Risk of recurrence at the time of withdrawal of short- or long-term methimazole therapy in patients with Graves' hyperthyroidism: a randomized trial and a risk-scoring model

PURPOSE

In Graves' disease, administration of low-dose methimazole for more than 60 months induces higher remission rates compared with the conventional duration of 12-18 months. However, the risk of recurrence and its predictors beyond 48 months of drug withdrawal are not known. The aims of this study were to determine the risk of recurrence during 84 months after withdrawal of short- or long-term methimazole therapy and a risk stratification for recurrence of hyperthyroidism.

METHODS

A total of 258 patients were treated with methimazole for a median of 18 months and randomized to discontinuation of the drug(conventional short-term group; n = 128) or continuation of the treatment up to 60-120 months(long-term group; n = 130). Patients were followed for 84 months after methimazole withdrawal. Cox proportional hazards modeling was performed to identify factors associated with relapse and develop a risk-scoring model at the time of discontinuing the treatment.

RESULTS

Hyperthyroidism recurred in 67 of 120(56%) of conventionally-treated patients versus 20 of 118(17%) of those who received long-term methimazole treatment, p < 0.001. Age, sex, goiter grade, triiodothyronine, thyrotropin, and thyrotropin receptor antibodies were significant predictors of recurrence in both "conventional" and "long-term" groups but free thyroxine just in the "long-term" group. The risk-scoring model had a good discrimination power (optimism corrected c-index = 0.78,95%CI = 0.73-0.82) with a range of 0-14 and sensitivity of 86% and specificity of 62% at the risk-score of eight.

CONCLUSION

A relapse-free state was achieved in 83% of patients with Graves' hyperthyroidism 84 months after cessation of long-term methimazole treatment which could be predicted by some significant predictors in a simple risk-scoring system.

Self-rated Health in Youth with Different Screen Time in Their Adolescence: Tehran Lipid and Glucose Study

BACKGROUND

The long-term effects of childhood screen time on health-related quality of life (HRQoL) are still unclear. This study aimed to investigate the relationship between screen time during adolescence and sex-specific HRQoL in early youth.

METHODS

We studied the data from 642 adolescents aged 13-19 years, who participated in the Tehran Lipid and Glucose Study from 2005 to 2011 (baseline) with complete data on HRQoL in their early adulthood (22-28 years at the last follow-up). Physical and Mental HRQoL were assessed using the Iranian version of the short-form 12-item health survey version 2 (SF-12v2). Screen time and leisure-time physical activity were evaluated using the Iranian Modifiable Activity Questionnaire (MAQ). All analyses were conducted in Stata (version 14); MI used the mi impute command.

RESULTS

The mean±SD of age, body mass index (BMI), and physical activity in childhood were 16.33±1.27, 23.27±4.63 and 13.77±16.07, respectively. Overall, 35% of boys and 34% of girls had high screen time (HST) in childhood. In general, the HRQoL scores in male participants were higher than in females in both the mental and physical domains. HST in males in childhood was associated with decreased mental health (β=-6.41, 95% CI: -11.52, -1.3 and P=0.014), social functioning (β=-5.9, 95% CI: -11.23, -0.57 and P=0.03) and mental component summary (MCS) (β=-2.86, 95% CI: -5.26, -0.45 and P=0.02). The odds of poor MCS were significantly higher in those with HST compared to their counterparts with low screen time (LST) after adjusting for all potential cofounders.

CONCLUSION

The results of the present study showed the negative effect of screen time during adolescence on HRQoL in early youth. This effect was observed in men, mainly in the mental dimension. Investigating the long-term consequences of screen-time behaviors on self-assessed health in other populations with the aim of effective primary prevention is also suggested.

Cigarette smoking trajectories among adolescents and young adults in the Islamic Republic of Iran

Background

Cigarette smoking follows a progressive pattern throughout the lifetime; most adult smokers started smoking during adolescence.

Aim

To understand the cigarette smoking trajectories and their predictors among adolescents and young adults in the Islamic Republic of Iran.

Methods

Using data from the Tehran Lipid and Glucose Study, we followed 1169 adolescents (12-18 years old) into their young adulthood (28-32 years old), from 2002 to 2016. We used cigarette smoking as the outcome variable for group-based trajectory modelling. After detecting the trajectories, we investigated the effects of independent variables, namely, individual employment; education; physical activity; and paternal smoking, employment and education, on the trajectories. We analysed the data using STATA version 16 and SPSS version 26.

Results

Three trajectories were detected: non-smokers (79%), experimenters (12%) and escalators (9%). Boys were approximately 3 times (OR = 2.94, 95% CI: 2.32-3.24, P < 0.001) and 25 times (OR = 25.00, 95% CI: 23.92-26.08, P < 0.001), respectively, more likely than girls to be in the experimenter and escalator groups. Receiving a university education decreased the odds of being in the escalator trajectory for 18% (OR = 0.82, 95% CI: -0.04-0.96, P = 0.002) of the study participants. Employment after high school increased the odds by approximately two folds for the experimenter (OR = 2.00, 95% CI: 1.42-2.50, P = 0.01) and escalator (OR = 2.33, 95% CI: 1.33-2.93, P = 0.03) trajectories. Paternal smoking was associated with 1.88 and 2.23, respectively, increased odds of experimenting and escalating smoking among the adolescents.

Conclusion

Iranian adolescents follow 3 cigarette smoking trajectories into young adulthood: non-smokers, experimenters and escalators. Male sex, employment after high school, and living with a smoker father were associated with unfavourable smoking patterns. Findings from this study provide valuable insights for designing targeted interventions to reduce cigarette smoking among adults and adolescents in the Islamic Republic of Iran.

The association between leisure-time physical activity and blood pressure changes from adolescence to young adulthood: Tehran Lipid and Glucose Study

The effectiveness of long-term leisure time physical activity (LTPA) on blood pressure (BP) changes is still under debate. Since adolescence lifestyle behaviors shape the adulthood health profile, this study aimed to investigate the sex-specific impact of LTPA on BP changes from adolescence to young adulthood. This longitudinal study uses the data of 1412 adolescents (52% females) aged 12-18 years through a median follow-up of 12.2 years in the Tehran Lipid and Glucose Study (TLGS) framework. LTPA was calculated using the reliable and valid Iranian version of the modified activity scale (MAQ), and BP was measured at least twice by trained physicians. The linear mixed model was used to examine the study variables, considering individual and intrapersonal differences during the study. The majority of participants consistently demonstrated insufficient LTPA throughout the follow-up assessments, ranging from 54.7 to 67.1% for males and 77.7-83.4% for females. Despite a declining trend in LTPA (β = - 2.77 for males and β = - 1.43 for females), an increasing trend was noticeable in SBP, DBP, and BMI (β = 1.38, β = 1.81, β = 0.97 for males, and β = 0.10, β = 0.20, β = 0.97 for females, respectively). The unadjusted model revealed a significant trend in all variables for both sexes, except for female BP (P = 0.45 for SBP and P = 0.83 for DBP). Using the adjusted model, no significant association was observed between LTPA and changes in BP over time in both sexes. Our study indicates no association between LTPA and BP changes from adolescence to young adulthood. Insufficient LTPA levels, particularly among Iranian females, are likely the primary factor. Further research is crucial to identify appropriate LTPA levels to promote cardiovascular health and implement targeted interventions to achieve optimal LTPA levels in the Iranian population.

How Do Active and Passive Cigarette Smokers in Iran Evaluate Their Health? A Sex-Specific Analysis on the Full-Spectrum of Quality of Life

INTRODUCTION

This study aimed to determine the sex-specific effects of active and passive cigarette smoking on the full spectrum of health-related quality of life (HRQoL) among a sizeable adult population.

METHODS

This study was conducted within the Tehran Lipid and Glucose Study (TLGS) framework. Participants included 7478 adults in the last examination of the TLGS. We used a quantile regression model to compare sex-specific HRQoL distributions among non-, current, and passive smokers. Two-step cluster analysis was used to consider the synergic effects of confounder variables.

RESULTS

In men, current smoking was negatively associated with only mental HRQoL in all percentiles of its distribution with a decrease in absolute estimation values from the lowest (5 th: β=-6.59, p<0.001) to the highest (90 th: β=-0.93, p=0.027). Also, passive smoking was negatively associated with men's physical HRQoL in the upper percentiles of its distribution (75 th: β=-1.12, p=0.010; 90 th: β=-1.26, p=0.016). In women, the current (β= -4.17 to -4.45 for 25 th to 90 th percentiles) and passive smokers (β= -2.05 to -4.25 for 10 th to 90 th percentiles) had lower mental HRQoL in the mentioned percentiles. Also, the current smoking had a negative association with the 5 th percentile (β=-2.04, p=0.008), and a positive association with the 50 th (β=1.94, p< 0.008) and 75 th percentile of physical HRQoL (β=2.25, p=0.004).

CONCLUSIONS

The present study showed the harmful effect of smoking on mental HRQol in all participants. In contrast, the physical effect of smoking was only observed in female active smokers and at the extreme levels of the physical HRQoL spectrum.

IMPLICATIONS

According to the harmful effect of smoking on HRQoL, understanding active and passive smokers' perceptions of how smoking impacts their health is critical for tobacco control programs. Since most previous studies of smoking and HRQoL have mainly focused on the extreme parts or central values of the HRQoL distribution, the use of a multiple regression approach enables the evaluation of other parts of the conditional distribution of the outcome variable. This study demonstrated the prominent effect of smoking on the mental HRQoL as well as the more serious public health burden of passive smoking in women.

