Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design

Association of diet quality scores with risk of metabolic-associated fatty liver disease in Iranian population: a nested case-control study

Background and aim

A healthy diet has been recommended for non-alcoholic fatty liver disease (NAFLD). We aim to investigate the associations of diet quality indices with the risk of developingmetabolic-associated fatty liver disease (MAFLD).

Methods

We conducted this nested case-control study by recruiting 968 cases with MAFLD and 964 controls from the participants of the baseline phase of the Sabzevar Persian Cohort Study (SPCS). MAFLD was defined as having a fatty liver index ≥ 60 plus at least one of the following: overweight or obese, Type II diabetes mellitus, or evidence of metabolic dysregulation. Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) were calculated from a validated food frequency questionnaire. We estimated the associations of HEI-2015 and AHEI-2010 with MAFLD risk using multivariable logistic regression.

Results

Among those in the highest relative to the lowest quintile of HEI-2015 and AHEI-2010, the multivariable-adjusted odds ratios (OR) were 0.45 (95% CI [confidence interval] 0.29-0.69; P trend = 0.002) and 0.55 (95% CI 0.35-0.85; P trend = 0.04), respectively.

Conclusion

The results of our study suggest that there is a significant associationbetween adherence to a healthy diet, indicated by a higher score of HEI or AHEI, and a reduced likelihood of developingMAFLD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01544-x.

The relationship between hysterectomy, menopause, and tubal ligation, with coronary heart diseases in North of Iran: a population-based case-control study

Previously, menopause, hysterectomy, and tubal ligation (TL) have been evaluated as coronary heart disease (CHD) risk factors. However, the results regarding the significance of these associations were conflicting. Thus, the present study aimed to assess whether hysterectomy, menopause, and TL increase the odds of CHD. This case-control study included data from the enrollment phase of the Tabari cohort study (TCS) consisting of 564 cases of CHD and 564 healthy controls. Logistic regression was used to calculate the odds ratio (OR) of CHD in relation to hysterectomy, menopause, and TL status after adjustment for confounders. The univariate logistic regression analysis showed a significantly higher odds of CHD among post-menopausal participants (OR: 5.09, 95%CI 3.92-6.61), participants with TL (OR: 1.81, 95%CI 1.41-2.32), and women with hysterectomy (OR: 2.43, 95%CI 1.69-3.50). However, none of the associations were statistically significant (Hysterectomy: OR: 1.21, 95%CI 0.8-1.85; Menopause: OR: 1.43, 95%CI 0.88-2.31; TL: OR: 1.01, 95%CI 0.74-1.37) in the fully adjusted model (after adjustment for age, diabetes, hypertension, residential area, waist-to-hip ratio, pregnancy number, socio-economic state, occupation, education, and physical activity). Although some models showed significance, none of the reproductive factors showed a significant association with CHD after full adjustment.

Association between caries experience and reproductive history of women; a population-based study

BACKGROUND

The underlying cause of poor oral health in women of reproductive age remains unclear. This study aimed to explore the association between caries experience and reproductive history, focusing on age at menarche, age at menopause, and number of pregnancies.

METHODS

This cross-sectional study analyzed women from the baseline phase of the Ravansar Non-Communicable Disease (RaNCD) cohort. Data on reproductive history, including age at menarche, number of pregnancies, age at first pregnancy, and breastfeeding duration, were collected via questionnaire. The Decayed, Missing, and Filled Teeth (DMFT) index was assessed using dental examinations conducted with standard instruments. Reproductive history was considered the exposure variable, while caries experience was the outcome. Statistical analyses, including t-tests, One-way ANOVA, and linear regression, were conducted to examine associations between reproductive history and oral health.

RESULTS

A total of 5,151 women were assessed, with a mean age of 47.56 ± 8.46 years. Of these 42.46% lived in rural areas. The mean DMFT score in the overall population was 16.47 ± 9.19. Women who used dental floss had a significantly lower median DMFT than those who did not (16 vs. 12, P < 0.001). In the adjusted model, DMFT increased significantly by 0.30 for each additional pregnancy (β = 0.30,95%CI:0.04,0.56). However, no significant associations were observed between age at menstruation, frequency of abortion, age at first pregnancy, or age at menopause and DMFT.

CONCLUSIONS

The findings indicate that the number of pregnancies is significantly associated with caries experience. Further, longitudinal studies are needed to replicate this study findings.

Socioeconomic inequality in mental health disorders: A cross-sectional study from the Tehran University of Medical Sciences employees' cohort study

Understanding socioeconomic inequalities in health helps identify vulnerable groups and guide targeted interventions. Mental health disorders significantly affect well-being and productivity. This study assessed the prevalence and socioeconomic inequalities in depression, anxiety, and stress among employees of the Tehran University of Medical Sciences. This cross-sectional study analyzed data from the Tehran University of Medical Sciences Employees' Cohort (TEC) baseline phase, comprising 4,442 individuals. The Depression, Anxiety, and Stress Scale-42 (DASS-42) was utilized to measure mental health disorders. Education level and wealth index were considered as socioeconomic indicators. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were employed to estimate socioeconomic inequality. The age-adjusted prevalence of depression, anxiety, and stress was 8.7%, 8.6%, and 11.5%, respectively. The relative wealth-related inequality analysis revealed that, after adjusting for age, sex, marital status, and education level, the prevalence of depression, anxiety, and stress in the lowest wealth index was 2.54, 2.89, and 1.65 times higher than in the highest wealth index, respectively. Additionally, the relative education-related inequality analysis indicated that, adjusted for age, sex, marital status, and wealth index, individuals with primary education or no formal education had 2.58, 2.99, and 2.14 times higher prevalence of depression, anxiety, and stress compared to those with a doctoral degree, respectively. Significant disparities in the prevalence of mental health disorders were found across educational and wealth index levels. Targeted interventions and policies should aim to achieve and sustain long-term benefits for vulnerable and disadvantaged groups.

Distribution and Prevalence of Contact Lens Use in Iranian Adult Population, Results of the Persian Eye Cohort Study

OBJECTIVES

To determine the age- and gender-specific prevalence of contact lens wearers among Iranian adults aged 31 to 70 years (results from the nationwide Persian Cohort Eye Study).

METHODS

This multicenter population-based cross-sectional study used a cluster sampling procedure to recruit 48,618 Iranian participants aged 31 to 70 years (mean age: 42.9±7.9 SD) from six different provinces between 2015 and 2020. Demographic characteristics and medical and ocular history of participants were gathered through the interview. All participants underwent a thorough history-taking interview and a comprehensive optometric examination in the clinic. We used logistic regression on the multilevel analysis to determine the effect of different variables on contact lens use.

RESULTS

In total, 228 participants (0.34%, of all) used contact lenses. Among them, 141 subjects (0.22%) used corrective lenses, 82 subjects (0.13%) wore cosmetic lenses, and five subjects wore both. The mean age of the population was 42.9±7.9 SD (31-70 years). There was an inverse association between advancing age and both lens wear (adjusted ORs: 0.26, 0.15). Wearing both types of lenses was correlated with being female (adjusted ORs: 3.22, 9.03), having higher education (adjusted ORs: 7.94, 5.49), and high wealth score index (adjusted ORs: 3.64, 1.46). The mean spherical equivalent of the whole population, corrective lens, and cosmetic lens users were -1.46±2.91 D, -2.04±3.42 D, and -0.55±1.21 D, respectively. Most cosmetic lens users were emmetropes (68.75%), while myopia was the most frequent refractive error among corrective lens wearers (67.88%). There was a significant difference in usage between centers. Professional prescriptions and other unknown sources were the main purchase sources for corrective and cosmetic lens users, respectively.

CONCLUSIONS

The prevalence of contact lens use in the older adult population of Iran is very low, highlighting an important opportunity for public health and eye care professionals. The population-based information reported in this article indicates a significant gap in public and professional awareness and attitudes toward contact lens use, emphasizing the need for targeted educational initiatives and accessibility improvements. These findings offer valuable insights for future eye care planning, policy development, and potential growth in contact lens practice and marketing in Iran.

Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort

BACKGROUND

Socioeconomic status (SES) and education influence medication use, but their effects at both individual and community levels remain poorly understood. This study investigates the association between medication count and polypharmacy with SES and education at both levels.

METHODS

We used data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), comprising 163,770 individuals aged 35-70 from 18 sites in Iran. Individual SES was evaluated using asset analysis, while community SES was determined based on the prevalence of low SES individuals in each site. Individual education level was dichotomized into having at least 5 years of schooling or not, while community education level was determined by the frequency of individuals with high education level in each site. Multi-level Poisson regressions, were conducted to explore the association between these variables and medication count in this cross-sectional study.

RESULTS

Approximately 45% of participants used at least one medication, with an average of 1.32 medications per person. Polypharmacy was observed in 8.85% of the population. Higher individual SES was associated with a slightly increased medication count (PR 1.05; 95% CI: 1.02-1.08) and a modest increase in polypharmacy risk (PR 1.08; 95% CI: 1.03-1.14). Residing in middle-SES communities was linked to lower medication use (PR 0.88; 95% CI: 0.85-0.91) but was not significantly associated with polypharmacy. Higher individual education was associated with reduced medication count (PR 0.92; 95% CI: 0.88-0.96) and a lower likelihood of polypharmacy (PR 0.85; 95% CI: 0.79-0.91). However, living in highly educated communities was associated with increased medication count (PR 1.70; 95% CI: 1.62-1.78) and a higher risk of polypharmacy (PR 1.81; 95% CI: 1.16-2.81). The models were adjusted for age, gender, residence, ethnicity, marital status, body mass index, physical activity level, smoking status, opium use, hookah use, and alcohol consumption.

CONCLUSION

Higher education was associated with lower medication use, whereas living in more educated communities was linked to higher usage. Although the association between individual SES and medication use was relatively weak, residing in middle-SES communities was associated with lower medication usage. These findings show the importance of addressing community-level factors in health research and policymaking.

Iranian females report more severe symptoms on the SNOT-22: A cross-sectional population-based study

PURPOSE

Rhinosinusitis encompasses a group of conditions characterized by inflammation of the nasal mucosa and paranasal sinuses, impacting the quality of life for those affected. This study was designed to assess the quality of life in the general population using the SNOT-22 questionnaire. This study was designed to assess quality of life among the general population using the SNOT-22 questionnaire, which is a tool for measuring quality of life related to rhinological issues.

