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There is scarce research focusing on the relationship between the low-carbohydrate dietary score and the development of a metabolically unhealthy phenotype. Therefore, this cohort study was designed to assess the association between the low-carbohydrate dietary score and the risk of metabolically unhealthy phenotypes (MUP). This study included 1299 adults with healthy metabolic profiles who were followed for 5.9 years. Results indicated an inverse association between the second tertile of the low-carbohydrate dietary score and the risk of developing metabolically unhealthy obesity (MUO) (HR: 0.76, 95% CI: 0.59-0.98). In addition, we found an inverse association between the healthy low-carbohydrate dietary score and the risk of MUO (HR: 0.77, 95% CI: 0.60-0.99). Our results revealed a nonlinear inverse association between the low-carbohydrate dietary score and the risk of MUP only in subjects with overweight or obesity. This relationship was independent of animal protein and fat intake. Also, we found that a lower intake of unhealthy carbohydrates was associated with a lower risk of MUP only in subjects with overweight or obesity.

Background: Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data., Methods: In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1)., Results: Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model., Conclusions: It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD., (© 2024. The Author(s).)

Objective: To evaluate sex- and age-stratified body composition (BC) parameters in subjects with wide age range of 20-79 years., Design: Cross-sectional., Setting: Participants of Tehran Lipid and Glucose Study (TLGS)., Participants: Two thousand nine hundred seventy participants met our inclusion criteria. They were divided into five age groups, and BC parameters were analysed based on sex and age using a bioelectrical impedance analyser (BIA)., Result: The mean age of the participants was 42·1 ± 12·5 years, and 54 % of them were males. The mean BMI was 26·7 ± 3·7 kg/m 2 . Obesity indices were significantly higher in females ( P < 0·001); however, skeletal muscle mass (SMM) and fat-free mass (FFM) were significantly higher in males ( P < 0·001). Both SMM and FFM decreased significantly after the age of 50 years. Obesity indices significantly increased from the age group of 20-29 to 30-39 years in males and the age groups of 30-39 to 40-49 years and 40-49 to 50-59 years in females. The fat mass ratio (fat mass/SMM) showed two peaks in both sexes (after the ages of 30 and 50 years in males and 40 and 50 years in females). A strong correlation was found between BMI and percentage of body fat ( r = 0·823 in females v . r = 0·768 in males)., Conclusion: This is the first community-based study in the MENA region identifying sex- and age-stratified BC values using BIA. Our findings can be used as a reference for comparison in appropriate settings.

This study aimed to investigate the interaction of the healthy eating index (HEI) and the dietary approach to stop hypertension (DASH) diet scores with FTO polymorphisms in relation to change in obesity traits. A total of 4480 subjects aged ≥ 18 years were selected from participants of the Tehran lipid and glucose study and followed-up 3 years. Selected polymorphisms (rs1421085, rs1121980, rs8050136) were genotyped and genetic risk score (GRS) was computed. HEI and DASH scores were computed based on dietary data. Changes in body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and visceral adiposity index (VAI) were measured. Higher adherence to both DASH and HEI scores were increased with higher ages. Individuals with high GRS had a lower change in BMI when they had higher adherence to HEI, compared to subjects with lower HEI score (P trend = 0.01). Change in WC in participants in the fourth quartile of HEI score in minor allele carriers of FTO variants was lower compared to the first quartile; conversely, higher adherence to the DASH score by this genotypic group was related to increase in WC. No significant interaction was seen between FTO polymorphisms and both diet scores regarding changes in any of obesity traits. In conclusion, in individuals with high GRS higher adherence to HEI score was associated with lower change in BMI and WC, while higher adherence to DASH diet was associated with higher change in WC, compared to individuals with lower adherence to both scores., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Blood pressure (BP) is influenced by both individual and environmental factors such as ambient temperature. However, the gender-stratified and component-specific impact of temperature on BP is not well understood. Herein, we examined the temperature and seasonal effects on four main BP components, namely systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP), in both genders. A total of 8990 (3954 men) Tehranian adults during 2015-2018 were included. Linear regression models for analyzing data in three models including unadjusted, age-adjusted, and further adjusted for known sociodemographic and cardiovascular confounders were conducted. Among women, each 10 °C increment was associated with a significant decrease of - 0.48 mmHg (95% confidence interval (CI): - 0.86, - 0.19) and - 0.65 mmHg (- 0.76, - 0.41) in SBP and MAP, respectively. In men, the corresponding value for SBP was - 0.46 (- 0.82, - 0.16) mmHg (P = 0.058). Gender-specific analysis in each season showed that among women, PP increased in autumn and winter with each 10 °C decrease (P < 0.05). The mean increase in SBP (3.4 and 2.06 mmHg in women and men, respectively), DBP (1.66 and 1.19 mmHg), and MAP (2.71 and 1.12 mmHg) was observed during winter compared to summer (all P < 0.05). PP showed seasonality only in women (1.46 mmHg, P-value = 0.003). In both genders, SBP in age > 60 years was more susceptible to variation compared to younger ages. Furthermore, obese women had more SBP changes compared to their non-obese counterparts (all P for interaction < 0.05). In conclusion, there was a sex difference in BP response to the outdoor temperature, with higher vulnerability among women. The reverse relation between temperature and BP occurred particularly among elderly and obese individuals. Careful monitoring of BP in cold seasons, specifically in the mentioned subgroups, could potentially attenuate cardiovascular risks., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The long-term parallel changes of physical activity and body mass index (BMI) in the adult population are still unclear. The present study assessed the association between physical activity and BMI over time, considering obesity risk trajectory groups and sex strata., Methods: Total sample of 6897 adults was followed for an average of 12 years. The reliable and validated Iranian version of the Modifiable Activity Questionnaire measured physical activity. After determining the risk clusters in each reexamination using a 2-step cluster analysis, the latent growth curve modeling was used to identify distinct subgroups of individuals following a similar change of risk cluster over time. Latent growth curve modeling estimated the parameters of cross-sectional, prospective, and parallel associations., Results: Three trajectories were identified, including stable low risk, unstable risk, and stable high risk. The results showed significant increases in BMI (kg/m2/year) for the stable low-risk trajectory group 0.478 (95% confidence interval [CI] 0.444 to 0.513), unstable risk 0.360 (95% CI, 0.324 to 0.396), and those in the stable high-risk trajectory group 0.255 (95% CI, 0.221 to 0.289). In cross-sectional -0.483 kg/m2 (95% CI, -0.836 to -0.129) and parallel -0.93 kg/m2 (95% CI, -1.862 to 0.00) estimations, significant statistical associations were observed in the stable high-risk trajectory group., Conclusions: The current results showed that changes in physical activity could slightly affect BMI only in stable high-risk adults.

This study aims to assess the effects of central and general adiposity on development of cardiovascular diseases (CVDs) mediated by cardiometabolic risk factors and to analyze their degree of dependency for mediating their effects. To this end, data from the the Tehran Lipid and Glucose Study cohort with 6280 participants were included in this study. The hazard ratios were calculated using a 2-stage regression model in the context of a survival model. Systolic blood pressure (BP), total serum cholesterol, and fasting plasma glucose were designated as mediators. Assessing the interactions revealed that BP was the most important mediator for general ( (HR NIE : 1.11, 95% CI 1.17-1.24) and central obesity (CO) (HR NIE : 1.11, 95% CI 1.07-1.15) with 60% and 36% proportion of the effects mediated in the total population, respectively. The proportion of mediated risk for all three metabolic risk factors was 46% (95% CI 31-75%) for overweight, 66% (45-100%) for general obesity and 52% (39-87%) for central obesity. BP was the most important mediator for overweight and central obesity in men, comprising 29% and 36% of the risk, respectively. The proportion of the risk mediated through all three metabolic risk factors in women was 23% (95% CI 13-50%) for overweight, 36% (21-64%) for general obesity and 52% (39-87%) for central obesity. Based on the results of this study, cardiometabolic mediators have conciliated more than 60% of the adverse effects of high BMI on CVDs in men. Controlling the metabolic risk factors in women does not efficiently contribute to decreasing CVDs as effectively., (© 2022. The Author(s).)

