–1.55], respectively).

Conclusions

Exposure to cumulative excess weight and cumulative excess WC confers little additional risk beyond their current and maximum values. Even current and maximum WC were associated with incident CHD in the presence of obesity mediators, and the latter was a significant predictor of stroke in the presence of confounders.

Factors related to reduction in the consumption of fast food: application of the theory-based approaches

Background

The Trans-Theoretical model (TTM) and Theory of Planned Behaviour (TPB) may be promising models for understanding and predicting reduction in the consumption of fast food. The aim of this study was to examine the applicability of the Trans-Theoretical model (TTM) and the additional predictive role of the subjective norms and perceived behavioural control in predicting reduction consumption of fast food in obese Iranian adolescent girls.

Materials and Methods.

A cross sectional study design was conducted among twelve randomly selected schools in Sabzevar, Iran from 2015 to 2017. Four hundred eighty five randomly selected students consented to participate in the study. Hierarchical regression models used to predict the role of important variables that can influence the reduction in the consumption of fast food among students. using SPSS version 22.

Results

Variables Perceived behavioural control (r=0.58, P<0.001), Subjective norms (r=0.51, P<0.001), self-efficacy (r=0.49, P<0.001), decisional balance (pros) (r=0.29, P<0.001), decisional balance (cons) (r=0.25, P<0.001), stage of change (r=0.38, P<0.001), were significantly and positively correlated while experiential processes of change (r=0.08, P=0.135) and behavioural processes of change (r=0.09, P=0.145), were not significant.

Conclusions

The study demonstrated that the TTM (except the experiential and behavioural processes of change) focusing on the perceived behavioural control and subjective norms are useful models for reduction in the consumption of fast food.

Obesity and its socioeconomic determinants in Iran

OBJECTIVE

To investigate the socioeconomic inequality of obesity and its determinants in Iran.

METHODS

Data was from Iran's surveillance system for risk factors of non-communicable diseases which was conducted on 89,400 individuals aged 15-64 years in 2005. Principal component analysis was used to create a new variable for defining socioeconomic status of participants. We assessed inequality by calculating a slop index of inequality and concentration index for obesity. Oaxaca-Blinder decomposition analysis was used to determine the determinants of inequality.

RESULTS

The slop index of inequality and concentration index for obesity was -13.1 (95% Confidence Intervals [CI]: -16.3 to -9.8) percentage points and -0.123, respectively. The level of inequality varied widely between different provinces in Iran and was more severe in women and urban population. Obesity persisted in 20.2% (95% CI: 19.4-20.9) of the low-socioeconomic group and 11.0% (95% CI: 10.5-11.6) of the high-socioeconomic group. More than 90% of this gap was due to differences of independent variables (mainly age, gender and marital status) in two socioeconomic status groups.

CONCLUSIONS

A pro-rich inequality existed in the obesity in Iran. Older age, female gender and rural residency contributed most to the economic inequality of obesity.

Trends of contraception use among married reproductive age women: Tehran lipid and glucose cohort study 2002-2011

OBJECTIVES

This study aimed to examine the trends of contraception use among married reproductive age women in Tehran Lipid and Glucose study between 2002 and 2011.

METHODS

This analysis investigated a proportion of women users and non-users of family planning, using data from 10year population-based Tehran Lipid Glucose Study from surveys conducted in 2002, 2005, 2008, and 2011. Of the 6813, 6993, 7077, and 6789 women in the four phases mentioned, 34.1%, 33.9%, 33.5% and 35% of participants in each phase preferred to use contraception. Number of participants studied were 2506 women in 2002, 2529 women in 2005, 2594 women in 2008 and 2525 women in 2011.

RESULTS

Types of methods and patterns of change in contraception differed across time. The percentage of women using traditional methods increased significantly from 25.7% in 2002 to 34.6% in 2011 (p value for trend=0.001). Accordingly, modern contraception use showed a reverse trend. From 2002 to 2011, 61.4%, 61%, 57.7%, and 51% of married women reported currently using various modern contraceptives, respectively (p value for trend=0.001). The proportion of users relying on condoms showed a significant increase during this decade, being 10.9% in 2002, 15.2% in 2005, 20% in 2008 and 21.9% in 2011. The prevalence of non-users for contraception was generally low; 12.7%, 8.2%, 8% and 14.3%, respectively from 2002 to 2011, but increased significantly across time (p=0.005) CONCLUSION: Relying on less effective contraceptive methods has increased rapidly among women in the Tehran Lipid and Glucose cohort study, a trend that could be a warning to policy makers about the possibility of higher unsafe abortion and maternal mortality/morbidity rates in the near future.

General and Central Obesity in Two Iranian Ethnic Groups Living in Urmia, West Azerbaijan, Iran: Effect of the Neighborhood Environment

BACKGROUND

Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight status of the residents.