MATERIAL AND METHODS

This population-based cross-sectional study was conducted as part of the baseline assessment for the Hoveyzeh cohort study, focusing on adults aged 35-70 in southwest Iran. Data related to socioeconomic factors, demographic characteristics, and anthropometric measurements were gathered. Subsequently, a random sample of 1324 individuals participated in the study, completing the Self-reported SNOT-22 questionnaire.

RESULT

The mean age of 1324 participants was 49.92 ± 8.97 years, and about 60 % were women. The average SNOT-22 score was 7.84 ± 10.78. Approximately 34 % of the participants had an abnormal score on the SNOT-22 questionnaire. These participants were assessed for domains related to nasal, otologic, sleep and emotional symptoms. The most common issues reported were sneezing, dizziness or vertigo, waking up tired, and feelings of sadness, respectively. We observed that the odds of having an abnormal SNOT-22 scores were 62 % higher in women compared to men.

CONCLUSION

Our results revealed a relatively higher prevalence of abnormal SNOT-22 scores, especially among women. Therefore, designing and implementing therapeutic and educational interventions for these people seems necessary.

Recurrent aphthous stomatitis (RAS) and its related factors among the Azar cohort population

INTRODUCTION

Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions, characterized by painful ulcers that develop on non-keratinized oral mucosa, significantly affecting the quality of life. This study aimed to evaluate the prevalence of RAS and its associated risk factors within the Azar cohort population.

METHODS

This cross-sectional study utilized data from the Azar cohort, which has been ongoing since 2014 in Shabestar City, East Azarbaijan, Iran, involving 15,006 adults aged 35 to 70 years. To assess the prevalence of RAS, participants were provided with a description of these lesions and asked whether they had ever experienced RAS in the oral cavity. Data collection was based on self-reports and examinations conducted by the physicians involved in the Azar cohort. Participants with RAS were classified into the RAS group, while the remaining participants were categorized into the non-RAS group. We assessed the association between RAS and various factors using binary logistic regression.

RESULTS

In the study population, there were 3,503 individuals in the RAS group and 11,503 individuals in the non-RAS group. The prevalence of RAS in the Azar cohort was 23.34%. Individuals over 50 years of age (p < 0.001), those with a poor (p < 0.001) or very poor (p = 0.02) socio-economic status, a low educational level (p = 0.01), smokers (p < 0.001) and individuals with a history of smoking who have since quit (p = 0.01) were significantly less affected by RAS. Conversely, individuals with genital aphthous lesions (p < 0.001), depression (p < 0.001), rheumatoid disease (p = 0.01), and food allergies (p < 0.001) were significantly more affected by RAS.

CONCLUSIONS

Factors such as being under 50 years of age, possessing a high socioeconomic status, having a higher level of education, experiencing genital aphthous disease, suffering from depression, having rheumatoid disease, and having food allergies may be associated with a higher prevalence of RAS.

Dietary patterns and colorectal cancer: a multicenter case-control study in an Iranian population

Evidence on the association between dietary patterns (DPs) and colorectal cancer (CRC) is inconclusive. Thus, we aimed to evaluate it in an Iranian population. We analyzed data from a multicenter hospital-based case-control study conducted in Iran during 2017-2020. We derived a posteriori DPs using principal component factor analysis, and used reduced rank regression (RRR) to derive a DP high in unhealthy fats. We estimated adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between quartiles of DPs and CRC. False discovery rate (FDR)-corrected p-values were computed. We included 865 CRC cases and 3,204 controls in the study. After FDR correction, the Western-type diet (ORQ4vsQ1 4.15; 95% CI 2.49-6.90; ptrend < 0.001) identified through factor analysis was positively associated with CRC. Similarly, the DP high in unhealthy fats derived using RRR (with high factor loadings for animal products) was associated with CRC (ORQ4vsQ1 2.14; 95% CI 1.40-3.26; ptrend < 0.001). Results were consistent among CRC subsites and different participants' characteristics, including cigarette and waterpipe smoking and opium use. Our study showed that both a Western-style diet and DP high in unhealthy fats are associated with CRC, suggesting that consumption of unhealthy foods, including those high in trans and saturated fatty acids, should be reduced.

Socioeconomic inequality in the prevalence of anemia: decomposing analysis among Kurdish people

INTRODUCTION

Anemia is a prevalent public health issue affecting millions worldwide, particularly among vulnerable populations. This study examines anemia prevalence among Iran's Kurdish population, revealing socioeconomic inequality and emphasizing the need for targeted interventions.

MATERIALS & METHODS

A cross-sectional analysis was conducted in 2019 using baseline data from the Dehgolan Prospective Cohort Study, involving 3,869 adults aged 35-70. Anemia was defined according to WHO guidelines, and socioeconomic status was assessed through household asset indices and educational attainment. Logistic regression and concentration index methods were employed to analyze the data.

RESULTS

The prevalence of anemia was found to be 4.4%, with a higher rate in females (6.1%) compared to males (2.2%). Significant disparities were observed based on education and wealth, with illiterate individuals showing a prevalence of 5.5%. The analysis revealed that education and gender were the most influential factors contributing to socioeconomic inequality in anemia prevalence.

CONCLUSION

The study highlights the critical role of socioeconomic factors in the prevalence of anemia among the Kurdish population. Addressing these inequalities is essential for improving health outcomes and developing effective public health strategies.

Association Between Smoking and Amnesia in Southwest Iran: A Population-Based Cross-sectional Study

BACKGROUND

Amnesia is a cognitive impairment that manifests as a deficit in the retrieval of previous memories and the acquisition of novel information. Limited research, especially in Iran, exists on the risk factors of amnesia, and smoking might be linked to a greater likelihood of experiencing memory issues and cognitive decline, including amnesia. The aim of this study was to explore the risk factors associated with amnesia and the connection between smoking and amnesia. Study Design: A population-based cross-sectional study.

METHODS

This study was conducted at the baseline of the Hoveyzeh cohort study on adults aged 35-70 years in southwest Iran between 2016 and 2018. The required data on socioeconomic factors, demographic characteristics, history of stroke, history of epilepsy, and history of head trauma were collected from the participants. The relationship between smoking and amnesia was assessed, and multiple logistic regression was employed to account for potential confounding variables.

RESULTS

The mean age of the participants was 48.83±9.20 years, and 39% were male. The overall prevalence of amnesia was 4.2% (95% confidence interval [CI]: 3.8-4.6). The odds of having amnesia were significantly higher in smokers than in nonsmokers (adjusted odds ratio=1.52 [95% CI: 1.21-1.91]). Additionally, several other factors, including age, education level, type of residence, history of stroke, epilepsy, and history of trauma, were associated with amnesia.

CONCLUSION

Our investigations revealed a direct correlation between smoking and amnesia. To gain a more comprehensive understanding of the underlying mechanisms of these associations, it will be imperative to conduct future longitudinal studies.

Relationship between Anemia and Anthropometric Profile in Tabari Cohort Population: A Case-Control Study

BACKGROUND

Anemia is a common blood disorder in developing countries and is associated with diseases such as diabetes, as well as cardiovascular and pulmonary diseases. This study aimed to investigate the relationship between anemia and anthropometric profiles in the Tabari cohort population. Study Design: A case-control study.

METHODS

In this study, we used a subset of data collected during the first phase of the Tabari cohort study (TCS). All participants who had anemia were included in the case group (1352 individuals) using the census method. The control group (1352 individuals) consisted of participants who did not have anemia and were randomly selected from the remaining participants. The case and control groups were matched for age and gender. Anthropometric indices, including body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR), were measured by qualified and trained persons. Hematological indices were measured, and data were analyzed using the chi-square test and independent t test. A multiple logistic regression analysis was used to adjust for possible confounding variables.

RESULTS

The place of residence, education level, socioeconomic status, WC, BMI, and WHR were significantly different between the case and control groups (P<0.05). Anthropometric indices, including BMI (adjusted OR=0.75; 95 % CI 0.61, 0.91), WC (adjusted OR=0.86; 95 % CI 0.74, 1.00), and WHR (adjusted OR=0.75; 95 % CI 0.64, 0.88), were significantly different between the case and control groups (P<0.05).

CONCLUSION

Anthropometric indices were associated with anemia, and participants with higher BMI, WC, and WHR were less likely to develop anemia.

Relationship Between Physical Activity Levels and Type 2 Diabetes in Adults: Zahedan Adult Cohort Study, Iran

Background

Given the influence of lifestyle on type 2 diabetes mellitus (T2DM), the present study aimed to investigate the association between physical activity (PA) intensity and T2DM among sedentary and active participants in the Zahedan Adult Cohort Study (ZACS), Iran.

Methods

This cross-sectional study was conducted as part of the population-based Persian Prospective Epidemiological Research Studies in Iran (Persian Cohort). The baseline data from the ZACS collected between 2015 and 2019 were utilized. A total of 10,004 adults aged 35-70 years were included in the analysis. Data were gathered through self-reported questionnaires covering general information, socioeconomic status, sleep status, medical history, and PA. Anthropometric measurements and biochemical parameters were obtained from participants after a 12-h fasting period. The data were analyzed using descriptive statistics, independent-sample t-test, chi-square, and logistic regression tests in SPSS22.

Results

The study found that the majority of the 10,004 adult participants (81.2%) were sedentary, while only 18.8% were classified as active. Sedentary participants exhibited significantly higher mean values for various health markers, including age, education, sleep duration, weight, body mass index (BMI), and blood lipid levels, as well as higher prevalence of hypertension, cardiac conditions, and stroke compared to active participants. Additionally, 21.7% of the participants had T2DM, which was associated with older age, longer sleep duration, higher weight and BMI, and abnormal waist circumference. The prevalence of diabetes increased with higher BMI, from 4.8% in underweight to 27.1% in obese participants, and was 77% in sedentary individuals compared to 16% in active individuals. Even after adjusting for demographic factors (OR = 0.65, p < 0.001), lipid levels (odds ratio [OR] = 0.68, p = 0.001), sleep status (OR = 0.72, p = 0.001), and family history (OR = 0.66, p = 0.001), active individuals were found to have a significantly lower likelihood of being diabetic compared to their sedentary counterparts.

