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Objectives: To investigate the association between the Dietary Inflammatory Index (DII) and osteosarcopenia using nationally representative data., Methods: We utilized data from 1,418 men and women aged ≥ 50 years old participating in Iranian Multicenter Osteoporosis Study (IMOS), a nation-wide, cross-sectional study conducted in 2021. Osteosarcopenia was defined based on standard criteria, considering the presence of both osteopenia/osteoporosis and sarcopenia. We assessed dietary patterns using a semi-quantitative 168-item Food Frequency Questionnaire (FFQ) and calculated energy-adjusted DII (E-DII) scores based on 31 specific food items. Multivariable logistic regression models were used to examine the association between osteosarcopenia and E-DII, adjusting for potential confounders. Nutrient intake calculations were performed using Nutritionist IV software., Results: The mean age of participants was 60.1 (SD = 7.9) years, with 770 (54.3%) being women. The prevalence of osteosarcopenia was 8.8% (95% CI: 7.3-10.6%). Osteosarcopenia was more prevalent among women, older participants, and rural inhabitants. However, the difference was not statistically significant for sex and area of residence. After adjusting for confounders, the odds ratios for osteosarcopenia in the second and third tertiles of E-DII score were 2.23 (95% CI: 1.23-4.05) and 2.47 (95% CI: 1.40-4.37), respectively., Conclusions: Our findings suggest an association between osteosarcopenia and the DII. A healthy low-inflammatory diet may play a crucial role in maintaining musculoskeletal health among the elderly., Competing Interests: Conflict of interestAuthors declare that they have no conflict of interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2025. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Abstract: Chronic diseases such as osteoporosis and low bone mineral density (BMD) are significant public health concerns for people living with HIV (PLWH), especially with the increased life expectancy because of antiretroviral therapy (ART). This study evaluated the prevalence and associated factors of low BMD among 94 PLWH in Kerman, Iran, from September 2021 to February 2022. Using dual-energy X-ray absorptiometry, BMD was measured, with low BMD defined by specific T-scores and Z-scores. Predictors were assessed through interviews, medical records, and blood tests. Bivariable and multivariable logistic regression models identified associations between low BMD and various factors. The study found a 51.1% prevalence of low BMD, with significant associations with hypogonadism (adjusted odds ratio [aOR]: 3.19), longer ART duration (aOR per month: 1.02), and lower body mass index (aOR per unit: 0.83). The findings highlight the need for regular screening and timely intervention for low BMD among PLWH, particularly with prolonged ART use., (Copyright © 2025 Association of Nurses in AIDS Care.)

Objectives: This study evaluated the effectiveness of the IraPEN program, an adapted version of the WHO Package of Essential Non-communicable Disease (PEN) intervention, in managing diabetes from September 2020 to September 2021 using the Input-Process-Output-Outcome framework., Methods: In this Cross-sectional/Ecological study, aggregated data was collected from IraPEN facilities by medical universities using the electronic health system. The data was presented as numbers and proportions, for urban and rural healthcare facilities separately., Results: The study surveyed 610 NCD facilities from184 comprehensive health centers under the supervision of 56 medical universities, which provided services to 1,785,226 individuals aged > = 30 years. In terms of input/process, 78% of NCD facilities had functional point-of-care testing, and 14% of health centers with drugstore experienced a stock-out of core medications during the past three months. In urban facilities, 66% had at least a trained nutritionist, and 82% trained psychologist. Regarding output/outcome, 26% of expected diabetes and 23% of expected pre-diabetes, as estimated by the STEPS 2016 survey, were enrolled in NCD facilities, with higher rates in rural than urban areas. Among the referred patients, 38.7% took statins, 53% visited a physician in the last three months, 57.2% were referred for dietary assessment, and 72.5% were referred to secondary care. Around 39% of diabetic patients with at least one HbA1c laboratory test had good glycemic control., Conclusions: The IraPEN program has managed only a quarter of diabetic patients, and less than half of them are in good glycemic control. Urgent improvements, mainly in coverage and effectiveness, are necessary., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01550-z., Competing Interests: Competing interestsThe authors declared that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Diabetes mellitus, particularly Type 2 diabetes (T2D), represents a significant global health challenge, with its prevalence steadily rising over the past few decades. This study was conducted with the aim of estimating the economic burden of T2D in Iran., Methods: This study employed a prevalence-based approach to estimate the economic burden of T2D and its attributable complications in adults above 20 years old in Iran for 2022. Both direct medical costs and indirect costs were considered in our analysis. Direct medical costs included inpatient and outpatient costs attributable to T2D and its complications, while indirect costs encompassed absenteeism, presenteeism, inability to work, and premature mortality costs due to the disease., Results: The findings showed that a total of 5,702,547 people, equivalent to 14.2% of Iranian adults, had T2D. The estimated total direct medical cost of T2D and its attributable complications in Iran in 2022 was 1,879.2 million US dollars (US$-PPP 6,676.9 million). Chronic kidney disease accounted for the largest proportion, followed by ischemic heart disease (IHD), and T2D itself. The total economic burden of T2D and its attributable complications in Iran in 2022, was estimated to be $2,905.7 million US dollars (US$-PPP 10,324.2 million). The direct medical cost constituted the majority of the economic burden (64.7%), while the inability to work due to these health conditions also contributes significantly (28.6%). Absenteeism (2.9%), presenteeism (1.7%), and premature mortality (2.2%) make up smaller proportions of the overall economic impact of T2D and its complications in Iran during that year., Conclusion: Our study highlights the significant and diverse economic impact of T2D and its complications in Iran. This burden encompasses not only healthcare-related expenses but also negative impacts on society and productivity, as well as the occurrence of early death. To successfully address this burden, a comprehensive strategy is needed, which includes programs to prevent diabetes, better access to healthcare services, and increased social support for individuals with this long-term condition., Competing Interests: Declarations. Ethics approval and consent to participate: The study has been approved by the Research Ethics Committees of Endocrine & Metabolism Research Institute—Tehran University of Medical Sciences(IR.TUMS.EMRI.REC.1401.127). The required data were extracted from previous studies on this topic according to the study aims, and consequently, obtaining informed consent was not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: This study examined the moderating role of e-health literacy (eHL) and patient-physician communication in the relationship between online diabetes information-seeking behavior (online DISB) and self-care practices., Methods: A total of 1143 individuals with type 2 diabetes mellitus completed a cross-sectional survey assessing sociodemographic characteristics, data relating to diabetes clinical history, online DISB, eHL (eHealth Literacy Scale), aspects of patient-physician communication (IPC survey), patient self-care (Self-Care Inventory-Revised), and medication adherence (measure of adherence to prescribed diabetes medications). The data were analyzed using both bivariate (correlation) and multivariate (multiple linear regression) analyses using maximum likelihood estimation procedures in Mplus., Results: Our results showed online DISB significantly predicted diabetes self-care (p < 0.001) and medication adherence behaviors (p = 0.005). Lower Hurried Communication (p < 0.001, p = 0.03), higher Elicited Concerns (p = 0.005, p = 0.03), higher Explained Results (p = 0.03, p = 0.008), and higher eHL (p = 0.02, p = 0.02) were significantly associated with better self-care and medication adherence. Explained Results and eHL moderated the relationship between online DISB and both self-care and medication adherence., Conclusions: Findings support the role of patient eHL and patient-physician communication in amplifying the positive impact of online DISB on patients' behavioral outcomes in diabetes., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its amendments. The study protocol was reviewed and approved by the medical research ethics committee of the Tehran University of Medical Sciences (IR.TUMS.EMRI.REC.1401.093). All participants have completed an informed consent form to conduct the study and all scales have been completed anonymously. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The introduction of antiretroviral therapy (ART) has significantly improved the life expectancy of people living with HIV (PLHIV), leading to an increased prevalence of age-related comorbidities such as osteoporosis. This study investigates the incidence and characteristics of low bone mineral density (BMD) and the treatment effectiveness of low BMD participants among PLHIV in Kerman, Iran., Methods: A longitudinal study utilized dual-energy X-ray absorptiometry (DEXA) to screen 94 PLHIV in Kerman, Iran, for low BMD. Participants were aged 30 or older and had received antiretroviral therapy (ART) for at least 12 months. Those with low BMD were entered into a single-arm clinical trial and received the appropriate treatment. These people were checked to assess the treatment effectiveness 11 months after completion of the treatment. Those with normal BMD entered a cohort study and were checked to determine the cumulative incidence of low BMD. Data on demographics, medical history, and laboratory tests were collected. A chi-square test was used to assess the association between the categorical variables. A t-test (for normally distributed variables), or Mann-Whitney U (for non-normally distributed variables) was used to assess the differences of BMD between the two groups. Statistical significance was set at p ≤ 0.05, with analyses conducted in Stata 17., Results: Among 94 PLHIV at baseline, 48 participants (51%) had low BMD. During the follow-up, 11 participants (11.7%) missed the follow-up visits. In the follow-up, 83 PLHIV (40 with low BMD and 43 with normal BMD at baseline) were available. Among 40 participants who received treatment, 5 had normal BMD (treatment effectiveness: 12.5%). However, among 43 PLHIV with normal BMD at baseline, 7 PLHIV had low BMD at the follow-up visit (cumulative Incidence 16.3%). Those with lower body mass index (BMI) had a higher prevalence of low BMD than those with normal BMI during the follow-up (p-value: 0.003). Lumbar spine BMD increased modestly (0.005 g/cm 2 ), while femoral neck and total hip BMD declined in total participants (0.011, 0.007 g/cm 2 , respectively). Osteocalcin and β-isomerized C-terminal telopeptides (β-CTx) levels were higher in the low BMD group in the follow-up, indicating increased bone turnover., Conclusions: The study highlights the high cumulative incidence of 16.3% and treatment effectiveness of 12.5% of low BMD among PLHIV in Kerman, Iran, with implications for fracture risk. Despite a steady state in spine BMD decline, the risk of fracture remains elevated due to continued femoral neck and total hip BMD reduction. Gender-specific factors and BMI may influence susceptibility to low BMD., Competing Interests: Declarations. Ethics approval and consent to participate: Before the study, the study’s objectives, benefits, and potential risks of participating in the study were explained to eligible participants, and they were asked to sign a written informed consent form. The study protocol and consent form were reviewed and approved by the Ethical Committee of Tehran University of Medical Sciences (Number: IR.TUMS.EMRI.REC.1400.002). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Skeletal muscle relies on resident muscle stem cells (MuSCs) for growth and repair. Aging and muscle diseases impair MuSC function, leading to stem cell exhaustion and regenerative decline that contribute to the progressive loss of skeletal muscle mass and strength. In the absence of clinically available nutritional solutions specifically targeting MuSCs, we used a human myogenic progenitor high-content imaging screen of natural molecules from food to identify nicotinamide (NAM) and pyridoxine (PN) as bioactive nutrients that stimulate MuSCs and have a history of safe human use. NAM and PN synergize via CK1-mediated cytoplasmic β-catenin activation and AKT signaling to promote amplification and differentiation of MuSCs. Oral treatment with a combination of NAM and PN accelerated muscle regeneration in vivo by stimulating MuSCs, increased muscle strength during recovery, and overcame MuSC dysfunction and regenerative failure during aging. Levels of NAM and bioactive PN spontaneously declined during aging in model organisms and interindependently associated with muscle mass and walking speed in a cohort of 186 aged people. Collectively, our results establish the NAM/PN combination as a nutritional intervention that stimulates MuSCs, enhances muscle regeneration, and alleviates age-related muscle decline with a direct opportunity for clinical translation.