This population-based longitudinal study is the first investigation that assesses the association of common MC4R SNPs with the obesity-related parameters over time and determines the effect of risk alleles during the three adulthood life periods (early, middle, and late) in a large Iranian cohort, a population with a unique genetic make-up that has been understudied and relatively unexplored. We obtained the genotype of 5370 unrelated adults who participated in the ongoing Tehran Cardiometabolic Genetic Study (TCGS) cohort project for the common MC4R SNPs. Linear regression and linear mixed model analyses were performed to examine the effect of MC4R polymorphisms on maximum BMI and other obesity-related factors over time. We recognized that several SNPs associated with the maximum BMI and the increased BMI, waist circumference, and waist-hip ratio across Iranian adults over a lifetime. Interestingly, we found that rs9954571-A has a yet unreported protective role against obesity-related factors, including BMI, waist circumference, waist-hip ratio, and triglyceride level. Additionally, a survey of the impact of the MC4R risk score throughout the adulthood life periods indicated that the MC4R risk score is influenced both the elevated BMI and waist circumference only during the early adulthood period. Our findings can expand our knowledge about the MC4R genetic variant's contributions to adulthood obesity and highlight the importance of evaluating the genetic components affecting obesity over a lifetime, which could be considered for obesity clinical screening and treatment., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: Aging is associated with significant changes in fat distribution and menopause may alter this process. This study aimed to investigate the longitudinal effect of menopause on changes in adiposity indices (AI)., Methods: A total number of 3876 non-menopausal women, aged > 20 years, who participated in the Tehran Lipid and Glucose study, were selected for the present study. They were followed from 1998 to 2018 at a 3-year interval and their adiposity indices were measured. Throughout the study, participants were categorized into two groups according to their menopausal status as group 1): women who reached menopause and group 2): women who did not reach menopause. The generalized estimation equation (GEE) models were used to compare the trend of changes in AIs between these two groups., Results: At the end of the study, a total number of 1479 (38.2%) participants reached menopause. The odds of general obesity decreased by 5% (OR: 0.95, 95% CI: 0.90-0.99), and the odds of central obesity increased by 6% in group1 compared to group2 (OR: 1.06, 95% CI: 1.01-1.12)., Conclusions: Menopause alters the impact of aging on central fat distribution. Increasing awareness of the related risk in menopausal women and their healthcare professional may prevent adverse related outcomes., (© 2021. Italian Society of Endocrinology (SIE).)

Background: Due to the increasing worldwide prevalence of obesity, it is essential to determine the prevalence of obesity-related thyroid dysfunctions. The purpose of this study was to investigate the prevalence of thyroid dysfunctions, namely hypothyroidism and hyperthyroidism, and their association with BMI among adult Iranian overweight and obese individuals., Method: This cross-sectional study was carried out within the framework of the Tehran Thyroid Study (TTS); 5353 participants (57.5% female) entered our study. Anthropometric measurements were performed. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were assayed. We categorized individuals into 3 BMI groups (normal-weight, overweight and obese), then calculated prevalence rate, odds ratio (OR), and 95% confidence interval (CI) for outcomes in overweight and obese groups. The normal-weight group was used as the control group., Results: We found a higher prevalence of hypothyroidism (11.6% vs 8.2% Total, 4.0% vs 1.1% overt and 7.6% vs 7.1% subclinical, P < 0.001) and TPOAb positivity (17.3% vs 11.6%, P < 0.001) in obese participants compared with normal-weight participants. Hyperthyroidism's overall prevalence was 4.2, 5.7, and 4.9% in obese, overweight, and normal-weight groups, respectively. Obesity was associated with higher odds of overt hypothyroidism (OR: 2.0, 95% CI: 1.15-3.49, P < 0.05) and TPOAb positivity (OR: 1.29, 95% CI: 1.04-1.60, P < 0.05) after adjusting for confounding variables. In contrast, no association was observed between the overweight group and the odds of hypothyroidism and TPOAb positivity in the adjusted results., Conclusions: Obesity was associated with an increased risk of overt hypothyroidism and TPOAb positivity.

Obese individuals can be categorized as "healthy obese" (MHO) and "unhealthy obese" (MUO) based on the presence or absence of metabolic abnormality. This study sets out to assess potential genetic causes behind persistence of healthy metabolic status in individuals categorized as "healthy obese". This study was conducted in the framework of the Tehran cardio-metabolic genetic study (TCGS). 766 MHO subjects at the start of the study followed up 15 years for occurrence of metabolic unhealthy status. These two groups (persistent MHO, MUO) were compared regarding the presence or absence of 16 single nucleotide polymorphisms (SNPs) identified as being associated with obesity phenotype in previous studies. We used logistic regression model for assessing the association between MHO/MUO with candidate SNPs. By the end of the follow up, 206 (27%) were categorized as the persistent MHO and 560 (73%) as MUO groups. Considering interaction effect between some SNP and sex, a sex stratification analysis was applied. When the analysis was performed by gender, rs1121980 associated with a decrease, and rs7903146 with an increase in the likelihood of persistent MHO individuals. Another analysis was separately performed on postmenopausal women from both groups; it showed that rs13107325 was associated with an increase in the likelihood of persistent MHO status in this subgroup of woman. In all cases, the markers had dominant inheritance. This findings suggest that the expression of some genetic markers are associated with persistence of healthy metabolic status, in female obese individuals.