OBJECTIVES

To assess the relationship between general and central obesity and the neighborhood environment in two ethnic groups (Azeri Turks and Kurds) living in Urmia city, Northwestern Iran.

PATIENTS AND METHODS

In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and a health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with general and central obesity was analyzed by a logistic regression model.

RESULTS

Three common neighborhood environments were identified: 1) modern-affluent, 2) central-high access and 3) marginal. These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results. However, after adjustment for educational level, the association was not significant.

CONCLUSIONS

The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran

Objective

To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran.

Design

A cross-sectional study.

Setting

All four geographical zones of Urmia city.

Subjects

Participants (n 723; 427 women and 296 men), aged 20–64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds).

Results

Three major dietary patterns were extracted: ‘Traditional High SES’ (THS), ‘Traditional Low SES’ (TLS) and ‘Transitional’. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The ‘Transitional’ pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level.

Conclusions

Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Detecting overweight and obesity among young Syrian boys based on skinfold thickness

There is no data on the prevalence of overweight and obesity in young Syrian boys. Therefore, the present study aimed to provide baseline and reference data on the prevalence of overweight and obesity among young Syrian boys using skin-fold thickness measurements and deuterium dilution (DD) as a reference method. The sample of 2470 healthy Syrian 18- to 19-year-old boys were enrolled in this study. SFTs were measured at the biceps (B), triceps (T), subscapular (SI) and suprailiac locations (SS) were done and validated using the DD technique as a reference method. Receiver operating characteristics (ROC) curve was drawn to determine appropriate cut-off points of the Σ2 limb SFT (T+B), Σ2 trunk SFT (SI+SS), Σ4 SFT (T+B+SI+SS) and Log Σ4 SFT for defining overweight and obesity. The overall prevalence of overweight and obesity in young Syrian boys, based on biceps SFT, triceps SFT, subscapular SFT, suprailiac SFT, Σ2 limb SFT, Σ2 trunk SFT, Σ4 SFT, logarithm Σ4 SFT, and DDT were 35.3%, 32%, 31.6%, 14.8%, 32.9%, 26.6%, 28.1%, 24.1%, 46.5%, respectively. Strongly positive correlation was found between SFT and total body fat in adolescents. For diagnosing overweight on the basis of Σ2 limb SFT, Σ2 trunk SFT, Σ4 SFT and logarithm Σ4 SFT, we propose the following cut-off points: 17.25 mm, 23.50 mm, 39.25 mm and 1.60, respectively. To predict obesity, Σ2 limb SFT, Σ2 trunk SFT, Σ4 SFT and logarithm Σ4 SFT threshold were increased to 23.25 mm, 32.50 mm, 55.25 and 1.75, respectively. Basing on SFT clearly leads to underestimates of the prevalence of weight problems among young boys. SFT measurement screen missed 11.2 to 31.7% of overall overweight and obesity cases.

Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes and its predictors in general population aged 15 to 75 years: A community-based study (KERCADRS) in southeastern Iran

BACKGROUND

The goal of this research was to measure the age-sex standardized prevalence of pre-diabetes (pre-DM) and diabetes (DM), and the effectiveness of diabetes management (using HbA1C as the indicator) in an urban area in Iran.

METHODS

Using a randomized cluster household survey, we recruited 5900 individuals whose age ranged from 15 to 75 from Kerman for assessing coronary artery disease risk factors (KERCADRS) including diabetes. In 2010 and 2011, all of the participants were interviewed by trained staff for medical history and physical activities, and were then examined for blood pressure and anthropometric measures. Venus blood sample was also collected for fasting plasma glucose and HbA1c.

RESULTS

The age-sex standardized prevalence of pre-diabetes, diagnosed and undiagnosed was 18.7%, 6.3% and 2.7%, respectively. Diabetes increased by age (from 14.7% in the 15-24 years old group to 28.4% in the 65-75 years old group), particularly after 40 years. Occasional opium users had the highest prevalence of Pre-DM (34.6%). Seventy-nine percent of the depressed and 75.5% of the anxious participants with diagnosed-DM were identified as uncontrolled-DM. More than 60% of diagnosed diabetic cases had impaired HbA1c. Overweight and obesity (adjusted odds ratio (AOR) 1.6) and low physical activity (AOR 1.5) were the most preventable risk factors associated with diabetes.

CONCLUSION

Considerable prevalence of diabetes, susceptibility in progressing to diabetes and uncontrolled diabetes among individuals living in Kerman, suggested ineffective prevention and treatment of diabetes in urban areas in Iran. Successful experience regarding primary health-care in rural areas should be expanded to urban settings.