Background: Adequate dietary consumption of calcium is crucial in the preservation of bone health and the prevention of osteoporosis. This study investigated the prevalence of insufficient dietary calcium intake among individuals aged ≥50 years in Iran., Methods: We analyzed data from the Iranian Multicenter Osteoporosis Study (IMOS-2021). Participants aged 50 years and older completed a 168-item food frequency questionnaire. Insufficient dietary calcium intake was characterized as a daily calcium intake of <1000 mg for men aged 50-70 years, and <1200 mg for men over 70 years and women over 50 years and older. Stata v17 statistical software facilitated a survey set analysis to estimate the population's mean and median dietary calcium intake and the prevalence of insufficient dietary calcium intake., Results: The study included 1450 participants with a mean age of 60.7±7.9 years. The estimated mean dietary calcium intake in Iran was 1062.7 mg/day (95% CI: 1029.6-1095.8), with a median intake of 943.5 mg/d (95% CI: 910.5-976.4). The prevalence of insufficient dietary calcium intake in Iran was estimated to be 62.9% (95% CI: 60.0%-65.7%). Notably, the prevalence was higher among women at 75.5% (95% CI: 71.9%-78.8%), compared to men at 47.8% (95% CI: 43.4%-52.3%) with a significant difference (P<0.001). In age-related findings, individuals aged 65 years and older had a higher prevalence of insufficient intake, at 69.0% (95% CI: 63.9%-74.0%), versus those under 65 years, at 60.3% (95% CI: 56.9%-63.8%), with this difference being statistically significant (P = 0.007). Furthermore, a significant inverse relationship was identified between both educational years and socioeconomic status and the prevalence of insufficient dietary calcium intake (Ps for trends<0.001)., Conclusion: Our findings revealed a significant prevalence of insufficient dietary calcium intake in women and those aged 65 and older. We advocate for targeted public health strategies to ensure sufficient dietary calcium intake across these populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ghazbani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Sclerostin, a protein encoded by the SOST gene, is an important genetic risk factor for osteoporosis in postmenopausal women. This study was conducted on the Iranian postmenopausal women, to investigate the association between this gene and the Trabecular Bone Score (TBS) as a novel index used for assessing osteoporosis., Methods: The present study, conducted in 2024, was performed on 1071 women aged 60 years and older who participated in the Bushehr Elderly Health (BEH) program. The associations between seven independent Single Nucleotide Polymorphisms (SNPs) within the SOST gene and mean TBS of L1 to L4 were examined using the additive, dominant, and recessive models. Genetic risk scores (GRS) were calculated for each postmenopausal woman based on the coefficient regressions derived from the additive and dominant models. The relationship between the GRS quartiles and TBS was evaluated using a linear regression model., Results: After adjusting for age and Body Mass Index (BMI), the associations between the rs2023794-C and TBS were significant in the additive (β = 0.03, P= 4.7×10 -5 , PFDR= 0.0003) and dominant (β = 0.032, P= 5×10 -5 , PFDR= 0.0003) models. The GRS derived from both additive and dominant models were related to TBS ( P <0.05). For the additive model GRS, TBS showed an average increase of 0.022 score for the fourth quartile in comparison with the first quartile, adjusted for age, BMI, type 2 diabetes mellitus (T2DM), and smoking status ( P =0.001)., Conclusion: SOST gene is associated with TBS and may have implications for personalized medicine. Targeting sclerostin through SOST could offer a therapeutic approach in managing osteoporosis in high-risk postmenopausal women., (Copyright© 2024 Bidkhori et al. Published by Tehran University of Medical Sciences.)

Objectives: The efficacy and safety of drug treatments vary widely due to genetic variations. Pharmacogenomics investigates the impact of genetic variations on patient drug response. This research investigates the frequency of UGT1A1 genetic variations in the Iranian population, comparing them with global data to provide insights into the pharmacogenomic approach in the Iranian population., Methods: The study was conducted using the data of the Bushehr Elderly Health (BEH) program, a population-based cohort study of the elderly population aged ≥ 60 years. Genotyping of three UGT1A1 variant alleles ( UGT1A1 *6, UGT1A1 *27, and UGT1A1 *80) was performed on a group of 2730 elderly Iranian participants with the Infinium Global Screening Array., Results: The genotyping analysis revealed significant differences compared to major global populations that were addressed in the gnomAD database. UGT1A1 *80 was found at a high frequency (32.34%), and followed by UGT 1A1 *6 (0.76%) and UGT1A1 *27 (0.018) at a low frequency in the Iranian group., Conclusions: The UGT1A1 *80 was the more prevalent allele between investigated alleles in the present study which can be considered as an important allele for pharmacogenomic testing., Competing Interests: Conflict of interestThere are no conflicts of interest declared by the authors., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background & Objective: Osteoporosis is a growing public health concern, particularly among the aging population. This study aimed to evaluate the association between osteoporosis and quality of life (QoL) in a sample of older adults., Methods: This cross-sectional study utilized data from all the participants of Bushehr Elderly Health program (BEHP), phase 2. QoL was assessed using the 12-Item Short Form Survey (SF-12 Questionnaire), and participants were classified as having osteoporosis or not based on the WHO diagnostic criteria. The physical (PCS) and mental (MCS) component summaries of QoL were estimated. The association between osteoporosis and QoL was evaluated separately for men and women, considering various health and lifestyle factors using linear regression analysis., Results: The study included 2,399 participants (average age 71.27 ± 7.36 years). 1,246 were women and 1,153 were men. Osteoporosis was present in 59% of women and 23% of men. Participants with osteoporosis had significantly lower PCS scores compared to those without osteoporosis (women: 38.1 vs. 40.2, p < 0.001; men: 44.3 vs. 45.8, p: 0.002). However, there was no statistically significant difference in MCS scores. Stratified by sex, osteoporosis was significantly associated with PCS in women [β = -2.14 (-3.13, -1.15)] and men [β = -1.53 (-2.52, -0.54)]. After accounting for relevant variables, the association remained significant in women [β=-0.95 (-1.87, -0.03)], but not in men [β=-0.63 (-1.55,0.28)]., Conclusion: This study highlights the significant association between osteoporosis and the physical component of QoL in both older men and women, particularly among women. Further research and interventions focusing on enhancing physical QoL in individuals with osteoporosis are warranted to promote healthier aging., (© 2024. The Author(s).)