Background: A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ) has been reported. In this study, we investigated the trends in the prevalence of severe obesity among Tehranian adults over the past two decades., Methods: A representative sample of 10,045 Tehranians aged ≥19 years were followed from 1999 to 2017. The trends in the prevalence of severe obesity were investigated over six cross-sectional phases with 3.6-year intervals using generalized estimating equations., Results: In this cohort, the overall prevalence of severe obesity increased from 4.6% (1.8% in males and 6.7% in females) in 1999 to 10.1% (4.7% in males and 14.3% in females) in 2017. The persisted rising in prevalence in the youngest age-group in both genders, with the most rapid increase among females aged 19-29 years, plateaued in the older ages and remained unchanged among males aged over 50 years. After age-sex standardized analysis by using Tehranian urban population data, the prevalence rates of severe obesity in Tehranian men and women were estimated to be 1.9% and 5.7% in 1996, and 4.5% and 10.9% in 2016, respectively., Conclusion: A high prevalence of severe obesity among Tehranian adults has been stabilized over the past two decades. Preventive interventions should be focused on the younger and middle-aged population, to mitigate the subsequent burden of severe obesity on Tehranian population and the healthcare system., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Introduction: Data shows that interactions between dietary factors and genetic variants can modulate the association of polymorphisms such as the Melanocortin-4 receptor (MC4R) gene with obesity. Considering the limited data available on this topic we aimed to investigate interactions between dietary patterns (DPs) and MC4R polymorphisms in relation to obesity phenotypes., Methods: This cohort study was performed in the framework of Tehran Lipid and Glucose Study; for eligible participants in this study (n=3850), the median follow-up was 4 years. DPs were determined using factor analysis. The genotypes of polymorphisms (17782313rs and 12970134rs) were identified and their interaction with DPs were assessed in relation to incidence of obesity phenotypes including central obesity, general obesity and visceral adiposity dysfunction., Results: The mean age of participants (62.5% females) were 37.0±13.7 years. Two main DPs (healthy and unhealthy) were extracted. C-allele carriers of rs17782313 in higher quartiles of the healthy DP score had a significant decrease in the incidence of general obesity, compared to those who had the TT genotype (HR=0.61, 95% CI=0.42-0.89, P interaction=0.01). For rs12970134 A-allele carriers, subjects in the second compared to the first quartile of the healthy DP score, had a significant decrease in the incidence of general obesity (HR=0.68, 95% CI=0.46-0.99). There were no significant interaction between DPs and MC4R variants in relation to other obesity phenotypes., Conclusion: Our results indicate that the healthy DP could interact with rs17782313 in relation to incidence of general obesity., (Copyright © 2020 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Objectives: To investigate the incidence rates for different malignancies and assess the risk factors for all-cancer incidence in Tehran., Study Design: Cohort study., Methods: This study consists of 8599 participants aged ≥ 30 years who were free of cancer (3935 men). Cancer diagnosis was based on pathology reports. Sex-stratified crude incidence rates and age-standardized incidence rates (ASRs) using Segi's method were calculated for all-cancers. Multivariate Poisson regression models were used to evaluate associations of potential risk factors, including sex, age, obesity status (body mass index [BMI]: 25-30 kg/m 2 as reference), education, smoking status, and diabetes mellitus with the incidence of cancers among the population. Incidence rate ratios (IRRs) with 95% confidence interval (CI) were also reported., Results: During a median follow-up of 13.9 years, there were 130 and 129 incident cancers for men and women, respectively; the corresponding ASRs were 356.1 and 243.6 per 100,000 person-years, respectively. The three most incident cancers among men were gastrointestinal (GI) (ASR = 127.5), hematopoietic (ASR = 99.5), and reproductive system malignancies (ASR = 46.3). The most common incident cancers in women were breast cancer (ASR = 92.1), GI (ASR = 65.4), and reproductive system malignancies (ASR = 16.8). Among risk factors for cancer incidence, age (IRR [95% CI]: 1.05 [1.03-1.06]) and having a BMI < 25 kg/m 2 (IRR [95% CI]: 1.38 [1.01-1.90]) had a statistically significant association with incident cancer., Conclusions: The high rates of cancers in Tehran during more than a decade of follow-up calls for a need to define risk factors as well as to implement programs for early screening., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Obesity phenotypes can be regarded as an indicator of CVD risk factors. The aim of the present study was to determine the prevalence of adolescents with different obesity phenotypes and the role of obesity phenotypes in prediction of the metabolic syndrome (MetS) in adults. For this population-based cohort study, 2159 adolescents aged 11-18 years were included. Subjects were divided into four obesity phenotype groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Cox proportional hazard modelling was used to estimate the incidence of the MetS in adults after a median follow-up of 11·3 years. The incidence rate of the MetS in early adulthood was 111·6 (95 % CI 98·7, 126·3) per 10 000 person-years, with higher values in boys (210·1 (95 % CI 183·0, 241·3)), compared with girls (39·7 (95 % CI 30·2, 52·1)). In the age- and adult BMI-adjusted model, the hazard ratio of the MetS in adulthood for boys was 3·33 (95 % CI 2·08, 5·32) among MUO phenotype followed less than 6 years, 1·71 (95 % CI 1·01, 2·90) among MHO, and 2·52 (95 % CI 1·72, 3·68) among MUNW. All associations were attenuated in girls except for MUO phenotype followed less than 6 years (5·72 (95 % CI 2·14, 15·3)). In conclusion, MUNW and MHO phenotypes in boys, but not in girls, and MUO phenotype in both sexes with less than 6 years of follow-up increased the risk of adult MetS compared with MHNW. It seems that lack of obesity at least in boys does not protect them from MetS development in adulthood.

The current study aimed at investigating the association between Dietary Approach to Stop Hypertension (DASH) diet and odds of obesity phenotypes, is a cross sectional study conducted on 3218 Iranian overweight or obese participants (BMI >25 kg/m 2 ), aged ≥20 years, who participated in the fourth phase (2009-2011) of the Tehran Lipid and Glucose Study. Using a valid and reliable food-frequency questionnaire, DASH diet scores between 8 and 40 points were determined. Obesity phenotypes including metabolic unhealthy obesity (MUHO) and metabolic healthy obesity (MHO) were defined using criteria of the Joint International statement(JIS) for metabolic syndrome. Multivariable logistic regression was used to determine the odds ratio (OR) for obesity phenotypes according to the tertiles of the DASH diet. Mean ± SD age of participants (43.5% male) was 39.2 ± 9.5 years and median (25-75 interquartile range) DASH diet score was 24 (21-27); percentages of MHO and MUHO subjects were 33.4 and 66.6%, respectively. In the multivariable adjusted model, after controlling for age, sex, BMI, physical activity, smoking status, socioeconomic status, and energy intake, participants in the highest tertile of DASH diet had lower odds of MUHO (OR:0.79;95%CI:0.64-0.98), in comparison to those in the lowest one (P for trend = 0.040). Our findings indicate that adherence to DASH diet may be favourable in prevention of metabolic abnormalities in overweight and obese individuals.

The present study investigated whether dietary patterns could interact with fat mass and obesity-associated (FTO) polymorphisms in relation to changes in BMI and waist circumference (WC) over 3⋅6 years of follow-up. Subjects were selected from participants of the Tehran Lipid and Glucose Study (n 4292, 43⋅2 % male). Dietary data were collected using a valid and reliable FFQ. Dietary patterns were determined using factor analysis. The genotypes of polymorphisms (rs1421085, rs1121980, rs17817449, rs8050136, rs9939973 and rs3751812) were determined. Genetic risk score (GRS) was calculated using the weighted method. Mean ages of men and women were 42·6 (sd 14) and 40⋅4 (sd 13) years, respectively. The healthy (e.g. vegetables and fruits) and the Western dietary patterns (WDP; e.g. soft drinks and fast foods) were extracted. In carriers of the risk alleles rs1121980, rs1421085, rs8050136, rs1781799 and rs3751812, BMI was approximately 2-fold higher in individuals in the higher quartile of WDP score, compared with the first quartile (P &lt; 0⋅05). WC increased with increasing WDP score in carriers of the risk alleles rs1121980 and rs3751812, but not in individuals who did not carry any risk alleles. BMI and WC increased to a greater extent in the high GRS group while increasing quartiles of the WDP score, compared with the low GRS group (BMI change; Q1: 1⋅04 (se 0⋅34) v. Q4: 2⋅26 (se 0⋅36)) (WC change; Q1: 0⋅47 (se 0⋅32) v. Q4: 0⋅95 (se 0⋅34)) (P interaction &lt; 0⋅05). These results suggest that adults with higher genetic predisposition to obesity are more susceptible to the harmful effects of adherence to the WDP, which emphasised the need to reduce the consumption of unhealthy foods for the prevention of obesity.