Type 2 diabetes mellitus incidence in Chinese: contributions of overweight and obesity

AIMS

To estimate the incidence of Type 2 diabetes mellitus (T2DM) and the number of those with T2DM attributable to overweight and obesity in China.

METHODS

We conducted a prospective cohort study among 15680 participants (46.4%, men) aged 35-74 years. The mean duration of follow-up was 8.0 years. We examined the relationship between overweight, obesity and risk of T2DM by Cox proportional hazards models. Population attributable risk (PAR) of overweight and obesity was also calculated. Moreover, we estimated the number of T2DM events attributed to overweight and obesity using PAR, incidence of T2DM and the population size of China in 2010.

RESULTS

During a mean follow-up of 8.0 years, the age-standardized incidence of T2DM was 9.5 per 1000 person-years in men and 9.2 in women. Overweight accounted for 28.3% (95% confidence interval [CI]: 20.1, 36.2) of incident T2DM among men and 31.3% (95% CI: 25.5, 36.9) among women. The corresponding PAR of obesity was 10.1% (95% CI: 6.0, 14.2) among men and 16.8% (95% CI: 12.0, 21.6) among women. Approximately 3.32 million (95% CI: 2.47, 4.24) incident T2DM were attributable to overweight and obesity in Chinese adults who were 35 to 74 years in 2010.

CONCLUSION

Our results indicate that incident T2DM is mainly attributable to overweight and obesity in China. It is extremely important to advocate healthy lifestyle and prevent excessive weight gain for reducing T2DM burden in China.

High prevalence of type 2 diabetes and pre-diabetes in adult Zoroastrians in Yazd, Iran: a cross-sectional study

Background:

The prevalence of type 2 diabetes mellitus (T2DM) varies among ethnic groups. We aimed to estimate the prevalence of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) for the first time in an ethnic population, specifically Zoroastrian citizens in Yazd, Iran whose ages were 30 or older.

Methods:

In a cross-sectional study, participants aged≥30 years were selected using systematic random sampling. An inventory, including socio-demographic data, was completed. Weight, height, body mass index (BMI), and blood pressure (BP) were measured using standard methods. Also, blood levels of glucose, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), urea, creatinine (Cr), and uric acid were measured. The latest criteria established by the American Diabetes Association (ADA) were used to diagnose DM.

Results:

The mean age of the participants (n=403) was 56.9±12.8 years. The total prevalence of diabetes, including previously diagnosed and undiagnosed diabetes, IFG, and IGT was 26.1%, 18.6%, 7.5%, 34.7% and 25.8%, respectively. Participants with diabetes had higher fasting blood sugar (FBS) (P<0.001), oral glucose tolerance test (OGTT) (P<0.001), urea (P=0.019), BMI (P=0.001), systolic blood pressures (P<0.001), TG (P=0.007) and lower HDL (P=0.034) than patients with IFG, IGT, and normoglycemic subjects.

Conclusions:

The current study showed a high prevalence of T2DM in the Zoroastrian population of Yazd, Iran. One-third of the total cases with diabetes were undiagnosed.

Prevalence of obesity and overweight in adults and children in Iran; a systematic review

BACKGROUND

Obesity is one of the most important underlying risk factors for chronic disease. Dramatically increasing and following complication of obesity should be alerted to health politicians and practitioners to prevent associated health risks. This review aimed to give a better insight into the prevalence of obesity and overweight in different areas of Iran.

METHOD

All published internal (SID, Irandoc, Iranmedex), and international (Web of Knowledge, Pubmed, Scopus) source studies, reported the prevalence of overweight/obesity among normal population samples, during Jan 2005 through Jan 2014, were assessed in this review. Paper selection processes were done by two researchers separately. Studies which met the eligible criteria were included in this review.

RESULT

One hundred ninety three eligible studies enter into our review. Of 193 final selected studies, 86 (15 national, 71 sub national) of them were reported the prevalence of obesity/overweight in adult, and 107 studies (11 national, 96 sub national) in under-18 by individual. The range of overweight and obesity prevalence in national studies in adult, was 27.0-38.5 (95% CI: 26.8-27.1, 37.2-39.8), and 12.6-25.9 (95% CI: 12.2-13.0, 24.9-26.8), separately. In under-18 the range of overweight and obesity prevalence in national studies were 5.0-13.5 (95% CI: 4.5-5.5, 13.4-13.6), and 3.2-11.9 (95% CI: 3.0-3.4, 11.3-12.4).

CONCLUSION

Obesity as an important public health problem has been discussed in recent few decades worldwide. Although the national reported prevalence of obesity in Iran was not considerably diverse, but remarkable differences were seen in the sub national prevalence which must be noticed more in political health programs especially among women and children.

Impaired enzymatic antioxidant defense in erythrocytes of women with general and abdominal obesity

OBJECTIVE

The aim of this study was to investigate erythrocyte antioxidant enzyme activities in general and abdominal obese women.