Neural EGFL like 1 (NELL-1), is a secreted glycoprotein and stimulates osteogenic cell differentiation and bone mineralization. This study aimed to explore the relationship between NELL-1 and Trabecular Bone Score (TBS) as a novel tool for the evaluation of osteoporosis in an elderly population-based cohort study in Iran. A single-locus analysis was performed on TBS using data from 2,071 participants in the Bushehr Elderly Health (BEH) Program. The study investigated 376 independent single nucleotide polymorphisms (SNPs) within the NELL-1 on chromosome 11p15.1. The association between SNPs and the mean TBS L1 to L4 was analyzed through an additive model. Significant variants in the additive model (PFDR<0.05) were further examined within dominant, recessive, over-dominant, and co-dominant models. Multiple linear regression was employed to assess the relationship between the genetic risk score (GRS) derived from significant SNPs and TBS. Three SNPs within the NELL-1 showed a statistically significant association with TBS after adjusting for age and sex. The associations for rs1901945 (β = 0.013, PFDR = 0.0007), rs1584851 (β = -0.011, PFDR = 0.0003), and rs58028601 (β = 0.011, PFDR = 0.0003) were significant in the additive model. Additionally, significant results were observed for rs1901945 and rs58028601 in the dominant model (P<0.05). The GRS showed a statistically significant relationship with TBS, considering adjustments for age, sex, Body Mass Index, type 2 diabetes, and smoking (β = 0.077, P = 1.7×10-5). This study highlights the association of NELL-1 with TBS, underscoring its potential as a candidate for further research and personalized medicine concerning the impact of this gene on bone quality., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bidkhori et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Objective: Obesity has been linked to various conditions, including nephrolithiasis. Given the rising prevalence of both nephrolithiasis and obesity in older adults, this study aimed to examine the association of different obesity-related indices with nephrolithiasis., Methods: This cross-sectional study included 2419 individuals (mean age 69.34 ± 6.40; 51.92 % female) from the Bushehr Elderly Health (BEH) program, a population-based measured using Dual-energy X-ray absorptiometry (DXA), while nephrolithiasis history was assessed through medical records. The associations between obesity-related indices and nephrolithiasis were analyzed using multivariable logistic regression models, adjusted for relevant confounders., Results: Among the 2419 participants, 212 (8.76 %) had a history of nephrolithiasis. In the overall population, only the android-to-gynoid fat mass (FM) ratio was significantly associated with nephrolithiasis (odds ratio [OR] 3.28, 95 % Confidence Interval [CI] 1.06-10.18). In females, the trunk-to-limb FM ratio (OR 2.62, 95 % CI 1.10-6.23) and the visceral adipose index (VAI) (OR 1.092, 95 % CI 1.005-1.187) were associated with nephrolithiasis. In males, only the body adipose index (BAI) was significantly associated with nephrolithiasis (OR 1.082, 95 % CI 1.017-1.151)., Conclusion: In this study, the android-to-gynoid FM ratio in the total population, the trunk-to-limb FM ratio and VAI in females, and BAI in males were significantly associated with nephrolithiasis. Monitoring and managing these indices may enhance quality of life for elderly individuals by facilitating early diagnosis of nephrolithiasis and preventing stone formation., Competing Interests: Declaration of Competing Interest All authors declared no competing interests., (Copyright © 2024 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Background: The control of blood pressure (BP) is a challenge in diabetic patients and is associated with adverse outcomes of diabetes. In this systematic review and metaanalysis, we investigated the BP control rate among hypertensive diabetic patients in the Eastern Mediterranean Region (EMR) countries., Methods: We systematically searched PubMed, Scopus, Embase, Cochrane, and Web of Science databases up to January 2023 for observational studies on BP control among hypertensive diabetic patients in all EMR countries. We included studies reporting the proportion of hypertensive, type 2 diabetic patients with controlled BP, defined as systolic/diastolic BP < 140/90 or <130/80 mmHg. Study quality was assessed using modified STROBE guidelines, and a random-effect meta-analysis was conducted to pool prevalence data and calculate overall rates. Subgroup analysis was performed by gender, study design, country, and BP control cut-offs (140/90 and 130/80)., Results: Among the 1949 retrieved studies, 20 studies assessing 27956 individuals were included. The proportion of BP control regardless of cut-off points was 36.8% (95% CI=29.1%45.3%) based on the studies reported for both genders.The prevalence was 53.2% (95% CI=36.1%- 69.6%) and 43.5% (95% CI=20.0%-70.3%) based on the studies reported just for women or men, respectively., Conclusion: Our findings indicate that BP control targets are not successfully achieved in hypertensive diabetic patients in the Eastern Mediterranean region. It is recommended to place greater emphasis on the quality of hypertension care in the management of type 2 diabetes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: The rising prevalence of overweight and obesity among children and adolescents is a global public health issue. This trend has led to increased obesity-related comorbidities and a higher risk of adulthood obesity in this sensitive population. This study aims to establish the first obesity registry for Iranian children and adolescents to enhance the understanding of pediatric obesity and its determinants and consequents., Methods: We intended to establish a detailed registry for pediatric obesity in Iran, focusing on epidemiological, demographic, and clinical aspects, as well as evaluating various interventions and outcomes. The study will enroll eligible children aged 2 to 17 years with gender- and age-specific BMI > 85th percentile. The initial phase will involve the collaboration of Tehran University of Medical Sciences (TUMS)-affiliated children's hospitals, aiming to register at least 1200 patients over three years (2023-2026). Data collection will include demographic information, medical and medication history, family history, lifestyle behaviors, quality of life, behavioral and psychological assessments, physical examinations, anthropometric measurements, biochemical markers, and obesity-related outcomes., Conclusion: The goal of this registry is to gather extensive information on the factors influencing the occurrence, management, and treatment of obesity and overweight among children and adolescents at individual, family, and community levels. This extensive data is expected to facilitate improvements in health outcomes and behaviors related to obesity and to provide a solid foundation for future research in this field., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01467-7., Competing Interests: Conflict of interestPejman Rohani, Hanieh-Sadat Ejtahed, Shima Shojaie, Mohammad Hassan Sohouli, Shirin Hasani-Ranjbar, Bagher Larijani, and Afshin Ostovar declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024, corrected publication 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Falls are a common cause of fractures in older adults. This study aimed to investigate the factors associated with spontaneous falls among people aged ≥ 60 years in southern Iran., Methods: The baseline data of 2,426 samples from the second stage of the first phase of a prospective cohort, the Bushehr Elderly Health (BEH) program, were included in the analysis. A history of spontaneous falls in the year before recruitment was measured by self-report using a standardized questionnaire. Demographic characteristics, as well as a history of osteoarthritis, rheumatoid arthritis, low back pain, Alzheimer's disease, epilepsy, depression, and cancer, were measured using standardized questionnaires. A tandem gait (heel-to-toe) exam, as well as laboratory tests, were performed under standard conditions. A multiple logistic regression model was used in the analysis and fitted backwardly using the Hosmer and Lemeshow approach., Results: The mean (standard deviation) age of the participants was 69.34 (6.4) years, and 51.9% of the participants were women. A total of 260 (10.7%, 95% CI (9.5-12.0)%) participants reported a spontaneous fall in the year before recruitment. Adjusted for potential confounders, epilepsy (OR = 4.31), cancer (OR = 2.73), depression (OR = 1.81), low back pain (OR = 1.79), and osteoarthritis (OR = 1.49) increased the risk of falls in older adults, while the ability to stand ≥ 10 s in the tandem gait exam (OR = 0.49), being male (OR = 0.60), engaging in physical activity (OR = 0.69), and having high serum triglyceride levels (OR = 0.72) reduced the risk of falls., Conclusion: The presence of underlying diseases, combined with other risk factors, is significantly associated with an increased risk of falls among older adults. Given the relatively high prevalence of falls in this population, it is crucial to pay special attention to identifying and addressing these risk factors., (© 2024. The Author(s).)

Background: The rise of the internet and social media has led to increased interest among diabetes patients in using technology for information gathering and disease management. However, adequate eHealth literacy is crucial for protecting patients from unreliable diabetes-related information online., Objective: To examine the psychometric characteristics and explore the preliminary validity of the Persian version of the Condition-specific eHealth Literacy Scale for Diabetes (Persian CeHLS-D) to assess eHealth literacy in the context of diabetes care., Methods: After adapting, translating, examining content validity, and pilot testing the questionnaire, it was administered to 300 patients with type 2 diabetes mellitus (T2DM). Construct validity was assessed through confirmatory factor analysis, convergent and known-groups validity. The internal consistency (Cronbach's alpha), composite reliability and maximum reliability, and test-retest correlation were assessed., Results: Factor analysis supported the hypothesized two-factor model with 10 items, and the standardized factor loadings ranged from 0.44 to 0.86 (P-values < 0.001). Cronbach's alpha and test-retest correlation were good for each factor. Convergent validity was confirmed by significant correlations of Persian CeHLS-D with diabetes health literacy, perceived usefulness and importance of using the internet for health information, internet anxiety, and perceived physical and mental health. Know-groups validity determined using groups with different internet-use frequencies, and different attitudes towards providing online healthcare services, were satisfied., Conclusion: This study demonstrated the Persian CeHLS-D as a reliable and valid measure of eHealth literacy among patients with T2DM in Iran. Its satisfactory psychometric properties support its use in research and clinical settings to assess eHealth literacy and inform interventions., (© 2024. The Author(s).)