Conclusions

The findings revealed a clear association between sedentary lifestyles and an increased risk of T2DM. Physical inactivity was correlated with adverse health markers and an elevated incidence of T2DM, which was mitigated by an active lifestyle. These results underscore the importance of public health initiatives to promote PA as a critical strategy for diabetes prevention.

Relationship between metabolic syndrome and dietary diversity in the Rafsanjan cohort study

The rapid increase in metabolic syndrome (MetS) as a major public health problem may be attributed to changes in population behavior patterns in modern society, including nutritional habits and physical activity. Therefore, this study investigated the association between dietary diversity score (DDS) and adult metabolic syndrome. In this cross-sectional study, 9715 participants aged 35-70 years from the Rafsanjan Cohort Study (RCS) were included. Demographic, medical, and habitual histories were collected. DDS was calculated using a food frequency questionnaire (FFQ). All analyses were performed using Stata 14, with p-values < 0.05. Based on the DDS, subjects were divided into four groups (quartiles). The multivariate-adjusted model showed that the risk of MetS increased by 18% in the third quartile and by 25% in the fourth quartile (OR: 1.18; 98% CI: 1.02-1.36 and OR: 1.25; 98% CI: 1.06-1.48, respectively). Additionally, an increased risk of high serum triglyceride levels was observed in the third quartile (OR: 1.19; 98% CI: 1.05-1.35). The results suggest that there is a relationship between DDS and metabolic syndrome, although this relationship changed after adjusting for confounders.

The association between age at menarche and depression: a cross-sectional analysis of the TABARI cohort at enrollment phase

BACKGROUND

Puberty, particularly menarche, involves hormonal changes that may influence depressive symptoms. However, research on the association between age at menarche (AAM) and depression yields contradictory results, possibly due to sample differences and differences in socioeconomic status, parenting style, and cultural factors within each studied population. Thus, this study aimed to investigate the association between AAM and depression in a large cohort of the Northern Iranian population.

METHODS

This cross-sectional study comprised 6103 female adults aged between 35 and 70 years from the Tabari cohort study. The association between depression and three different AAM subgroups (≤ 11 as early menarche, 12-13 as normal menarche, and ≥ 14 as late menarche) was compared using logestic regression models after adjusted sociodemographic factors.

RESULTS

The crude model showed that females with early AAM and normal AAM had higher odds of depression (OR: 1.27, 95% CI: 0.96-1.69, P = 0.09, and OR: 1.21, 95% CI: 1.03-1.43, P = 0.024, respectively) compared to the late AAM group (P for trend = 0.042). However, in the fully adjusted model, there were no significant associations (OR: 0.97, 95% CI: 0.73-1.29, P = 0.827 for early versus late AAM, and OR: 0.98, 95% CI: 0.82-1.17, P = 0.830 for normative versus late AAM).

CONCLUSION

Our results indicated that, while no significant relationship was observed between different AAM subgroups and depression in the multivariable model, there was a notable trend suggesting an improvement in depression with later AAM.

Dietary Calcium to Magnesium Ratio and Risk of Cardiovascular Diseases

Dietary factors are critical risk factors for cardiovascular diseases (CVD). Among various aspects of dietary intake, the dietary calcium-to-magnesium (Ca: Mg) ratio has been less studied. The present study aimed to evaluate the association of the dietary Ca: Mg ratio with 10-year cardiovascular risk among participants of the health cohort of medical staff in Shiraz, Iran. This cross-sectional study utilized baseline data from the Shiraz University of Medical Sciences Employees' Health Cohort Study (SUMS EHCS). Demographic, anthropometric, and laboratory data were collected. A 113-item food frequency questionnaire was used to assess dietary intake. The 10-year risk of developing cardiovascular disease (CVD) was estimated using the Framingham Risk Score. Linear regression modeling examined the association between the dietary Ca: Mg ratio and 10-year coronary risk. Of the SUMS EHCS participants, 3,382 subjects (1,515 males and 1,867 females) with a median (IQR) age of 41.00 (10.00) years were eligible for the study. In both univariate and adjusted models, a 1-unit increase in the Ca: Mg ratio was associated with higher levels of 10-year coronary risk: B = 0.097 (95% CI: 0.044, 0.150) in the univariate model and B = 0.091 (95% CI: 0.038, 0.143) in the adjusted model. The findings indicated that a higher dietary Ca: Mg ratio was associated with a higher 10-year risk of CVD.

Evaluation of dyslipidemia based on ATP III guideline in adults in Southwest Iran: a population-based study

Dyslipidemia is a primary risk factor for cardiovascular disease. This study aims to investigate the prevalence of dyslipidemia and its associated risk factors in the southwest region of Iran. This population-based cross-sectional study was conducted with 9846 participants aged 35 to 70 in southwest Iran. Data was collected on socioeconomic factors, demographic characteristics, comorbidities, laboratory tests, anthropometric measurements, and lifestyle variables. The criteria for dyslipidemia were based on the ATP III classification. A multivariable logistic regression model was used to control for potential confounders. Results showed that the overall prevalence of dyslipidemia was 43.5%, with abnormal levels of HDL, LDL, TC, and TG at 17.9, 21.8, 36.2, and 44%, respectively. The multivariable logistic regression analysis revealed that males (OR 1.92, 95% CI 1.74-2.14), individuals with abnormal waist circumference (OR 1.88, 95% CI 1.67-2.12), those with low physical activity (OR 1.30, 95% CI 1.15-1.46), smokers (OR 1.17, 95% CI 1.05-1.31), rich people (OR 1.19, 95% CI 1.04-1.36), and patients with hypertension (OR 1.16, 95% CI 1.05-1.27) had higher odds of dyslipidemia. Our findings suggest that dyslipidemia is a complex condition that is influenced by various biological and lifestyle factors. Different prevention and treatment strategies may be necessary for various population subgroups.

Association between plant-based dietary patterns and hypertension among adults with type 2 diabetes in Azar cohort study in northwestern Iran: a cross-sectional study

OBJECTIVES

Most previous research on plant-based diets and hypertension primarily focused on the general population, with limited data available among adults with type 2 diabetes (T2DM). Therefore, the present study was designed to investigate the association between plant-based dietary patterns and hypertension among adults with T2DM.

DESIGN

Cross-sectional study.

SETTING

The AZAR cohort is part of the Persian Cohort, an Iranian screening programme, and includes participants who were residing in Shabestar county, East Azerbaijan Province, Iran for a minimum of 9 months PARTICIPANTS: A total of 1947 participants with T2DM were included in the current analysis.

OUTCOME MEASURES

Hypertension was the outcome measure. This was defined as blood pressure ≥140/90 mm Hg, self-reported physician-diagnosed hypertension (supported by medical records) or use of antihypertensive medications.

RESULTS

The mean age of the participants was 54.90±8.25 years, with 61% being female. The prevalence of hypertension among the participants was 48.6% (n=946). Adherence to plant-based diet index (PDI) showed a significant inverse association with hypertension in the crude model (OR: 0.60, 95% CI: 0.46 to 0.80, P-trend<0.001), but this association became non-significant after adjusting for confounders (OR: 0.88, 95% CI: 0.63 to 1.24, P-trend: 0.54). Moreover, healthful plant-based diet index displayed a significant positive association with hypertension in unadjusted analysis (OR: 2.03, 95% CI: 1.52 to 2.70, P-trend<0.001), which also disappeared after controlling for potential confounders (OR: 0.86, 95% CI: 0.61 to 1.21, P-trend: 0.35). However, no significant relationship was found between adherence to unhealthful plant-based diet index and hypertension in crude or fully adjusted models. Findings remained consistent across different subgroups, as well as sensitivity analyses.

CONCLUSIONS

The present study did not find a significant association between adherence to PDIs and hypertension in T2DM patients. Future studies are needed to investigate this association and to explore potential mechanisms linking plant-based dietary pattern with hypertension in diverse populations.

Adherence to global diet quality score in relation to gastroesophageal reflux disease and flatulence in Iranian adults

INTRODUCTION

Gastroesophageal reflux disease (GERD) and flatulence are both prevalent afflictions and negatively impact the quality of life. This study aims to determine the relationship between the Global Diet Quality Score (GDQS), a novel metric based on the Prime Diet Quality Score with GERD and flatulence in Iranian adults.

METHODS

The cross-sectional study was conducted among 6202 adults in the context of the Shahedieh cohort study accomplished. Dietary intakes of participants were collected by food frequency questionnaires (FFQs). To calculate GDQS, 25 food groups were comprised (16 healthy and 7 unhealthy food groups and two food groups categorized as unhealthy when consumed excessively). GERD and flatulence were assessed by a self-reported questionnaire. To examine the association between GDQS with GERD and flatulence, logistic regression was performed in crude and adjusted models (Model I: adjustments for age and energy intake; Model II: gender, physical activity, marital status, occupation, educational levels, WSI, and BMI; and Model III: smoking status, depression, diabetes, hypertension, and cardio events.) RESULTS: Participants in the highest quintile of GDQS had 20% higher odds of having GERD than individuals in the lowest one (OR: 1.20; 95% CI: 0.88-1.65, P trend = 0.508). Compared to the lowest quintile, the participants in the highest quintile had no significant reduction in probability of having flatulence in the crude model (OR: 0.94; 95% CI: 0.81-1.11, P trend = 0.578). These associations remained non-significant after adjustments for confounding variables.

CONCLUSION

No significant associations were observed between higher adherence to GDQS with odds of GERD and flatulence in Iranian adults. To better understand these findings, longitudinal studies especially randomized clinical trials are needed.

