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Hajihashemi P, Hassannejad R, Haghighatdoost F, Mohammadifard N, Sadeghi M, Roohafza H, Sajjadi F, Sarrafzadegan N. The long-term association of different dietary protein sources with metabolic syndrome. Sci Rep 2021; 11:19394. [PMID: 34588516 PMCID: PMC8481327 DOI: 10.1038/s41598-021-98688-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Due to scarce epidemiologic data linking dietary protein intakes and metabolic syndrome (MetS), we aim to determine the longitudinal association of different types of dietary protein with the incidence of MetS among Iranians adults. The study was conducted in the framework of the Isfahan Cohort Study (ICS) on 6504 adults, aged ≥ 35 years, and free of MetS at baseline. A validated food frequency questionnaire was used for assessing usual dietary intakes. MetS was defined according to the Joint Scientific Statement. Mixed-effects logistic regression was applied to examine the associations between changes in weekly frequency consumption of protein and MetS status. After a median follow-up of 11.25 years, in multivariate-adjusted model, each additional frequency consumption of total protein intake (OR 0.83; 95% CI 0.81–0.85), animal protein (OR 0.80; 95% CI 0.77–0.83), plant protein (OR 0.70; 95% CI 0.64–0.76), red meat (OR 0.74; 95% CI 0.70–0.78), poultry (OR 0.73; 95% CI 0.68–0.78), egg (OR 0.79; 95% CI 0.72–0.88) and nuts and seeds (OR 0.77; 95% CI 0.71–0.84) was associated with reduced risk of MetS. No significant association was found for processed meat (OR 0.96; 95% CI 0.87–1.01) and legumes and soy (OR 0.96; 95% CI 0.86–1.07) with MetS. Our results suggest an independent inverse association between total protein, animal and plant protein and the risk of MetS. These associations did not differ by sex. Although our results can be considered to be a strategy to reduce MetS risk by dietary guidelines, randomized clinical trials are required to confirm our findings.
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Affiliation(s)
- Parisa Hajihashemi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Hassannejad
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. .,Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, PO Box 81745, Isfahan, Iran.
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, PO Box 81745, Isfahan, Iran.
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Sajjadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, PO Box 81745, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, PO Box 81745, Isfahan, Iran
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Mohammadifard N, Haghighatdoost F, Nouri F, Khosravi A, Sarrafzadegan N. Is urinary sodium excretion related to anthropometric indicators of adiposity in adults? JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:50. [PMID: 32765620 PMCID: PMC7377121 DOI: 10.4103/jrms.jrms_1048_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 10/22/2019] [Accepted: 01/22/2020] [Indexed: 11/04/2022]
Abstract
Background Although increasing salt intake is associated with greater odds of obesity, little is known about its relationship with body fat. We investigated the relation of urinary sodium (UNa) with obesity indices, including Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), a body shape index (ABSI), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Materials and Methods A total of 508 free-living adults aged ≥ 19 years were selected through stratified multistage random method as a representative of general population from central parts of Iran and were included in this cross-sectional study. Dietary sodium intake was measured using 24-h UNa (24-UNa) excretion. Weight, height, and WC were measured using standard protocols and calibrated equipment and used to measure obesity indicators, including BMI, WHtR, ABSI, and CUN-BAE. Adjusted univariate multiple logistic regression was used to assess the risk of having greater obesity measures across the tertiles of 24-UNa. Results Individuals in the top tertile of 24-UNa in comparison with those in the first tertile had greater body weight (72.02 ± 1.00 vs. 66.02 ± 0.89 kg; P < 0.0001), BMI (26.14 ± 0.33 vs. 24.82 ± 0.29 kg/m2; P = 0.007), and CUN-BAE (29.89 ± 0.42 vs. 28.38 ± 0.78; P = 0.036). There was a trend toward an increment in WC by increasing sodium intake (P = 0.073). After controlling for potential confounders, individuals with greater sodium consumption had greater chance for overweight (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.001-1.007; P = 0.015), abdominal obesity (OR: 1.004, 95% CI: 1.00-1.008; P = 0.031), and more body fat (OR: 1.007, 95% CI: 1.003-1.01; P = 0.001). No significant association was found for sodium and WHtR and ABSI. Conclusion Greater 24-UNa excretion was associated with greater means of body weight, BMI, WC, and CUN-BAE. Although changes in obesity indices per each additional 24-UNa excretion were small, our findings are relevant because of the rising obesity epidemic.