Background: It has been documented that old age and chronic diseases are associated with poor prognosis and mortality among COVID-19 patients. Osteosarcopenia is a geriatric syndrome with a considerable prevalence which increases morbidity and mortality. This study investigated the relationship between COVID-19 mortality and osteosarcopenia and its parameters in-hospitalized patients in Bushehr, Iran., Methods: In this retrospective cohort study, participants of the Bushehr Elderly Health (BEH) program who were hospitalized due to COVID-19 between 1st March 2020 and 23rd September 2021 were assessed. Osteosarcopenia was considered as the presence of both osteopenia/osteoporosis and sarcopenia. We used the Cox proportional hazards model to identify the association between oteosarcopenia and the risk of COVID-mortality in 2442 person-days., Results: Among 4173 participants,297 patients were in-hospitalized due to COVID-19. We found that 80(26.94%) patients expired due to COVID-19 during the follow-up period. Osteosarcopenia and its parameters were more prevalent in patients who expired. The incidence rate of mortality among osteosarcopenic patients was 5.04(3.43- 7.40) per 100 person-days. In the Cox proportional hazards models, osteosarcopenia and its parameters increase the risk of COVID-mortality [Osteosarcopenia: HR adjusment :1.73(1.00-3.01), sarcopenia: HR adjusment :1.72(1.00-2.99), Osteoporosis: HR adjusment :2.67(1.53-4.67), Low muscle mass: HR adjusment :1.90(1.05-3.46), low muscle strength: HR adjusment :1.80(1.03-3.16), and low gait speed: HRadj:2.39(1.31-4.38). The ORs of ICU admission and use of invasive mechanical ventilation among osteosarcopenic patients and its parameters were higher than those without it., Conclusions: This study identified the impact of osteosarcopenia and its parameters on the mortality of in-hospitalized patients with COVID-19. Assessment of musculoskeletal disorders could help in early warning of older patients with severe COVID-19., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01443-1., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: While only a few postmenopausal women exhibit biochemical signs of hypovitaminosis D, it has been shown that vitamin D insufficiency has detrimental effects on the overall skeleton mineralization, bone turnover rate, and may be a significant risk factor for osteoporosis and fracture. We evaluated the concurrent effect of Vitamin D levels and biochemical markers of bone turnover on bone health of postmenopausal women., Methods: The present study was conducted within the framework of the Bushehr Elderly Health (BEH) program, a population-based prospective cohort study being conducted in Bushehr, a southern province of Iran. In summary, 400 persons from participants of the second stage were selected; serum bone turnover markers (bone-specific alkaline phosphatase (bALP), amino-terminal procollagen propeptides of type I collagen (P1NP), osteocalcin (OC), tartrate-resistant acid phosphatase isoenzyme 5b (TRAP)) and vitamin D were measured. Vitamin D deficiency was defined as serum 25(OH) D below 20 ng/ml, and Bone health was considered in terms of Osteoporosis and degraded bone microarchitecture., Results: The number of partially or significantly degraded microstructure based on TBS was higher than the number of osteoporotic women based on BMD. Women with higher CTX levels were more prone to being degraded microarchitecture. Although we couldn't find any association between vitamin D deficiency and bone health, when we considered the vitamin D levels in univariable modelling, the effect of it was significant., Conclusions: In this study, only CTX was found to be significantly correlated with TBS while BMD was associated with CTX, OC, and TRAP., Competing Interests: Conflict of interestSafoora Gharibzadeh, Noushin Fahimfar, Hossein Yarmohammadi, Samira Goudarzi, Farideh Razi, Patricia Khashayar, Gita Shafiee, Ramin Heshmat, Nahid Moradi, Mahnaz Sanjari, Kazem Khalagi, Alireza Raeisi, Iraj Nabipour, Bagher Larijani, and Afshin Ostovar declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: Non-communicable diseases (NCDs) cause 74% of global deaths annually, for which poor diet is the leading risk factor. Diet improvement could prevent 20% of global deaths. This paper presents a policy package for socio-cultural factors, strategies, and policies to promote a healthy diet in Iran., Methods: This is a qualitative health policy analysis. We conducted 30 semi-structured, in-depth, and face-to-face interviews with purposefully identified key informants, i.e., experts, policy-makers, and high-level managers, during 2018-19 in Iran. All interviews were digitally recorded and transcribed verbatim. The MAXQDA 11 software was used to facilitate data analysis., Results: We developed several recommendations for different stakeholders, including improving cultural habits, promoting the use of fruit and vegetables, establishing healthy taste from early childhood, enhancing people's health literacy, developing health-promoting schools, and implementing a healthy buffet., Conclusions: In line with target 3.4 of the Sustainable Development Goals (SDG) and the World Health Organization (WHO) recommendations for the prevention and control of NCDs, since 2015, Iran has developed its national action plan, including several nutritional interventions to achieve the target of reducing 30% of premature death due to NCDs and related risk factors by 2030. Our evidence-based recommendations can assist the government and other stakeholders, as we envisage, boost their activities to combat unhealthy diets, the biggest risk factor of NCDs in Iran, and perhaps beyond., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01449-9., Competing Interests: Competing interestsThe authors declare that they have no conflict of interest about the publication of this paper., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: Various risk factors are mentioned for osteoporosis, sarcopenia, and osteosarcopenia. Our aim is to assess the impacts of anti-diabetic drugs on these disorders., Methods: To perform this study, the participants' data was extracted from the Bushehr Elderly Health (BEH) program in Iran. Afterward, the data were categorized into three subgroups: osteoporosis, sarcopenia, and osteosarcopenia, based on WHO and European Working Group on Sarcopenia in Older People (EWGSOP-2) working group definitions. Demographic characteristics, anthropometric measures, past medical history, and current medications were recorded. Pearson chi-squared and simple/multiple logistic regression using Python (3.11.4) and R (4.3.1) programming software assessed the association between anti-diabetic agents and these bone disorders., Results: Out of 1995 participants, 820, 848, and 404 had osteoporosis, sarcopenia, or osteosarcopenia, respectively. Among all types of anti-diabetic drugs, a significant protective association between osteoporosis and consumption of second-generation sulfonylureas was found; Adjusted Odd Ratio (AOR) = 0.65 ([95% CI: 0.45-0.94], p-value = 0.023). No associations were found between sarcopenia and consumption of anti-diabetic agents. A significant association was observed between using Meglitinides and the risk of osteosarcopenia; AOR = 4.98 ([95% CI: 1.5-16.55], p-value = 0.009)., Conclusion: In conclusion, a protective association between consumption of second-generation sulfonylureas and osteoporosis was found. Moreover, a positive association was found between the consumption of meglitinides and osteosarcopenia. However, to support these findings, further studies are recommended., (© 2023. The Author(s), under exclusive licence to Tehran University of Medical Sciences.)

Background: The aim of this study was to investigate the association of osteosarcopenia with frailty and poor health conditions among older Iranian adults., Methods: This cross-sectional study analyzed data from the Bushehr Elderly Health Program. Osteosarcopenia was defined as the presence of osteopenia/osteoporosis and sarcopenia, while the Fried criteria were used to assess frailty. We assessed the history of falls and health-related quality of life (HRQoL), including physical and mental component summaries (PCS and MCS, respectively), history of fractures, activities of daily living (ADL), and instrumental activities of daily living (IADL), as indicators of poor health conditions., Results: This study included a total of 2,371 older adults. The prevalence rates of osteosarcopenia-only, frailty-only, and osteosarcopenia with frailty were 17.4%, 3%, and 4.8%, respectively. The prevalence of a history of falls, poor ADL, and poor IADL was significantly higher in the frailty-only and osteosarcopenia with frailty groups. Osteosarcopenia with frailty was significantly associated with a history of falls (adjusted odds ratio [adjOR]=1.94; 95% confidence interval [CI], 1.20-3.15), poor ADL (adjOR=2.85; 95% CI, 1.81-4.50), and poor IADL (adjOR=5.09; 95% CI, 2.85-9.11). However, the frailty-only group also showed an association with falls and poor ADL and IADL. Only osteosarcopenia was associated with an increased OR for fracture. Frailty had the greatest effect on the MCS and PCS scores, whereas osteosarcopenia with frailty had a moderate impact., Conclusion: Osteosarcopenia with frailty significantly increased the odds of falls, poor ADL, poor IADL, and lower HRQoL compared with the robust group. Combined osteosarcopenia and frailty were not associated with poor health. These findings indicate the importance of diagnosing osteosarcopenia and frailty as separate entities to provide appropriate interventions and treatment.

Background: Ensuring the comprehensive and accurate representation of data within cancer registries holds paramount significance across various facets of public health decision-making. This study delves into the evaluation of data completeness in breast cancer (BC) pathology reports within a population-based cancer registration system in Iran, spanning the period from 2016 to 2018., Methods: Employing a retrospective and descriptive analytical approach, we harnessed secondary data extracted from pathology reports encompassing breast cancer diagnoses, which were duly recorded in the Integrated Cancer Information Management System database during 2016-2018. A total of 4000 pathology reports were thoughtfully selected from each of the three years. The spectrum of pathology information encompassed tumor type, site grade, size (T), and involvement of lymph nodes (N). Summary statistics were provided as percentages of categorical variables and mean with standard deviation of continuous variables. A comparison of categorical variables was performed using the Chi-squared test., Results: The participants' mean age was 51.8±12.5 years. Among the 12,000 studied patients, 5744 (47.9%) were ≤ 50 years old, 5233 (43.6%) were aged 50-69 years, and 1023 (8.5%) were >60 years old. The completeness of BC pathology reports varied for different variables. Interestingly, the completeness of these variables increased with older age groups. The proportion of specific tumor types differed significantly among age groups ( P = 0.001). Notably, the prevalence of invasive ductal carcinoma was higher in the ≤ 50 years age group compared to the older cohorts. Likewise, notable variations in tumor sizes were observed ( P = 0.009), with a higher prevalence of missing tumor size data noted in the age group ≤ 50 years. On the other hand, pathologic T stage also demonstrated age-dependent variations ( P = 0.014), indicating a higher prevalence of missing stages in the ≤ 50 years age group. Finally, tumor grade exhibited a statistically significant difference ( P < 0.001), with a higher proportion of grade 1 tumors observed in the 50-69 years age group., Conclusion: Tumor grade had the highest completeness rate, while tumor size, pathologic T stage, and pathologic N stage had the lowest. Therefore, a good understanding of completeness of pathology reports, as well as improvement in the registration of stage, integrated system at the national level for BC is warranted., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

In this study, postnatal metal (loid)s (MLs) exposure was compared between the petrochemical and gas area of Asaluyeh (PGA) and urban area of Kaki (UA) in Bushehr province, Iran. Two hundred human breast milk (BM) samples from the industrial and urban areas were analyzed for MLs using Inductivity Coupled Plasma-Optical Emission Spectrometry (ICP-OES). Boron (B), copper (Cu), iron (Fe), and nickel (Ni) were found at the highest levels in both study areas. Adjusted multiple linear regression models revealed that the mean concentration of total MLs in BM samples collected from the PGA was statistically significantly greater than that of the UA (655.85 vs. 338.17 µg/L). Also, the mean concentrations of all detected MLs in BM samples collected from the PGA were statistically significantly higher than those collected from the UA. The hazard index (HI) of combined MLs in the PGA and UA illustrated non-cancer risk for infants. Lead (Pb) and chromium (Cr) in the PGA and Cr in the UA showed the risk of cancer. So it can be concluded that nursing infants from an industrial area are most at risk for MLs exposure during entire lactation course than those from an urban area., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event., Materials and Methods: This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013-2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture., Results: A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06-20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50-7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively., Conclusion: Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population., (© 2024. The Author(s).)