Evidence on the association of vitamin D and parathyroid hormone (PTH) with cardiovascular risk factors in the young is limited. We therefore assessed the relationships of circulating vitamin D and PTH concentrations and subclinical atherosclerosis in overweight or obese children and adolescents. This was a cross-sectional study, investigated the association of 25-hydroxyvitamin D (25(OH)D), intact PTH (iPTH), and iPTH/25(OH)D ratio with carotid intima-media thickness (cIMT) in 368 Iranian children and adolescents with a body mass index (BMI) ≥1 z-score based on WHO criteria. Ultrasound measurement of cIMT was performed. Multivariable linear and logistic regressions were used to test associations between 25(OH)D, iPTH, and iPTH/25(OH)D ratio using one-ln-unit increment with cIMT. Median (25-75 interquartile range) 25(OH)D and iPTH concentrations were 11.8 (8.2-18.6) ng/ml and 38.2 (25.0-61.4) pg/ml, respectively. Among boys, each one-ln-unit increase of iPTH and iPTH/25(OH)D ratio was significantly associated with 0.194 mm and 0.147 mm increase, respectively, in cIMT, after adjustment for confounders. A similar pattern of association was observed between iPTH (β = 0.143, p = 0.037) and iPTH/25(OH)D ratio (β=0.172, p = 0.007) with cIMT among obese participants. Furthermore, among obese participants in the fully adjusted model, each one-ln-unit increase of iPTH and 25(OH)D/iPTH ratio was significantly associated with 53% and 39% increased odds of having high cIMT, respectively. Girls and those who were overweight did not show any significant association of 25(OH)D, iPTH, and iPTH/25(OH)D ratio with cIMT. High iPTH and iPTH/25(OH)D ratio were associated with increased cIMT in boys and those who are obese., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Data of studies focusing on the trends of adiposity indices among women with prior gestational diabetes mellitus (GDM), are limited and controversial. The aim of this study was to compare overtime trends of adiposity indices in women with and without history of GDM, using data of the long term longitudinal population-based Tehran-Lipid and Glucose-Study (TLGS)., Methods: A total of 3395 eligible women aged (20-50 years), including 801 women with prior history of GDM and 2594 non-GDM controls were recruited from among Tehran-Lipid and Glucose-Study participants. Generalized estimating equations were applied to assess the time trend of adiposity indices including obesity, central obesity, body mass index (BMI), lipid accumulation product index (LAP), visceral adiposity index (VAI) and a body shape index (ABSI) in women with prior GDM and the non-GDM groups after further adjustment for age and BMI., Results: Median follow-up years for the GDM and non-GDM groups were 12.12 and 11.62 years, respectively. Women with GDM at initiation had worse adiposity indices than their healthy counterparts. While overall odds of obesity in women with prior GDM were significantly higher those of the non-GDM groups (OR: 1.35; 95% CI, 1.03-1.7; P = 0.03), both these groups overtime revealed a positive trend in obesity (P trend  < 0.001), an incremental trend which was less pronounced in GDM women (OR: 0.87; 95% CI, 0.80, 0.95; P interaction  = 0.001). Women with prior GDM had higher odds of central obesity, compared to non-GDM groups (OR: 1.44; 95% CI, 1.06-1.96; P = 0.02) and showed a significant an incremental trend overtime for both groups (P trend  < 0.001 for both) without statistically significant interaction in terms of their GDM status (P interaction  = 0.134). Mean VAI in women with prior GDM was significantly higher than the non-GDM group (19.7, 95%CI: 6.24, 33.15, P = 0.004), although both groups overtime experienced a negative trend (- 10.9, 95%CI: -13.1, - 2.1, P < 0.001); the GDM group showed a higher decrease in VAI (mean changes: -6.62; 95% CI, - 11,-2.1; P interaction  = 0.001). However overtime there was a positive trend in LAP and ABSI among both women with and without prior-GDM, though the mean changes were less obvious in women with prior GDM., Conclusion: Women with prior GDM gained better control of their adiposity than non-GDM women. Nevertheless the increasing numbers of individuals with GDM and uncontrolled adiposity indices, require prompt attention be paid to the issue.

We determined cutoff points of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), for predicting hypertension in an Iranian population. Study sample included 6359 (3678 female) participants aged ≥20 and <60 years of a prospective cohort. The sex stratified multivariate hazard ratios (HRs) for all indices were estimated using Cox regression in two age groups (20-39 and 40-59 years). Receiver operating characteristic (ROC) was used to evaluate the predictive ability and determine the optimal cut-off values of the indices. In both genders and two age groups, the confounders adjusted HRs were significant for general and central obesity measures indices. AUCs of the indices were similar in men; however, among women 40-59 years, WC and WHtR had significantly higher AUC compared to BMI. Generally, the optimal cut-off values were higher in the 40-59 year age group. Optimal BMI, WC and WHR and WHtR cut-off values were 24.15 kg/m 2 , 90.5 cm, 0.90 and 0.49 among men, aged 20-39 years; the corresponding values were 28.41 kg/m 2 , 86.5 cm, 0.96 and 0.50 in men aged 40-59 years, respectively. In women, the aforementioned values were 26.38 kg/m 2 , 83.5 cm, 0.79 and 0.51 in the age group of 20-39 years, and 29.57 kg/m 2 , 90.5 cm, 0.88 and 0.59 in the 40-59 year age group, respectively. Our results suggest that gender and age differences in the association between anthropometric indices and hypertension should be considered.

Purpose: This study aimed to explore the association between different obesity phenotypes and health-related quality of life (HRQoL) among Tehranian men and women., Methods: The participants of this study were 2880 healthy adults (aged>19 years) who participated in Tehran Lipid and Glucose Study (TLGS). To obtain socio-demographic and HRQoL information, participants were interviewed by trained interviewers and were stratified by body mass index categories and metabolic status. Dysmetabolic status was defined as having either metabolic syndrome or diabetes according to the Joint Interim Statement definition and American Diabetes Association. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to compare sex-specific odds ratios., Results: Mean age of participants was 47.7±15.6 and 47.8±14.2 years in men and women respectively. The most and the least common obesity phenotypes were overweight-normal metabolic status and normal weight-dysmetabolic status, respectively. Only mean scores for physical HRQoL were significantly different among obesity phenotypes in both men and women (p<0.05). In addition, after adjusting for age, marital status, level of education, job status and physical activity, the odds of reporting poor physical HRQoL was significantly higher in men (OR: 1.960, 95% CI: 1.037-3.704; p<0.05) and women (OR: 2.887, 95% CI: 1.674-4.977; p<0.001) with obese-dysmetabolic status, compared to their counterparts with normal weight-normal metabolic status. However, except for overweight-normal metabolic women, who were less likely to report poor mental HRQoL (OR: 0.638, 95% CI: 0.415-0.981; p<0.05), none of the phenotypes were associated with poor mental HRQoL in either gender., Conclusions: Compared to those with normal weight normal metabolic status, only obese dysmetabolic individuals were more likely to report poor physical HRQoL in both genders., Competing Interests: The authors have declared that no competing interests exist.

Objective: The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. This systematic review and meta-analysis was conducted to investigate the associations in reproductive-aged women., Methods: PubMed and Scopus were searched up to December, 2016. Original studies on the association of BMI with ovarian reserve markers, anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin β, and antral follicle count (AFC), either according to BMI categories or a continuous variable, were selected. Analyses were stratified into three groups based on polycystic ovary syndrome (PCOS) and fertility status of women., Results: Of 4,055 records identified, 45 studies were eligible for inclusion. Comparing the obese with nonobese, the pooled mean differences (MDs) and 95% confidence intervals (CIs) were -1.08 (95% CIs -1.52, -0.63) ng/mL for AMH, -0.22 (95% CIs -0.39, -0.06) mIU/mL for FSH, -0.09 (95% CIs -0.60, 0.42) for AFC, and -21.06 (95% CIs -41.18, -0.85) pg/mL for inhibin β in overall populations. The MDs were significant for AMH in fertile non-PCOS and PCOS women, and for FSH only in PCOS women. Fisher's Z showed significant correlations of BMI with AMH in the overall populations (-0.15 [95% CIs -0.20, -0.11]) and in all subgroups, and with FSH in the fertile non-PCOS women (-0.16 [95% CIs -0.28, -0.04])., Conclusion: Ovarian reserve markers of AMH and FSH are significantly lower in obese than in nonobese women, and BMI is negatively correlated with AMH in all study populations, and with FSH in fertile non-PCOS subgroups. PCOS and fertility status do not appear to affect the associations.