Health-related quality of life in women with various levels of spiritual health

This study investigates for the first time the relationship between spiritual health (SH) and health-related quality of life (HRQoL) in different periods of life in healthy women, which could be important in the current critical post-pandemic situation. We recruited data from 2238 healthy women in the Tehran Lipid and Glucose Study (TLGS) framework, performed a cross-sectional study, and divided them into four age groups: 1) 20-34, 2) 35-44, 3) 45-54, and 4) 55≤ years. HRQoL and SH were measured using Short-Form 12-Item Health Survey version 2 and spiritual health inventory in Muslim adults (SHIMA-48). We defined low and high SH as the first and third tertile of SHIMA-48 scores. Most participants were in the first age group (39 percent), were married (74.7 percent), and were housewives (74.7 percent). The mean mental component summary score and its domains were directly associated with age. This subscale was significantly higher in individuals with high SH scores in all age groups. However, except for general health, other physical subscales did not differ significantly between the two levels of SH among the age groups studied. Results indicate higher HRQoL, especially mental health, in healthy women with increased spiritual well-being. This finding can be used in programs to improve psychological health in women.

Active and Passive Smoking in Adults Undergoing a Long-Term Multi-Setting Healthy Lifestyle Education: Tehran Lipid and Glucose Study

We aimed to investigate the effects of a multi-setting lifestyle education on men's cigarette, hookah, and passive smoking, and women's passive smoking, in Iran. Data of Tehran Lipid and Glucose Study (TLGS) were used. TLGS started in 1999 with every-3-year follow-ups. Multi-stage cluster random sampling was used to recruit participants under the coverage of three health centers. One health center implemented multi-setting lifestyle education at school, family, and community setting. Our analytic sample for generalized estimating equation was restricted to 1322 and 3593 adults (respectively as intervention and control) who were followed for 15.8 years. Intervention reduced the odds of men's cigarette smoking by 27%. The estimated mean cigarettes/day was 1.58 lower in intervention men. The intervention reduced the odds of men's hookah use by 42% in short term. Intervention women had 33% lower odds of passive smoking. Lifestyle education with community outreach can help achieve pragmatic tobacco control goals.

Health-related quality of life in those with persistent or transient obesity phenotypes during two decades: Tehran Lipid and Glucose Study

INTRODUCTION

The current longitudinal study aimed to investigate the association of three stable obesity phenotypes (persistent metabolically healthy normal weight (P MHNW), persistent metabolically healthy obese (P MHO), persistent metabolically unhealthy obese (P MUO)), and one transient (MHO to MUO) obesity phenotype with health-related quality of life (HRQoL) throughout an 18-year period.

METHODS

1932 participants (649 men and 1283 women) who completed the HRQoL questionnaire during 2016-2019 were recruited in the current investigation. Based on the body mass index (BMI) and metabolic status, participants were classified into four obesity phenotypes, including 1) P MHNW, 2) P MHO, 3) P MUO, and 4) Transient from MHO to MUO. The HRQoL was compared between groups using analysis of covariance. Participants' age, marital status, occupation status, education level, physical activity, and smoking were adjusted.

RESULTS

After adjustment for confounder variables, a significant difference among obesity phenotypes was indicated in PCS scores of both sexes and MCS scores just in women (P value=<0.001). The P MUO had the lowest scores in PCS and MCS, and P MHO had the highest MCS scores compared to other obesity phenotypes in either sex.

CONCLUSION

The results of the present study indicate the negative effect of long-term concurrence of obesity and metabolic disorders on the HRQoL of adults. However, long-term obesity alone or loss of metabolic health in the short term did not affect individuals' assessment of their physical and mental health. These findings highlight the importance of preventive interventions in people with obesity; also indicate the need for awareness-raising strategies about healthy lifestyles to improve the quality of life in society.

Mean versus variability of lipid measurements over 6 years and incident cardiovascular events: More than a decade follow-up

Background

Lipid variability (LV) has emerged as a contributor to the incidence of cardiovascular diseases (CVD), even after considering the effect of mean lipid levels. However, these associations have not been examined among people in the Middle East and North Africa (MENA) region. We aimed to investigate the association of 6-year mean lipid levels versus lipid variability with the risk of CVD among an Iranian population.

Methods

A total of 3,700 Iranian adults aged ≥ 30 years, with 3 lipid profile measurements, were followed up for incident CVD until March 2018. Lipid variability was measured as standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of mean (VIM). The effects of mean lipid levels and LV on CVD risk were assessed using multivariate Cox proportional hazard models.

Results

During a median 14.5-year follow-up, 349 cases of CVD were recorded. Each 1-SD increase in the mean levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), TC/high-density lipoprotein cholesterol (HDL-C), and non-HDL-C increased the risk of CVD by about 26-29%; for HDL-C, the risk was significantly lower by 12% (all p-values < 0.05); these associations resisted after adjustment for their different LV indices. Considering LV, each 1-SD increment in SD and ARV variability indices for TC and TC/HDL-C increased the risk of CVD by about 10%; however, these associations reached null after further adjustment for their mean values. The effect of TC/HDL-C variability (measured as SD) and mean lipid levels, except for LDL-C, on CVD risk was generally more pronounced in the non-elderly population.

Conclusion

Six-year mean lipid levels were associated with an increased future risk of incident CVD, whereas LV were not. Our findings highlight the importance of achieving normal lipid levels over time, but not necessarily consistent, for averting adverse clinical outcomes.

Body mass index trajectories from childhood concerning emotional states in young adulthood: Tehran Lipid and Glucose Study

This study aimed to identify body mass index (BMI) trajectories from childhood and their relationships with depression, anxiety, and stress symptoms in young adulthood. A total of 687 children aged 4-18 years were recruited from the Tehran Lipid and Glucose Study. Throughout 18 years of follow-up, BMI was measured every 3 years for a maximum of 6 data points. Participants completed the depression, anxiety, and stress scale in their young adulthood (aged 22-36). The group-based trajectory modelling was applied to identify BMI patterns. The logistic regression model was used to assess the association between BMI trajectories and depression, anxiety, and stress symptoms in adulthood. Two BMI trajectories were identified from childhood to young adulthood: healthy weight (HW = 69.6%) and persistent increasing overweight/obesity (PIO = 30.4%). After adjusting for potential confounders, compared with the HW group, men in the PIO group were more likely to experience higher stress levels (OR: 1.62, 95% CI: 0.99-2.63; p = 0.05). No significant association was observed between the PIO trajectory and depression and anxiety among both sexes and stress symptoms in females. Our results highlight that developing overweight and obesity from childhood may be related to increased stress in males.

Effectiveness of a practical multi-setting lifestyle intervention on the main BMI trajectories from childhood to young adulthood: A community-based trial

Background

Preventing overweight in childhood and subsequent stages of life is still a global challenge. Despite numerous relevant lifestyle interventions, data on their impact on different BMI change pathways over time is rare. The present study aimed to investigate the effect of a multi-setting lifestyle intervention on BMI trajectories from childhood to young adulthood.

Methods

A multi-setting lifestyle intervention at the school, family, and community levels have been conducted in the Tehran Lipid and Glucose Study framework. A total of 2145 children (4–18 years, 49% boys, and 18% intervention) were recruited for the baseline assessment and were followed through five follow-up examinations during a median of 16.1 years. Using a group-based trajectory model, BMI trajectories from childhood to young adulthood were identified, and their association with the implemented intervention was assessed.

Results

Four trajectory groups of BMI from childhood to young adulthood were identified, including Normal weight (41%), Young adulthood overweight (36%), Early childhood increasing overweight and adulthood obesity (19%), and Early childhood increasing obesity (4%). Only Young adulthood overweight and Early childhood increasing obesity were affected by the intervention and were concomitant with lower BMI levels than the control group, with the highest estimated effect in the latter (β=-0.52 and p = 0.018; β=-1.48 and p < 0.001, respectively).

Conclusion

The current findings indicate the highest effectiveness of a practical, healthy lifestyle intervention on those whose obesity started in the early years of life or youth. Our results could help policymakers and planners design more targeted lifestyle modification and weight control interventions.

Trial registration

This study is registered at Iran Registry for Clinical Trials, a WHO primary registry (http://irct.ir). The Iran Registry for Clinical Trials ID and date are IRCTID:IRCT138705301058N1, 29/10/2008.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14306-2.

The Long-Term Effectiveness of a Multisetting Lifestyle Intervention on Tobacco-Related Habits in Adolescent Boys and Girls: Tehran Lipid and Glucose Study

BACKGROUND

This study assesses the long-term effectiveness of a lifestyle intervention on cigarette, passive, and hookah smoking in adolescent boys and girls.

METHODS

One thousand one hundred and fifty-nine adolescent participants of Tehran Lipid and Glucose Study (TLGS) (2001-2004) were followed for 12 years. Participants in the intervention area received lifestyle interventions in family, schools, and community settings, with the largest part implemented in schools. After excluding those with missing baseline parental data (n = 66), complete parental data of 1093 adolescents was used for cluster analysis. Families were classified as low- and high-risk. Two hundred and ninety-six individuals who did not complete intervention/follow-ups were excluded, GEE was performed on 797 adolescents (369 boys, 192 intervention) to assess the intervention effect on tobacco-related habits.