Background: The COVID-19 pandemic affected the control of many chronic conditions, including hip fractures, worldwide. This study was to examine the impact of the COVID-19 pandemic on the management of hip fractures in a referral orthopedic hospital in Iran. By understanding how the pandemic has influenced the care of hip fracture patients, we can gain valuable insights into the challenges, adaptations, and potential improvements in orthopedic healthcare during such public health crises., Methods: Data was collected on hip fracture patients aged 50 and above who were admitted to the hospital before and during the pandemic. The number of admissions and operations, length of hospital stay, and time from admission to surgery were recorded from the hospital information system (HIS) and compared between the two periods., Results: The median number of admitted hip fracture patients per month increased slightly during the pandemic (11%), although this increase was not statistically significant (p = 0.124). After adjusting for potential confounders, the mean length of hospital stay was significantly lower during the pandemic period, indicating that patients were discharged sooner (p = 0.019) and the time from admission to surgery was shorter during the pandemic (p = 0.004). Although the increase in the number of hip fracture surgeries per month during the pandemic was not statistically significant (P = 0.132), a higher percentage of patients underwent surgery during the pandemic compared to before (84.8% VS. 79.4%)., Conclusion: The study suggests that the COVID-19 pandemic did not have a negative impact on hip fracture management in the investigated orthopedic hospital in Iran. further research is needed to explore the effects of the pandemic on other aspects of healthcare services, particularly in general hospitals., (© 2024. The Author(s).)

Purpose: Obesity is a global health challenge due to its high prevalence and increased related morbidity and mortality. Accordingly, creating a platform to enter data on patients with obesity, treatment process and outcome is mandatory. The objective of this registry is to provide such a database regarding Iranian adults with obesity in order to facilitate future research designs and effective decision making to control this condition., Methods: After obtaining informed consent from eligible individuals, a practical questionnaire will be used to gather information about basic characteristics, family history, past medical history, regular medications, dietary intakes and other relevant information of adults with obesity. This data along with the results of laboratory tests, physical examination, and anthropometric measurements will be registered into the registry system by trained members of the team during an in-person visit. Patients will undergo a specific treatment plan based on the multidisciplinary medical team's decision. Then, changeable variables and the outcomes of their treatment process will be registered later in the follow-up sessions., Conclusion: This registry aims to provide a comprehensive dataset on the epidemiology, outcomes and management process of obesity to serve as a foundation for later research projects and improve medical approaches toward this condition., Competing Interests: Competing interestsThe authors declared no relevant financial or non- financial interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

One of the goals of the HORIZON 2020 project PoCOsteo was to develop a medical device, which would measure and/or quantify proteomic as well as genomic factors as present in whole blood samples collected through finger prick. After validating the tool in the clinical setting, the next step would be its clinical validation based on the existing guidelines. This article presents the protocol of a validation study to be carried out independently at two different centers (Division of Endocrinology and Diabetology at the Medical University of Graz as a clinic-based cohort, and the Endocrinology and Metabolism Research Institute at the Tehran University of Medical Sciences as a population-based cohort). It aims to assess the tool according to the Clinical & Laboratory Standards Institute guidelines, confirming if the proteomics and genomics measurements provided by the tool are accurate and reproducible compared with the existing state-of-the-art tests. This is the first time that such a detailed protocol for lab validation of a medical tool for proteomics and genomic measurement is designed based on the existing guidelines and thus could be used as a template for clinical validation of future point-of-care tools. Moreover, the multicentric cohort design will allow the study of a large number of diverse individuals, which will improve the validity and generalizability of the results for different settings., (© The Author(s) 2024. Published by Oxford University Press.)

Background and Objective: Considering the importance of diabetes and its increased prevalence with aging, this study aimed to evaluate the association between diabetes status and quality of life (QOL) and the determining factors in individuals over 60., Methods: Two thousand three hundred seventy-five individuals including 819 (34.5%) with diabetes, aged 69.4 ± 6.4, from Bushehr Elderly Health Program (BEHP) were enrolled. We categorized the participants as non-diabetic, controlled diabetic, and poorly controlled diabetic. The QOL was assessed using the SF-12 questionnaire. The physical (PCS) and mental (MCS) component summaries of QOL were estimated. We compared the SF-12 domains and components between the categories using ANOVA. Further, the association of diabetes status with PCS and MCS was assessed after adjustment for possible confounders including age, sex, depression, cognitive impairment, physical activity, and other relevant factors using linear regression analysis., Results: Individuals with diabetes had lower PCS (40.9 ± 8.8 vs. 42.7 ± 8.6, p-value < 0.001), and MCS scores (45.0 ± 10.2 vs. 46.4 ± 9.4, p-value < 0.001) compared to participants without diabetes. No significant differences were observed in PCS or MCS scores between controlled or poorly controlled individuals with diabetes. Diabetes status was associated with PCS and MCS scores in univariable analysis. Regarding physical component of QOL, after adjusting for other confounders, poorly controlled diabetes was significantly associated with PCS [beta: -1.27 (-2.02, -0.52)]; some other determinants include depression [-7.66 (-8.51, -6.80)], male sex [3.90 (3.24,4.57)], and good physical activity [1.87 (1.17,2.57)]. As for the mental component, controlled diabetes was significantly associated with MCS [-1.17 (-2.13, -0.22)]; other contributing factors include depression [-14.35 (-15.34, -13.37)], male sex [1.97 (1.20,2.73)], good physical activity [-1.55 (-2.35, -0.75)], and smoking [-1.42 (-2.24, -0.59)]. BMI had an inverse association with PCS [-0.19 (-0.26, -0.13)] and a direct association with MCS [0.14 (0.07,0.21)]., Conclusion: Individuals with diabetes exhibited reduced QOL scores. Upon adjusting for other variables, it was found that uncontrolled diabetes correlated with decreased PCS scores, whereas controlled diabetes was linked to lower MCS scores. Factors such as depression and being female were identified as contributors to diminished QOL in both physical and mental aspects. These results have the potential to guide healthcare decision-making, facilitating the creation of tailored interventions aimed at improving the QOL for individuals with diabetes, with a specific focus on women and depression., (© 2024. The Author(s).)

As the population ages, the global burden of cardiometabolic disorders will increase. This study aimed to investigate the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) in elderly and to evaluate the effects of various variables including age, sex, education, marital status, smoking, income, physical activity, dementia and depressed mood on untreated cardiometabolic disorders. This was a cross sectional study conducted in Bushehr Elderly Health Program. A total 2381 participants were included. Medical data were collected by trained interviewers. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20-2.15), older adults (OR = 1.02, 95%CI = 1.00-1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52-0.92). Males (OR = 2.16, 95%CI = 1.64-2.84) and current smokers (OR = 1.42, 95%CI = 1.05-1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08-0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29-0.89) and dementia (OR = 0.78, 95%CI = 0.61-1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19-2.66) and males (OR = 1.66, 95%CI = 1.21-2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53-6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28-1.01)., (© 2024. The Author(s).)