Background: To determine the anthropometric indices that would predict type 2 diabetes (T2D) and delineate their optimal cut-points., Methods: In a cohort study, 7017 Iranian adults, aged 20-60 years, free of T2D at baseline were investigated. Using Cox proportional hazard models, hazard ratios (HRs) for incident T2D per 1 SD change in body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and hip circumference (HC) were calculated. The area under the receiver operating characteristics (ROC) curves (AUC) was calculated to compare the discriminative power of anthropometric variables for incident T2D. Cut-points of each index were estimated by the maximum value of Youden's index and fixing the sensitivity at 75%. Using the derived cut-points, joint effects of BMI and other obesity indices on T2D hazard were assessed., Results: During a median follow-up of 12 years, 354 men, and 490 women developed T2D. In both sexes, 1 SD increase in anthropometric variables showed significant association with incident T2D, except for HC in multivariate adjusted model in men. In both sexes, WHtR had the highest discriminatory power while HC had the lowest. The derived cut-points for BMI, WC, WHtR, WHR, and HC were 25.56 kg/m 2 , 89 cm, 0.52, 0.91, and 96 cm in men and 27.12 kg/m 2 , 87 cm, 0.56, 0.83, and 103 cm in women, respectively. Assessing joint effects of BMI and each of the obesity measures in the prediction of incident T2D showed that among both sexes, combined high values of obesity indices increase the specificity for the price of reduced sensitivity and positive predictive value., Conclusions: Our derived cut-points differ between both sexes and are different from other ethnicities.

Background: Considering inconsistent and conflicting data on associations of thyroid function, within the reference range, with anthropometric measures and metabolic syndrome, this study aimed to investigate the relationship between thyroid function and different obesity phenotypes over nine years of follow-up., Methods: This study was conducted on 1938 individuals from an ongoing population-based cohort study, the Tehran Thyroid Study. Participants were categorized into four obesity phenotypes based on body mass index and metabolic status. To investigate the associations of thyrotropin and free thyroxine (fT4) with incidence of different obesity phenotypes across the study period, a multivariate approach based on a generalized estimating equation method was used., Results: At baseline, individuals with the metabolically healthy normal weight (MHNW) phenotype had higher serum fT4 levels (1.2 ± 0.16 ng/dL vs. 1.14 ± 0.14 ng/dL, 1.16 ± 0.14 ng/dL, and 1.17 ± 0.15 ng/dL in metabolically healthy obese [MHO], metabolically unhealthy normal weight, and metabolically unhealthy obese individuals, respectively). The results of the generalized estimating equation analysis after multivariate adjustment for age, sex, smoking, physical activity, education level, thyroid peroxidase antibody status, and homeostasis model assessment-insulin resistance showed that each 1 ng/dL increment in fT4 levels within the reference range was accompanied with a 1.65-fold [confidence interval (CI) 1.09-2.5] increase of developing the MHNW phenotype during 9.2 years of follow-up. Moreover, each 1.0 ng/dL increment in fT4 within the reference range was associated with a 50% decreased risk of developing the MHO phenotype (odds ratio = 0.50 [CI 0.32-0.76]). Meanwhile, a significant positive association was found between serum thyrotropin levels and development of the metabolically unhealthy normal weight phenotype (odds ratio = 1.22 [CI 1.01-1.48])., Conclusions: Serum fT4 concentrations within the reference range are associated with the development of some obesity phenotypes, including the MHNW and MHO phenotypes, after consideration of potential confounders.

Background: This study aimed to determine the association between different weight histories, including cumulative excess weight, cumulative excess waist circumference (WC), duration of general and central adiposity, current and maximum body mass index, and current and maximum WC, and incident coronary heart disease (CHD) and stroke., Methods and Results: The study population consisted of 4398 adults aged ≥40 years without CHD or stroke at baseline. Associations between different weight histories and CHD and stroke were determined by multivariable time-varying Cox regression models after adjustment for age, sex, and time-varying confounders. Further adjustment was also done for mediators (eg, diabetes mellitus, hypercholesterolemia, and hypertension). During median follow-up of 13.9 years, 718 incident CHD and 158 stroke events were documented. Multivariable adjusted hazard ratios (HRs) were calculated in the sex and confounder adjusted model for CHD per 1-SD increase in cumulative excess weight (HR: 1.02; 95% confidence interval [CI], 0.96-1.07), cumulative excess WC (HR: 1.14; 95% CI, 1.04-1.24), duration of general adiposity (HR: 1.00; 95% CI, 0.92-1.08), duration of central adiposity (HR: 1.01; 95% CI, 0.93-1.09), current body mass index (HR: 1.03; 95% CI, 0.99-1.07), current WC (HR: 1.21; 95% CI, 1.11-1.32), maximum body mass index (HR: 1.01; 95% CI, 0.95-1.07), and maximum WC (HR: 1.17; 95% CI, 1.07-1.28). After further adjustment for mediators, current and maximum WC still showed a significant risk (HR: 1.13 [95% CI, 1.03-1.23] and 1.09 [95% CI, 1.00-1.20], respectively). Moreover, in the sex and confounder adjusted model, cumulative excess WC and maximum WC were associated with higher risk of stroke (hazard ratio: 1.21 [95% CI, 0.99-1.48] and 1.25 [95% CI, 1.02-1.55], respectively)., Conclusions: Exposure to cumulative excess weight and cumulative excess WC confers little additional risk beyond their current and maximum values. Even current and maximum WC were associated with incident CHD in the presence of obesity mediators, and the latter was a significant predictor of stroke in the presence of confounders., (© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)

Aims: To examine the association of the risk of incident type 2 diabetes (T2D) with cumulative excess weight (CEW) and cumulative excess waist circumference (CEWC) scores., Methods: Adults participants without T2D (n = 4635) aged  ≥20 years were included in the study. The differences between the body mass index (BMI) and waist circumference (WC) values and their normal references were calculated until the incident T2D. The CEW and CEWC scores represent the accumulation of BMI and WC deviations from normal values over time, i.e. (kg/m 2  × years and cm × years, respectively). Time-dependent Cox models, adjusting for confounders were used to examine the association between CEW/CEWC and the risk of T2D. Further multivariate analyses were performed to examine the association of CEW and CEWC with incident diabetes in baseline BMI and WC strata., Results: There were 503 incident cases of T2D over a median follow-up 9.38 years. The multivariate sex adjusted hazard ratios (HR) per one standard deviation (SD) increase in CEW and CEWC were 1.23 (95% CI: 1.15-1.32) and 1.41 (1.25-1.59), respectively. After further adjustment for baseline BMI and WC, no significant association was observed for CEW (1.02: 0.84-1.23) and CEWC (1.09: 0.93-1.28) and incident T2D. A strong association was found between CEW and CEWC with incident diabetes among overweight (2.12: 1.20-3.74) and centrally obese individuals (1.29: 1.10-1.51), respectively., Conclusions: Generally, CEW and CEWC were not associated with risk of T2D, independent of baseline values for BMI and WC, respectively. Moreover, CEW and CEWC highlighted an increased risk among overweight and centrally obese participants for T2D., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Controversies surrounding the effectiveness of fiber intake for prevention of obesity can be attributed to differences in the genetic makeup of individuals. This study aims to examining the interaction between dietary fiber intake and common fat mass and obesity-associated (FTO) single-nucleotide polymorphisms (SNPs), in relation to obesity. Subjects of this nested case-control study were selected from among adult participants of the Tehran Lipid and Glucose Study. Cases (n = 627) were individually matched with controls, who had normal weight. Six selected SNPs (rs1421085, rs1121980, rs17817449, rs8050136, rs9939973, and rs3751812) were genotyped by tetra-refractory mutation system-polymerase chain reaction analysis. Genetic risk scores (GRS) were calculated using the weighted method. A significant interaction was observed between total fiber intake and the GRS in relation to obesity (Pinteraction = 0.01); the difference in the risk for obesity was more pronounced in individuals with GRS ≥ 6 who consumed ≥ 14 grams of fiber a day (OR: 2.74, CI: 2.40-3.35 vs Ref.; P trend = 0.0005) than in individuals with GRS < 6 (P trend = 0.34). Dietary fiber intakes modified the association of FTO SNPs and the GRS with general obesity, an effect which was more pronounced in those who consumed high levels of dietary fiber and had a high number of risk alleles.