RESULTS

Adolescents' mean baseline age was 15.21 ± 1.95. Those living in high-risk families were more at risk of cigarette, passive, and hookah smoking. Intervention decreased odds of cigarette and passive smoking by 38% and 57%, respectively. Intervention did not reduce hookah smoking in adolescents. After sex-specific analysis, the intervention reduced current cigarette smoking by 40% only in boys and passive smoking in both sexes.

CONCLUSIONS

Targeting lifestyle behaviors in school-aged adolescents and their families reduces cigarette smoking in boys and protects both sexes from secondhand smoke.

A pragmatic multi-setting lifestyle intervention to improve leisure-time physical activity from adolescence to young adulthood: the vital role of sex and intervention onset time

BACKGROUND

The long-term effectiveness of healthy lifestyle interventions on improving leisure-time physical activity (LTPA) in adolescents and its factors in low- and middle-income communities is unclear. This study is the first to investigate LTPA trends in a population of Iranian adolescents who underwent a multi-setting lifestyle intervention, considering sex and the time of intervention onset.

METHODS

Participants were 2374 adolescents (57.2% girls), aged 12-18 years, who participated in the Tehran Lipid and Glucose Study (TLGS) during 1999-2001 and followed for a median follow-up of 15.9 over five data points every 3 years. Adolescent participants were assigned to the intervention or control groups based on their residential areas. Boys and girls were categorized into 12-15 or 16-18 years old to minimize participants' bio-psychological differences, facilitate environmental interventions by more compliance with the Iranian educational system and identify the best time to start the intervention. All adolescents in the intervention area received healthy lifestyle interventions via the school-, family-, and community-based programs. LTPA was assessed using the reliable and validated Iranian Modifiable Activity Questionnaire (MAQ) version over the five data points. The Generalized Estimating Equations method was used to evaluate educational intervention's effect on LTPA in adolescents during the follow-up.

RESULTS

In boys who experienced the early onset of intervention (12-15 years), the interaction effect of follow-up examinations and the intervention was significant where the impact of the intervention differed over time. In this group, LTPA was higher in the control group than in the intervention group at the first follow-up examination (β = - 1088.54). However, an increasing trend of LTPA was observed in the intervention group until the third follow-up examination (β = 1278.21, p = 0.08, and β = 1962.81, p = 0.02, respectively), with borderline significance levels at the 2nd (P = 0.08) and the 4th (P = 0.08) measurements. The interaction terms and main effects of intervention and follow-up examinations were not significant in boys with late intervention onset. Although older boys in the intervention group had higher LTPA than the control group, there were no significant differences among study groups in all follow-up examinations. Regarding girls, LTPA did not differ significantly between intervention and control groups in all follow-up examinations (P > 0.05).

CONCLUSION

Our results showed that a multi-setting practical lifestyle intervention could improve long-term energy expenditure in LTPA in adolescent boys who have experienced an early onset intervention. Findings emphasized the vital role of gender and the onset of these interventions. The current results would be valuable to plan tailored interventions to improve LTPA and community health.

TRIAL REGISTRATION

This study is registered at Iran Registry for Clinical Trials (IRCT), a WHO primary registry ( http://irct.ir ). The TLGS clinical trial was the very first registration in the IRCT (Iran Registry of Clinical Trials). it was registered on 2008-10-29 by the registration number IRCT138705301058N1 . Based on the international committee of medical journal Editors (ICMJE), "retrospective registration" is acceptable for trials that began before July 1, 2005.

Risk of hypertension in school-aged children undergoing a long-term community-based lifestyle intervention: Tehran Lipid and Glucose Study

Childhood hypertension which increases the risk of cardiovascular diseases in adulthood is becoming more prevalent. For the first time in the Middle-East region, this study aimed to assess the long-term effectiveness of a community-based lifestyle intervention on the incidence of hypertension in school-aged children during 16 years of follow-up. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were 2080 children aged 8-18 years with normal blood pressure who were under the coverage of three health care centers selected using multistage cluster random sampling method. One of the health care centers far from the other two was selected for implementing lifestyle intervention (1053 children, 48.2% boys). Triennial examinations were conducted, and survival Cox models were used to assess intervention effects on the incidence of hypertension in boys and girls. Crude incidence rates (per 1000 person-years) of hypertension were 8.11, 3.7, and 5.8 among boys, girls, and the total sample, respectively. Our results showed that HTN has occurred significantly less (P = 0.025) in the intervention group than in the control group, only in female participants. These results remained significant even after adjusting for individuals' and parental characteristics (P = 0.033). Although the risk of hypertension in boys was more than twice that observed in girls, the effectiveness of the recent community-based healthy lifestyle intervention was observed only in girls and not in boys. Further studies are needed to understand gender differences in promoting the effectiveness of similar future programs. The TLGS is registered at Iran Registry for Clinical Trials, a WHO primary registry (http://irct.ir; IRCTID: IRCT138705301058N1).

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study

Background

Cardiovascular diseases (CVDs) are among the most common causes of death worldwide, including in Iran. Considering the adverse effects of CVDs on physical and psychosocial health; this study aims to investigate the association between experience of CVDs and health-related quality of life (HRQoL) in adult participants of the Tehran Lipid and Glucose Study (TLGS).

Methods

The participants of this cross-sectional study were 7009 adults (≥ 20 years) who participated in the TLGS during 2014–2017. Demographic information and HRQoL data was collected through validated questionnaires by trained interviewers. HRQoL was assessed by the Iranian version of the SF-12 questionnaire. Data was analyzed using the SPSS software.

Results

The mean age of participants was 46.8 ± 14.6 years and 46.1% of them were men. A total of 9.0% of men and 4.4% of women had CVDs. In men, the mean physical HRQoL summary score was significantly lower in those with CVDs compared to those without CVDs (46.6 ± 0.8 vs. 48.5 ± 0.7, p > 0.001). In women, the mean mental HRQoL summary scores was significantly lower in those with CVDs compared to those without CVDs (42.8 ± 1.0 vs. 45.2 ± 0.5, p = 0.009). In adjusted models, men with CVDs were more likely to report poor physical HRQoL compared to men without CVDs (OR(95%CI): 1.93(1.32–2.84), p = 0.001); whereas for women, the chance of reporting poor mental HRQoL was 68% higher in those with CVDs than those without CVDs (OR(95%CI): 1.68(1.11–2.54), p = 0.015).

Conclusion

The findings of the current study indicate poorer HRQoL in those who experienced CVDs compared to their healthy counterparts with a sex specific pattern. While for men, CVDs were associated with more significant impairment in the physical dimension of HRQoL, women experienced a similar impairment in the mental dimension of HRQoL.

Risk of hypertension in school-aged children with different parental risk: a longitudinal study from childhood to young adulthood

BACKGROUND

Although previous studies have shown the relationship between different parental factors and children's blood pressure status, there is limited data on the cumulative effect of these factors. Considering parental socio-demographic, behavioral and cardio-metabolic characteristics, the current study aimed to distinguish parental risk clusters and their impact on the incidence of hypertension in school-age children over 13 years.

METHODS

Parental characteristics of 1669 children, including age, education, employment, smoking, physical activity, metabolic syndrome (MetS), hypertension (HTN), weight status, and diabetes were considered to categorize parents into low and high-risk clusters. Crude incidence rates (per 10,000 person-years) of HTN in children were assessed in each maternal and paternal cluster. Using Cox proportional hazard model, results on the association between parental risk clusters and HTN incidence in children were reported in five different models.

RESULTS

Mean age of children was 13.96 ± 2.89 years, and 51.2% (n = 854) were girls. MetS, HTN, and weight status were the most important factors distinguishing low and high-risk parental clusters, respectively. Crude incidence rates (per 10,000 person-years) of HTN were 86 (95% CI: 71-106) and 38 (95% CI, 29-52) in boys and girls, respectively. Moreover, incidence rates (per 10,000 person-years) of HTN were 50 (95% CI, 40-63) and 80 (95% CI, 64-102) in maternal low and high-risk clusters, respectively. The incidence rates (per 10,000 person-years) of HTN in paternal low and high-risk clusters were 53 (95% CI, 41-70) and 68 (95% CI, 56-84), respectively.

CONCLUSION

Our findings underscore the prognostic value of maternal characteristics in predicting the incidence of HTN in their offspring. The current results could be valuable in planning related programs to prevent hypertension in similar communities.

Endogenous estrogen exposure and chronic kidney disease; a 15-year prospective cohort study

BACKGROUND

Despite strong evidence demonstrating the role of estrogen as a protective factor for kidney function in women, limited data are available regarding the influence of endogenous estrogen exposure (EEE) on chronic kidney disease (CKD). The present study aimed to assess the incidence of CKD in women with various levels of EEE.

METHODS

In a prospective population-based study over a 15-year follow-up, a total of 3043 eligible women aged 30-70 years, participating in Tehran-Lipid and Glucose-Study were recruited and divided into two groups (EEE < 11 and EEE ≥ 11 years). EEE calculated based on age at menarche, age at menopause, number and duration of pregnancies, lactation, and duration of oral contraceptive use after excluding the progesterone dominant phase of the menstrual cycle. Cox's proportional hazards model was applied to estimate the hazard ratio of CKD between the study groups, after adjusting for confounders.