Cigarettes and waterpipe use and risk of colorectal cancer in Iran: the IROPICAN study

We aimed to investigate the association between cigarettes and waterpipe use and colorectal cancer (CRC) in an Iranian population. We analyzed data from a multicenter hospital-based case-control study in Iran (IROPICAN). Data on tobacco smoking, including cigarettes, and waterpipe smoking, were collected in detail. Multivariate logistic regressions estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between cigarette and waterpipe smoking and CRC, accounting for confounders including age, sex, socioeconomic status, opium use, marital status, family history of cancer, red meat, fiber, body shape at age 15 and perceived physical workload, and each other of the two exposures. The study population consisted of 3215 controls and 848 cases, including 455 colon and 393 rectum cancers. We found no association between CRC and cigarette smoking (OR, 0.8; 95% CI, 0.6-1.0) or waterpipe smoking (OR, 1.1; 95% CI, 0.9-1.5). Analysis by categories of cigarette pack-year and frequency of waterpipe smoking (head-year) did not show associations. We observed an inverse association between colon cancer and cigarette smoking (OR, 0.6; 95% CI, 0.5-0.9). There was, however, no significant association by pack-year categories. Cigarette and waterpipe smoking was not associated with CRC in the Iranian population. Further studies are needed to better understand the role of waterpipe on CRC.

The association between serum uric acid levels and the cardiometabolic phenotype among healthcare workers of Tabriz University of Medical Sciences

Introduction

It is unclear whether hyperuricemia can be considered as an independent risk factor or just as a marker to represent the correlation between uric acid levels and other risk factors of MetS. In this work, we intend to study the correlation between serum uric acid (SUA) and the cardiometabolic phenotype among Tabriz University of Medical Science healthcare workers.

Methods

In this cross-sectional study, anthropometric measurements, serum fasting blood sugar (FBS), triglyceride (TG), cholesterol, high-density lipoprotein (HDL), liver enzymes, blood urea nitrogen (BUN), SUA, creatinine (Cr), and blood pressures of 1,451 healthcare workers were evaluated. MetS was diagnosed based on ATP III. We classified the participants into four cardiometabolic phenotypes: metabolically-healthy lean (MHL), metabolically-unhealthy lean (MUHL), metabolically-healthy obese (MHO), and metabolically-unhealthy obese (MUHO).

Results

MHL (26.6%) and MHO (65.8 %) had the highest prevalence rates in the first and second SUA categories, respectively (P≤0.001). Compared to the lowest SUA category, the odds of MHO and MUHO increased by 3.13 (95% CI 2.21-4.44) and 5.50 (95%CI 3.53-8.57) in the highest category, respectively. This trend was not observed regarding the association between MUHL and the SUA classification.

Conclusion

We propose using the easily-measured SUA level as a marker for early diagnosis of at-risk MUHL and MHO individuals to administer proper interventions. Further prospective studies are needed to identify the effects of SUA on the progression of MetS in various body-size subgroups.

Kidney stone and risk of cardiovascular diseases: a cross-sectional study in the southeast of Iran

BACKGROUND

Since the prevalence of kidney stones and cardiovascular diseases (CVD) is increasing globally and also in Iran, it is vital to assess the associations between both disorders. The current study aimed to investigate the association between kidney stones and the risk of CVD.

METHODS

This study was cross-sectional in design, which used the data of the Rafsanjan cohort study (RCS), a population-based Prospective epidemiological research study in Iran (PERSIAN) that recruited 10,000 participants of both genders aged 35-70 years from four urban and suburban areas of Rafsanjan. Demographic factors, medical history, personal habits, biochemical parameters including Fasting blood sugar (FBS), glomerular filtration rate (GFR), creatine (Cr), Blood urea nitrogen (BUN), urine specific gravity (USG), and lipids of the participants were collected according to standard protocols.

RESULTS

The results showed that the risk of CVD was higher in men (51.02%) than in women (48.98%). Also, the results showed the highest risk of CVD development for age ≥ 56 years old. The results were presented in about 31% of patients with kidney stones, 19.5% of patients with abnormal urine tests, 9.84% with Proteinuria, more than 33% with abnormal USG, and more than 94% of patients with abnormal GFR had CVD. The odds of CVD were increased in patients with kidney stones (22%), female (25%), and age ≥ 56 years old (24%).

CONCLUSIONS

There was a high prevalence of kidney stones and CVD risk factors, such as gender, age, and kidney stones that increased the risk of cardiovascular disease.

The relationship between hepatic enzymes, prediabetes, and diabetes in the Azar cohort population

BACKGROUND

Early prediabetes screening holds immense significance in decreasing the incidence of diabetes. Therefore, we aimed to evaluate the association of hepatic enzymes with prediabetes and diabetes in the Azar cohort population in Iran.

METHODS

This cross-sectional study utilized data from the Azar cohort study, initiated in 2014, with 14,865 participants aged 35-70 years. This study defines prediabetes, according to the American Diabetes Association (ADA), as fasting blood sugar (FBS) of 100-125 mg/dl. An FBS ≥ 126 mg/dL or a history of diabetes indicates diabetes. Serum liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) were measured, and associations with prediabetes and diabetes were analyzed using binary logistic regression.

RESULTS

In a study of 14,865 participants, 16% had prediabetes and 14.1% had diabetes. The serum levels of ALT, AST, GGT, and ALP were significantly higher (P < 0.05) in the prediabetic and diabetic patients. The adjusted logistic regression model showed a dose-response increase for all hepatic enzymes, with the highest ORs in the fourth quartile for both prediabetes and diabetes. The highest OR for prediabetes and diabetes was in the fourth GGT quartile.

CONCLUSION

Our findings suggest that serum ALT, GGT, and ALP levels are strongly associated with prediabetes and diabetes. These hepatic enzymes may be considered easy and valuable early indicators of diabetes risk, prompting timely interventions to slow disease progression.

Prevalence and predictors of thyroid nodules among adults: analyzing the association with metabolic syndrome in a cross-sectional study

BACKGROUND

Thyroid nodules are prevalent clinical findings with potential for malignancy, particularly in aging populations. Metabolic syndrome, characterized by interrelated metabolic abnormalities, has been implicated as a potential risk factor. This study explores the prevalence of thyroid nodules and their association with metabolic syndrome, leveraging data from a large cohort.

METHODS

A cross-sectional study was conducted within the Persian Organizational Cohort in Mashhad, comprising 4,121 participants aged 35-70 years. Thyroid nodules were identified via ultrasonography, and metabolic syndrome was assessed using the NCEP ATP III criteria. Demographic, clinical, and laboratory data were analyzed using descriptive statistics, chi-square tests, and logistic regression models to identify predictors of thyroid nodules.

RESULTS

Thyroid nodules were detected in 27.4% of participants, with a higher prevalence in females (60%) than males (40%, p < 0.001). The average age of individuals with nodules was significantly higher than those without (47.9 vs. 43.5 years, p < 0.001). Metabolic syndrome prevalence was notably higher among those with thyroid nodules (5.3% vs. 3.8%, p = 0.028). Logistic regression analysis identified metabolic syndrome (OR = 1.43, p = 0.03), age (OR = 1.05 per year increase, p < 0.001), and gender as significant predictors of thyroid nodules.

CONCLUSION

Metabolic syndrome significantly predicts the presence of thyroid nodules, suggesting shared pathophysiological mechanisms, including chronic inflammation and hormonal dysregulation. These findings underscore the importance of integrating metabolic health management into thyroid nodule evaluation and highlight the need for multidisciplinary approaches to optimize care and prevention strategies.

Adherence to combined healthy lifestyle and odds of metabolic syndrome in Iranian adults: the PERSIAN Dena cohort study

The relationship between lifestyle choices and health outcomes has received significant scholarly attention. Research indicates that factors such as obesity, insufficient physical activity, tobacco use, and poor dietary habits may elevate the odds of developing metabolic disorders. This study aimed to investigate the association between the combined healthy lifestyle score (HLS) and the odds of metabolic syndrome (MetS) and its associated components in a population of apparently healthy adults. This cross-sectional study utilized data from the Dena PERSIAN cohort, which comprised 2,971 healthy adults. Participants' combined HLS were evaluated using validated questionnaires that assessed body mass index (BMI), physical activity level (PAL), smoking status, and dietary quality. The evaluation of dietary nutritional quality was conducted using the most recent version of the Healthy Eating Index (HEI), known as HEI-2020. The combined HLS was measured on a scale ranging from zero, indicating an unhealthy lifestyle, to four, representing the healthiest lifestyle. Individuals with the highest combined HLS score had 81% lower odds of having MetS compared to those with the lowest score (OR: 0.19; 95% CI: 0.11-0.33). Higher combined HLS scores were significantly associated with decreased odds of abdominal adiposity (OR: 0.11; 95% CI: 0.07-0.18), abnormal glucose homeostasis (OR: 0.55; 95% CI: 0.35-0.86), elevated serum triglycerides (OR: 0.41; 95% CI: 0.26-0.67), and low high-density lipoprotein cholesterol (HDL-C) levels (OR: 0.39; 95% CI: 0.24-0.65) after adjusting for sex, age, education level, and marital status (P < 0.05). The findings indicated a significant association between adherence to a combined HLS and a decreased odds of developing MetS and its associated components among Iranian adults.

Relationship between dietary intake and atherogenic index of plasma in cardiometabolic phenotypes: a cross-sectional study from the Azar cohort population

BACKGROUND

Cardiovascular diseases are a leading cause of global mortality, with diet playing a key role in their progression. The Atherogenic Index of Plasma (AIP) is a predictive marker for cardiovascular risk, but its association with dietary intake across cardiometabolic phenotypes remains underexplored. This study investigates the relationship between dietary intake and AIP, hypothesizing that energy intake and macronutrients influence AIP and, consequently, cardiovascular risk.

METHODS

This cross-sectional study analyzed data from 9,515 participants aged 35-55 in the Azar cohort study. Based on Body Mass Index (BMI) and metabolic syndrome (MetS), participants were classified into four phenotypes: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUHO). Dietary intake was evaluated using a semi-quantitative food frequency questionnaire (FFQ), and AIP was calculated. Adjustments were made for age, gender, socioeconomic status, and physical activity.

RESULTS

A notable difference was observed in demographic and clinical status between cardiometabolic groups of males and females. The AIP was highest in the MUHNW (0.42 for males; 0.28 for females) and lowest in the MHNW (0.05 for males; -0.05 for females, P < 0.001). There was a statistically significant difference in the mean energy intake and the percentage of energy intake from protein among the cardiometabolic phenotypes (p < 0.001). After adjusting for confounders, only weak but meaningful correlations remained for energy, carbohydrate, and protein intake in the MUHO (r = 0.048, P = 0.01; r = 0.057, P = 0.003; and r = 0.050, P = 0.01) and for carbohydrate and lipid intake in the MHO (r = 0.034, P < 0.01 and r = -0.055, P < 0.001).