Modification of photocatalysts to improve their adsorption and photocatalytic activity in the oxidative desulfurization of liquid fuels has been reported by many investigators. In this study, Pt-decorated carbon-doped TiO 2 nanoparticles were synthesized by hydrothermal and photo-deposition techniques and were subsequently used in photocatalytic oxidative desulfurization of dibenzothiophene (DBT) in n-heptane as a simulated liquid fuel with methanol as the extracting solvent. Carbon-doped TiO 2 was first synthesized by a simple self-doping method. Pt was then loaded by a photo-deposition technique. The synthesized photocatalysts (labeled as YPt-CT where Y is percent Pt loading) were characterized by of X-ray diffraction (XRD), photoluminescence (PL), field emission scanning electron microscopy (FESEM), N 2 -physisorption, UV-Vis diffusive reflectance spectra (UV-Vis DRS), transmission electron microscopy (TEM), Fourier transform infrared spectra (FTIR), and nitrogen sorption measurements. The removal efficiency of DBT was 98% in the presence of 2 g/l of 0.5Pt-CT catalyst under visible-light irradiation (λ > 400 nm), ambient pressure, and reaction temperature of 40°C., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Mitochondrial dysfunction and low nicotinamide adenine dinucleotide (NAD + ) levels are hallmarks of skeletal muscle ageing and sarcopenia 1-3 , but it is unclear whether these defects result from local changes or can be mediated by systemic or dietary cues. Here we report a functional link between circulating levels of the natural alkaloid trigonelline, which is structurally related to nicotinic acid 4 , NAD + levels and muscle health in multiple species. In humans, serum trigonelline levels are reduced with sarcopenia and correlate positively with muscle strength and mitochondrial oxidative phosphorylation in skeletal muscle. Using naturally occurring and isotopically labelled trigonelline, we demonstrate that trigonelline incorporates into the NAD + pool and increases NAD + levels in Caenorhabditis elegans, mice and primary myotubes from healthy individuals and individuals with sarcopenia. Mechanistically, trigonelline does not activate GPR109A but is metabolized via the nicotinate phosphoribosyltransferase/Preiss-Handler pathway 5,6 across models. In C. elegans, trigonelline improves mitochondrial respiration and biogenesis, reduces age-related muscle wasting and increases lifespan and mobility through an NAD + -dependent mechanism requiring sirtuin. Dietary trigonelline supplementation in male mice enhances muscle strength and prevents fatigue during ageing. Collectively, we identify nutritional supplementation of trigonelline as an NAD + -boosting strategy with therapeutic potential for age-associated muscle decline., (© 2024. The Author(s).)

Background: Metabolic syndrome (MetS) known as a risk factor for cardiovascular diseases (CVDs) has developed into a major source of health issue, especially for the elderly. In the present study, we investigated the association between continuous MetS (cMetS) score and its components with electrocardiographic (ECG) abnormalities in the community-dwelling older adults., Methods: This cross-sectional study is derived from the second phase of BEH cohort study which is conducted on individuals aged over 60 years old. Standard 12-lead ECGs were recorded and coded by qualified physicians and continuous values of metabolic syndrome risk scores (cMetS) were measured. Data regarding socio-demographic, medical history, and lifestyle variables were collected by trained interviewers. The multinomial regression analysis was used to investigate the relationship between cMetS and its components with ECG abnormalities in the included participants., Results: 2426 individuals (mean age ± standard deviation: 69.30 ± 6.33 years) were included in the final analysis. Overall, 22.5% of the participants showed ECG abnormalities. Among these, 8.0% (n = 139) of participants had minor and 14.6% (n = 354) had major ECG abnormalities. In the final models, cMetS (OR = 1.04), mean arterial pressure (MAP((OR = 1.01), and higher fasting blood glucose (FBG) (OR = 1.01) increased the risk of ECG abnormalities (p < 0.05). Also, cMetS (OR = 1.05) and MAP (OR = 1.02) were associated with an increased risk of major ECG abnormalities (p < 0.05)., Conclusion: MetS and MAP were significantly associated with ECG abnormalities. The results of the present study suggest that ECG screening in the older population with MetS could potentially help to detect those at the higher risk of CVDs., (© 2024. The Author(s).)

Background: Urinary tract cancers including bladder, kidney, ureter, and pelvis are a common malignancy worldwide with high mortality ratio. Aimed to investigate the prevalence of these cancers, we conducted this study., Methods: In this study, all the information related to ICD10 codes, gender, age and province of residence of individuals were obtained from the data of Iran's cancer registry by the Ministry of Health, Medicine and Medical Education and demographic evidence for each sub-country from the reports of Statistics Center of Iran (SCI). Also, the data of two Iranian national survey studies CASPIAN-III, IV, and V (information related to the care and prevention of non-communicable diseases (NCD) in childhood and adolescence) and STEPs (including information on NCD in adults over 18 years old) were used. The data was analyzed using Poisson regression with mixed effects to estimate the incidence of cancers., Results: Bladder and kidney neoplasm are the most common cancers of the urinary system in Iran. The prevalence of bladder cancer has increased from 5.82 to 11.50 per 100,000 individuals. The increasing trend is growing faster in men compared with women. The incidence of kidney neoplasm has increased over the years (2.03 in 2005 vs. 7.02 in 2020 per 100,000). Having a higher incidence ratio compared with bladder cancer, kidney cancer is responsible for 35.06% of all urinary cancers in 2020 compared with 23.71% in 2005. Both neoplasms of the ureter and renal pelvis were recorded rarely and with lower incidence in both sexes during this period., Conclusion: Considering the increasing trend in the incidence of urinary neoplasms in Iran during these years, the advantage of focusing on the risk of urinary cancers is highlighted. Therefore, investigating the prevalence and incidence of urinary cancers to plan and manage these cancers will result in prevention and reduction of the disease burden on the Iranian society. Future studies in this field can help in the prevention and well-timed diagnosis of these cancers., (© 2024. The Author(s).)

Introduction: We evaluate which screening and diagnostic approach resulted in the greatest reduction in adverse pregnancy outcomes due to increased treatment., Research Design and Methods: This study presents a secondary analysis of a randomized community non-inferiority trial conducted among pregnant women participating in the GULF Study in Iran. A total of 35 430 pregnant women were randomly assigned to one of the five prespecified gestational diabetes mellitus (GDM) screening protocols. The screening methods included fasting plasma glucose (FPG) in the first trimester and either a one-step or a two-step screening method in the second trimester of pregnancy. According to the results, participants were classified into 6 groups (1) First-trimester FPG: 100-126 mg/dL, GDM diagnosed at first trimester; (2) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at first trimester; (3) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at second trimester; (4) First trimester FPG: 92-99.9 mg/dL, healthy at second trimester; (5) First trimester FPG<92 mg/dL, GDM diagnosed at second trimester; (6) First trimester FPG<92 mg/dL, healthy at second trimester. For our analysis, we initially used group 6, as the reference and repeated the analysis using group 2, as the reference group. The main outcome of the study was major adverse maternal and neonatal outcomes., Results: Macrosomia and primary caesarean section occurred in 9.8% and 21.0% in group 1, 7.8% and 19.8% in group 2, 5.4% and 18.6% in group 3, 6.6% and 21.5% in group 4, 8.3% and 24.0% in group 5, and 5.4% and 20.0% in group 6, respectively. Compared with group 6 as the reference, there was a significant increase in the adjusted risk of neonatal intensive care unit (NICU) admission in groups 1, 3, and 5 and an increased risk of macrosomia in groups 1, 2, and 5. Compared with group 2 as the reference, there was a significant decrease in the adjusted risk of macrosomia in group 3, a decreased risk of NICU admission in group 6, and an increased risk of hyperglycemia in group 3., Conclusions: We conclude that screening approaches for GDM reduced the risk of adverse pregnancy outcomes to the same or near the same risk level of healthy pregnant women, except for the risk of NICU admission that increased significantly in groups diagnosed with GDM compared with healthy pregnant women. Individuals with slight increase in FPG (92-100 mg/dL) at first trimester, who were diagnosed as GDM, had an even increased risk of macrosomia in comparison to those group of women with FPG 92-100 mg/dL in the first trimester, who were not diagnosed with GDM, and developed GDM in second trimester TRIAL REGISTRATION: IRCT138707081281N1 (registered: February 15, 2017)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: One of the key strategies for effective management of osteoporosis is training health care professionals on early diagnosis and treatment of osteoporosis according to a structured course. The aim was to investigate the e-learning courses on osteoporosis around the world in order to develop an online course on osteoporosis management for general practitioners (GPs)., Methods: In this review, the Web of Science, Scopus, PubMed, Embase, and ERIC databases and the Google search engine were searched until March, 2021.Then, the contents of the eligible courses were extracted by two researchers independently and verified. After that, the content for an online course for GPs was developed and approved by a panel of experts constituted of endocrinologists, orthopedists, and other specialties involved in the management of osteoporosis to develop the final online course for GPs., Results: In this review, 22 e-learning courses provided through 3 studies, and 19 websites were included. The content of the osteoporosis e-learning course was categorized into ten thematic categories including bone health, osteoporosis definitions and pathophysiology, prevention of osteoporosis, diagnosis of osteoporosis, fractures, non-pharmacological treatments, pharmacological treatments, treatment follow-up, postmenopausal considerations and hands-on work. The final modules for the osteoporosis e-learning contained five main categories, including bone measurement and fracture risk assessment, diagnosis of osteoporosis, clinical management, monitoring and follow-up, and sarcopenia., Conclusion: Through a systematic approach, we developed modules for e-learning of osteoporosis management, which can be used to improve knowledge and skills of GPs in their practice in our setting., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01361-8., Competing Interests: Conflict of interestThe Authors declare that there is no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: Trabecular bone score (TBS), as a texture indicator of bone microarchitecture, predicts the risk of fracture. This study aims to explore the knowledge map of TBS., Methods: We searched Scopus for "trabecular bone score" or "trabecular score" from the beginning to 2021. Our inclusion criteria were original articles and reviews that were related to TBS and our exclusion criteria were non-English articles, non-related to TBS, and document type other than original articles and reviews. and related documents were included for bibliometric analysis. Excel, VOS viewer, and Science of Science (Sci2) software were used for data synthesis., Results: From 749 retrieved articles, 652 articles were included for analysis. These documents were cited 12,153 times and had an H-index of 56. The most productivity belonged to the USA (n = 130 documents), Switzerland (n = 101), and Italy (n = 67). "Osteoporosis International" (n = 80) had the highest participation in publishing. The research topics of interest were mainly related to the applicability of TBS for fracture risk assessment in chronic endocrine disorders such as osteoporosis and diabetes mellitus. Bursting analysis of the title and abstract revealed the initial focus of the discriminative power of TBS for osteoporotic fracture and the more recent focus on comparing bone mineral density (BMD) and TBS in a variety of chronic diseases., Conclusion: The number of annual publications on TBS has increased, especially after 2016. These publications highlight the importance of in-depth knowledge of TBS in predicting fracture risk and also its strengths and limitations of treatment monitoring in different health conditions., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01338-7., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: This cross-sectional study, conducted as part of the Bushehr Elderly Health program stage II in Bushehr, Iran, aimed to evaluate health-related quality of life (HR-QoL) in individuals aged ≥ 60 with osteosarcopenia, a condition characterized by the co-occurrence of osteopenia/osteoporosis and sarcopenia. Given the increasing elderly population worldwide, understanding the HR-QoL of this demographic is crucial, with osteosarcopenia being a significant factor., Methods: The study enrolled 2369 participants aged ≥ 60 and collected demographic and anthropometric data. Various questionnaires, including the Short Form 12, Patient Health Questionnaire-9, Activities of Daily Living, and Instrumental Activities of Daily Living, were administered. Comparisons were made between individuals with and without osteosarcopenia. Regression models were employed to identify variables associated with HR-QoL in those with osteosarcopenia., Results: Key findings revealed that 22.5% of participants had osteosarcopenia. Significantly different HR-QoL measures were observed between the 2 groups, especially in physical functioning and physical component summary scores. Male gender, advanced age, and chronic illnesses were linked to lower physical and mental HR-QoL scores among those with osteosarcopenia. In female participants, a history of fractures and physical disability were associated with reduced quality of life., Conclusions: This study underscores the negative impact of osteosarcopenia on HR-QoL, particularly in male participants, with a focus on physical aspects. It also highlights age and chronic disease as contributing factors to diminished HR-QoL in individuals with osteosarcopenia. These findings emphasize the importance of addressing osteosarcopenia in the elderly population to improve their overall well-being., Competing Interests: The authors declare no competing interests., (© 2024 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V.)