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Affiliation(s)
- Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Nouri F, Feizi A, Taheri M, Mohammadifard N, Khodarahmi S, Sadeghi M, Sarrafzadegan N. Temporal Trends of the Incidence of Ischemic Heart Disease in Iran Over 15 Years: A Comprehensive Report from a Multi-Centric Hospital-Based Registry. Clin Epidemiol 2020; 12:847-856. [PMID: 32848474 PMCID: PMC7429231 DOI: 10.2147/clep.s259953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We sought to explore the temporal trend of ischemic heart disease (IHD) incidence rate (IR) in a large city of Iran. METHODS The study population comprised hospitalized patients who were living in Isfahan, Iran, with first or recurrent IHD during the period of 2001 to 2016. To identify patients, clinical diagnostic codes were applied according to the International Classification of Diseases 10 (ICD-10: I20.0, I21-I25) and the "World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease" diagnostic categories (WHO-MONICA). Using a direct method, we calculated age-, sex-, and place-of-residence-adjusted incidence rates based on multiple reference populations. To examine the long-term trend for the IR, a bootstrap robust zero-truncated negative binomial regression model was used. RESULTS A total of 102,254 hospitalized patients, with a mean (SD) age of 61.85 (12.79), were registered between 2001 and 2016. After an initial reduction from 2006 to 2010, crude and adjusted IRs of IHD increased between 2010 and 2016. We further observed a significant increasing long-term temporal trend in the IR with an average annual change of 1.42% to 3.36% over the study period. CONCLUSION Our findings showed a decreasing trend in the IR of IHD between 2006 and 2010, possibly attributed to the comprehensive community-based interventions named "Isfahan Healthy Heart Program" performed from 2001 to 2007, followed by an increase in the adjusted IR of IHD between 2010 and 2016 in Isfahan; this indicates the importance of continuing the preventive measures to preclude the risk factors of cardiovascular diseases in our population.
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Affiliation(s)
- Fatemeh Nouri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Khodarahmi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Sajjadi F, Mohammadifard N, Maghroun M, Shirani F, Karimi S, Taheri M, Sarrafzadegan N. The effect of educational and encouragement interventions on anthropometric characteristics, obestatin and adiponectin levels. ARYA ATHEROSCLEROSIS 2019; 15:123-129. [PMID: 31452660 PMCID: PMC6698083 DOI: 10.22122/arya.v15i3.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lifestyle modification is the most important strategy for control of obesity and overweight. Obestatin and adiponectin are the biomarkers of obesity. Thus, this study was performed to examine the effect of educational and encouragement interventions and lifestyle modifications on obesity anthropometric as well as obestatin and adiponectin levels. METHODS This semi-experimental study was conducted on a subsample of TABASSOM study. Participants were 41 overweight and obese children and adolescents aged 6-18 years old and 45 overweight and obese adults aged 19-65 years old. Anthropometric characteristics including height, weight, waist and hip circumferences, and body fat percentage (BFP) were measured at the first and after one year at the end of study. We implemented some educational and encouragement interventions regarding dietary modification and physical activity during the study. Obestatin and adiponectin levels were measured at the first and end of study by enzyme-linked immunosorbent assay (ELISA) method. RESULTS The study did not show significant effect on anthropometric characteristics such as body mass index (BMI) and waist circumference (WC). BFP decreased significantly in boys, total children and adolescent group, and waist-to-hip ratio (WHR) decreased significantly only in adolescent boys after 1 year (P < 0.050). CONCLUSION Educational and encouraging interventions and lifestyle modifications could lead to decrease of body WHR and BFP in adolescent boys. This is helpful in controlling the increasing rate of obesity.
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Affiliation(s)
- Firoozeh Sajjadi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Assistant Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Maghroun
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Shirani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simin Karimi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Taheri
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Najafian J, Nouri F, Mohammadifard N. Association between sleep duration and hypertension: Isfahan Healthy Heart Program, Iran. ARYA ATHEROSCLEROSIS 2019; 15:22-26. [PMID: 31440281 PMCID: PMC6597801 DOI: 10.22122/arya.v15i1.1657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypertension (HTN) is an important risk factor for atherosclerotic and non-atherosclerotic cardiovascular disease (CVD). HTN increases risk of stroke and diabetes complications and at the end stage renal disease. Sleep disorders including short sleep duration are involved in pathogenesis of HTN. This study aimed to examine the association between self-reported sleep duration and HTN in a group of adult population in Isfahan City, Iran. METHODS This cross-sectional survey was performed as part of the Isfahan Healthy Heart Program (IHHP). A total of 12492 individuals aged over 19 years (6110 men and 6382 women) entered the study. Sleep duration was recorded according to subjects' self-report. HTN was defined as a systolic blood pressure (SBP) of ≥ 140 mmHg, a diastolic blood pressure (DBP) of ≥ 90 mmHg, or use of antihypertensive medication. The relation between sleep hours and HTN was examined using multiple logistic regression in three models, unadjusted, adjusted according to age and sex, and adjusted according to age, sex, body mass index (BMI), and waist circumference (WC). RESULTS Sleeping time less than 5 hours, in comparison to sleep duration of 7-8 hours per night,was associated with a higher risk of HTN [odds ratio (OR) = 2.52, 95% confidence interval (CI): 2.17-2.93]. This association remained significant even after adjustment for age, sex, BMI, and WC (OR = 1.38, 95% CI: 1.16-1.64). Sleep duration over 9 hours had a negative association with risk of HTN among those under 60 years old (OR = 0.63, 95% CI: 0.47-0.86). CONCLUSION Sleep duration less than 5 hours is positively associated with HTN. It seems that sleep duration might affect HTN and atherosclerotic CVD.