METHODS

In this study, 160 women 20-45 years old were randomly selected. General information data were gathered from each sample using questionnaires and face-to-face interviews. Activities of erythrocyte antioxidant enzymes were also evaluated by measuring activities of copper zinc-superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) in selected subjects.

RESULTS

Mean activity of CuZn-SOD was significantly lower in overweight and obese groups compared to normal weight group (721 ± 81 vs. 987 ± 84, p < 0.01 and 638 ± 74 vs. 987 ± 84, p < 0.001, respectively). Furthermore, both erythrocyte GSH-Px (97.6 ± 45.2 vs. 148.7 ± 54.2, p < 0.01) and CAT (184.2 ± 37.8 vs. 316.7 ± 65.8, p < 0.01) activities was significantly lower in obese women compared to normal weight women. In addition, women with abdominal obesity had lower erythrocyte CuZn-SOD (632 ± 76 vs. 871 ± 84, p < 0.001), GSH-Px (103.6 ± 52.8 vs. 154.7 ± 62.4, p < 0.01) and CAT (216.6 ± 76.4 vs. 298.3 ± 71.1, p < 0.05) activities compared to women with normal body fat distribution. Moreover, multiple linear regression analysis suggests higher prediction of waist circumference (i.e. higher R(2)) on antioxidant enzyme activities in relation to other adiposity indicators.

CONCLUSION

Our results provides further evidence suggesting that obesity and, especially, abdominal adiposity associated with decreased antioxidant enzyme activities which in turn, may contribute to oxidative stress related to obesity.

Association of nutritional status with quality of life in breast cancer survivors

Nutritional status and dietary intake play a significant role in the prognosis of breast cancer and may modify the progression of disease. The aim of this study was to determine the influence of nutritional status on the quality of life of Iranian breast cancer survivors. Cross-sectional data were collected for 100 Iranian breast cancer survivors, aged 32 to 61 years, attending the oncology outpatient clinic at Golestan Hospital, Ahvaz, Iran. Nutritional status of subjects was assessed by anthropometric measurements, Patient-Generated Subjective Global Assessment (PG-SGA) and three non-consecutive 24-hour diet recalls. The European Organization of Research and Treatment of Cancer Quality of Life form (EORTC QLQ-C30) was used to assess quality of life. Ninety-four percent of the survivors were well-nourished, 6% were moderately malnourished or suspected of being malnourished while none were severely malnourished. Prevalence of overweight and obesity was 86%. Overall, participants had an inadequate intake of vitamin D, E, iron and magnesium according to dietary reference intake (DRI) recommendations. Survivors with better nutritional status had better functioning scales and experienced fewer clinical symptoms. It appears important to provide educational and nutritional screening programs to improve cancer survivor quality of life.

Overweight and obesity and related factors in urban Iranian population aged between 20 to 84 years

BACKGROUND

Obesity is one of the most common health problems in the world and is assuming epidemic proportions in both developed and developing countries.

AIM

The present study aimed to provide population-based data on the prevalence of obesity and estimation the risk of some of demographic factors associated with obesity.

SUBJECTS AND METHODS

From May 2007 through December 2008, we conducted a community-based cross-sectional survey on 3,000 males and females (age ≥ 20 years) in Tehran province. Respondents were asked to give their height and weight in the questionnaire. Body mass index (BMI) is recognized as the measure of overall obesity and calculated as body weight divided by the square body height in meters (kg/m(2)).

RESULTS

The overall prevalence of overweight and obesity was 34.1% (924/2708) and 15.4% (417/2708). The combined prevalence of both overweight and obesity was 51.2% (1387/2708) in males and 57.5% (1557/2708) in females. The mean (SD) BMI for the total population studied was 26.14 (4.71) and it was higher in women than in men (P < 0.001). The overall prevalence of overweight and obesity was 39.5% (376/952) and 11.7% (111/952) in men and 36.9% (548/1458) and 20.6% (306/1458) in women. The multivariate-adjusted odds ratios of obesity showed that higher ages, females, married and low educated subjects had more chance to being obese.

CONCLUSION

This population-based cross-sectional survey indicates that the prevalence of overweight and obesity are moderately high in the general Iranian population and must be considered as a significant public health problem at national level especially among women.

Correlation between Body Mass Index and Central Adiposity with Pregnancy Complications in Pregnant Women

BACKGROUND

The prevalence of obesity is increasing throughout the world.Obesity assessed by body mass index (BMI) has shown to be associated with gestational complications while the relationship using waist circumference (WC) is not clear yet. The present study was aimed to determine the relationship between WC and adverse pregnancy complications.