CONCLUSION

The study found weak but meaningful correlations between energy, carbohydrate, and protein intake and AIP in the MUHO phenotype and between carbohydrate and lipid intake and AIP in the MHO phenotype. This highlights the role of energy and carbohydrates in AIP within specific subgroups. Future research should focus on the effects of macronutrient combinations on AIP and long-term dietary impacts on metabolic health instead of BMI.

Prevalence of food allergy and its association with atopic dermatitis in Iran: Results from the PERSIAN birth cohort

Background

The incidence of food allergy (FA) has been increasing worldwide, causing growing concern on a global scale.

Objective

This birth cohort study analyzes the incidence of reported FA and other atopic comorbidities in children from birth to age 2 years who were living in 4 urban and semiurban areas in Iran.

Methods

Children were followed from birth until age 24 months, with follow-up questionnaires administered through parent or guardian interviews conducted when the children were aged 2, 4, 6, 12, and 24 months.

Results

The rate of physician-diagnosed FA reported by parents or guardians was higher than expected, with a cumulative incidence of 7.7% in children younger than 24 months. The highest prevalence of FA was found in Yazd, the most urban of the 4 cities studied. Breast-feeding was associated with a decreased cumulative risk of FA at age 12 months, with only 5% of breast-fed children developing parent-reported pediatrician-diagnosed FA compared with 13% of infants who never received breast milk after birth.

Conclusion

This study provides valuable insight into the incidence of FA in the Middle East, which has previously not been reported on, and it is crucial in our understanding of global FA prevalence. The study demonstrates a high incidence of FA in an area with historically lower rates and confirms that breast-feeding does prevent FA during infancy in this population.

Associations Between Body Mass Index (BMI) and Dyslipidemia: Results From the PERSIAN Guilan Cohort Study (PGCS)

Background

Obesity and dyslipidemia are interconnected complex conditions and their prevalence differs across different geographical regions. As a major risk factor for cardiovascular diseases, dyslipidemia is often misdiagnosed and inadequately treated, highlighting the need for region-specific public health policies. Therefore, the objective of this study was to examine the associations between BMI and dyslipidemia in the Prospective Epidemiological Research Studies in Iran (PERSIAN) Guilan Cohort study (PGCS) population.

Methods

This cross-sectional study analyzed the demographic and biochemical data from 10,519 participants of the PGCS population. Participants were divided into two groups with and without dyslipidemia and were compared based on BMI. Data analysis was performed in SPSS v16 with a significance level of < 0.05.

Results

The average age of the participants was 51.52 ± 8.90 years. The prevalence of dyslipidemia in all participants was equal to 75.83%. Among those with dyslipidemia, 41.18% and 35.39% had overweight and obesity, respectively. There was a positive association between BMI and the prevalence of dyslipidemia (unadjusted OR = 1.09, 95% confidence interval (CI): 1.08-1.10) (p < 0.01), indicating that for a one-unit increase in participants' BMI, the probability of having dyslipidemia increased by 9%, which remained statistically significant even after adjusting. Analysis of dyslipidemia components and BMI revealed a significant association between elevated TG and cholesterol, as well as low HDL levels and higher BMI (unadjusted OR = 1.04, 1.01, and 1.09, respectively) (p < 0.01). However, this was not statistically significant for high LDL levels (unadjusted OR = 1.01) (p = 0.05).

Conclusion

Given the high prevalence of dyslipidemia in our studied region and its strong association with obesity, prioritizing obesity management in public health decision-making is vital. Greater focus should be given on accessing and modifying the components of dyslipidemia, particularly LDL particles, as a potentially significant research target to prevent the mismanagement of dyslipidemia in individuals with obesity.

Prevalence and Factors Associated With Proton Pump Inhibitors (PPIs) Use: A Cross-Sectional Study of PERSIAN Guilan Cohort Study

Background and Aims

Proton pump inhibitors (PPIs) are used extensively in the treatment of patients with upper gastrointestinal disorders. In this study, we aimed to investigate the prevalence of PPI consumption and related factors in the Prospective Epidemiological Research Studies in Iran (PERSIAN) Guilan Cohort study (PGCS) population.

Methods

This was a cross-sectional study form the PGCS, and investigated 10,520 participants for PPI consumption, which were divided into two groups: users and nonusers. Demographical data, clinical characteristics, and PPI types were recorded. The data were analyzed using SPSS version 16 and GraphPad Prism version 9, and a significance level of 0.05 was considered.

Results

The prevalence of PPI use in the overall participants was 4.8%, and it was higher in females compared to males (6.1% vs. 3.3%). According to the regression analysis, being in the overweight category was associated with a 26% lower likelihood of PPI use (p = 0.021). Low physical activity was linked to a 1.72-fold higher odds of PPI consumption (p < 0.001). Individuals with reflux, multiple underlying diseases, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) had significantly higher odds ratios for PPI consumption (p < 0.001).

Conclusion

This study highlights the concerning trend of increasing PPI use and identifies low physical activity, reflux, multiple underlying diseases, and NSAID use associated with higher risk of PPI use. It emphasizes the need for caution in prescribing PPIs and raising awareness among both healthcare providers and patients about the potential risks and side effects.

Socioeconomic disparities in multimorbidity of chronic diseases in the RaNCD cohort study

There is limited understanding of socioeconomic inequality in multimorbidity in Iran. This study aims to investigate socioeconomic inequality in multimorbidity among adults in western Iran. Data from the Ravansar Non-Communicable Disease (RaNCD) cohort study were used in this cross-sectional study. A sample of 10,047 adults aged 35-65 years was analyzed. Principal component analysis was utilized to determine socioeconomic status (SES). The normalized concentration index (NCI) was used to assess the extent of socioeconomic disparities in multimorbidity. Decomposition analysis was conducted to identify and calculate the factors contributing to multimorbidity inequality. In this study, the prevalence of having at least two NCDs was 9.07%, while the prevalence of having at least three NCDs was 2.87%, and four or more NCDs was 1.25%. The NCI for multimorbidity was -0.061 (P < 0.001), indicating a higher concentration of multimorbidity among individuals with low SES. Age (52.5%), body mass index (BMI) (29.4%), gender (27.5%), physical activity (25.1%), and SES (15%) were identified as significant factors contributing to the increased inequality in multimorbidity. The study findings identified age, gender, BMI, physical activity, and SES as key factors driving multimorbidity disparities. It is recommended that health policymakers prioritize health interventions aimed at reducing socioeconomic inequalities in multimorbidity, particularly for low-SES groups, women, obese individuals, and older adults.

The influence of gender and waist circumference in the association of body fat with cardiometabolic diseases

BACKGROUND

The link between obesity and cardiometabolic risk has been well recognized. We investigated the association between body fat percentage (BF%), as an appropriate indicator of obesity, and prevalence of cardiometabolic diseases using baseline data of Fasa PERSIAN cohort study.

METHODS

The cross-sectional study was performed on data obtained at the first phase of the Fasa cohort study in Iran (n = 4658: M/F: 2154/2504). Anthropometric characteristics, blood pressure, cardiometabolic biomarkers, and body fat content were measured. Information on demographic and lifestyle factors, and history of cardiometabolic diseases (metabolic syndrome, type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), and myocardial infarction) was obtained.

RESULTS

Cardiometabolic risk factors (body mass index, waist circumference, blood pressure, blood glucose and lipids) had an inverse association with BF% tertiles in both sexes. Women had a higher BF% and prevalence of metabolic diseases than men, but men demonstrated stronger associations between BF% and cardiometabolic diseases. In both sexes, the association between BF% and metabolic syndrome and NAFLD was stronger than that between BF% and diabetes and myocardial infarction. Addition of waist circumference to the confounders either weakened (for NAFLD and metabolic syndrome) or faded (for type 2 diabetes and myocardial infarction) the relationship of BF% and cardiometabolic diseases.

CONCLUSION

Strategies to decrease body fat may be effective in ameliorating the risk of milder metabolic diseases, such as metabolic syndrome, but interventions to decrease abdominal fat (estimated by waist circumference) may be more effective in preventing more serious metabolic disorders such as type 2 diabetes and myocardial infarction.

Dental caries and related factors in the elderly of the Azar cohort population: A cross-sectional study

OBJECTIVE

Oral health is often overlooked among the elderly due to the numerous comorbidities prevalent in this population. However, oral health significantly influences quality of life by affecting both general health and psychological well-being. The present study aimed to assess dental caries in elderly individuals using the DMFT index (decayed, missing, and filled teeth) and to explore its relationship with various factors based on data from the Azar cohort study in Iran.

MATERIALS AND METHODS

In this cross-sectional study, data from the initial phase of the Azar cohort study, which involved 2629 elderly individuals (aged 60 years and older), were statistically analyzed. The Azar cohort study evaluated demographic factors, the history of chronic diseases, and behavioral habits using a well-designed questionnaire administered through face- to -face interviews. The DMFT index was evaluated through oral examination. A negative binomial regression analysis with a log link function was employed to investigate the relationship between the DMFT and related variables, including gender, age, marital status, level of education, socioeconomic status, chronic diseases, smoking, alcohol consumption, and body mass index.

RESULTS

The mean (SD) age of elderly individuals was 64.15±2.91 years. The mean (SD) DMFT was 28.42±6, and the mean (SD) number of missing teeth was 26.58±8.36. Approximately 70.8% of elderly individuals were edentulous. Women exhibited a higher mean DMFT score and a greater number of missing teeth compared to men. The mean DMFT score and its components significantly differed based on the level of education and socioeconomic status. However, no significant relationship was found between the DMFT index and the variables in the multiple regression analysis.

CONCLUSION

The high prevalence of edentulism and the elevated DMFT scores in the elderly population of the Azar cohort indicate a poor oral health status among older individuals. Providing the dental services within the primary health care system for the adults, can be beneficial in improving oral health in old age.

The mediating role of physical activity, morning wake-up time, and sleep-inducing medication use in the relationship between age and depression: a path analysis of a large kurdish cohort study in Iran

BACKGROUND

Depression is a common and debilitating psychiatric disorder worldwide. Recognizing the relationships between depression-related factors can play a significant role in depression management. However, no study has yet used path analysis to examine the mediating role of physical activity, morning wake-up time, and sleep-inducing medication in the relationship between age and depression.