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Affiliation(s)
- Jamshid Najafian
- Associate Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nooshin Mohammadifard
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Anand TN, Joseph LM, Geetha AV, Prabhakaran D, Jeemon P. Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2019; 7:e761-e771. [PMID: 31097278 PMCID: PMC6527522 DOI: 10.1016/s2214-109x(19)30077-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries. METHODS We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials. FINDINGS We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I2=84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I2=57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I2=0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I2=24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I2=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I2=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure. INTERPRETATION Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality. FUNDING Wellcome Trust/DBT India Alliance.
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Affiliation(s)
- T N Anand
- Centre for Chronic Disease Control, New Delhi, India
| | | | - A V Geetha
- Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Zaribaf F, Mohammadifard N, Sarrafzadegan N, Karimi G, Gholampour A, Azadbakht L. Dietary patterns in relation to lipid profiles among Iranian adults. J Cardiovasc Thorac Res 2019; 11:19-27. [PMID: 31024668 DOI: 10.15171/jcvtr.2019.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/01/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction: Lipid metabolism is one of the main concerns of cardiovascular disease and atherosclerosis. Little is known about the association between dietary patterns and dyslipidemia. Therefore, the present study aimed to determine such association among Iranian adults. Methods: This cross-sectional study was conducted on 1433 Iranian adults in Isfahan Healthy Heart Program (IHHP). Usual dietary intakes were assessed with the use of a 48 items food frequency questionnaire (FFQ). Factor analysis was used to identify dietary patterns. Three major dietary patterns were identified: western, semi healthy and healthy fat patterns. Results: After adjustment, subjects in the upper quartiles of western dietary pattern were more likely to have high total cholesterol concentrations than those in the first quartile (odds ratio [OR]: 2.07; 95% CI: 1.25-3.42). Individuals with greater adherence to western dietary pattern had greater odds of having high low-density lipoprotein-cholesterol (LDL-C) levels compared with those in the lowest quartiles (2.53; 1.45-4.40). Conclusion: Semi healthy dietary pattern was not associated with cardiovascular disease (CVD) risk factors. Same trend was observed for healthy fat dietary pattern. Significant association was found between western dietary pattern and dyslipidemia among Iranian adults.
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Affiliation(s)
- Fatemeh Zaribaf
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golgis Karimi
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdolali Gholampour
- Isfahan Health Center (No.2), Isfahan Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Basu S, Yudkin JS, Berkowitz SA, Jawad M, Millett C. Reducing chronic disease through changes in food aid: A microsimulation of nutrition and cardiometabolic disease among Palestinian refugees in the Middle East. PLoS Med 2018; 15:e1002700. [PMID: 30457995 PMCID: PMC6245519 DOI: 10.1371/journal.pmed.1002700] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/23/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus and cardiovascular disease and have become leading causes of morbidity and mortality among Palestinian refugees in the Middle East, many of whom live in long-term settlements and receive grain-based food aid. The objective of this study was to estimate changes in type 2 diabetes and cardiovascular disease morbidity and mortality attributable to a transition from traditional food aid to either (i) a debit card restricted to food purchases, (ii) cash, or (iii) an alternative food parcel with less grain and more fruits and vegetables, each valued at $30/person/month. METHODS AND FINDINGS An individual-level microsimulation was created to estimate relationships between food aid delivery method, food consumption, type 2 diabetes, and cardiovascular disease morbidity and mortality using demographic data from the United Nations (UN; 2017) on 5,340,443 registered Palestinian refugees in Syria, Jordan, Lebanon, Gaza, and the West Bank, food consumption data (2011-2017) from households receiving traditional food parcel delivery of food aid (n = 1,507 households) and electronic debit card delivery of food aid (n = 1,047 households), and health data from a random 10% sample of refugees receiving medical care through the UN (2012-2015; n = 516,386). Outcome metrics included incidence per 1,000 person-years of hypertension, type 2 diabetes, atherosclerotic cardiovascular disease events, microvascular events (end-stage renal disease, diabetic neuropathy, and proliferative diabetic retinopathy), and all-cause mortality. The model estimated changes in total calories, sodium and potassium intake, fatty acid intake, and overall dietary quality (Mediterranean Dietary Score [MDS]) as mediators to each outcome metric. We did not observe that a change from food parcel to electronic debit card delivery of food aid or to cash aid led to a meaningful change in consumption, biomarkers, or disease outcomes. By contrast, a shift to an alternative food parcel with less grain and more fruits and vegetables was estimated to produce a 0.08 per 1,000 person-years decrease in the incidence of hypertension (95% confidence interval [CI] 0.05-0.11), 0.18 per 1,000 person-years decrease in the incidence of type 2 diabetes (95% CI 0.14-0.22), 0.18 per 1,000 person-years decrease in the incidence of atherosclerotic cardiovascular disease events (95% CI 0.17-0.19), and 0.02 decrease per 1,000 person-years all-cause mortality (95% CI 0.01 decrease to 0.04 increase) among those receiving aid. The benefits of this shift, however, could be neutralized by a small (2%) increase in compensatory (out-of-pocket) increases in consumption of refined grains, fats and oils, or confectionaries. A larger alternative parcel requiring an increase in total food aid expenditure by 27% would be more likely to have a clinically meaningful improvement on type 2 diabetes and cardiovascular disease incidence. CONCLUSIONS Contrary to the supposition in the literature, our findings do not robustly support the theory that transitioning from traditional food aid to either debit card or cash delivery alone would necessarily reduce chronic disease outcomes. Rather, an alternative food parcel would be more effective, even after matching current budget ceilings. But compensatory increases in consumption of less healthy foods may neutralize the improvements from an alternative food parcel unless total aid funding were increased substantially. Our analysis is limited by uncertainty in estimates of modeling long-term outcomes from shorter-term trials, focusing on diabetes and cardiovascular outcomes for which validated equations are available instead of all nutrition-associated health outcomes, and using data from food frequency questionnaires in the absence of 24-hour dietary recall data.