RESULTS

The total cumulative incidence rate of CKD was 50.1 per 1000 person years; 95% CI: 47.7-52.6); this was 53.9 (95%CI, 50.2-57.8) and 47.1 (95%CI, 44.0-50.4) per 1000 person years in women with EEE < 11 and EEE ≥ 11 years, respectively. The model adjusted for age, BMI, smoking, hypertension, and diabetes showed that the hazard ratio (HR) of incidence CKD in women with EEE < 11 compare to those with EEE ≥ 11 years in the subgroup of women aged< 45 years was 2.66(95% CI, 2.2, 3.2), whereas, in the subgroup aged ≥45 years, it was 1.22 (95% CI, 1.04, 1.4).

CONCLUSION

This study shows a higher HR of CKD incidence in women with low EEE levels in their later life. Screening of these women for CKD may be recommended.

Development of a risk prediction model for early discrimination between permanent and transient congenital hypothyroidism

OBJECTIVE

To develop a risk prediction model for early discrimination between transient and permanent congenital hypothyroidism (CH).

DESIGN AND SETTING

In a retrospective cohort, 1047 confirmed CH neonates, from 15 randomly selected provinces in Iran, were entered to the study. Clinical and biochemical information of transient and permanent cases, distinct at the age of 3 years were retrospectively gathered.

RESULTS

Among CH neonates, the overall prevalence of permanent CH was 57.1%. Using forward stepwise multivariable logistic regression analysis, confirmatory venous TSH, total T4 < 8.2 ng/dl, requiring levothyroxine dosage increase, venous TSH ≥ 10 mU/l between 6 and 12 months of age, parental consanguinity and family history of thyroid diseases were associated with increased risk of permanent CH. The prediction model achieved a very good power in discriminating patients with transient and permanent CH with an optimism-corrected area under the ROC curve of 0.86 (95% CI:0.84-0.88) with a very good calibration. Integrated discrimination improvement (IDI) test indicated significantly greater diagnostic performance of the model compared to serum TSH alone.

CONCLUSIONS

Using several potential predictors for permanent CH, we developed a relatively powerful risk prediction model as a cost-saving screening tool in order to avoid unnecessary long-term treatment of transient cases which might empower clinicians for prognostication of the CH course and tailoring treatment up to 1 year of age.

Prognostic value of different maternal obesity phenotypes in predicting offspring obesity in a family-based cohort study

Background

Parental weight is studied as an important determinant of childhood obesity; however, obesity-related metabolic abnormalities have been less considered as determinants of childhood obesity. This study aimed to investigate the association between maternal obesity phenotypes and incidence of obesity in their offspring.

Methods

This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study. A total of 2151 non-obese children who had complete parental information were followed for incidence of obesity over a mean of 148.7 ± 34.7 months. Obesity in children was defined using the World Health Organization criteria. Maternal body mass index (BMI) was classified into three categories: normal weight, overweight and obese. Dysmetabolic status was considered as having metabolic syndrome or diabetes. Metabolic syndrome and diabetes were defined according to the Joint Interim Statement and American diabetes association criteria, respectively. Considering maternal BMI categories and metabolic status, six obesity phenotypes were defined as followed: 1) normal weight and normal metabolic status, 2) overweight and normal metabolic status, 3) obese and normal metabolic status, 4) normal weight and dysmetabolic status, 5) overweight and dysmetabolic status, and 6) obese and dysmetabolic status. The association between maternal obesity phenotypes and incidence of obesity in children was studied using Cox proportional regression hazard model.

Results

In male offspring, the risk of incidence of obesity significantly increased in those with maternal obesity phenotypes including overweight/normal metabolic: 1.75(95% CI: 1.10–2.79), obese/normal metabolic: 2.60(95%CI: 1.51–4.48), overweight/dysmetabolic: 2.34(95%CI: 1.35–4.03) and obese/dysmetabolic: 3.21(95%CI: 1.94–5.03) compared to the normal weight/normal metabolic phenotype. Similarly, in girls, the risk of incidence of obesity significantly increased in offspring with maternal obesity phenotypes including overweight/normal metabolic: 2.39(95%CI: 1.46–3.90), obese/normal metabolic: 3.55(95%CI: 1.94–6.46), overweight/dysmetabolic: 1.92(95%CI: 1.04–3.52) and obese/dysmetabolic: 3.89(95%CI: 2.28–6.64) compared to normal weight/normal metabolic phenotype. However, maternal normal weight/dysmetabolic phenotype did not significantly change the risk of obesity in both male and female offspring.

Conclusion

Except for normal weight/dysmetabolic phenotype, all maternal obesity phenotypes had significant prognostic values for incidence of offspring obesity with the highest risk for obese/dysmetabolic phenotype. This study provides valuable findings for identifying the first line target groups for planning interventions to prevent childhood obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10932-4.

Validation of the Framingham hypertension risk score in a middle eastern population: Tehran lipid and glucose study (TLGS)

Background

The Framingham hypertension risk score is a well-known and simple model for predicting hypertension in adults. In the current study, we aimed to assess the predictive ability of this model in a Middle Eastern population.

Methods

We studied 5423 participants, aged 20–69 years, without hypertension, who participated in two consecutive examination cycles of the Tehran Lipid and Glucose Study (TLGS). We assessed discrimination based on Harrell’s concordance statistic (c-index) and calibration (graphical comparison of predicted vs. observed). We evaluated the original, recalibrated (for intercept and slope), and revised (for beta coefficients) models.

Results

Over the 3-year follow-up period, 319 participants developed hypertension. The Framingham hypertension risk score performed well in discriminating between individuals who developed hypertension and those who did not (c-index = 0.81, 95% CI: 0.79–0.83). Initially, there was a systematic underestimation of the original risk score (events predicted), which was readily corrected by a simple model revision.

Conclusions

The revised Framingham hypertension risk score can be used as a screening tool in public health and clinical practice to facilitate the targeting of preventive interventions in high-risk Middle Eastern people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10760-6.

Treatment of Subclinical Hyperthyroidism in the Elderly: Comparison of Radioiodine and Long-Term Methimazole Treatment

Background: This study aimed to compare the effectiveness and safety of radioiodine (RAI) and long-term methimazole (MMI) in the treatment of subclinical hyperthyroidism (SH) in the elderly. Methods: From 306 patients, aged ≥65 years, with SH, 83 patients with thyrotropin <0.1 mU/L entered the study. In this randomized parallel-group trial, 41 and 42 patients were randomized to either RAI or long-term MMI treatment, respectively. Results: In the RAI and MMI groups, 3 and 4 patients were excluded due to side effects, choosing other modes of treatment, and not returning for follow-up; 35 and 36 patients completed 60 months of follow-up, respectively. In the RAI group, 23 (66%) became hypothyroid, and 12 (34%) remained euthyroid 60 months after a fixed dose of 15 mCi RAI. In the MMI group, the starting dose was 10 mg daily and decreased to 4.9 ± 1.0, 4.3 ± 1.0, 4.4 ± 1.4, 4.3 ± 1.8, and 3.7 ± 1.3 mg after 1, 2, 3, 4, and 5 years of continuous MMI treatment, employing titration method. By the end of study, 34 (94%) patients were euthyroid and 2 patients with diffuse goiter developed spontaneous hypothyroidism with MMI treatment. Minor adverse events occurred in both groups in the first four months of treatment. No death or serious side effects were observed during 60 months of follow-up. Conclusions: Both RAI and long-term low-dose MMI therapies are effective and safe for treatment of SH in the elderly.

The Cigarette Smoking Initiation and Continuation in Adolescents Undergoing a Long-Term Behavioral Intervention

INTRODUCTION

Targeting adolescents' smoking reduces its burden on health systems. We investigated the effects of the first multidisciplinary community-based lifestyle intervention in the Eastern Mediterranean region, on smoking initiation, continuation, and risk of current smoking in Iranian adolescents.

METHODS

The current analyses were conducted on 945 nonsmoker adolescents (12-18 years) who participated in Phase II of Tehran Lipid and Glucose Study (TLGS) and were examined four times in 12 years. The lifestyle intervention including school-based and public programs was implemented, focusing on all components of healthy lifestyle. Using a two-step cluster analysis, families were classified as high and low risk, based on parental risk factors of adolescents' smoking. Participants who failed to complete all the follow-ups (n = 99) and those with missing smoking data were excluded. Subsequently, 872 adolescents (538 control, 334 intervention) were included in the Cox model on smoking initiation, and 674 adolescents (414 control, 260 intervention) were included in the logistic regression on smoking status.

RESULTS

Mean age of adolescents was 15.08 ± 1.94 years at baseline. The hazard of the smoking initiation was significantly lower in the intervention (hazard ratio = 0.71, 95% confidence interval: 0.51-0.99; p = .044) compared with control group. At the end of the fourth follow-up, intervention reduced the odds of current cigarette smoking by 29%. Within the intervention group, the high-risk cluster was at a 35% lower risk of initiating smoking and had 37% lower odds of becoming a current smoker. However, the intervention could not make a difference in preventing those who initiated smoking from maintaining it during the follow-ups.

CONCLUSIONS

Our results demonstrate that lifestyle modification programs targeting at-risk populations could reduce risk of smoking initiation and current smoking in adolescents in long term.