METHODS

This path analysis study utilized data from the baseline phase of the Ravansar non-communicable disease cohort study. This study was conducted on people aged 35 to 65 years using sociodemographic, clinical, and the PERSIAN cohort's standard physical activity questionnaires. These analyses were done using SPSS (version 22) and MPLUS (version 8.3). Path analysis was applied to evaluate the direct, indirect, and total effects of age on depression.

RESULTS

The results indicated that increasing age was associated with an increase in depression through a decrease in physical activity and an increase in sleep-inducing medication use. In addition, an increase in age was significantly related to a reduced incidence of depression via an earlier morning wake-up time.

DISCUSSION

We found evidence for a mediational effect of age on depression, as the biopsychosocial model of mental illness implies. The findings of this study can add to the existing body of knowledge on depression management and help clarify the mechanisms of the effect of age on depression.

Association between abdominal obesity and nutritional supplement use among Iranian adults in the Shahedieh cohort study

The relationship between the use of supplements and the presence of abdominal obesity is a topic that is currently being debated. The purpose of the present study was to evaluate the existence of such an association. The current cross-sectional investigation included a population of 9878 individuals who were the focus of the study's initial phase in the Shahedieh cohort study, conducted in Yazd, Iran. Waist circumference was measured with the help of an inflexible tape measure. In addition, the data regarding the consumption of various supplements, including multivitamins, folic acid, ferric compounds, omega 3, calcium, vitamin D, zinc, and other supplements, were collected through interviews conducted by trained interviewers. Among the entire sample, 4785 individuals (50.6%) were found to have abdominal obesity, while 4093 individuals (43.3%) reported using at least one type of supplements. In the simple regression analysis, all of the supplements, except for multivitamins and zinc, were identified as adverse factors for abdominal obesity. However, in the multivariable regression analysis, only ferric compounds remained significant as a protective factor (OR = 0.73, 95%CI: 0.57‒0.94). The findings of this study suggest that dietary supplements, particularly ferric compounds, may have implications for managing abdominal obesity. These findings could inform public health strategies by incorporating ferric compound supplementation into dietary interventions aimed at reducing abdominal obesity prevalence. Furthermore, the potential clinical application of ferric compounds highlights the need for integrating nutritional approaches in obesity management programs. However, longitudinal studies are needed to establish causal relationships and confirm the long-term effectiveness and safety of such interventions.

The relationship between kidney function and cardiometabolic risk factors, anthropometric indices, and dietary inflammatory index in the Iranian general population: a cross-sectional study

BACKGROUND

The prevalence of chronic kidney disease (CKD) is estimated to be about 13.4% worldwide. Studies have shown that CKD accounts for up to 2% of the health cost burden. Various factors, such as genetic polymorphisms, metabolic disorders, and unhealthy lifestyles, can contribute to the occurrence of CKD. Therefore, the present study aimed to investigate the relationship between renal function and cardiometabolic risk factors, anthropometric characteristics, and the dietary inflammatory index (DII) in an Iranian population.

METHODS

This study was conducted on 2472 male and female employees of Shiraz University of Medical Sciences (SUMS), selected through census between 2018 and 2019. In this cross-sectional study, renal function was evaluated using serum creatinine (sCr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Biochemical indices including sCr, BUN, fasting blood sugar (FBS), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) were measured using standard laboratory methods. eGFR was calculated using the Modification of Diet in Renal Disease formula. Systolic (SBP) and diastolic (DBP) blood pressure as well as anthropometric indices such as height (Ht), weight (Wt), hip circumference (HC), waist circumference (WC), body mass index (BMI), conicity index (C-Index), visceral adiposity index (VAI), abdominal volume index (AVI), body adiposity index (BAI), and body shape index (ABSI) were measured and calculated using standard methods and formulas. Diet was evaluated through a 113-item food frequency questionnaire, and the DII was calculated according to its specific instructions. To predict the factors influencing renal function and to remove the impact of confounders, multivariable linear regression was employed using the backward elimination method.

RESULTS

There was a significant direct relationship between sCr and FBS, TG, HDL, DBP, Wt, and BAI as well as between BUN and age, TG, HDL, and BAI. In addition, there was a significant inverse relationship between eGFR and SBP, Wt, BAI, and VAI. In women compared to men, sCr and BUN values were significantly lower, while eGFR levels were significantly higher.

CONCLUSIONS

It seems that age, gender, lipid profile, glycemic status, BP, BAI, VAI, and Wt can be considered factors associated with renal function.

Prevalence of cataracts in Iran based on the Persian eye cohort study

The PERSIAN eye cohort study is a population-based study that evaluates the overall prevalence of cataracts and their subtypes (nuclear sclerosis, cortical, and PSC) in Iran. In this study, from January 2015 to September 2021, 16,016 participants over 35 years of age from four provinces who were selected by random cluster sampling were examined. Demographic information, education, socioeconomic status, and place of residence were collected through interviews. The cataract status of the study participants was examined by two experienced ophthalmologists using slit lamp photography. The average age of the study participants was 49.52 ± 9.31 and 8891 (55.5%) were female. The overall prevalence of each type of cataract, nuclear sclerosis, cortical, and PSC was 18.90%, 12.65%, 9.20%, and 3.08%, respectively. The results indicated that the prevalence of any type of cataract (adjusted OR = 0.85, 95% CI: 0.78-0.92, p < 0.001) and NS cataract (adjusted OR = 0.80, 95% CI: 0.73-0.88, p < 0.001) is lower in women. The risk of developing cataracts increased exponentially with aging. The prevalence of any type of cataract and cortical subtype was higher in rural than urban populations. Also, the risk of developing cataracts decreased with an increase in education level and socioeconomic status and some Iranian races such as Arabs, Azari, and Guilak were also at a higher risk of cataracts. The results of this study indicate the importance of a comprehensive regard of cataract as one of the causes of avoidable blindness in Iran due to its higher prevalence than the global average.

Paternal addiction to cigarettes, alcohol, and opium and the psychological distress of their youths in southeast Iran

Previous studies have reported inconsistent findings regarding paternal addiction to cigarettes, alcohol, and opium with psychological distress in youths. This study examined the association between paternal addiction to cigarettes, alcohol, and opium and the psychological distress of youths in southeast Iran. This cross-sectional study was conducted on 895 youths (aged 15-35) from the baseline phase of the Rafsanjan Youth Cohort Study (RYCS) whose fathers also participated in the Rafsanjan Cohort Study (RCS). The RYCS is a part of the RCS, a branch of prospective epidemiological research studies in Iran (PERSIAN). Smoking, alcohol consumption, and opium usage in youths and their fathers were assessed using a self-reported questionnaire. Psychological distress was assessed using the Kessler Psychological Distress Scale (K6 and K10). Fathers who used opium were more likely to have youth with psychological distress based on the K6 score (OR:1.37, CI:1.01-1.86) and K10 score (OR:1.34, CI: 1.01-1.80). The duration of opium consumption lower than or equal to the median was associated with increased odds of having a youth with psychological distress based on the K6 or K10 scores (OR:1.62, CI:1.14-2.31, OR:1.44, CI:1.01-2.03 respectively), but there was no significant association with duration above the median. In addition, consuming opium more than the median dosage increased the chance of having a psychologically distressed youth up to 1.47 times based on the K6 score (OR 1.47, CI 1.01-2.14) and 1.55 times based on the K10 score (OR 1.55, CI:1.08-2.22). Smoking cigarette duration lower than or equal to the median increased the chance of having a psychologically distressed youth to 1.52 times more based on the K6 score (OR 1.52, CI 1.07-2.15). There was no significant association between paternal alcohol consumption and the odds of having a psychologically distressed youth. Parental addiction to opium can lead to an increase in psychological distress in youths in the absence however of a consistent dose and duration relationship.

The relationship between dental caries with asthma, disease duration, and type of medications in the Azar cohort population

INTRODUCTION

Due to the high prevalence of asthma worldwide, paying attention to oral health is important. This study explores the relationship between DMFT (decayed, missing, and filled teeth) and asthma, disease duration, and related medications in the Azar cohort population.

METHODS AND MATERIALS

In this cross-sectional analytical study, the part of the data related to asthma, disease duration, type of medications, and DMFT were extracted from the Azar cohort study. Azar cohort started among 15,006 adults (35-70 years old) in 2014 in the northwest of Iran. In the present study, all 538 asthmatic people in Azar cohort population included in asthma group and 1076 of non-asthmatic people included in the control group. The outcome variable was DMFT, D, M and F. A negative binomial with loglink was used to adjust the effect of confounding variables in regression models.

RESULTS

Among the asthmatics, 28.3% were using anti-asthmatic medications. In 38.3% of the asthmatic group, the disease duration was ten years or more. In the asthmatic group, the mean DMFT was 23.15 ± 8.67, and the greatest section of the DMFT was related to M component. The relationship of DMFT and M component with asthma, disease duration, and medication were insignificant but D component showed significant relationship with asthma.

CONCLUSION

It can be assumed that the history of asthma does not have an effective role in DMFT index and M component in adults but decayed teeth were higher in asthmatics.

Socioeconomic inequality in exposure to second-hand smoke among middle-aged adults of the RaNCD cohort study: a decomposition analysis

BACKGROUND

Secondhand smoke (SHS) can cause various health problems among different age groups worldwide. Socioeconomic factors may influence the distribution of SHS exposure among population subgroups. We aimed to estimate socioeconomic inequality in SHS exposure and identify its contributing factors among a sample of Iranian adults.

METHODS

This cross-sectional investigation utilized baseline data from the Ravansar Non-Communicable Disease cohort study. The study population comprised 7991 middle-aged adults aged between 35 and 65 years. To determine socioeconomic status (SES) principal component analysis (PCA) was used. The Wagstaff normalized concentration index (Cn) was utilized to measure the extent of socioeconomic inequality in SHS. Furthermore, decomposition analysis was performed to identify the factors contributing to the observed inequality in SHS exposure.