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Affiliation(s)
- Sanjay Basu
- Stanford University, Stanford, California, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Seth A. Berkowitz
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
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9
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Mozafari L, Amani R, Hamzeh B, Haghighizadeh MH, Bigvand M. The impacts of Beliefs, Attitude, Subjective Norms, Enabling Factors-based educational program on cardiovascular risk factors through enhanced nutritional behaviors in water and wastewater organization employees. J Family Med Prim Care 2018; 7:27-33. [PMID: 29915729 PMCID: PMC5958586 DOI: 10.4103/jfmpc.jfmpc_122_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Cardiovascular disease is the main cause of disability and morbidity in many countries. Considering the significance of education in correcting unhealthy eating habits and improving nutritional behaviors that prevents cardiovascular diseases, the current study has been carried out to investigate the impacts of Beliefs, Attitude, Subjective Norms, Enabling Factors (BASNEF)-based educational program on the employees' nutritional behaviors. Materials and Methods: This study was carried out on 120 randomly selected employees of Water and Wastewater Organization of Kermanshah. Individuals were divided into the control and intervention groups. Questionnaires devised based on BASNEF model and food frequency questionnaires were collected preintervention and 3-month postintervention. Educational program was performed in four training sessions. Results: Significant differences between mean scores of knowledge and other items of BASNEF model as well as nutritional improvements were observed in the intervention group after 3 months (P < 0.01). Conclusion: BASNEF educational model positively affected nutritional behaviors of the employees to reducing cardiovascular risk factors.
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Affiliation(s)
- L Mozafari
- Department of Nutrition, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - R Amani
- Department of Nutrition, Diabetes Research Centre, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - B Hamzeh
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - M H Haghighizadeh
- Department of Statistics and Epidemiology, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - M Bigvand
- Director of Research Committee, Kermanshah Province Water and Wastewater Company, Kermanshah, Iran
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10
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Nakao YM, Miyamoto Y, Ueshima K, Nakao K, Nakai M, Nishimura K, Yasuno S, Hosoda K, Ogawa Y, Itoh H, Ogawa H, Kangawa K, Nakao K. Effectiveness of nationwide screening and lifestyle intervention for abdominal obesity and cardiometabolic risks in Japan: The metabolic syndrome and comprehensive lifestyle intervention study on nationwide database in Japan (MetS ACTION-J study). PLoS One 2018; 13:e0190862. [PMID: 29315322 PMCID: PMC5760033 DOI: 10.1371/journal.pone.0190862] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/21/2017] [Indexed: 02/06/2023] Open
Abstract
Background Lifestyle interventions can substantially improve obesity and cardiometabolic risks. However, evidence of long-term benefits of national intervention is sparse. We aimed to evaluate the long-term effectiveness of a nationwide program for abdominal obesity. Methods A retrospective cohort study was performed using a longitudinal nationwide individual data in subjects aged 40–74 years who underwent checkups in fiscal year (FY) 2008. Lifestyle interventions were provided via interview in subjects with abdominal obesity and at least one cardiometabolic risk factor. Subjects who attended the lifestyle intervention (participants) were compared to those who did not attend (non-participants). Outcomes were waist circumferences (WC) and body mass index (BMI) reduction, reversal of metabolic syndrome (MetS), and changes in cardiometabolic risks. We used a three-step process with robust analytic approaches to account for selection bias that included traditional multivariate analysis, propensity-score matching and instrumental variable (IV) analyses. Results Of 19,969,722 subjects, 4,370,042 were eligible for analyses; 111,779 participants and 907,909 non-participants. A higher percentage of participants had ≥5% reductions in obesity profiles at year 3, compared to non-participants (WC, 21.4% vs 16.1%; BMI, 17.6% vs 13.6%; p<0.001 each). Participants also had higher reversal for MetS (adjusted odds ratio 1.31; 95% confidence interval: 1.29–1.33; p<0.001). Greater reductions in cardiometabolic risks were observed in participants. Those results were confirmed in analyses using a propensity score-matched cohort (n = 75,777, each) and IV analyses. Limitations of this work include the use of non-randomized national data in Japan to assess the effectiveness of the nationwide preventive program. Conclusions In the nationwide lifestyle intervention for abdominal obesity, the at-risk population achieved significant reductions in WC, BMI, and cardiometabolic risks in 3 years. This study provides evidence that the nationwide program effectively achieved long-term improvement in abdominal obesity and cardiometabolic risks.