METHODS

In this prospective cohort study, 1140 nulliparous pregnant women at 1st trimester of pregnancy referred to health care centers in Tabriz, Iran were enrolled in 2009-2010. Anthropometric indexes including (weight, height and WC) were measured using standardized measures and methods. BMI was classified into normal, overweight and obesity based on WHO classification. Abdominal obesity was defined as WC ≥ 88 cm. Pregnancy complication including gestational diabetes, hypertension and preeclamsia. Data were analyzed using SPSS, version 16.

RESULTS

Mean of BMI and WC were 24.32±4.08 kg/m(2), 81.84±9.25cm at 1(st) trimester of pregnancy, respectively. Prevalence of overweight (BMI=25-29.9kg/m(2)) and obesity (BMI>29.9 kg/m(2)) was 27.6%, 8.8%, respectively. Abdominal obesity based on WC was 34.8%. Significant correlations were found between BMI and WC (r=0.73, P =0.0001). Women with BMI>29.9 kg/m(2) and WC>88 cm were more likely to suffer from gestational pregnancy and hypertension, as well as preeclampsia and preterm delivery.

CONCLUSION

Early maternal WC similar to BMI is related with pregnancy complications.

Global gender disparities in obesity: a review

There is a global obesity pandemic. However, the prevalence of overweight and obesity among men and women varies greatly within and between countries, and overall, more women are obese than men. These gender disparities in overweight and obesity are exacerbated among women in developing countries, particularly in the Middle East and North Africa. Yet, in developed countries, more men are overweight than women. Current knowledge suggests that myriad sociocultural dynamics throughout the world exacerbate gender disparities in excess weight gain. Different contextual factors drive gender differences in food consumption, and women often report consuming healthier foods, yet may consume more sugar-laden foods, than men. Acculturation, through complex sociocultural pathways, affects weight gain among both men and women. The nutrition transition taking place in many developing countries has also affected excess weight gain among both genders, but has had an even greater impact on the physical activity levels of women. Furthermore, in some countries, cultural values favor larger body size among women or men as a sign of fertility, healthfulness, or prosperity. As the global obesity pandemic continues, more research on gender disparities in overweight and obesity will improve the understanding of this pandemic.

Trends in waist circumference and central obesity in adults, northern iran

OBJECTIVES

The main aim of this study is to determine the central obesity trends during the period from 2006 to 2010 among 15-65 years old people in Northern Iran.

METHODS

This was a population-based cross-sectional study conducted on 6466 subjects who had been chosen by a multi stage cluster random sampling within five steps. The subjects were randomly chosen from 325 clusters and each cluster included 20 cases. Central obesity was defined as waist circumference ³102 cm and ³88 cm in men and women, respectively.

RESULTS

Compared to 2010, the mean waist circumference in 2006 changed from 87.2 cm to 88.1 cm in men (p=0.237), and from 90.3 cm to 88.6 cm in women (p=0.045). The comparison between 2006 and 2010 revealed that the prevalence of central obesity slightly decreased, 6.8% and 2.4% in urban women and men, respectively. Generally, the mean of waist circumference significantly decreased in urban women (by 0.069 cm in each year; p=0.020); however, the decrease of waist circumference in urban men was not significant (0.006 cm decrease each year; p=0.915).

CONCLUSION

The prevalence of central obesity declined among both males and females in the urban area; however, there was an attenuated increasing trend in the rural area. The disparity of trends between the two regions should be considered for further study.

Association between paraoxonase-1 gene polymorphisms and risk of metabolic syndrome

Paraoxonase-1 (PON1), a high-density lipoprotein (HDL) associated enzyme, is involved in the metabolism and detoxification of insecticides and pesticides. Three polymorphisms within the PON1 gene affect the enzyme activity. Two of these (L55M and Q192R) are located at the coding region and the third (-107C/T) is in promoter region. We performed a case-control study in order to elucidate the possible contribution of variability within PON1 at three mentioned positions to the risk of MS in a South-East Iranian population. DNA was isolated from peripheral blood of patients (N = 119) with MS and healthy controls (N = 201). Allelic polymorphisms at positions Q192R, L55M and -107C/T in the PON1 gene were studied by Amplification Refractory Mutation System (ARMS)-PCR. It was observed that genotypes RR and QR + RR of Q192R locus significantly increased the risk of MS (OR = 2; 95% CI: 1.17-3.40, P = 0.0001 and OR = 1.62; 95% CI: 1.0-2.63; P = 0.05, respectively). The risk in patients with MM and LM + MM genotypes at the L55M locus was marginal (OR = 1.33; 95% CI: 0.68-1.85; P = 0.34 and OR = 1.12; 95% CI: 0.68-1.85; P = 0.73 respectively). The CC genotype at -107C/T locus also increased the risk of metabolic syndrome, but was not significant. This association was somewhat stronger when combined genotypes at Q192R and L55M loci were analyzed (OR = 3.30; 95% CI: 1.34-8.24; P = 0.007). Our results, in this first study, provide evidence for association of PON1 gene polymorphisms with the risk for metabolic syndrome.