Aims: To investigate the relationship between body mass index, waist circumference, waist-to-hip ratio and waist-to-height ratio, as well as the mediating factors through which they might exert their risk for cardiovascular disease/coronary heart disease and mortality events in the older Iranian population during a median follow up of 9.5 years., Methods: The study population included participants, aged ≥65 years, free of cardiovascular disease at baseline. The confounder-adjusted hazard ratio was calculated for a 1-SD change in each anthropometric measure with and without adjustment for hypercholesterolemia, diabetes and hypertension., Results: During the study follow up, 193 participants developed their first cardiovascular disease event and 183 deaths occurred. No association was found between cardiovascular disease/coronary heart disease and body mass index, even in the confounder-adjusted models. Central adiposity measures showed a significant risk for cardiovascular disease events in the confounder-adjusted model ranging from hazard ratio 1.16 (95% confidence interval 1.02-1.33) for waist-to-hip ratio to 1.21 (95% confidence interval 1.03-1.42) for waist-to-height ratio. Adjustment for hypertension alone or in combination with other metabolic mediators attenuated the hazard ratio to null. Although hypercholesterolemia did not show any mediating effect of central adiposity measures for cardiovascular disease/coronary heart disease, hypertension was the most powerful mediator, accounting for 30-45% of the excess risk., Conclusions: Central rather than general adiposity showed a significant role in determining cardiovascular disease/coronary heart disease risk. The harmful effect of central adiposity was completely attributable to mediators, especially hypertension. Clinical interventions for control of mediators focusing on hypertension should be emphasized. Geriatr Gerontol Int 2017; 17: 2017-2024., (© 2017 Japan Geriatrics Society.)

Purpose: This study aimed to investigate the interactive effect of polycystic ovary syndrome (PCOS) status and obesity status on the serum levels of adipokines., Methods: In this comparative case-control cross-sectional study, 58 women with PCOS and 104 eumenorrheic non-hirsute women as the control group were recruited. They were further divided into two subgroups of overweight/obese and normal weight. The interactive effect of the PCOS status and obesity status on the circulating levels of adipokines was assessed using general linear model with the adjustment of age., Results: A statistically significant negative interaction was reported between obesity status and PCOS status in the determination of serum adiponectin and resistin concentrations (effect size = -0.14, interaction P = 0.001, effect size = -0.15, P = 0.016). It indicated that adiponectin and resistin were significantly decreased in overweight/obese patients with PCOS compared with other subgroups. Statistically significant positive interactive effects were found between PCOS status obesity status and leptin (effect size = 0.321, interaction P = 0.036), indicating that the overweight/obese women with PCOS had the higher levels of leptin compared with the control group. Also, no interaction was reported between PCOS status and obesity status with regard to the serum levels of other adipokines., Conclusions: While no sufficient evidence is available with regard to the causal association between adipokines and PCOS, they may contribute to the development of PCOS and regarded as the novel biomarkers of PCOS.

Tools, called 'diet/dietary quality indices', evaluate the level of adherence to a specified pattern or a set of recommendations in populations. Yet, there are no review studies providing unanimous comprehensive results of dietary indices on obesity. We reviewed observational studies, focusing on the association of diet quality indices with general obesity or abdominal obesity in adults. We systematically conducted a search in all English language publications available on MEDLINE, ISI Web of Science and Embase between January 1990 and January 2016. Among the wide variety of indices and weight-derived variables, studies with dietary-guideline-based indices and mean changes for weight gain or OR for general obesity and abdominal obesity were selected. From a total of 479 articles, thirty-four studies were selected for the current review, ten of which had prospective designs and twenty-six had cross-sectional designs. Associations of weight status with the original Healthy Eating Index (HEI) and other versions of the HEI including alternative HEI, HEI-2005 and HEI-05 were examined in thirteen studies, with ten studies revealing significant associations. The HEI was a better general obesity predictor in men than in women. Diet scores lacked efficacy in assessing overall diet quality and demonstrated no significant findings in developing countries, in comparison with US populations. In addition, indices based on dietary diversity scores were directly associated with weight gain. Despite the insufficient evidence to draw definitive conclusions about the relation between dietary indices and obesity, HEI was found to be inversely associated with obesity and diversity-based indices were positively associated with obesity.

Background and Aims: Considering the inconsistent data available on cardiovascular (CV) risk of different obesity phenotypes, the aim of this study was to investigate the development of cardiovascular disease (CVD) in different obesity phenotypes over a median follow-up of 12 years., Methods: In this large population-based cohort, 7842 participants (44.8% men), aged ≥ 30 years, were enrolled. Participants were divided into six phenotypes based on body mass index and metabolic status. Metabolic health was defined based on two definitions: 1) having ≤1 component of metabolic syndrome using the Joint Interim Statement (JIS) criteria and 2) homeostasis model assessment-insulin resistance (HOMA-IR) < 2.6 mole × μU/L 2 . Multivariate adjusted hazard ratios (HRs) were calculated for cardiovascular events., Results: A total of 712 new CVD events occurred. CV risk increased in all metabolically unhealthy phenotypes. Multivariable adjusted HRs for CVD events in metabolically healthy overweight (MHOW) and metabolically healthy obese (MHO) participants were 1.22 (0.73-2.04) and 1.74 (0.68-4.44), respectively. CV risk increased in all obesity phenotypes based on insulin resistance except the insulin resistance-normal weight group. However, this increased risk disappeared after further adjustment for metabolic risk factors., Conclusions: Our findings showed that CV risk did not increase in MHOW and MHO phenotypes over a 12-year follow-up. However, all metabolically unhealthy phenotypes were associated with increased incident CVD. Further studies with longer follow-up are needed to confirm the benign nature of MHOW/MHO phenotypes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: Controversial findings are reported on the risk of cardiovascular disease in chronic kidney disease (CKD). There are some interactions between CKD and other metabolic disorders including metabolic syndrome (MS) and obesity regarding coronary heart disease (CHD) outcomes., Materials and Methods: A total of 2823 men and 3684 women aged 30 years and older, without cardiovascular disease, were followed for 10 years. Multivariable adjusted hazard ratio of CHD was estimated for those who developed CKD, MS or both by sex and body mass index levels below and above 27 kg/m2. The interaction term of CKD and MS and also CKD-MS components were assessed in the Cox proportional hazard models as well., Results: Chronic kidney disease without MS, showed a significant effect on CHD only in participants with low body mass index (hazard ratio, 2.06; 95% confidence interval, 1.28 to 3.31 in the men and hazard ratio, 2.56; 95% confidence interval, 1.04 to 6.31 in the women). The joint effect of CKD and MS decreased to one-third of their multiplicative effect in this subgroup, indicating a negative interaction between CKD, MS, and Obesity. The same interaction was observed between CKD and hypertension in both sexes and CKD and type 2 diabetes mellitus in the men., Conclusions: Our results showed that CKD was an independent risk factor for CHD only in nonobese individuals; however, its risk was wiped out when joined to MS. Following the concept of "obesity paradox," the term of "risk factors paradox" also needs more attention.

Background: The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults., Study Design: A prospective cohort study, the Tehran Lipid Glucose Study (TLGS)., Setting and Participants: Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD., Predictor: Obesity phenotypes., Outcome: Incidence of chronic kidney disease., Measurements: Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study., Results: CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p < 0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91-1.43) and 1.43 (95% CI, 1.09-1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93-1.62) and 1.43 (95% CI, 1.08-1.90), respectively., Conclusion: Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.