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Affiliation(s)
- Yoko M. Nakao
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- * E-mail:
| | - Kenji Ueshima
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shinji Yasuno
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Kiminori Hosoda
- Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Ogawa
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Kangawa
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuwa Nakao
- Medical Innovation Center, Kyoto University School of Medicine, Kyoto, Kyoto, Japan
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Mehrabani S, Asemi M, Najafian J, Sajjadi F, Maghroun M, Mohammadifard N. Association of Animal and Plant Proteins Intake with Hypertension in Iranian Adult Population: Isfahan Healthy Heart Program. Adv Biomed Res 2017; 6:112. [PMID: 28904940 PMCID: PMC5590402 DOI: 10.4103/2277-9175.213877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: There is evidence regarding the relationship between dietary proteins intake and blood pressure (BP), but they had inconsistent results. Therefore, this study was designed to assess the association between different kinds of protein intake (animal and plant protein) and BP. Materials and Methods: Data were collected from Isfahan Healthy Heart Program. We performed a cross-sectional study among 9660 randomly selected Iranian adults aged ≥19-year-old that they were selected from three large Iranian regions in 2007. A simplified validated 48-item-food frequency questionnaire was used to assess dietary intake including all kinds of protein. Systolic and diastolic BPs were measured in duplicate by trained personnel using a standard protocol. Multivariable regressions were applied to assess the relationship between protein intake and BP levels and the presence of hypertension (HTN). Results: More frequent consumption of animal, plant, and total protein intake were inversely associated with BP in a crude model (P < 0.001); however, after adjustment for potential confounders this relationship remained only for plant protein (P = 0.04). The risk of HTN occurrence decreased in the highest quintile of total and plant protein consumption by 19% (odds ratio [OR] = 0.81; confidence interval [CI]: [0.65–0.96]; P for trend = 0.004) and 18% (OR = 0.82; [CI: (0.67–0.94]; P for trend = 0.03), respectively. Conclusions: More frequent protein intake, especially plant protein consumption was inversely associated with BP and risk of HTN among Iranian adults.
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Affiliation(s)
- Sanaz Mehrabani
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Asemi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firouzeh Sajjadi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Maghroun
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Sadeghi M, Soleimani A, Roohafza H, Yazdekhasti S, Oveisgharan S, Talaei M, Sarrafzadegan N. Cardiovascular disease events and its predictors in women: Isfahan Cohort Study (ICS). J Cardiovasc Thorac Res 2017; 9:158-163. [PMID: 29118949 PMCID: PMC5670338 DOI: 10.15171/jcvtr.2017.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 07/03/2017] [Indexed: 01/19/2023] Open
Abstract
Introduction: As a lack of validated data about cardiovascular (CV) events and its risk factors (RFs) in women of Eastern Mediterranean region, we aimed to evaluate common predictors of CV events among Iranian women.
Methods: Isfahan cohort study (ICS) is a prospective cohort that followed 6323 residents (51.3% women, aged 35-75 years) from three counties and their rural districts in central Iran. Common cardiovascular disease (CVD) RFs namely hypertension (HTN), diabetes mellitus, dyslipidemia, abdominal obesity, smoking, low apolipoproteins A ( apo-A) and high apolipoprotein B (apo-B) were evaluated. End points (CV events) were defined as fatal and nonfatal myocardial infarction, sudden cardiac death (SCD), unstable angina and stroke.
Results: After 9 years of follow-up, 265 CV events were detected. The mean age of women with CV event was 57.6±10.9; about 8 years older than those without event. All CV RFs were significantly more prevalent in women with CV event except for low HDL cholesterol, overweight and low apo-A. HTN, diabetes, high triglyceride (TG), high LDL-C and obesity were significantly associated with CV events after adjustment for age, smoking and menopausal status (hazard ratios [95% CI]: 2.56 [1.93, 3.95], 2.43 [1.76, 3.35], 2.02 [1.49, 2.74], 1.59 [1.20, 2.11] and 1.49 [1.16-1.92], respectively), while low HDL cholesterol and abdominal obesity were not predictors for CV events (hazard ratios [95% CI]: 1.26 [0.96, 1.65], 1.71 [0.99, 2.96], respectively).