IMPLICATIONS

Experiencing cigarette smoking at the critical period of adolescence could result in adulthood habitual smoking. Therefore, identifying adolescents who are more at risk of smoking initiation and implementing targeted interventions are of great importance in public health. Our findings highlight the long-term effectiveness of a multidisciplinary community-based behavioral intervention on forming smoking behaviors in adolescents. The current intervention was successful in reducing smoking uptake in adolescents living in high-risk families.

Emotional states of different obesity phenotypes: a sex-specific study in a west-Asian population

BACKGROUND

The present study aimed to investigate the associations of obesity phenotypes with depression, anxiety, and stress symptoms among adults in the Tehran Lipid and Glucose Study (TLGS).

METHODS

Depression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study. Obesity was defined as body mass index (BMI) ≥30 kg/m², and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes.

RESULTS

The mean age of 2469 men and women was 46.2 ± 15.9 and 45.6 ± 14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25-2.54; P = < 0.001) or non-obese (OR: 1.61, 95% CI: 1.17-2.21; P = < 0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28-2.34; P = < 0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02-1.90; P = 0.04) compared to MHNO men and in MUO women (OR: 1.45, 95% CI: 1.07-1.96; P = 0.02) compared to MHNO women. No difference in depression levels was observed in either sex.

CONCLUSIONS

Our results showed that men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity in both sexes and utilizing future health promotion planning.

The risk of chronic kidney disease among women with polycystic ovary syndrome: A long-term population-based cohort study

BACKGROUND AND OBJECTIVE

Results of studies focusing on chronic kidney disease (CKD) among women with polycystic ovary syndrome (PCOS) are insufficient and controversial. This study aimed to evaluate the incidence rate of CKD in women with PCOS, compared to a control group of healthy women.

METHODS

This study was a population-based cohort study conducted from among 1460 reproductive-age women including 156 women with PCOS and 1304 controls. Incidence rates per 1000 person-years of follow-up were calculated for PCOS and control groups. Cox proportional hazards regression with age as the time-scale was used to estimate hazard ratios (HR) and 95% confidence intervals for developing CKD in relation to PCOS in both univariable and multivariable models.

RESULTS

During a median follow-up of 12.9 years, 330 new cases of CKD were identified, including 25 PCOS women (14.8 per 1000 person-years; 95% CI, 10-22) and 305 healthy controls (21.5 per 1000 person-years; 95% CI, 19.2-24.1). The results of the Cox model showed that the risk of CKD among women with PCOS and healthy women is comparable and women with PCOS did not have a higher risk of developing CKD compared to healthy women (unadjusted HR: 0.883; 95% CI: 0.587-1.328; P = .551). The results remained unchanged after adjustment for potential confounders of smoking status, BMI, hypertension and diabetes at baseline and follow-up of study (multiple adjusted HR: 0.911; 95% CI: 0.600-1.383; P = .661).

CONCLUSION

Our population-based study with a long-term follow-up period showed that the risk of CKD in PCOS patients was similar to the general female population. Large studies, with long-term follow-up and more diverse phenotypes, are needed to confirm the findings.

Association of leisure and occupational physical activities and health-related quality of life: Tehran Lipid and Gluycose Study

Background

Little is known about the association between different levels of physical activity (PA) and health-related quality of life (HRQoL) in the general Iranian population across sex groups. The current study aims to investigate the association between PA and HRQoL across sex groups, various types of physical activity (leisure time and occupational) and different dimensions of HRQoL in a large population of Tehranian adults.

Methods

This cross-sectional study was conducted using data from the Tehran Lipid and Glucose Study (TLGS). Data was collected from 7800 adults on their PA habits and HRQoL. Information on PA and HRQoL were assessed using the Modifiable Activity Questionnaire (MAQ) and Short-Form 12-Item Health Survey version 2 (SF-12v2), respectively. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to assess the association between physical activity levels and poor HRQoL.

Results

The mean age of participants was 46.4 ± 14.9 years and 45.6% of them were male. Levels of PA were significantly associated with most subscales of HRQoL in both men (p < 0.05) and women (p < 0.01). In both sexes, leisure time PA was significantly correlated to all subscales of HRQoL (p < 0.05) except for bodily pain in both sexes and for social functioning and role emotional in men. In adjusted models, men with both moderate (OR: 1.55, 95%CI: 1.18–2.04; p = 0.002) and low (OR: 1.46, 95%CI: 1.11–1.91; p = 0.007) levels of PA had a significantly higher chance of reporting poor mental component summary (MCS) compared to their counterparts with high levels of PA. Furthermore, women with low levels of PA had a significantly higher chance of reporting poor physical component summary (PCS) (OR: 2.39, 95% CI: 1.63–3.49; p < 0.001) compared to those with high levels of PA.

Conclusion

The findings show an association between PA and both domains of HRQoL in men and mostly the physical domain in women, suggesting a sex-specific pattern for this association, which could be considered to motivate participation in PA programs in future health promotion interventions.

Systemic Thyroid Hormone Status in Treated Graves' Disease

OBJECTIVES

We aimed to compare the markers of thyroid hormone status in treated euthyroid Graves' patients and levothyroxine (LT4)-treated hypothyroid Graves' patients.

METHODS

We collected the data of 277 patients, including 140 radioiodine-treated hypothyroid Graves' patients on LT4 treatment (group 1), 83 euthyroid Graves' patients on methimazole (MMI) therapy (group 2), and 54 euthyroid Graves' patients off MMI or radioiodine therapy for > 2 years (group 3). After the exclusion of diabetic patients, 130, 73, and 52 patients remained for analysis in groups 1, 2, and 3, respectively. Pearson and Spearman correlation coefficients were employed to assess the relationships between T3:T4 ratio and variables in each group along with univariate and multivariate linear regression models.

RESULTS

The mean age and female/male ratio were similar in the three groups. Serum fT4 was significantly higher and T3, TSH, TPOAb, and TRAb were significantly lower in group 1 than in group 2 and combined groups 2 and 3, which translated to 27% lower serum T3:T4 ratio in group 1. Higher BMI, serum cholesterol, and LDL cholesterol and lower HDL cholesterol were observed in group 1 than in combined groups 2 and 3. In multivariate regression analysis, the T3:T4 ratio was significantly higher in combined groups 2 and 3 than in group 1 in the presence of BMI and serum fasting blood glucose, triglycerides, and TSH.

CONCLUSIONS

Hypothyroid Graves' patients using LT4 exhibited lower T3:T4 ratio despite lower TSH levels and their BMI and lipid parameters differed from those of euthyroid Graves' patients.

Increased Remission Rates After Long-Term Methimazole Therapy in Patients with Graves' Disease: Results of a Randomized Clinical Trial

Background: Studies differ regarding whether, compared with courses of conventional duration, longer-term antithyroid drug treatment increases frequency of remission in patients with Graves' hyperthyroidism. We prospectively conducted a randomized, parallel-group study comparing relapse rates in patients receiving longer-term versus conventional-length methimazole therapy. We also sought variables associated with relapse following the latter. Methods: We enrolled 302 consecutive patients with untreated first episodes of Graves' hyperthyroidism. After 18-24 months of methimazole, 258 patients (85.4%) were randomized to an additional 36-102-month courses ("long-term group": n = 130; scheduled total time on methimazole: 60-120 months) or discontinuation of methimazole ("conventional group": n = 128). Patients were followed 48 months postmethimazole cessation. We performed Cox proportional hazards modeling to identify factors associated with relapse after conventional courses. Results: Methimazole was given for 95 ± 22 months in long-term patients and 19 ± 3 months in the conventional group. Fourteen patients experienced cutaneous reactions and 2 liver enzyme elevations during the first 18 months of treatment; no further methimazole-related reactions were observed despite therapy for up to another 118 months. Hyperthyroidism recurred within 48 months postmethimazole withdrawal in 15% (18/119) of long-term patients versus 53% (65/123) of conventional group patients. In the conventional group, older age, higher triiodothyronine or thyrotropin receptor antibody concentrations, lower thyrotropin concentration, or possession of the rs1879877 CD28 polymorphism or the DQB1-05 HLA polymorphism were independently associated with relapse. Conclusion: Administration of low-dose methimazole for a total of 60-120 months safely and effectively treats Graves' hyperthyroidism, with much higher remission rates than those attained by using conventional 18-24-month courses.

Smoking habits and incidence of cardiovascular diseases in men and women: findings of a 12 year follow up among an urban Eastern-Mediterranean population

BACKGROUND

Despite the strong association of smoking with cardiovascular disease (CVD) and cerebral stroke, the consequences of smoking have not been elucidated among Iranian populations. This study aimed to assess sex-specific incidence of CVDs among an urban Iranian population with different smoking habits.

METHODS

Participants were recruited from the Tehran Lipid and Glucose Study (TLGS). Data on socio-demographic features and smoking habits from a sample of 10,400 individuals (4378 men and 6022 women), aged ≥20 years without prior CVD history were analyzed. Participants were followed up for 12 years for incidence of CVD/CHD events. Men were categorized in six groups, including never-, passive, ex-, passive and ex-, occasional and daily smokers. Women were categorized in three groups, i.e. never smokers, passive smokers and ever smokers. Using cox regression model, adjusted hazard ratios (HRs) of incident CVD/CHD were calculated for each group, given never smokers as the reference.