Aim: To evaluate the relationship between inflammatory and pro inflammatory markers, with obesity and visceral adiposity in male subjects with or without metabolic syndrome (MS)., Subjects and Methods: A total of 37 patients with MS and 37 age matched controls were included (mean age 46.35 ± 1.6 years). MS was defined by the criteria of the international diabetes federation 2005. Anthropometric and biochemical profiles, including high-sensitivity C-reactive protein (Hs-CRP), visfatin and interleukin 6 (IL-6), were measured. Data were compared between groups by using t test. Pearson's correlation was used to evaluate the relationship between variables. P values less than 0.05 were considered as statistically significant., Results: In patients with MS, CRP and IL-6 were significantly correlated with body mass index, waist circumference and waist to hip ratio. Visfatin levels were significantly lower in patients with MS compared to controls (log visfatin: 1.74 ± 0.27 vs. 1.86 ± 0.13 ng/ml, MS vs. control group respectively). We cannot find any significant correlation between visfatin, CRP and IL-6. Also there were no correlation between visfatin levels and any anthropometric parameters in patients with MS or control groups., Conclusion: Serum visfatin was lower in patients with MS. Therefore it seems that visfatin could not be considered as a pro inflammatory adipocytokine in MS. The positive associations of obesity and visceral adiposity with elevated CRP and IL-6 levels suggest the importance of reducing visceral adiposity to prevent the risk of coronary disease.

We aimed at investigating whether insulin resistance (IR)/sensitivity are impaired in obese/non-obese polycystic ovary syndrome (PCOS) and obese/non-obese healthy controls. A comprehensive literature search was performed for observational, English language studies. Meta-analysis was performed with the random effects model according to the heterogeneity. Eligible studies, involving 3037 women in four groups of: 1-obese, PCOS; 2-non-obese, PCOS, 3-obese, non-PCOS and 4-Non-obese, non-PCOS were included. Based on the insulin resistance index (HOMA-IR) analysis, the pooled mean (95% Conf. Interval) of HOMA IR in groups 1-4 were 4.38 (3.84, 4.92), 2.68 (2.16, 3.20), 2.44 (2.06, 2.82) and 1.34 (1.06, 1.63), respectively. Meta-analysis showed that group 1 (obese, PCOS patients) statistically have the highest IR and group 4 (non-obese, non-PCOS women) have the highest insulin sensitivity. Group 2 (non-obese, PCOS patients) and group 3 (obese, non-PCOS women) were between this range and they had lower IR than group 1 (obese, PCOS) and lower insulin sensitivity than group 4 (non-obese, non-PCOS). So, there were statistical differences between all groups except between groups 2 and 3. Insulin sensitivity indexes (quickie and ISI), also confirm the IR index (HOMA-IR) results. Based on different IR/sensitivity indexes, we found no evidence of any different effects of BMI ≥ 30 kg/m(2) on IR/sensitivity. In conclusion, PCOS status intensifies the adverse effects of obesity on IR, it has to be appropriately addressed in primary and secondary preventive cares and treatments provided for these women.

Aim: Evaluating the incidence of obesity and its risk factors among Tehranian adults., Material & Methods: In this population-based cohort, non-obese participants, aged ≥20years, were followed for development of obesity (Body Mass Index (BMI) ≥30). Incidence density and cumulative incidence rates of obesity were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential obesity risk factors including: age, BMI, metabolic syndrome, waist circumference (WC), smoking, marital status, education, and physical activity., Result: A total of 7257 participants (3536 men) were followed for a median of 8years. At baseline, mean age, BMI and WC were 41.3±14.6years, 25.1±2.9kg/m(2) (24.9±3kg/m(2) men and 25.2±3kg/m(2) women), and 84.8±9.8cm (87.06±9.2cm men and 82.6±9.9cm women) respectively. During the follow-up, 1345 participants (876 women) developed obesity contributing to cumulative incidences of 31.3% (CI: 29.9%-32.7%), 38.1% (CI: 36.2%-40.1%), and 23.4% (CI: 21.6%-25.3%) for the whole population, women, and men, respectively. Corresponding incidence density rates per 1000 person-year were 25.9 (CI: 24.5-27.3), 33.67 (CI: 31.5-36.0), and 18.0 (CI: 16.5-19.7), respectively. Highest incidence rates were observed during their 40s and 20s for women and men, respectively. Participants with metabolic syndrome, lower educational level, higher BMI and WC, were at higher risk of obesity development in both sexes., Conclusion: High incidence of obesity was observed among Tehranian adults with higher incidence of obesity in women. Different modifiable variables may act as risk factors for obesity development which should be targeted to control the epidemic of obesity., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Some recent studies have shown stablity or declining trends in obesity while others still report increasing trends. The present study aimed to investigate the trends of obesity and abdominal obesity in Tehranian adults during a median follow-up of 10 years., Design: Prospective cohort study., Setting: Community-based data collection from the Tehran Lipid and Glucose Study (TLGS)., Subjects: Participants from four phases of the TLGS from 1999 to 2011 (n 10,368), aged ≥20 years., Results: The crude prevalence of obesity and abdominal obesity increased from 23·1% and 47·9% at baseline to 34·1% and 71·1% at the end of follow-up, respectively. Generalized estimating equation (GEE) models were used to analyse the correlated data and calculate the relative risks (RR). Risks of obesity and abdominal obesity increased over the whole study period for men (RR=1·62; 95% CI 1·49, 1·76 and RR=1·46; 95% CI 1·41, 1·52, respectively) and women (RR=1·24; 95% CI 1·19, 1·29 and RR=1·22; 95% CI 1·18, 1·27, respectively). These rising trends were observed in all subgroups regardless of age, marital status and educational level., Conclusions: Trends of obesity and abdominal obesity are increasing in Tehranian adults during a decade of follow-up in both genders and in all study subgroups. These results underscore the still growing obesity epidemic in the capital of Iran, calling for urgent action to educate people in lifestyle modifications and the need for effective preventive and educational strategies on obesity.

Objective: To evaluate the effect of different fat distribution measures on the risk of all-cause mortality events among chronic kidney disease (CKD) patients, which has not been previously evaluated., Methods: The present study consisted of 1,860 individuals with CKD, aged ≥30 years who participated in Tehran Lipid and Glucose Study. The estimated glomerular filtration rate was estimated using the abbreviated prediction equation, provided by the Modification of Diet in Renal Disease formula, and CKD was defined as estimated glomerular filtration rate < 60 mL/minute/1.73 m2. Cox proportional hazard regression was implemented to estimate the hazard ratios (HRs) of different anthropometric measures for predicting mortality events., Results: During 10.1 years of follow-up, 221 cases of all-cause mortality events occurred. In confounder-adjusted model (age, sex, creatinine, the history of cardiovascular disease, and smoking), none of the HRs of different anthropometric measures reached the significant level; however, when we also considered mediator variables (hypertension, diabetes, and hypercholesterolemia) in the model, there was significant interaction between sex and waist circumference for the risk prediction of mortality events. Among men, the HRs of mortality for 1 standard deviation increase in anthropometric measures were 0.73 (0.57-0.92) for weight, 0.67 (0.54-0.83) for waist circumference, 0.75 (0.58-0.97) for body mass index, and 0.71 (0.52-0.96) for hip circumference. However among women, none of the measures were associated with increased risk of all-cause mortality events., Conclusion: Among men with CKD, regardless of fat distribution in hip, waist, or in whole body, having more fat mass results in better survival., (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Polycystic ovary syndrome is a common endocrine disorder affecting women both physically and psychologically and can lead to a poor quality of life compared to their normal counterparts. The aim of the present study was to assess the impact of various clinical features of polycystic ovary syndrome on the health-related quality of life of Iranian women diagnosed with this syndrome., Materials and Methods: A total of 796 women diagnosed with polycystic ovary syndrome, aged 15-49 years, completed the questionnaires, interviews, and medical assessments required for this study. A reliable and validated Persian version of the health-related quality of life questionnaire for polycystic ovary syndrome patients was used. Linear regression models were used to assess the association between the symptoms of polycystic ovary syndrome and health-related quality of life., Results: The mean age of participants was 28.02 years. 35.4% of the subjects were classified as overweight or obese. Hirsutism, was reported to have the strongest impact on the patients' health-related quality of life, followed in descending order by body mass index, irregular menses and infertility. The relative level of hirsutism was directly proportional to decrease in health-related quality of life score (p<0.001)., Conclusions: The results of the study found that hirsutism had the strongest impact on the health-related quality of life measures in Iranian women diagnosed with polycystic ovary syndrome. Health care officials need to evaluate in depth the effect of each clinical feature of polycystic ovary syndrome separately and design management strategies, keeping in mind the psychological and physical manifestations.