Conclusion: In ICS, HTN, diabetes mellitus and high triglyceride are strong predictors for CV events in Iranian women. As almost all strong risk markers of CVD events are preventable, health policy makers have to give urgent consideration to make preventive public health strategies.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Soleimani
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Yazdekhasti
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Oveisgharan
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Mohammad Talaei
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Olivares DEV, Chambi FRV, Chañi EMM, Craig WJ, Pacheco SOS, Pacheco FJ. Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: A Web-Based Interactive and Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030251. [PMID: 28257087 PMCID: PMC5369087 DOI: 10.3390/ijerph14030251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 02/08/2023]
Abstract
Global health agencies estimate an increase of chronic diseases in South America. Nevertheless, few studies have investigated chronic diseases and their risk factors in the perspective of multimorbidity. This research aimed to identify these aspects in a primary health care setting of central Argentina. The Pan America version of the STEP wise approach surveillance (STEPS) instrument of the World Health Organization was applied to 1044 participants, 365 men and 679 women, with a mean age of 43 years. High prevalence of overweight (33.5%), obesity (35.2%), central obesity (54%), dyslipidemia (43.5%), metabolic syndrome (21.1%), low intake of fruit and vegetables (91.8%), low levels of physical activity (71.5%), risky alcohol consumption (28%), and smoking (22.5%) were detected. Hypertension and diabetes were the most prevalent chronic conditions and the total prevalence of multimorbidity was 33.1%, with 2, 3, 4, 5 and 6 chronic conditions found in 19.9%, 9.1%, 2.6%, 1.1% and 0.4% of the population, respectively. Multimorbidity affected 6.4% of the young, 31.7% of the adults, and 60.6% of the elderly, and was more prevalent among women, and in participants with lower levels of education. Having multimorbidity was significantly associated with obesity, central obesity, and higher concentrations of total blood cholesterol, low-density lipoprotein cholesterol, triglycerides, and glucose. A website was made available to the participants in order to share the experimental results and health-promoting information.
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Affiliation(s)
- David E V Olivares
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Frank R V Chambi
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Evelyn M M Chañi
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Winston J Craig
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Department of Public Health, Nutrition and Wellness, School of Health Professions, Andrews University, Berrien Springs, MI 49104, USA.
| | - Sandaly O S Pacheco
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Fabio J Pacheco
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
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Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. Cochrane Database Syst Rev 2015; 2015:CD011163. [PMID: 26272648 PMCID: PMC6999125 DOI: 10.1002/14651858.cd011163.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In many low- and middle-income countries (LMICs) morbidity and mortality associated with cardiovascular diseases (CVDs) have grown exponentially over recent years. It is estimated that about 80% of CVD deaths occur in LMICs. People in LMICs are more exposed to cardiovascular risk factors such as tobacco, and often do not have access to effective and equitable healthcare services (including early detection services). Evidence from high-income countries indicates that multiple risk factor intervention programmes do not result in reductions in CVD events. Given the increasing incidence of CVDs and lower CVD health awareness in LMICs it is possible that such programmes may have beneficial effects. OBJECTIVES To determine the effectiveness of multiple risk factor interventions (with or without pharmacological treatment) aimed at modifying major cardiovascular risk factors for the primary prevention of CVD in LMICs. SEARCH METHODS We searched (from inception to 27 June 2014) the Cochrane Library (CENTRAL, HTA, DARE, EED), MEDLINE, EMBASE, Global Health and three other databases on 27 June 2014. We also searched two clinical trial registers and conducted reference checking to identify additional studies. We applied no language limits. SELECTION CRITERIA We included randomised controlled trials (RCTs) of health promotion interventions to achieve behaviour change (i.e. smoking cessation, dietary advice, increasing activity levels) with or without pharmacological treatments, which aim to alter more than one cardiovascular risk factor (i.e. diet, reduce blood pressure, smoking, total blood cholesterol or increase physical activity) of at least six months duration of follow-up conducted in LMICs. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias, and extracted data. We combined dichotomous data using risk ratios (RRs) and continuous data using mean differences (MDs), and presented all results with a 95% confidence interval (CI). The primary outcome was combined fatal and non-fatal cardiovascular disease events. MAIN RESULTS Thirteen trials met the inclusion criteria and are included in the review. All studies had at least one domain with unclear risk of bias. Some studies were at high risk of bias for random sequence generation (two trials), allocation concealment (two trials), blinding of outcome assessors (one trial) and incomplete outcome data (one trial). Duration and content of multiple risk factor interventions varied across the trials. Two trials recruited healthy participants and the other 11 trials recruited people with varying risks of CVD, such as participants with known hypertension and type 2 diabetes. Only one study reported CVD outcomes and multiple risk factor interventions did not reduce the incidence of cardiovascular events (RR 0.57, 95% CI 0.11 to 3.07, 232 participants, low-quality evidence); the result is imprecise (a wide confidence interval and small sample size) and makes it difficult to draw a reliable conclusion. None of the included trials reported all-cause mortality. The pooled effect indicated a reduction in systolic blood pressure (MD -6.72 mmHg, 95% CI -9.82 to -3.61, I² = 91%, 4868 participants, low-quality evidence), diastolic blood pressure (MD -4.40 mmHg, 95% CI -6.47 to -2.34, I² = 92%, 4701 participants, low-quality evidence), body mass index (MD -0.76 kg/m², 95% CI -1.29 to -0.22, I² = 80%, 2984 participants, low-quality evidence) and waist circumference (MD -3.31, 95% CI -4.77 to -1.86, I² = 55%, 393 participants, moderate-quality evidence) in favour of multiple risk factor interventions, but there was substantial heterogeneity. There was insufficient evidence to determine the effect of these interventions on consumption of fruit or vegetables, smoking cessation, glycated haemoglobin, fasting blood sugar, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and total cholesterol. None of the included trials reported on adverse events. AUTHORS' CONCLUSIONS Due to the limited evidence currently available, we can draw no conclusions as to the effectiveness of multiple risk factor interventions on combined CVD events and mortality. There is some evidence that multiple risk factor interventions may lower blood pressure levels, body mass index and waist circumference in populations in LMIC settings at high risk of hypertension and diabetes. There was considerable heterogeneity between the trials, the trials were small, and at some risk of bias. Larger studies with longer follow-up periods are required to confirm whether multiple risk factor interventions lead to reduced CVD events and mortality in LMIC settings.