RESULTS

In men, HR of CVD was 1.13 (95%CI: 0.80-1.59) in passive smokers, 1.23 (95%CI: 0.91-1.66) in ex-smokers, 1.46 (95%CI: 0.90-2.36) in passive and ex-smokers, 2.33 (95%CI: 1.25-4.33) in occasional smokers and 2.05 (95%CI: 1.57-2.67) in daily smokers. In smokers of ≥21 cigarettes/day, HR of CVD was 3.79 (95%CI: 2.25-6.37), with less risk observed in those who smoked lesser numbers of cigarettes/day. Quitters of ≥15 years were almost risk free. In women, none of the HRs of CVD/CHD were significant.

CONCLUSION

An increased risk of incidence of CVD/CHD was found in current male smokers. To confirm and further elaborate these findings, more data of sex-specific studies are required from culturally diverse urban and rural areas of Iran.

Association between duration of endogenous estrogen exposure and cardiovascular outcomes: A population - based cohort study

AIMS

Duration of endogenous estrogen exposure is apparently associated with risk of cardiovascular disease, the longer durations being more cardiovascular disease protective in women. We aimed to investigate the association of cumulative duration of endogenous estrogen exposure over women's reproductive lifespans with cardiovascular disease outcomes.

MAIN METHODS

For the purpose of the present study, of 10,192 female participants, after excluding those using HRT (n = 84), 3656 women, aged ≥30 years, who met eligibility criteria were selected and divided into three groups based on tertiles (T1, T2, T3) of exposure durations to endogenous estrogen. Cox proportional hazards regression model was used to estimate associations between exposure durations and cardiovascular disease outcomes.

KEY FINDINGS

Cardiovascular events occurred in 352 participants over a median follow-up of 14.2 (13.5, 14.6) years (7.7 per 1000 person years; 95% CI: 6.9-8.5). Incidence of outcome was 10.9 per 1000 person years (CI, 9.4-12.8) in T₁, 7.2 per 1000 person years (CI, 6.0-8.7) in T₂, and 5.1 per 1000 person years (CI, 4.1-6.4) in T₃. The hazard ratio of cardiovascular events in T₁ was significantly higher than that inT₃, before and after adjustment for confounding variables. Before adjustment, women in T₂ had a 40% higher risk of CVD, compared to T₃; after adjustment however the risk was similar to that of women in T₃.

SIGNIFICANCE

Shorter durations of exposure to endogenous estrogen may increase the risk of cardiovascular diseases among these women later in life. Future studies should target women with short duration of exposure for timely screening and implementation of preventative interventions.

Effects of a Healthy Lifestyle Education on the Incidence of Metabolic Syndrome in Children during a 13-Year Follow-up

PURPOSE

This study aimed to determine effects of community-based healthy lifestyle education on the incidence of metabolic syndrome (MetS) in Tehranian children considering parental factors during a 13-year follow-up.

METHODS

This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) on 1603 healthy children, aged 8-18 years, who had complete parental data. Parental factors including MetS, education, age, occupation, and smoking were considered to distinguish parental clusters which could potentially predispose children to MetS. Lifestyle interventions were aimed at achieving healthy dietary patterns and increasing physical activity. Cluster analysis and survival Cox model were used to determine potential low and high risk parental clusters and the effect of intervention on the hazard of MetS in children respectively.

RESULTS

In a model adjusted for children's age and sex, the hazard of the MetS incidence was 36% higher in children from high-risk parental cluster than those from low-risk parental cluster (HR = 1.36, 95% CI = 1.07-1.73). Moreover, the intervention group showed a 39% lower risk for MetS incidence (HR = 0.61, 95% CI = 0.44-0.85) compared to controls, during the first 6 years after baseline assessment (short term), although the risk lowering effect of the intervention was not maintained long term.

CONCLUSION

A healthy lifestyle education was successful in reducing the short-term risk of MetS in children. To identify ways of maintaining long-term results, further research is definitely warranted.

TRIAL REGISTRATION

This study was funded by National Research Council and Planning and Management Organization and has been reviewed and approved by the Iranian registry of clinical trials (ISRCTN52588395).

Health-Related Quality of Life in Tehran Lipid and Glucose Study

CONTEXT

Beyond the objective outcomes of metabolic syndrome (MetS), the association between this syndrome and its patient-centered outcomes need to be investigated in Middle-Eastern countries. This report aims to summarize the Tehran lipid and glucose study (TLGS) findings regarding the association between MetS and health-related quality of life (HRQoL) and its influential factors through the past decade.

EVIDENCE ACQUISITION

The current review has been conducted on the TLGS published data regarding different aspects of the association between MetS and HRQoL in adult participants through the last decade. To assess HRQoL, the Iranian version of short form health survey (SF-36) was used. To define MetS the most commonly used insulin resistance (IR)-and waist circumference (WC) - based MetS definitions have been applied in the publications reviewed.

RESULTS

As a whole, MetS was a determinant of poor physical HRQoL only in women (OR: 1.78; 95% CI: 1.21 - 2.61), particularly in those with more component of MetS (P < 0.001). Results further showed that only reproductive aged women with MetS were more likely to report poor PCS compared to those without MetS even after adjusting for age (OR: 1.7, 95% CI: 1.0 - 3.0; P < 0.05). Different structures of MetS and physical HRQoL constructs in men and women as well as age and smoking with significant gender-specific effects on mental HRQoL were factors responsible for the gender specific pattern observed. Considering the duration of MetS, only women with intermittent MetS indicated higher risk for reporting poor PCS (OR: 2.75, 95% CI: 1.19 - 6.37; P < 0.001) compared to those without MetS. The observed sex-specific pattern used to detect poor HRQoL in those with MetS was confirmed by all WC-based definitions except for the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definition. However, none of IR-based definitions could detect poor physical and mental HRQoL in either gender.

CONCLUSIONS

In summary, in the TLGS population, the association between MetS and HRQoL followed a sex specific pattern, mainly significant only in women and in the physical aspect.

Which obesity phenotypes predict poor health-related quality of life in adult men and women? Tehran Lipid and Glucose Study

Purpose

This study aimed to explore the association between different obesity phenotypes and health-related quality of life (HRQoL) among Tehranian men and women.

Methods

The participants of this study were 2880 healthy adults (aged>19 years) who participated in Tehran Lipid and Glucose Study (TLGS). To obtain socio-demographic and HRQoL information, participants were interviewed by trained interviewers and were stratified by body mass index categories and metabolic status. Dysmetabolic status was defined as having either metabolic syndrome or diabetes according to the Joint Interim Statement definition and American Diabetes Association. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to compare sex-specific odds ratios.

Results

Mean age of participants was 47.7±15.6 and 47.8±14.2 years in men and women respectively. The most and the least common obesity phenotypes were overweight-normal metabolic status and normal weight-dysmetabolic status, respectively. Only mean scores for physical HRQoL were significantly different among obesity phenotypes in both men and women (p<0.05). In addition, after adjusting for age, marital status, level of education, job status and physical activity, the odds of reporting poor physical HRQoL was significantly higher in men (OR: 1.960, 95% CI: 1.037–3.704; p<0.05) and women (OR: 2.887, 95% CI: 1.674–4.977; p<0.001) with obese-dysmetabolic status, compared to their counterparts with normal weight-normal metabolic status. However, except for overweight-normal metabolic women, who were less likely to report poor mental HRQoL (OR: 0.638, 95% CI: 0.415–0.981; p<0.05), none of the phenotypes were associated with poor mental HRQoL in either gender.

Conclusions

Compared to those with normal weight normal metabolic status, only obese dysmetabolic individuals were more likely to report poor physical HRQoL in both genders.

The Effects of a Community-Based Lifestyle Intervention on Metabolic Syndrome and Its Components in Adolescents: Findings of a Decade Follow-Up

BACKGROUND

The increasing prevalence of metabolic syndrome (MetS) in childhood makes lifestyle interventions imperative during adolescence. This study aimed to assess the effects of a community-based lifestyle intervention on MetS and its components in adolescents.

METHODS

Adolescents, based on their residential area were categorized into three groups: complete intervention (residing in the intervention area at baseline and during all follow-ups), incomplete intervention (residing in either the intervention or control areas and were in transition between these two areas), and control group (residing in the control area at baseline and throughout all follow-ups). All measurements were repeated every 3 years for up to 9 years. Lifestyle intervention aimed at achieving healthy dietary patterns and increasing physical activity. Generalized estimating equation models were used to analyze data.

RESULTS

In boys with incomplete intervention versus controls, the prevalence of MetS was significantly lower in the short term (14.0 vs. 22.9), but not in long term. In boys with complete intervention, the prevalence was significantly lower versus controls (9.0 vs. 23.4) in the long term. In girls, the short-term prevalence of MetS was significantly lower in the complete intervention group compared with controls (2.5 vs. 9.1) and then remained constantly low in all study groups after that. Among MetS components, in boys, triglycerides and fasting plasma glucose in the short term and high-density lipoprotein mid term, and in girls HDL in mid and long term were both significantly improved. The odds of MetS decreased significantly in the complete [odds ratio (OR): 0.516, confidence interval (95% CI): 0.273-0.973] and incomplete (OR: 0.591, 95% CI: 0.358-0.976) intervention groups only in boys. The short- and long-term interventions resulted improvement in some of the MetS components in both genders.

CONCLUSIONS

The healthy lifestyle intervention reduced the risk of MetS in both genders in short and long term, but with different patterns and improved some of the MetS components.

Polycystic ovary syndrome is a risk factor for diabetes and prediabetes in middle-aged but not elderly women: a long-term population-based follow-up study

OBJECTIVE

To study the incidence rate and hazard ratios of diabetes and prediabetes between women with PCOS and healthy subjects.