Double burden of nutritional disorders in young Iranian children: findings of a nationwide screening survey

OBJECTIVE

To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry.

DESIGN

Cross-sectional nationwide survey.

SETTING

Mandatory national screening programme before entrance to elementary school in 2008 in Iran.

SUBJECTS

All Iranian children entering public and private elementary schools.

RESULTS

The study population comprised 862,433 children (48.4% girls, 77.2% urban resident). Overall, 6.5% of children had short stature, 19.1% were underweight, 12.8% were overweight and 3.4% were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces.

CONCLUSIONS

The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children's growth.

The association of general and central obesity with major dietary patterns of adult women living in Tehran, Iran

OBJECTIVES

Using a dietary pattern analysis method could provide more information about the nutritional etiology of chronic diseases such as obesity. The aim of this study is to determine the association between major dietary patterns and general and central obesity among adult women living in Tehran.

MATERIALS AND METHODS

A cross-sectional study was conducted in Tehran, Iran, with 460 women aged 20-50 y. Dietary intake in the previous year was collected by a semi-quantitative food frequency questionnaire. Weight, height and waist circumstance (WC) were measured with standard methods and body mass index (BMI) was calculated. General obesity was defined as BMI > or = 30 kg/m(2) and central obesity as WC > or = 88 cm. Factor analysis was used for identifying major dietary patterns. The association between major dietary patterns and general and central obesity were assessed by logistic regression analysis.

RESULTS

Two major dietary patterns were extracted: "Healthy" and "Unhealthy" dietary patterns. After adjusting for confounders, individuals in the highest quartile of the unhealthy dietary pattern score were more likely to have general (OR=7.33, 95% CI: 2.39-22.51) and central obesity (OR=4.99, 95% CI: 2.08-11.94), whereas, those in the upper quartile of healthy dietary pattern were less likely to have general (OR=0.38, 95% CI: 0.15-0.98) or central obesity (OR=0.33, 95% CI: 0.16-0.71).

CONCLUSION

Our data suggest that a dietary pattern rich in fruit, vegetables, low-fat dairy products and poultry might be negatively associated with obesity. Furthermore our data showed that a dietary pattern high in processed meats, soft drinks, sweets, refined grains, snacks and processed juice might be positively associated with obesity among women aged 20-50 y.

Dietary diversity score is related to obesity and abdominal adiposity among Iranian female youth

Objective

To assess the relationship between diet and disease, consideration of whole-diet indices may be more informative than single-nutrient intake. The present study was conducted to report the relationship among dietary diversity score (DDS), obesity and abdominal adiposity among female university students.

Design

Cross-sectional study.

Setting

Isfahan, Iran.

Subjects

A representative sample of 289 healthy female students aged 18–28 years was selected randomly from Isfahan University of Medical Sciences, Iran. Usual dietary intake was assessed using a validated semi-quantitative FFQ. DDS was calculated according to the scoring of the five food groups based on the US Department of Agriculture Food Guide Pyramid. This is a score of diet variety, and shows the diversity of the consumed diet. Participants were categorised on the basis of quartile cut-off points of DDS. Potential confounders such as age, total energy intake and physical activity were considered in all the analyses.

Results

The means (sd) of BMI and waist circumference were 25·9 (sd 5·1) kg/m2 and 85·5 (sd 14) cm, respectively. The probability of obesity decreased with quartiles of DDS (OR among quartiles: 1·00, 0·41, 0·31 and 0·21, P = 0·03; this was the same for abdominal adiposity: 1·00, 0·55, 0·36 and 0·21, P = 0·02). Those in the lowest quartile of the DDS had the highest risk for being overweight.

Conclusions

There were inverse associations among DDS, obesity and abdominal adiposity among the female students of Isfahan University. Further prospective investigations are needed to confirm this finding.

Trends of obesity and abdominal obesity in Tehranian adults: a cohort study

Background

Considering the increasing trend of obesity reported in current data, this study was conducted to examine trends of obesity and abdominal obesity among Tehranian adults during a median follow-up of 6.6 years.

Methods

Height and weight of 4402 adults, aged 20 years and over, participants of the Tehran Lipid and Glucose Study (TLGS), were measured in 1999-2001(phase I) and again in 2002-2005(phase II) and 2006-2008 (phase III). Criteria used for obesity and abdominal obesity defined body mass index (BMI) ≥ 30 and waist circumference ≥ 94/80 cm for men/women respectively. Subjects were divided into10-year groups and the prevalence of obesity was compared across sex and age groups.