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Affiliation(s)
- Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of WarwickWarwick Centre for Applied Health Research and Delivery (WCAHRD)WarwickUK
| | - Louise Hartley
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
| | - Fiona Taylor
- London School of Hygiene & Tropical MedicineDepartment of Non‐communicable Disease EpidemiologyKeppel StreetLondonUKWC1E 7HT
| | - Shah Ebrahim
- London School of Hygiene & Tropical MedicineDepartment of Non‐communicable Disease EpidemiologyKeppel StreetLondonUKWC1E 7HT
| | - Aileen Clarke
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
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Hovsepian S, Kelishadi R, Djalalinia S, Farzadfar F, Naderimagham S, Qorbani M. Prevalence of dyslipidemia in Iranian children and adolescents: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2015; 20:503-21. [PMID: 26487880 PMCID: PMC4590206 DOI: 10.4103/1735-1995.163979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/10/2015] [Accepted: 05/13/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dyslipidemia is considered as an important modifiable risk factor for cardiovascular disease (CVD). The link between childhood dyslipidemia and occurrence of atherosclerosis and its sequels in adulthood are well-documented. This study aimed to systematically review the prevalence of dyslipidemia among Iranian children and adolescents. MATERIALS AND METHODS An electronic search was conducted on studies published from January 1990 to January 2014. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases with systematic search capability including IranMedex, Irandoc, and Scientific Information Database (SID). We included all available population-based studies and national surveys conducted in the pediatric age group (aged <21 years). RESULTS In this review, 1772 articles were identified (PubMed: 1464; Scopus: 11; ISI: 58; SID: 90; IranMedex: 149; Irandoc: 57). During three refine steps and after removing of duplicates, 182 articles related to the study domain were selected. After quality assessment, 46 studies were selected for text appraisal, of which 26 qualified articles were evaluated at the final step. The prevalence range of hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol (HDL-C) were 3-48%, 3-50%, 5-20% and 5-88%, respectively. Low HDL-C and hypertriglyceridemia were the most prevalent lipid disorders in this group of population. CONCLUSION Dyslipidemia is a common health problem among Iranian children and adolescents. Few data were available in preschool children. This finding provides useful information for health policy makers to implement action-oriented interventions for prevention and early control of this important CVD risk factor.
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Affiliation(s)
- Silva Hovsepian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Jafari-Adli S, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord 2014; 13:121. [PMID: 25610814 PMCID: PMC4301060 DOI: 10.1186/s40200-014-0121-2] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 12/06/2014] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Shahrzad Jafari-Adli
- />Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Jouyandeh
- />Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- />Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran
- />Non communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Soroush
- />Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- />Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 5th floor of Shariati Hospital, North Karegar St., P.O Box 1411413137, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- />Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- />Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, 5th floor of Shariati Hospital, North Karegar St., P.O Box 1411413137, Tehran, Iran
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Ahmadi A, Gharipour M, Nouri F, Kelishadi R, Sadeghi M, Sarrafzadegan N. Association between adolescence obesity and metabolic syndrome: Evidence from Isfahan Healthy Heart Program. Indian J Endocrinol Metab 2014; 18:569-573. [PMID: 25143919 PMCID: PMC4138918 DOI: 10.4103/2230-8210.137523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is more prevalent among Iranian adolescences. This study aimed to find the relationship between obesity and MetS among different education grades of Iranian adolescence. MATERIALS AND METHODS Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Fasting blood sugar, total cholesterol, triglyceride (TG), and high-density lipoprotein cholesterol (HDL) were measured. Trained individuals measured waist circumference and blood pressure. MetS was defined according to the De Ferranti definition. RESULTS The prevalence of overweight and obesity was 12.6% and 6.2% in junior and 11.5% and 4.3% in high school students, respectively. Obese subjects in both grades have higher waist circumference, systolic and diastolic blood pressure, and triglyceride than comparable groups. Multiple logistic regression models showed that overweight and obesity were strongly associated with MetS components analyzed. Compared to normal-weight children, overweight and obese in junior high school students were 1.47 and 2.23 times more likely to be having high TG, respectively, whereas overweight and obese in high school-students were also more likely to have elevated TG [ORs 1.94 (1.28-2.94), 4.96 (2.39-10.3) respectively]. CONCLUSION Obese children have the highest prevalence of MetS. Prevalence of MetS-related components has reached high level among Iranian adolescences that were overweight or obese.