DESIGN

Prospective population-based study.

SETTING

Not applicable.

PATIENT(S)

Women with PCOS (n = 178) and eumenorrheic, nonhirsute, healthy women as controls (n = 1,524), all followed for a median time of 12.9 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Incidence rate and hazard ratios of diabetes and prediabetes between women with PCOS and healthy controls.

RESULT(S)

We analyzed the participants on two pathways. First, for detecting new diabetes mellitus (DM) events, we selected participants who were free of DM at baseline (n = 39). Second, for detecting new pre-DM events, we selected participants who were free of pre-DM and DM at baseline (n = 222) from the baseline population. The rest of the population were included for final analysis to calculate the incidence rates and hazard ratio of diabetes and prediabetes events. The incidence rates of diabetes were 12.9 and 4.9 per 1,000 person-years for PCOS and controls, respectively. This incidence rate in women younger than 40 with and without PCOS was 13.4 and 4.2, respectively. The adjusted hazard ratio (HR) for women ≤40 was 4.9 (95% confidence interval [CI], 2.5-9.3). There were no statistically significant differences between the two groups studied after age 40. The incidence rates of prediabetes were 29.7 and 25.9 per 1,000 person-years for PCOS and healthy women, respectively. The incidence rate in women younger than 40 with and without PCOS was 30.3 and 23.9, respectively. The adjusted HR for women ≤40 years, 1.7 (95% CI, 1.1-2.6), disappeared after age 40.

CONCLUSION(S)

These data suggest that routine screening for diabetes in prevention strategies does not need to be emphasized for PCOS patients at late reproductive ages if they have not been affected by glucose intolerance up to that point.

Socio-Demographic Determinants of Health-Related Quality of Life in Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Health-related quality of life (HRQOL) is a multi-dimensional concept that is affected by different variables. A large body of evidence shows that socio-demographic factors have a significant influence on HRQOL. When considering differences in cultural contexts and social values of various countries and the lack of evidence regarding socio-demographic determinants of HRQOL among the Iranian general population, it is important to verify the main socio-demographic determinants of HRQOL in an urban Iranian population.

OBJECTIVES

This study aimed to explore socio-demographic factors associated with HRQOL and to ascertain the determinants of poor HRQOL in participants of the Tehran lipid and glucose study (TLGS).

METHODS

The participants included 3491 adults, aged ≥ 20 years, who had participated in the TLGS. To obtain socio-demographic and HRQOL information, participants were interviewed by trained interviewers. Mean HRQOL scores were compared using the student's t test and analysis of variance (ANOVA). To determine significant determinants of poor HRQOL, multivariate logistic regression analysis was performed.

RESULTS

Mean ages of males and females were 47.7 ± 15.6 and 47.8 ± 14.2 years, respectively and 58.6% of participants were male. Males had significantly higher scores compared to females in both the physical and mental domains of HRQOL (P < 0.001). In males, significant determinants of poor physical HRQOL were older age, being married, being unemployed yet having other sources of income, having literacy levels below high school diploma, and having chronic diseases (P < 0.05). In females, however older age and being housewives were significant determinants of poor physical HRQOL (P < 0.05). In addition, significant determinants of poor mental HRQOL were younger age and being single or divorced/widowed in males and younger age and being illiterate as well as having literacy levels below high school diploma in females (P < 0.05).

CONCLUSIONS

Current findings highlight the importance of socio-demographic determinants of HRQOL in both genders, specifically in the physical domain, and demonstrate their roles to be more prominent in males. These findings highlight gender-specific associations between socio-demographic factors and various aspects of HRQOL among the TLGS population, which could be applied in future research focusing on non-communicable diseases and planning health promotion programs.

Maternal Characteristics and Incidence of Overweight/Obesity in Children: A 13-Year Follow-up Study in an Eastern Mediterranean Population

Objectives To investigate clustering of parental sociobehavioral factors and their relationship with the incidence of overweight and obesity in Iranian children. Methods Demographics, body weight, and certain medical characteristics of the parents of 2999 children were used to categorize parents by cluster; children's weights were assessed for each cluster. Specifically, survival analysis and Cox regression models were used to test the effect of parental clustering on the incidence of childhood overweight and obesity. Results Maternal metabolic syndrome, education level, age, body weight status, and paternal age had important roles in distinguishing clusters with low, moderate, and high risk. Crude incidence rates (per 10,000 person-years) of overweight and obesity were 416.8 (95% confidence interval (CI) 388.2-447.5) and 114.7 (95% CI 101.2-129.9), respectively. Children of parents with certain constellations of demographic and medical characteristics were 37.0 and 41.0% more likely to become overweight and obese, respectively. Conclusions for Practice The current study demonstrated the vital role of maternal characteristics in distinguishing familial clusters, which could be used to predict the incidence of overweight and obesity in children.

Association between Metabolic Syndrome and Health-related Quality of Life among Individuals with Normal and Impaired Glucose Regulation: Findings from Tehran Lipid and Glucose Study

BACKGROUND

Recent studies have shown that metabolic syndrome is associated with poor health-related quality of life (HRQoL). Moreover, it is shown that the prevalence of MetS and impaired glucose regulation, which are shown to have negative impact on HRQoL, overlap. This study aimed to investigate the association between HRQoL and metabolic syndrome (MetS) considering glucose regulation status in a sample of non-diabetic Tehranian adults.

METHODS

This was a cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study (TLGS).Logistic regression analysis was used to estimate the odds ratio (OR) with 95% confidence interval (CIs) in normal and impaired glucose regulation. Cochran's Mantel-Haenszel test was used to test the homogeneity of the odds ratios for reporting poor HRQoL in those with MetS in two groups of normal and impaired glucose regulation.

RESULTS

Totally, 946 participants were studied. After adjustment for age and educational level in women, MetS showed a significant negative impact on physical functioning and bodily pain in those with impaired glucose regulation and physical role limitation in normal glucose regulation group. In impaired glucose regulation group, women with MetS were more likely to report poor physical functioning (OR: 2.86, CI: 1.02-2.79), and bodily pain (OR: 2.96 CI: 1.09-8.04). In women with normal glucose regulation, poor physical role limitation was significantly associated with MetS. This association was not seen in men in either group. Based on the test of homogeneity of odds ratio, the association between MetS and HRQoL in those with normal and impaired glucose regulation was different in role physical subscale.

CONCLUSIONS

The current study showed that in both normal and impaired glucose regulation groups, MetS was associated with poor physical HRQoL in women but not men.

Menstrual Cycle Irregularity and Metabolic Disorders: A Population-Based Prospective Study

The regularity of menstrual cycles is considered an indicator of women's reproductive health. Previous studies with a cross-sectional design have documented the relationship between menstrual cycle irregularities, insulin-resistance and the future risks for metabolic disorders. Limited data documented by prospective studies can lead to premature conclusions regarding the relationship between menstrual cycle irregularities and other conditions influencing women's health. The present study therefore, using a prospective design aimed to assess the risk of metabolic disorders in women with a history of irregular menstrual cycles, was based on the data gathered from the Tehran Lipid and Glucose study (TLGS) an ongoing prospective cohort study initiated in 1999. Participants of the current study were 2128 women, aged between 18-49 years, followed for 15 years. Based on their menstrual cycles, the women were divided into two groups: (i) women with regular menstrual cycles (n = 1749), and (ii) those with irregular menstrual cycles (n = 379). The proportional COX regression model was used to compare hazard ratios (HRs) between the groups for the proposed events, including diabetes mellitus (DM), pre-diabetes (pre-DM), hypertension (HTN), pre-hypertension (pre-HTN) and dyslipidemia. It was found that during a 15-year follow up, there were 123 cases of DM, 456 cases of pre-DM, 290 cases of HTN, 481 cases of pre-HTN, and 402 cases of dyslipidemia. Compared to those with regular cycles, women with irregular menstrual cycles were found to have an increased risk for DM2 (age adjusted Hazard Ratios (HRs), 2.01; 95% confidence intervals (CI:1.59-3.50), the increased risk for DM, associated with irregular cycles remained significant after the adjustment for Body Mass Index (BMI), fasting blood sugar (FBS), family history of diabetes, and parity (HRS, 1.73; 95% CI: 1.14-2.64). There was no significant difference in the increased risk for pre-DM between the groups (age adjusted HRs, 1.33, 95% CI: 1.05-1.69). However, after the adjustment of BMI, FBS and family history of pre-DM, compared to those with regular menstrual cycles, irregular menstrual cycles showed an increased risk for pre-DM (HRs, 1.33; 95% CI: 1.05-1.69). No statistically significant difference was found in the increasing risk for other proposed events between the groups demonstrating that menstrual cycle irregularities could be considered a marker of metabolic disorders and a predisposing factor of the increased risk for diabetes mellitus and pre-diabetes in women with irregular menstrual cycles.

Could "a body shape index" and "waist to height ratio" predict insulin resistance and metabolic syndrome in polycystic ovary syndrome?

OBJECTIVE

To investigate whether a body shape index (ABSI) and waist to height ratio (WHtR) could predict insulin resistance (IR) and metabolic syndrome (MetS) in women with polycystic ovary syndrome (PCOS) compared to healthy women.