RESULTS

The prevalence of SHS exposure among men, women, and the total population was 38.23%, 47.29%, and 43.89%, respectively. The concentration index (Cn) value for SHS exposure was - 0.121 (95% confidence interval [CI]: -0.146, -0.096) in the study participants. Among men and women, the values were - 0.080 (95% CI: -0.122, -0.037) and - 0.095 (95% CI: -0.112, -0.063), respectively, indicating a higher concentration of SHS among individuals with low SES. Female sex (35.17%), socioeconomic status (31.83%), being married (-26.36%), and rural residency (22.44%) were identified as the primary factors contributing to the observed inequality in SHS exposure.

CONCLUSION

The research findings revealed a pro-rich inequality in SHS, with a significant concentration among low-SES individuals. In terms of the main contributors to socioeconomic inequality in SHS exposure, policy interventions need to pay attention to females, individuals with low SES, and married individuals to address inequality in SHS exposure.

Does dietary intake of vitamin A and beta-carotene increase the risk of hypertension?

Background

Hypertension (HTN) is a major global public health issue influenced by genetics and lifestyle factors such as diet and psychological stress. Previous research suggests a potential link between HTN and dietary vitamin A intake. This study aims to explore the association between HTN and the intake of various forms of vitamin A.

Methods

This cross-sectional study was conducted on 1239 patients with HTN and 2945 normotensive individuals aged 35-70 years in Sabzevar, Iran. Dietary vitamin A intake was assessed using the Nutritionist IV software and a food frequency questionnaire.

Result

A positive association was found between HTN with total vitamin A intake [odds ratio (OR): 1.03, 95% confidence interval (CI): 1.01-1.05, P = 0.04] and β-carotene intake (OR: 1.03, 95% CI: 1.02-1.05, P = 0.03) after adjusting for age and sex. These associations remained statistically significant after adjusting for physical activity and BMI. The association between HTN and β-carotene intake remained significant after additional adjustment for calorie intake. No significant association was observed between dietary retinol intake and HTN.

Conclusion

Increased dietary intake of vitamin A and β-carotene may be associated with a higher risk of HTN. Further longitudinal studies are needed to confirm these findings and elucidate the underlying mechanisms.

The link between the risk of cardiovascular diseases and the intake of different types of dietary carbohydrates in Iranian adults

Background

The risk of cardiovascular diseases (CVDs) may be influenced by dietary carbohydrates. The aim of this study was to investigate the link between CVDs and the intake of carbohydrates.

Methods

In this cross-sectional study, data was extracted from the Prospective Epidemiologic Research Studies in Iran (PERSIAN) cohort in Sabzevar, Iran. A total of 4241 adults, including 1535 patients with CVDs and 2706 people without CVDs, were included. A validated 237-item food frequency questionnaire was used to estimate the intake of different types of dietary carbohydrates.

Results

A positive association was found between stroke and dietary intake of starch (OR = 1.108; 95% CI, 1.005-1.220; P = 0.039). Additionally, a negative association was found between stroke and dietary intake of sucrose (OR = 0.97; 95%CI, 0.94-0.99; P = 0.037). No association was found between other types of CVDs and the intake of different types of carbohydrates.

Conclusion

This study provided some evidence for the association between CVDs and different types of dietary carbohydrates. Consumption of starch may increase the risk of stroke, while a higher intake of sucrose may decrease the risk of stroke. Further studies are warranted.

Relationship between macronutrients and energy intake and liver serum transaminase levels in elderly athletes and non-athletes: findings from the Neyshabur longitudinal study on aging

BACKGROUND

Assessing liver health and its determinants in the elderly is crucial. Lifestyle factors, including nutrition and exercise, may influence liver function. This study aimed to investigate the association between macronutrients and energy intake with serum levels of aminotransferases in elderly Iranian athletes and non-athletes.

METHODS

A cross-sectional study involving 811 elderly participants (369 athletes, 442 non-athletes) from the Neyshabur Longitudinal Study on Aging (NeLSA) was conducted. Dietary intake was assessed using a food frequency questionnaire. Serum Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured. Regression analyses were employed to evaluate the associations between macronutrient intake and liver enzymes, adjusting for potential confounding variables.

RESULTS

In elderly athletes, higher calorie, protein, and carbohydrate intake were significantly associated with elevated ALT levels (p < 0.01 for all). Additionally, higher carbohydrate and calorie intake were linked to increased AST levels in athletes (p < 0.05 for both). For elderly non-athletes, only higher protein intake was significantly associated with increased ALT levels (p < 0.05), while no nutritional factors were associated with changes in AST levels.

CONCLUSIONS

This study revealed that higher calorie, protein, and carbohydrate intake were associated with elevated ALT and AST levels in elderly individuals, particularly athletes. For athletes, all three nutrients were linked to elevated ALT, while only carbohydrates and calories impacted AST. For non-athletes, only protein affected ALT. These findings suggest that tailored nutritional strategies may be necessary to preserve liver health in active aging populations.

The predictive power of conventional and novel obesity indices in identifying metabolic syndrome among the southern Iranian populations: findings from PERSIAN cohort study

BACKGROUND

Metabolic syndrome (MetS) contributes to an increased risk of cardiovascular diseases. Traditional metrics like body mass index (BMI) have limitations in discerning fat distribution. The purpose of this study was to evaluate the diagnostic accuracy of traditional and novel anthropometric indices in metabolic syndrome and its components in the south coast of Iran.

METHODS

In this cross-sectional study, 2694 adults aged 35 to 70 were included. Comprehensive anthropometric and biochemical data were collected and analyzed. There were eight anthropometric indices evaluated in this study, including a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body roundness index (BRI), abdominal volume index (AVI), weight-adjusted waist index (WWI) and waist-height ratio (WHtR).

RESULTS

WHtR (AUC: 0.766 for males, 0.799 for females), BRI (AUC: 0.766 for males, 0.799 for females), and AVI (AUC: 0.769 for males, 0.793 for females) were the best predictors of MetS. ABSI had the weakest correlation with metabolic variables.

CONCLUSIONS

AVI, WHtR, BRI, and WHR were superior to other measures as anthropometric indexes for determining MetS and its components. The study contributes valuable insights into the utility of traditional and novel metrics in clinical practice, highlighting the need for standardized diagnostic approaches and further research in diverse populations.

Association between the dietary inflammatory index and risk of lung cancer: a multi-centered case-control study

PURPOSE

Dietary factors might contribute to the risk of lung cancer by increasing the concentration of inflammatory markers. The literature-derived Dietary Inflammatory Index (DII) has been established to evaluate the inflammatory potential of diet correlated with inflammatory markers. The association between DII scores and the risk of lung cancer has been conflicting. So, in the current study, we aimed to assess the effect of pro-inflammatory dietary patterns measured with DII and the risk of lung cancer.

METHODS

A multi-center case-control study was carried out on 616 patients with lung cancer and 3412 healthy controls. Dietary intakes were collected using a 131-item food frequency questionnaire during a face-to-face interview. The DII scores including thirty-six nutrients were calculated after energy adjustments. Finally, the association between DII level and the risk of lung cancer was evaluated by performing a multi-variable regression method after adjusting for potential confounders.

RESULTS

The risk of overall lung cancer, small cell, and squamous cell carcinoma was elevated in the third tertile compared to the first tertile of the DII score, (odds ratio [OR] T3 vs. T1 of overall lung cancer = 1.38 (95% confidence interval [CI] 1.08-1.77), P trend = 0.01, OR T3 vs. T1 of squamous cell lung cancer = 1.82 (95% CI 1.02-3.24), P trend = 0.04, OR T3 vs. T1 of small cell lung cancer = 1.66 (95% CI 1.08-2.54), P trend = 0.019). However, no increase was observed in the risk of adenocarcinoma by adherence to a pro-inflammatory dietary pattern.

CONCLUSION

A positive link was found between DII and the risk of overall lung cancer, small-cell, and squamous-cell lung cancer. However, there was no association between DII and the risk of lung adenocarcinoma.

Type of menopause, age of menopause and cardiovascular disease: a cross-sectional study based on data from Rafsanjan cohort study

BACKGROUND

Cardiovascular disease is the leading cause of death among women, but sex-specific risk factors are incompletely understood. In this study, we aimed to assess the associations between the type of menopause, and age at natural menopause with the odds of cardiovascular disease (CVD), and coronary heart disease (CHD).

METHODS

This cross-sectional study is a part of data from the Rafsanjan Cohort Study (RCS) which is a branch of the Prospective Epidemiological Research Studies in Iran (PERSIAN). A sample of 1767 postmenopausal women were included. The diagnosis for CVD and CHD was based on self-report questionnaires. Menopause age was categorized as < 40, 40-44, 45-49, and ≥ 50. Also, the menopause types were classified as natural and induced menopause (surgery or chemotherapy). The association was evaluated by logistic regressions.

RESULTS

The menopause age < 40 years had higher odds of CVD compared to women with menopause age > 40 years (OR: 2.66; 95%CI 1.29-5.48). Women with induced menopause had higher odds of CVD compared to women with natural menopause (OR = 1.44, 95% CI 1.04-1.98). In terms of the odds of CHD, the results showed that the odds of CHD increased in menopause age < 40 years and induced menopause compared to reference groups (OR: 2.49, 95% CI 1.15-5.37, OR = 1.48; 95% CI 1.06-2.07, respectively).

CONCLUSION

Premature menopause and induced menopause should be considered as important risk factors for CVD, and CHD. Health policymakers should pay more attention to the type of menopause and the age of menopause in postmenopausal women to predict the risk of CVD and preventive strategies.