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Affiliation(s)
- Alireza Ahmadi
- Department of Preventive Pediatric Cardiology, Isfahan Cardiovascular Research Center, Isfahan, Iran
| | - Mojgan Gharipour
- Department of Metabolic Syndrome, Isfahan Cardiovascular Research Center, Isfahan, Iran
| | - Fatemeh Nouri
- Department of Statistic, Hypertension Research Center, Isfahan, Iran
| | - Roya Kelishadi
- Department of Preventive Pediatric Cardiology, Isfahan Cardiovascular Research Center, Isfahan, Iran
| | - Masoumeh Sadeghi
- Research Department, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Department of Preventive Pediatric Cardiology, Isfahan Cardiovascular Research Center, Isfahan, Iran
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Tetra Dewi FS, Stenlund H, Marlinawati VU, Öhman A, Weinehall L. A community intervention for behaviour modification: an experience to control cardiovascular diseases in Yogyakarta, Indonesia. BMC Public Health 2013; 13:1043. [PMID: 24188684 PMCID: PMC3840649 DOI: 10.1186/1471-2458-13-1043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable Disease (NCD) is increasingly burdening developing countries including Indonesia. However only a few intervention studies on NCD control in developing countries are reported. This study aims to report experiences from the development of a community-based pilot intervention to prevent cardiovascular disease (CVD), as initial part of a future extended PRORIVA program (Program to Reduce Cardiovascular Disease Risk Factors in Yogyakarta, Indonesia) in an urban area within Jogjakarta, Indonesia. METHODS The study is quasi-experimental and based on a mixed design involving both quantitative and qualitative methods. Four communities were selected as intervention areas and one community was selected as a referent area. A community-empowerment approach was utilized to motivate community to develop health promotion activities. Data on knowledge and attitudes with regard to CVD risk factors, smoking, physical inactivity, and fruit and vegetable were collected using the WHO STEPwise questionnaire. 980 people in the intervention areas and 151 people in the referent area participated in the pre-test. In the post-test 883 respondents were re-measured from the intervention areas and 144 respondents from the referent area. The qualitative data were collected using written meeting records (80), facilitator reports (5), free-listing (112) and in-depth interviews (4). Those data were analysed to contribute a deeper understanding of how the population perceived the intervention. RESULTS Frequency and participation rates of activities were higher in the low socioeconomic status (SES) communities than in the high SES communities (40 and 13 activities respectively). The proportion of having high knowledge increased significantly from 56% to 70% among men in the intervention communities. The qualitative study shows that respondents thought PRORIVA improved their awareness of CVD and encouraged them to experiment healthier behaviours. PRORIVA was perceived as a useful program and was expected for the continuation. Citizens of low SES communities thought PRORIVA was a "cheerful" program. CONCLUSION A community-empowerment approach can encourage community participation which in turn may improve the citizen's knowledge of the danger impact of CVD. Thus, a bottom-up approach may improve citizens' acceptance of a program, and be a feasible way to prevent and control CVD in urban communities within a low income country.
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Affiliation(s)
- Fatwa Sari Tetra Dewi
- Public Health Division, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
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Al-Khudairy L, Stranges S, Kumar S, Al-Daghri N, Rees K. Dietary factors and type 2 diabetes in the Middle East: what is the evidence for an association?--a systematic review. Nutrients 2013; 5:3871-97. [PMID: 24077241 PMCID: PMC3820049 DOI: 10.3390/nu5103871] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/08/2013] [Accepted: 09/09/2013] [Indexed: 12/25/2022] Open
Abstract
This review aims to search and summarise the available evidence on the association between dietary factors and type 2 diabetes mellitus (T2DM) in Middle Eastern populations, where diabetes prevalence is among the highest in the world. Electronic databases were searched; authors, libraries, and research centres in the Middle East were contacted for further studies and unpublished literature. Included studies assessed potential dietary factors for T2DM in Middle Eastern adults. Two reviewers assessed studies independently. Extensive searching yielded 17 studies which met the inclusion criteria for this review. The findings showed that whole-grain intake reduces the risk of T2DM, and potato consumption was positively correlated with T2DM. Vegetables and vegetable oil may play a protective role against T2DM. Dietary patterns that are associated with diabetes were identified, such as Fast Food and Refined Grains patterns. Two studies demonstrated that lifestyle interventions decreased the risk of T2DM. In summary, the identified studies support an association between some dietary factors and T2DM; however, many of the included studies were of poor methodological quality so the findings should be interpreted with caution. The review draws attention to major gaps in current evidence and the need for well-designed studies in this area.
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Affiliation(s)
- Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; E-Mails: (S.S.); (K.R.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +44-(0)-2476-575-593
| | - Saverio Stranges
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; E-Mails: (S.S.); (K.R.)
| | - Sudhesh Kumar
- WISDEM Centre, University Hospitals of Coventry and Warwickshire, NHS Trust, Clifford, Bridge Road, Coventry, CV2 2DX, UK; E-Mail:
| | - Nasser Al-Daghri
- Prince Mutaib Chair for Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia; E-Mail:
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; E-Mails: (S.S.); (K.R.)
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