STUDY DESIGN

In a population-based study a cohort of 754 reproductive-aged women including 704 eumenorrheic non-hirsute subjects and 50 PCOS women selected according to the national institutes of health's (NIH) criteria. The ability of ABSI and WHtR for the prediction of IR was estimated by the homeostasis model and metabolic syndrome according to the joint interim statement criteria.

RESULTS

Age and BMI adjusted prevalence of IR and MetS in PCOS women vs. healthy controls were 34% vs. 26%, P=0.041 and 15% vs. 14%, P=0.917, respectively. Mean (SD) of ABSI in PCOS women and healthy women were 0.76 (0.05) and 0.76 (0.053), respectively (P=0.363). The area under curve (CI 95%) of WHtR for predicting IR and MetS among PCOS women vs. healthy women were 0.751 (0.60-0.89) vs. 0.69 (0.65-0.73) and 0.902 (0.81-0.98) vs. 0.802 (0.76-0.83), respectively. As such, the area under curve (CI 95%) of ABSI for ROC curve analysis for predicting IR and MetS among PCOS women vs. healthy women were 0.482 (0.31-0.64) vs. 0.537 (0.49-0.58) and 0.538 (0.35-0.72) vs. 0.584 (0.60-0.69), respectively.

CONCLUSIONS

These findings suggested that WHtR but not ABSI were a good predictor of IR and MetS among PCOS and healthy women. WHtR may be proposed as a screening tool for IR and MetS risk assessment among PCOS women as a sensitive, inexpensive, noninvasive, simple to assess and easy to calculate measurement tools.

A comparative study of dydrogesterone and micronized progesterone for luteal phase support during in vitro fertilization (IVF) cycles

The aim of the present study was to compare the efficacy, tolerability and patients' satisfaction after the use of oral dydrogesterone with vaginal micronized progesterone for luteal-phase support (LPS) among infertile women undergoing in vitro fertilization (IVF). A total of 210 women (aged 20-40 years old) with a history of infertility, who underwent controlled ovarian stimulation for fresh intra-cytoplasmic sperm injection-embryo transfer cycles, were included in the study. Consequently, they were randomized to receive LPS with dydrogesterone 20 mg twice daily (n = 96) or micronized progesterone 400 mg twice daily at the day of oocyte retrieval (n = 114). The clinical success rate (31% versus 33%; p = 0.888), miscarriage rate (5.0% versus 3.0%; p = 0.721), ongoing pregnancy rate (30.0% versus 30.0%; p = 1.000), implantation (22.0% versus 24.0%; p = 0.254) and multiple pregnancy rate (5.30% versus 7.20%; p = 0.394) were comparable among the two groups. Serum progesterone levels were significantly lower among the patients receiving dydrogesterone than the control group (13.62 ± 13.83 ng/ml versus 20.66 ± 18.09 ng/ml; p = 0.001). However, there was no statistically significant difference regarding the patients' satisfaction (p = 0.825) and tolerability (0.790) between the two groups. Our results showed that oral dydrogesterone (40 mg/day) is as effective as vaginal micronized progesterone considering its clinical outcomes and patients' satisfaction and tolerability, for LPS among women undergoing IVF.

Which insulin resistance-based definition of metabolic syndrome has superior diagnostic value in detection of poor health-related quality of life? Cross-sectional findings from Tehran Lipid and Glucose Study

Background

The superiority of the diagnostic power of different definitions of metabolic syndrome (MetS) in detecting objective and subjective cardiovascular outcomes is under debate. We sought to compare diagnostic values of different insulin resistance (IR)-based definitions of MetS in detecting poor health-related quality of life (HRQoL) in a large sample of Tehranian adults.

Methods

This cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study on a total sample of 742 individuals, aged ≥ 20 years. Metabolic syndrome was defined according to the World Health Organization (WHO), the European Group for the study of Insulin Resistance (EGIR), and the American Association of Clinical Endocrinology (AACE). Health-related quality of life was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis and Receiver Operating Characteristic (ROC) curve were used to investigate the impact of the three IR-based definitions of MetS on HRQoL and compare their discriminative powers in predicting poor HRQoL.

Results

Compared with other definitions, the WHO definition identified more participants with MetS (41.8 %). Although the AACE definition had higher adjusted odds ratios for reporting poor physical HRQoL (OR: 1.95; CI: 0.84–4.53 and OR: 1.01; CI: 0.55–1.85 in men and women respectively) and mental HRQoL (OR: 0.97; CI: 0.41–2.28 and OR: 1.00; CI: 0.56–1.79 in men and women respectively), none of the three studied definitions were significantly associated with poor physical or mental HRQoL in either gender; nor did ROC curves show any significant difference in the discriminative powers of IR-based definitions in detecting poor HRQoL in either gender.

Conclusions

None of the three studied IR-based definitions of MetS could significantly detect poor HRQoL in the physical or mental domains, indicating no significant superior diagnostic value for any of these definitions.

Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study

OBJECTIVE

To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndrome vs. control women.

METHODS

This study was conducted on 637 participants (85 PCOS and 552 control reproductive aged, 18-45 years) of Tehran Lipid and Glucose Study (TLGS), an ongoing population-based cohort study with 12 years of follow-up. The cardiovascular risk factors of these groups were assessed in three-year intervals using standard questionnaires, history taking, anthropometric measures, and metabolic/endocrine evaluation. Generalized estimating equation was used to analyze the data.

RESULTS

Overall mean of insulin (3.55, CI: 0.66-6.45), HOMA-IR (0.63, CI: 0.08-1.18), and HOMA-β (45.90, CI: 0.86-90.93) were significantly higher in PCOS than in healthy women after adjustment for age, BMI, and baseline levels. However, the negative interaction (follow-up years × PCOS status) of PCOS and normal women converged overtime. Comparing third follow-up with first, insulin and HOMA-IR decreased 10.6% and 5%, respectively in PCOS women; and increased 6.7% and 14.6%, respectively in controls (P<0.05). The results did not show any significant result for other cardio-metabolic variables including WC, lipid profile, FPG, 2-h PG, SBP, and DBP.

CONCLUSION

While the insulin level and insulin resistance rate were higher in reproductive aged PCOS than in healthy women, the difference of these risk factors decreased overtime. Thus, the metabolic consequences of PCOS women in later life may be lower than those initially anticipated.

Identifying Some Risk Factors of Time to Relapses in Schizophrenic Patients using Bayesian Approach with Event-Dependent Frailty Model

OBJECTIVES

Schizophrenia patients often experience relapses once and even more with no limit on number of relapses. The time among relapses are rarely considered in studies. The aim of this study was to identify some risk factors of time to elapses in schizophrenic patients with recurrent events model in survival analysis.

METHODS

In a retrospective longitudinal study, the medical records of 159 schizophrenic patients who referred to Razi hospital in Tehran from 2003 to 2005 were conveniently sampled, investigated and followed until the end of 2009. The time to recurrent relapses were considered in weeks. The patients with at least one relapse in this duration were included in the study. Event-dependent frailty model, using Bayesian approach, was applied to fit the data and identify the risk factors of time to relapses.

RESULTS

In this recurrent failure time model, the effects of age of onset (95% CI = (0.058, 0.086)), gender (95% CI = (0.146, 0.686)), marital status (95% CI = (0.475, 0.965)) and family history (95% CI = (0.115, 0.543)) were significant on the hazard time to relapses. According to the credible interval of frailty variance, elapsed time to relapse is dependent on patients' characteristics (95% CI = (0.084, 0.369)). Subsequent relapses are likely to be influenced by the occurrence of the first relapse, too (95% CI = (2.504, 3.079)), with decreasing hazard of time to relapse.

CONCLUSIONS

Subsequent relapses are likely dependent on the first and previous relapses. Age of onset, gender, marital status and family history are important risk factors influencing hazard of time to relapses. More studies are required to clear out the effect of other covariates with this model.

Do Different Metabolic Syndrome Definitions Predict Cerebrovascular Events and Coronary Heart Disease Independent of Their Components?

Background and Purpose—

The purpose of this study was to examine whether metabolic syndrome (MetS), applying different definitions, predicts incident coronary heart disease (CHD) and cerebrovascular events (CVAs) independent of its components.

Methods—

Among 2548, aged ≥50 years, World Health Organization, International Diabetes Federation, and Joint Interim Statement criteria were used to define MetS. Cox proportional hazards regression was implemented to estimate hazard ratios of incident CVA and CHD.

Results—

During 9.3 years of follow-up, 72 and 343 cases of CVA and CHD events occurred. The multivariate hazard ratios (95% CI) of incident CVA and CHD were 2.71 (1.57–4.68) and 2.07 (1.63–2.64) for MetS as defined by the Joint Interim Statement, respectively. There was no difference among the 3 definitions of MetS regarding the prediction of the CVA incidence. However, MetS as defined by the Joint Interim Statement predicted CHD better than the International Diabetes Federation definition. After adjustment for components, MetS lost its association with CHD and CVA; in this model, the elevated blood pressure and high fasting plasma glucose (International Diabetes Federation definition) showed significant risk for CVA events; regarding CHD events, the elevated blood pressure, high fasting plasma glucose, and, for World Health Organization definition, obesity and dyslipidemia remained as predictors.

Conclusions—

All definitions of MetS were associated with CVA and CHD events. After adjusting its components, MetS lost its association with incident CVA and CHD; however, elevated blood pressure for both CVA and CHD events and high fasting plasma glucose for CHD events remained as independent predictors in all definitions.