Purpose: The prevalence of osteoporosis increases as the population ages. The aim of this study was to conduct a systematic review and meta-analysis to estimate the prevalence of osteoporosis among the general population ≥ 50 years old in Iran., Methods: Multiple databases including Scopus, WOS, Medline, Embase, and Persian databases (SID and Magiran) were systematically searched to identify relevant research papers. All population-based studies estimating the prevalence of osteoporosis in the Iranian population were included and imported into Endnote software. Two authors independently reviewed the articles. The Newcastle-Ottawa Scale was used to assess the risk of bias. Statistical analysis was performed using Stata software, and a significance level of 0.05 was applied to the analyses., Results: Totally 2117 documents were retrieved from the databases up until October 11, 2022. After reading the full texts, 10 documents were included in the study. Our results indicated that the pooled prevalence of osteoporosis in the femoral neck region was 0.19 (95%CI: 0.12-0.26) and 0.19 (95%CI: 0.13-0.25) for women and men, respectively. Pooled prevalence of spinal osteoporosis was 0.29 (95%CI: 0.21-0.38) among women and 0.16 (95%CI: 0.12-0.19) among men. The total pooled prevalence of osteoporosis was 0.38 (95%CI: 0.29-0.48) for women and 0.25 (95%CI: 0.22-0.29) for men., Conclusion: Our study highlights the elevated prevalence of osteoporosis among individuals aged 50 years and older, with females exhibiting higher rates. Notably, osteoporosis in the femoral neck region demonstrated the lowest prevalence in both sexes. The implementation of comprehensive strategies is imperative to address osteoporosis problems effectively., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01352-9., Competing Interests: Competing interestsThe authors have no competing interests to declare that are relevant to the content of this article., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Osteosarcopenic obesity is a new syndrome that has been recently discussed in the scientific community. It is a condition that affects the elderly and involves the loss of bone, muscle, and fat tissue. The few studies that have been done on this disease showed that it has a high prevalence among the elderly and can cause various complications. This study was the first one to investigate this syndrome in Iran, and found that its prevalence was 19.83%., Background: Osteosarcopenic obesity syndrome (OSO) is a condition that involves osteopenia/osteoporosis, sarcopenia, and obesity. It leads to a reduction in the quality of life of the elderly and an increase in hospitalization which has attracted the attention of physicians. This study aimed to determine the prevalence and risk factors of osteosarcopenic obesity in people over 60 years of age in Bushehr., Materials and Methods: We used data from the Bushehr study, which included 2426 participants aged ≥ 60 years. We assessed osteoporosis/osteopenia based on T-score; sarcopenia based on hand grip strength, skeletal muscle mass index (SMI), and walking speed; and obesity based on fat mass and BMI for diagnosing OSO. We first examined the factors related to OSO in the univariable analysis and then fitted the multiple logistic regression model, separately for women and men. The result was summarized as adjusted odds ratios with a 95% confidence interval., Results: In total, 2339 elderly were examined in our study, of which 464 elderly were suffering from osteosarcopenic obesity. The standardized prevalence of OSO was 23.66% (95% CI: 21.15-26.16) in women and 18.53% (95% CI 16.35-20.87) in men. Age was positively linked to osteosarcopenic obesity in both genders and so was diabetes in men. However, education, physical activity, and protein intake were negatively linked to osteosarcopenic obesity in both genders, as well as hypertriglyceridemia and hypertension in women., Conclusion: The prevalence of OSO among men and women of Bushehr city is high and is related to increasing age, low levels of education, physical activity, and protein intake among women and men., (© 2023. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Background: Osteoporotic fractures can result in significant health complications and an increased risk of death. Registry studies could provide better treatment options and improve patient outcomes by providing useful information about the disease. The present study describes the protocol for an osteoporosis registry in Iran., Materials and Methods: This registry is a prospective multicenter cohort study recruiting patients with osteoporosis from Iran. The inclusion criteria of the study are individuals diagnosed with primary or secondary osteoporosis according to the diagnostic criteria of the study; patients will be identified and recruited from outpatient clinics in this registry. All patients diagnosed with primary or secondary osteoporosis are the target population of the study. Our expected sample size is 1000 participants and the study will continue for at least 2 years. The measurements of the Iranian Osteoporosis Registry include four parts: (i) variables measured by the specific questionnaires package, (ii) bone mineral density (BMD, (iii) clinical examination, and (iv) lab data. The final questionnaire package includes "demographics information", "socioeconomic status", "lifestyle", "reproductive health", "medical history and medication", "Osteoporosis diagnosis gap", "Osteoporosis adherence and treatment gap", "fracture history and fall risk assessment", "FRAX ® tool ", "hospitalization and death outcomes", "low back pain", "hospitalization history", "attitude toward osteoporosis", "osteoporosis awareness", "osteoporosis related-performance", "quality of life (Iranian version of SF12 questionnaire )", and "food frequency questionnaire (FFQ)". Clinical examination of this registry includes anthropometric measurements (including height, weight, body mass index (BMI), waist circumference, hip circumference, and right wrist circumference), and blood pressure. The baseline questionnaires will be filled out right after patients are diagnosed with osteoporosis and then osteoporotic patients will be followed up regularly on a yearly basis. In the follow-up visit, variables that may have changed over time are updated. The main outcomes include registration of fall, fracture, hospitalization, medication adherence, and death. An online web-based user-friendly software is also developed for data collection. Data analysis will be conducted with the collaboration of data-mining experts and epidemiologists at the end of each follow-up., Conclusion: The Iran Osteoporosis Registry will be a valuable source of information regarding osteoporosis outcomes (i.e. fractures, hospitalizations, adherence, and death at the national level), and its results will be very beneficial and practical for policy makers in the field of musculoskeletal diseases., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Rheumatoid arthritis (RA) and low back pain (LBP) are among the most prevalent musculoskeletal disorders (MSDs). The need for investigation of regional and local patterns of these two MSDs seems inevitable for better policy-making. The current study presents updated results of the Global Burden of Disease (GBD) Study 2019 and reports the burden of RA and LBP in North Africa and Middle East (NAME) countries from 1990 to 2019., Methods: Incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors, including high body mass index, occupational ergonomic factors, and smoking, were extracted based on the GBD 2019 data., Results: The age-standardized prevalence and mortality of RA were 120.6 (95% uncertainty interval [95% UI] 107.0-135.7) and 0.1 (95% UI 0.1-0.2) per 100 000 population in 2019 with 28.3% (95% UI 25.5%-30.9%) increase and 7.5% (95% UI -37.5% to 32.5%) decrease since 1990, respectively. Turkey had the highest age-standardized incidence, prevalence, and DALYs of RA in 2019. All RA burden measures were higher for women; however, the incidence was almost the same at ages greater than 65 years. The age-standardized prevalence and DALYs of LBP were 7668.2 (95% UI 6798.0-8636.3) and 862 (95% UI 605.5-1153.3) in 2019, which had decreased by 5.8% (95% UI -7.4% to -4.3%) and 6.0% (95% UI -7.7% to -4.2%) since 1990, respectively. Moreover, although Turkey had the highest incidence and prevalence in 1990, Iran was at the top in 2019. The regional age-standardized DALY rates due to RA and LBP attributed to smoking were 1.7 (95% UI 0.5-3.2) and 139.4 (95% UI 87.3-198.8) in 2019, respectively, which had decreased 2.2% (95% UI -19.2% to 13.7%) and 15.4% (95% UI -19.4% to -10.5%) since 1990, respectively., Conclusion: RA still imposes a significant burden in the NAME region as the burden measures have increased from 1990 to 2019. On the other hand, regarding LBP, a decreasing pattern was observed. Differences among the countries and between ages and genders can have implications, and the results of this study may be helpful for policy-makers in the NAME countries., (© 2023 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background: Persistent uncontrolled hyperglycemia is recognized as one of the risk factors for cognitive disorders. Accordingly, both type 1 and type 2 diabetes may predispose individuals to cognitive impairment, particularly in cases where glycemic control is insufficient. The objective of this comprehensive study is to separately assess cognitive dysfunctions in diabetic and non-diabetic older adults., Methods: This cross-sectional study is part of phase 2 of the Bushehr elderly health program (BEHP). Cognitive function was evaluated using the Mini-cog and categorical verbal fluency tests (CFTs). Patients were classified as non-diabetics, pre-diabetics, or diabetics based on the diagnostic criteria for diabetes mellitus (DM). To compare the means of the two groups, we utilized the t-test or the Mann-Whitney test. Additionally Multivariable logistic regression models were used to determine the association between pre-diabetes or DM and cognitive impairment., Results: Out of 1533 participants, 693 (45.2%) were identified as having cognitive impairment. The average hemoglobin A1C was higher in participants with cognitive impairment compared to those without cognitive impairment. (5.8 ± 1.6% vs. 5.5 ± 1.4%, P  = 0.004). Furthermore, the mean blood glucose levels were found to be more elevated in cases of cognitive impairment (108.0 ± 47.4 mg/dL vs. 102.1 ± 0.35 mg/dL, P  = 0.002). After adjusting for age, gender, body mass index (BMI), waist circumference, amount of physical activity, and smoking, the multivariable logistic regression model, declared an association between diabetes and cognitive impairment (OR = 1.48, P  = 0.003). In addition, older patients, females, widows, and individuals with elevated LDL-Cs and those with high blood pressure were found to be more vulnerable to cognitive impairment., Conclusion: The Bushehr Elderly Health Program (BEHP) study revealed that individuals affected with cognitive impairment may exhibit higher levels of HbA1c. This suggests a positive correlation between elevated HbA1c and cognitive impairment., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: The association between osteoporosis and cardiovascular disease, two major health problems, has been reported in some studies. In this study was aimed to investigate the relationship between osteoporosis and the CVD risk score based on Framingham and American College of Cardiology and the American Heart Association (ACC/AHA) prediction models in the population over 60 years old., Methods: A cross-sectional analysis was conducted on data from 2389 men and women participating in the Bushehr Elderly Health (BEH) program. Osteoporosis was defended as T-score ≤  - 2.5 at any site (total hip, femoral neck and lumbar spine (L1-L4). Based on Framingham and ACC/AHA risk scores, participants were categorized as non-high risk (< 20%) or high-risk (≥ 20%). Logistic regression model, was applied to investigate the relationship between osteoporosis and cardiovascular disease risk scores. All comparisons were stratified by sex., Results: Considering the cut point of ≥ 20% for CVD risk, 36.7% of women and 66.2% of men were categorized as having high risk of CVD in ACC/AHA model. These values in women and men based on the Framingham model were 30% and 35.7%, respectively. In general, there was a negative significant correlation between BMD in the femoral neck, total hip and TBS except for the spine with the CVD risk score in both models. After adjusting for confounding variables, a significant positive association was observed between osteoporosis only at femoral neck with CVD risk score ≥ 20% based on ACC/AHA in both genders., Conclusion: The ACC/AHA model is effective in identifying the CVD risk difference between individuals with and without osteoporosis., Competing Interests: Conflicts of interestNone of the authors has any conflicts of interest that are directly relevant to the content of this article., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: The prevalence of overweight/obesity and abdominal obesity is increasing worldwide, accompanied by an increase in the incidence of non-communicable diseases. This study aims to determine the trends of Body Mass Index (BMI) and prevalence of overweight/obesity and abdominal obesity changes in Iranian adult population from 2004 to 2021., Methods: We conducted this study based on the eight national surveys of noncommunicable disease risk factor surveillance (STEPS) from 2004 to 2021 in Iran. We estimated the crude and standardized mean of BMI and prevalence of general and abdominal obesity in these eight STEPS surveys data. Data weighted using post-stratification method and the trends depicted based on the standardized estimates., Results: Between 2004 and 2021, and based on the standardized estimates, the mean of BMI increased from 25.19 kg/m 2 in 2004 to 26.63 kg/m 2 in 2021 (P-value for trend = 0.03). The standardized mean of WC increased from 86.38 cm in 2004 to 91.65 cm in 2021 (P-value for trend = 0.38). The standardized prevalence of obesity (class I and II) increased from 14.54% in 2004 to 20.17% in 2021 (P-value for trend = 0.01). The standardized prevalence of obesity class III increased from 0.82% in 2004 to 1.35% in 2021 (P-value for trend = 0.03). The standardized prevalence of abdominal obesity based on the national and international cut-points increased, but the trend was not statistically significant [(National cut-point: 27.53% in 2004 to 40.43% in 2021 (P-value for trend = 0.71)) (International cut-point: 27.58% in 2004 to 41.81% in 2021 (P-value for trend = 0.06))]., Conclusion: The standardized mean of BMI and prevalence of overweight/obesity and abdominal obesity increased among Iranian adults between 2004 and 2021. Because of the negative public and clinical health implications of obesity, health policymakers should develop comprehensive programs to control this increasing trend of weight gain., Competing Interests: Conflict of interestsThe authors have no conflicts of interest to declare., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: This registry aims to collect information to create an appropriate platform for the development of a basis for clinical research and basic sciences to carefully study pituitary adenomas., Methods: Demographic data, diagnosis, treatment, and outcome information of the patients with a confirmed diagnosis of pituitary adenomas will be collected by investigators of the registry. Analysis of registry data generates aggregate reports summarizing pituitary tumor epidemiology, treatment, and outcome. These reports include annual public data reports. In the future, the registry program may provide a wider network in Iran and ultimately support the expansion of international studies., Conclusion: For a long time, patients with pituitary adenomas should be observed. Implementing a registration system would greatly reduce the challenges of patients' follow-up so that their monitoring can be improved., Competing Interests: Conflict of interestThe authors declared that they have no conflict of interest., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: The IraPEN program is an adapted version of the WHO-PEN program designed to prevent four major non-communicable diseases in Iran. This study aimed to determine the rate of compliance and related factors among individuals participating in the IraPEN program for the prevention of cardiovascular disease., Method: In this study, compliance was defined as timely referral to the health center as scheduled, and the researchers approached four pilot sites of IraPEN from March 2016 to March 2018. Sex-stratified logistic regressions were applied to investigate factors related to compliance. However, it is important to note that in this study, compliance was defined as compliance to revisit, not compliance to taking prescribed medications or behavioral lifestyle changes., Results: The total compliance rate, including timely compliance and early and late compliance, was 16.5% in men and 23.3% in women. The study found that cardiovascular risk factors such as diabetes, hypertension, hypercholesterolemia, and being underweight were associated with lower compliance. The higher calculated risk of CVD was associated with higher compliance, but after adjusting for cardiovascular risk factors, high-risk individuals showed lower compliance. There was negligible interaction between sex and other factors for compliance., Conclusion: The compliance rate with scheduled programs for cardiovascular preventive strategies was very low, and high-risk individuals were less compliant, regardless of their high level of risk factors. The study recommends further training to increase awareness and knowledge regarding the IraPEN program and the prevention of non-communicable diseases among high-risk populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hadavandsiri, Khalili, Mahdavi, Afkar, Ostovar, Hashemi-Nazari and Derakhshan.)