Results

The prevalence of obesity was 15.8, 18.6 and 21% in men and 31.5, 37.7 and 38.6% in women in phases I, II and III respectively (p < 0.001). The prevalence of abdominal obesity in men was 36.5, 57.2 and 63.3% and in women was 76.7, 83.8 and 83.6% in the three periods mentioned (p < 0.001). Men aged between 20-29 years had highest increase rates of obesity and abdominal obesity in phase III in comparison with phase I (with a respective rates of 2.2- and 3.3-fold). In both sexes, an increased trend was observed between phases I and II, whereas between phases II and III, this trend was observed in men, but not in women.

Conclusion

This study demonstrates alarming rises in the prevalences of both obesity and abdominal obesity in both sexes especially in young men, calling for urgent action to educate people in lifestyle modifications.

Association of educational level with risk of obesity and abdominal obesity in Iranian adults

BACKGROUND

The impact of education on obesity may vary according to population and geographic region. The objective of the present study was to determine the association between education and obesity.

METHODS

A cross-sectional study of 3600 subjects aged 20-70 years was conducted by using a cluster sampling technique in an adult population residing in the north of Iran, in 2004. Weight, height, waist and hip circumference were measured and data concerning education level, demographic characteristics and physical activities were collected by interview. Logistic regression analysis was used to estimate the association between education and general obesity (body mass index >or=30) as well as abdominal obesity (waist circumference >88 cm in women and 102 cm in men).

RESULTS

The adjusted odds ratio (OR) for general obesity at education level of high school and college compared with illiterate and primary level was 0.55 [95% confidence interval (CI): 0.43-0.71]. A greater negative association was observed for education at university level (OR = 0.32, 95% CI: 0.22-0.47) irrespective to sex. However, with regard to abdominal obesity, after controlling for confounding factors, the adjusted OR for education at university level remained significant only in women but not in men.

CONCLUSION

The findings of this study indicate that education level is inversely associated with general obesity in both sexes but with abdominal obesity only in women.

Obesity in the Iranian population

There is an obesity epidemic worldwide, which has been increasing in recent years. An epidemiologic cross-sectional study was conducted among 3799 persons who were 30-70 years old in Semnan Province, Iran. Multistage cluster sampling was performed, and subjects were selected from urban and rural populations. Body weight, height and waist circumference (WC) were measured, and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Overweight and obesity were defined as 25 < or = BMI < 30 and > or =30 respectively in men with WHR > or = 0.9 or WC > or = 102 cm, and women with WHR > or = 0.8 or WC > or = 88 cm were considered centrally obesite. Prevalence of obesity and overweight was 26.3% and 40.6% respectively. Prevalence of obesity was more among women (39.5%) than men (14.5%) with central obesity prevalence using WHR and WC cut-points of 72.2% and 26.6% respectively. There was a significant association between obesity and age, gender, residential area and educational level (P < 0.01). In conclusion, prevalence of obesity and overweight among 30-70 years old, especially among women, was higher than expected. A comprehensive educational programme on obesity risk factors and obesity-related diseases is necessary.

Five-year changes in adiposity and cardio-metabolic risk factors among Guatemalan young adults

BACKGROUND

Rapidly transitioning societies are experiencing dramatic increases in obesity and cardio-metabolic risk; however, few prospective studies from developing countries have quantified these increases or described their joint relationships.

METHODS

We collected dietary, physical activity, demographic, anthropometric and cardio-metabolic risk factor data from 376 Guatemalan young adults in 1997-98 (aged 20-29 years) and in 2002-04 (aged 25-34 years).

RESULTS

In total, 42 % of men and 56 % of women experienced weight gain >5 kg in 5 years. Percent body fat (%BF) and waist circumference (WC) increased by 4.2 % points and 5.5 cm among men, and 3.2 % points and 3.4 cm among women, respectively. Five-year increases in both %BF and WC were associated with lower physical activity, urban residence and shorter height among men but not among women (test for heterogeneity P < 0.05 for residence and physical activity). Changes in %BF and WC and concomitant changes in cardio-metabolic risk factors were similar for men and women. In standardised regression, change in %BF was associated with changes in TAG (beta=0.19; 95 % CI 0.08, 0.30), total:HDL cholesterol (beta=0.22; 95 % CI 0.12, 0.33) and systolic (beta=0.22; 95 % CI 0.12, 0.33) and diastolic (beta=0.18; 95 % CI 0.08, 0.28) blood pressure, but not with glucose; associations were similar for WC.

CONCLUSIONS

Over 5 years this relatively young population of Guatemalan adults experienced rapid increases in multiple measures of adiposity, which were associated with adverse changes in lipid and blood pressure levels.