A randomized clinical trial evaluating Hydralazine's efficacy in early-stage Alzheimer's disease: The EHSAN Study

Alzheimer's Disease (AD), a neurodegenerative disorder escalating worldwide, remains incurable with existing interventions merely mitigating symptoms. Hydralazine, an antihypertensive agent, has displayed neuroprotective potential in AD animal models via amplification of mitochondrial functionality and stimulation of stress management and repair pathways. Nevertheless, its effectiveness and tolerability in human AD cohorts are yet to be confirmed. This study protocol describes the design of an ongoing, single-center, randomized, triple-blind, placebo-controlled trial to assess hydralazine's effects on cognitive function in mild to moderate -stage AD patients. We will enroll 424 patients aged 50 and older, meeting NINCDS-ADRDA criteria for probable AD with Mini-Mental State Examination scores from 12-26. They'll be randomly assigned to receive either hydralazine HCL (25 mg, thrice daily) or a placebo for 12 months. The primary outcome is the Alzheimer's Disease Assessment Scale change from baseline to 12 months. Secondary outcomes include various measures using Lawton instrumental activities of daily living scale, neuropsychiatry inventory, and caregiver activity survey. This trial will explore the potential benefits and risks of hydralazine in mild to moderate AD treatment. It's the first trial examining hydralazine's impact on mild to moderate -stage AD in human and is registered at the Iranian Registry of Clinical Trials (IRCT20200711048075N1, registered 29/07/2020) and ClinicalTrials.gov (NCT 04,842,552AQ, registered 13/04/2021). Ethics approval was granted by the Research Ethics Committee of the National Institute for Medical Research Development (IR.NIMAD.REC.1398.424), following the SPIRIT Statement guidelines. Findings will be disseminated via peer-reviewed publications and conferences. This inaugural human clinical trial evaluates hydralazine's impact on patients in the mild to moderate AD. Executed with a randomized, triple-blind, placebo-controlled methodology, this study incorporates a significant sample size and an extended monitoring duration. Multiple parameters, including cognitive capabilities, will be assessed. Potential limitations include the inherent homogeneity of the AD cohort, the lack of biomarker assays, and the unpredictable progression of the disease. Notably, the study might not elucidate the protracted effects of hydralazine beyond a 12-month period. Another limitation of our clinical trial is that patients were diagnosed with Alzheimer's disease based solely on clinical evaluation and MRI findings, without the inclusion of specific biomarkers, which may impact the accuracy and specificity of the diagnosis. Trial registration: Iranian Registry of Clinical Trials (IRCT20200711048075N1, registered 29/07/2020) and ClinicalTrials.gov (NCT 04,842,552, registered 13/04/2021).

Weight-adjusted waist index and cardiovascular disease: a population-based study in Ravansar, Iran

BACKGROUND

The weight-adjusted-waist index (WWI) is a relatively new index to obesity. This study aimed to explore the reationship between WWI and cardiovascular disease (CVD).

METHODS

This cross-sectional study included 8,899 participants aged 35 to 65 from the Ravansar non-communicable diseases (RaNCD) cohort study in Ravansar, Iran. The WWI was calculated by dividing waist circumference (WC) by the square root of weight. The receiver operating characteristic (ROC) curve was utilized to assess the predictive performance of WWI in relation to CVD. The study applied multiple logistic regression to assess the association between WWI and CVD.

RESULTS

Participants had an average age of 47.52 ± 8.29 years, with 45.30% being men and 41.13% residing in rural areas. The prevalence of CVD was found to be 17.36%. A positive correlation between WWI and CVD was obseved, with individuals in the highest WWI quartile having a 36% (OR = 1.36, 95%CI: 1.11, 1.78) greater odds of CVD compared to those in the lowest quartile (OR = 1.03, 95%CI: 0.79, 1.33) (ptrend = 0.010). Subgroup analyses indicated stronger links between WWI and CVD among participants over 50, males, urban residents, those of high socioeconomic status (SES), and passive smokers (p < 0.001). The ROC analysis revealed that WWI is a greater ability in predicting CVD (AUC: 0.64, 95%CI: 0.61, 0.64) compared to body mass index (BMI) (AUC: 0.60, 95%CI: 0.58, 0.61) and WC (AUC: 0.61, 95%CI: 0.59, 0.62).

CONCLUSION

The increase in WWI elevates the odds of CVD, making the management of WWI crucial for CVD prevention.

Undiagnosed hypertension and diabetes mellitus in the Tabari cohort: a population-based study

BACKGROUND

Undiagnosed hypertension (HTN) and diabetes mellitus (DM) are major public health challenges worldwide. We aimed to investigate the prevalence of undiagnosed HTN and DM, and their correlates, in a large-scale population-based cohort study.

METHODS

In this cross-sectional study, data collected during the enrollment phase of the Tabari Cohort study (TCS) were utilized. Data were collected in the TCS using a standard questionnaire, blood collection, and measurement of anthropometric indices and blood pressure. Data were analyzed using the chi-squared test and univariate and multivariate logistic regression analyses. Undiagnosed HTN included those who were not aware of HTN at the time of enrollment but had systolic and diastolic blood pressures ≥ 140 mm or ≥ 90 mmHg, respectively. Undiagnosed DM included participants who were unaware of their DM at the time of enrollment and had FBS levels ≥ 126 mg/dL.

RESULTS

The total prevalence of undiagnosed HTN and DM were 5% (508) and 4.7% (485), respectively. The findings of multivariable logistic regression analysis showed that young age (OR: 0.40, P < 0.001), residents of urban regions (OR: 0.70, P = 0.03), lower Body Mass Index kg/m2 (BMI) (OR: 0.51, P = 0.002), waist-to-hip ratio (WHR)(OR: 0.70, P = 0.023), total cholesterol (TC) ≥ 200 mg/dL (OR: 0.1.83, P < 0.001), lack of history of DM (OR: 0.38,P < 0.001), cardiovascular diseases (CVD)(OR: 0.12, P < 0.001), and lack of a positive family history of HTN in first-(OR: 0.39, P < 0.001) and second-degree(OR: 0.56, P = 0.009) relatives were the main predictors of undiagnosed HTN. Accordingly, male sex(OR: 0.52, P = 0.004), young age(OR: 0.28, P < 0.001), residence in urban regions(OR: 0.30, P < 0.001), BMI ≥ 30 (OR: 1.51, P = 0.044), low-density lipoprotein (LDL) ≥ 130 mg/dL (OR:1.93, P < 0.001), TC ≥ 200 mg/dL (95% CI, 1.47-2.51, P < 0.001), positive history of chronic kidney disease (OR:1.39, P = 0.010 ), and lack of family history of first-(OR: 0.38, P < 0.001) and second-degree (OR: 0.62, P < 0.015) DM were the main predictors of undiagnosed DM.

CONCLUSION

Overall, younger participants, those residing in urban areas, those with TC ≥ 200 mg/dL, and those without a positive family history of HTN or DM were at a greater risk of undiagnosed HTN/DM.

Association between chronic kidney disease and cardiovascular disease risk factors in elderly: results from the first phase of Fasa and Shahedieh cohort studies

BACKGROUND

Chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) risk factors and morbidity in the elderly population. This study aimed to examine the association between CKD and CVD risk factors in the elderly population of Fasa and Yazd (Shahdieh), Iran, using the data from the enrolment phase of Fasa and Shahedieh cohort studies.

METHODS

We conducted a cross-sectional analytical study using data from Fasa and Shahedieh cohort studies, which enrolled 1487 and 1507 participants aged over 60 years, respectively. We collected data on demographic and clinical variables, kidney problems, and CVD from the two studies. We estimated the glomerular filtration rate (eGFR) using the modification of diet in renal disease (MDRD) formula and considered values less than 60 ml/min/1.73 m2 as CKD. We used independent t-tests, Spearman's correlation coefficient, chi-square, one-way analysis of variance, and logistic regression to analyze the data. We performed the analyses using SPSS V. 22.0 software and set the significance level at 0.05.

RESULTS

The overall prevalence of CKD was 41.9%; 25.7% in women and 16.2% in men. The prevalence of CKD based on reported kidney problems was 1.7%, of which 54.7% were in stage 3 of CKD. Compared to participants in the early stages of CKD, participants in advanced stages had a higher prevalence of diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (IHD) (p < 0.001), and myocardial infarction (p < 0.001). In addition, participants in higher stages of CKD were more obese, had lower physical activity, smoked more, and consumed more opium (p < 0.001).

CONCLUSION

Our study showed that more than half of the patients were in stage three CKD, which is an advanced stage of this disease. Diabetes Melitus, hypertension, dyslipidemia, IHD, and myocardial infarction were more prevalent in patients than others. These findings demonstrate the importance of screening for CKD in patients with diabetes mellitus and hypertension. The results also suggest that lifestyle modification and prevention strategies are needed to reduce the burden of CKD and CVD in this population.

The mediation effect of liver and anthropometric indices on the relationship between incidence of diabetes and physical activity: results of 5-year follow up azar cohort study

BACKGROUND

It has been documented that regular physical activity is considered one of the most effective strategies for preventing diabetes; however, it is not the sole contributing factor. Therefore, we decided to evaluate the meditation effect of liver function and anthropometric indices on the relationship between incidence of diabetes and physical activity (PA) in the Azar cohort population.

MATERIALS AND METHODS

Subjects who were diabetic in the baseline phase from 15,006 participants in study of azar cohort population were excluded and to follow up, a total of 13,253 people was included in the analysis. Demographic characteristics, physical activity, 10 anthropometric indices (AI) and seven liver indices (LI) were measured. Evaluated and displayed using Pearson correlation heatmap and canonical correlation of liver and anthropometric indices. The Generalized Structural Equation Modeling (GSEM) with the Maximum Likelihood method employed to estimate the model.

RESULTS

During the follow-up years, a total of 685 participants developed diabetes. The measurements of the AI were significantly higher in subjects with diabetes (P < .001). Patients with diabetes were older, had a higher proportion of women, and had lower values of PA (P < .05). Body Roundness Index (BRI) and Waist height ratio (WHtR) exhibited the largest AUCs for predicting diabetes onset risk (both AUC = 0.6989) among these anthropometric measures. The increase in AI (RR [95%CI] = 1.25 [1.22,1.29], P < .001) and liver enzyme (LE) (RR [95%CI] = 1.14 [1.08.1.19], P < .001) increase the risk of diabetes by 25% and 14%, respectively. Despite the mediation effects of AI and Liver Enzymes for an increase of one MET of PA, the risk of developing diabetes decreases by 5% (RR [95% CI] = .95 [.92,.99], P = .013). Around VAF = 53% of the association between PA and diabetes onset (Total effect: RR [95% CI] = .90 [.87,.94], P < .001) was mediated by AI and LE.

CONCLUSIONS

A low level of PA was found to be significantly correlated with high levels of AI and LI, all of which are associated with an increased risk of developing diabetes. These analyses provide evidence that when the relationship between PA and diabetes is mediated by AI and LI this association becomes stronger, with AI playing a more significant role than LI.