Background: We aimed to document the current state of exposure to low bone mineral density (BMD) and trends in attributable burdens between 2000 and 2019 globally and in different World Health Organization (WHO) regions using the Global Burden of Disease (GBD) study 2019., Methods: We reviewed the sex-region-specific summary exposure value (SEV) of low BMD and the all-ages numbers and age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributed to low BMD. We compared different WHO regions (Africa, the Eastern Mediterranean Region, Europe, Region of the Americas, Southeast Asia, and Western Pacific), age categories, and sexes according to the estimates of the GBD 2019 report., Results: The global age-standardized SEV of low BMD is estimated to be 20.7% in women and 11.3% in men in 2019. Among the WHO regions, Africa had the highest age-standardized SEV of low BMD in women (28.8% (95% uncertainty interval 22.0-36.3)) and men (16.8% (11.5-23.8)). The lowest SEV was observed in Europe in both women (14.7% (9.9-21.0)) and men (8.0% (4.3-13.4)). An improving trend in the global rate of DALY, death, and YLL was observed during 2000-2019 (-5.7%, -4.7%, and -11.9% change, respectively); however, the absolute numbers increased with the highest increase observed in global YLD (70.9%) and death numbers (67.6%). Southeast Asia Region had the highest age-standardized rates of DALY (303.4 (249.2-357.2)), death (10.6 (8.5-12.3)), YLD (133.5 (96.9-177.3)), and YLL (170.0 (139-197.7))., Conclusions: Overall, the highest-burden attributed to low BMD was observed in the Southeast Asia Region. Knowledge of the SEV of low BMD and the attributed burden can increase the awareness of healthcare decision-makers to adopt appropriate strategies for early screening, and also strategies to prevent falls and fragility fractures and their consequent morbidity and mortality.