High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study

BACKGROUND

To estimate the prevalence of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT in a large urban Iranian population aged > or = 20 years.

METHODS

The study population included 9,489 participants of the Tehran Lipid and Glucose Study with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. Age-adjusted logistic regression models were used to estimate the numbers needed to screen (NNTS) to find one person with undiagnosed diabetes.

RESULTS

The prevalence of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Participants with undiagnosed diabetes had higher age, body mass index (BMI), waist circumference, systolic and diastolic blood pressures, triglycerides (all p values <0.001) and lower HDL-cholesterol (only in women, p < 0.01) compared to normoglycemic subjects. Undiagnosed diabetes was associated with family history of diabetes, increased BMI (> or = 25 kg/m2), abdominal obesity, hypertriglyceridemia, hypertension and low HDL-cholesterol levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to a NNTS of 1.6 (95% CI: 1.57-1.71) and among women a combination of family history of diabetes and abdominal obesity, yielded a NNTS of 2.2 (95% CI: 2.1-2.4).

CONCLUSION

In conclusion, about one third of Tehranian adults had disturbed glucose tolerance or diabetes. One- third of total cases with diabetes were undiagnosed. Screening individuals with BMI > or = 25 kg/m2 (men), hypertension (men), abdominal obesity (women) and family history of diabetes may be more efficient.

Cord blood lipid profile in a population of Iranian term newborns

Premature coronary artery disease (CAD) and its risk factors are highly prevalent in Iran. It is well documented that atherosclerosis starts in childhood and there is evidence that this association with adult levels may originate at birth, so assessment of serum lipid levels in neonates might be of importance. In this study we aimed to measure serum lipoprotein and apolipoprotein levels in a representative sample of Iranian newborns. Cord blood lipid profile, apolipoprotein A, apolipoprotein B, and lipoprotein a (LPa) were analyzed in 378 full-term, Iranian newborns. The mean values of total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A, apolipoprotein B, and Lpa in girls were 81.4 +/- 28.3, 35.9 +/- 22.4, 31.1 +/- 9.9, 87.9 +/- 20.2, 34.2 +/- 18.2, and 21.0 +/- 2.8 mg/dL, respectively; these values in boys were 75.2 +/- 21.1, 32.1 +/- 16.3, 28.8 +/- 8.7, 84.3 +/- 16.0, 32.6 +/- 14.2, and 19.5 +/- 2.7 mg/dL, respectively. Median values of triglycerides (TGs) in boys and girls were 61 and 62 mg/dL, respectively. Female neonates had significantly higher concentrations of TC and HDL-C than males (81.4 +/- 28.3 vs. 75.2 +/- 21.1, p = 0.02, and 31.18 +/- 9.97 vs. 28.8 +/- 8.7, p = 0.02, respectively). Other biochemical factors were not significantly different between genders. The mean and median concentrations of LPa were 20.3 and 18.7 mg/dL, respectively, which are almost five times higher than those reported in some other studies. The TG concentration was 1.5-2 times higher than those previously reported. Our findings indicate that serum concentrations of LPa and TG in Iranian neonates are higher than those in previous studies; this disorder, which is likely placing Iranians at increased risk for future CADs, needs to be assessed in longitudinal studies.

Major dietary patterns in relation to general obesity and central adiposity among Iranian women

Studying the links between dietary patterns and obesity is especially relevant for Middle-Eastern populations because of their high prevalence of a particular type of obesity, the so-called Middle-Eastern pattern, and their diets' unique characteristics. Therefore, we wondered if major dietary patterns are related to the prevalence of general obesity and central adiposity among Iranian women. In this cross-sectional study of 486 women aged 40-60 y, usual dietary intakes were evaluated using a FFQ and anthropometric measurements. By the use of factor analysis, we extracted 3 major dietary patterns: healthy dietary pattern, western dietary pattern, and Iranian dietary pattern. Individuals in the upper category of the healthy pattern score were less likely to be generally (OR = 0.28; 95% CI = 0.14-0.53) and centrally obese (OR = 0.30; 95% CI = 0.16-0.55), whereas those in the upper quintile of western pattern had greater odds (for general obesity: 2.73; 95% CI = 1.46-5.08 and for central obesity: 5.74; 95% CI =2.99-10.99). Controlling for potential confounders attenuated the associations, but even after adjusting for energy intake, the associations were significant for both general and central obesity. Although the Iranian dietary pattern and general obesity were not significantly associated, subjects in the highest quintile had greater odds of being centrally obese, either before (OR = 2.15; 95% CI = 1.18-3.90) or after (OR = 2.08; 95% CI = 1.09-3.65) control for confounders. This study indicates significant associations among major dietary patterns, general obesity, and central adiposity in a Middle-Eastern country. Further prospective investigations are required to confirm such associations.