Aim: To determine the impact of body mass index and the presence of metabolic syndrome (MetS) on cardiovascular disease (CVD) and mortality events in an elderly Tehranian population., Methods: A population-based cohort of 1199 participants aged ≥65 years were followed for a mean of 9.74 years. Participants were stratified according to body mass index categories and MetS status. Cox regression analyses were used to estimate the hazard ratio of CVD and mortality events, given overweight participants without MetS as reference., Result: During follow up, 271 CVD events and 239 deaths (106 CVD deaths) occurred. Regarding CVD, multivariate-adjusted hazard ratios for CVD events in normal weight and obese participants without MetS were 1.21 (95% CI 0.77-1.91) and 1.46 (95% CI 0.64-3.34), respectively, and for normal weight, overweight and obese participants with MetS were 2.07 (95% CI 1.23-3.28), 1.72 (95% CI 1.13-2.62), and 1.53 (95% CI 0.95-2.45), respectively. Corresponding hazard ratios for CVD mortality were 2.08 (95% CI 0.93-4.82), 1.07 (95% CI 0.13-8.78), 3.71 (95% CI 1.55-8.85), 2.42 (95% CI 1.06-5.51) and 3.31 (95% CI 1.39-7.88), and for all-cause mortality were 1.41 (95% CI 0.9-2.23), 1.33 (95% CI 0.51-3.47), 1.84 (95% CI 1.1-3.09), 1.46 (95% CI 0.93-2.34) and 1.5 (95% CI 0.91-2.56), respectively. In the presence of diabetes in place of MetS, all of the diabetic participants regardless of body mass index category highlighted a significant risk for CVD and mortality events., Conclusion: Among the elderly population, the presence of MetS was necessary for exploring the risk of CVD events and its mortality; however, only the normal weight population with MetS had a significant risk for all-cause mortality, (© 2014 Japan Geriatrics Society.)

No study has yet evaluated the effect of wrist circumference on risk of incident hypertension and cardiovascular disease (CVD) in an adult population. The present study included 3642 women, aged ≥30 years, free of CVD at baseline, who had undergone health examinations between January 1999 and 2001 and were followed up until March 2010. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of wrist circumference for CVD and hypertension events. During 10 years of follow-up, 284 cases of first CVD and 615 cases of incident hypertension occurred. In a model adjusted for conventional CVD risk factors, the HR of 1 cm increase in wrist circumference was 1.15 (1.06-1.25) for hypertension and was marginally significant for CVD (HR, 1.12 [1.00-1.25]; P-value 0.052). After considering body mass index and waist circumference in the model, we found significant interaction between waist circumference and wrist circumference in risk prediction of hypertension and CVD (P < .001). In non-centrally obese women (waist circumference <95 cm), in multivariable model plus body mass index and waist circumference, increase in wrist circumference was independently associated with both hypertension (HR, 1.17 [1.02-1.35]) and CVD (HR, 1.29 [1.03-1.61]). However, among centrally obese women (waist circumference ≥95 cm), wrist circumference increase could not predict either hypertension (HR, 0.97 [0.84-1.18]) or CVD events (HR, 0.90 [0.75-1.07]). Wrist circumference as a novel anthropometric measure was an independent predictor for incident hypertension and CVD events among non-centrally obese women., (Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Background: To determine the association between fatty acid intake and the prevalence of risk factors for the metabolic syndrome., Methods: In this population-based cross-sectional study, a sample of 2750 Tehranian subjects (44% men and 56% women) aged 20-74 years, who completed a validated food frequency questionnaire, was studied. The metabolic syndrome (MetS) was defined in accordance with the modified guidelines of the National Cholesterol Education Program Adults Treatment Panel III, and waist circumference was coded according to the newly-introduced cut-off points for Iranian adults (≥95 cm for both sexes). Metabolic risk factors across quartile categories of each type of dietary fat [total fat intake, total poly-unsaturated fatty acid (PUFA) intake, total MUFA intake, total saturated fatty acid (SFA) intake expressed as percentage of energy and quartiles of the ratio of polyunsaturated fat to saturated fat (P : S)] were compared., Results: The mean (SD) ages of participants were 40.8 (14.6) and 38.6 (12.9) years, respectively, for men and women. The mean contribution of fat to energy intake was approximately 26% in men and women. A positive trend over successive quartiles of SFA intake with low-density lipoprotein-cholesterol (LDL-C) and triglyceride, as well as P/S ratio intake with high-density lipoprotein-cholesterol (HDL-C), was found. An inverse association between HDL-C with SFA and PUFA intake and a positive association with MUFA and the P/S ratio was found. A significant association of fatty acid consumption and risk of the MetS in this population was observed, except for total PUFA intake., Conclusions: Special dietary fatty acids are associated with metabolic risk factors among the Iranian population. Because of the high prevalence of cardiovascular disease and MetS, national nutrition policies must be developed accordingly for the modification of dietary fatty acid intake with respect to causation and prevention., (© 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.)

Background/objective: There is limited data from long-term prospective studies on the natural course of metabolic syndrome (MetS) incidence in healthy obese phenotypes. The aim of this study was to determine the incidence and predictors of the MetS in healthy obese subjects without the MetS at baseline after a decade of follow-up., Subjects/methods: In this prospective cohort study, 438 obese subjects free from MetS at baseline, aged ≥20 years, were selected from among the participants of the Tehran Lipid and Glucose Study and followed up for 10 years for development of MetS. Based on national data, central obesity was defined as waist circumference cutoff point of 89 cm for men and 91 cm for women., Results: Initially, subjects had a mean age of 41.1 ± 11.8 years and a body mass index of 32.7 ± 2.7 kg/m(2). At the end of follow-up, the cumulative incidence (95% confidence interval) of MetS was 44.0 (36.8-51.1)%. In the multivariable analysis, the adjusted odds ratios of hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C) and insulin resistance for the development of MetS were 3.08 (1.39-6.79), 2.84 (1.26-6.42), 6.49 (3.18-13.25) and 2.87 (1.55-5.32), respectively. The area under receiver operating characteristic curve of all the components was significantly higher than various combinations of MetS components, except for the two models including combinations of three components, that is, triglycerides (TGs), HDL-C and fasting blood sugar, as well as, TGs, HDL-C and systolic blood pressure., Conclusions: Our findings demonstrate that MetS developed in nearly half of the individuals during the 10 years of follow-up. Predictors of MetS in healthy obese subjects may differ from the general population, and waist circumference does not have an independent role.

Background: Nitric oxide (NO) plays a role in almost every biologic system including regulation of energy balance and food intake. This study aimed at determining association between serum nitric oxide metabolite (NOx) levels and obesity in a population-based study., Methods: In a cross-sectional study, NOx levels were measured in 3505 adult participants. Pregnant women and those with diabetes, renal dysfunction, chronic diarrhea, and hospitalization within the past three months, subjects using antihypertensive medications or aspirin, and those with missing data were excluded. Finally, 2445 subjects (1004 men and 1441 women) were included., Results: Women with body mass index (BMI) > 30 kg/m2 compared to those with BMI < 25 kg/m2, had significantly higher serum NOx concentrations after multivariable adjustment (B = 5.24, P = 0.002). In addition, there was a significant trend of increasing serum NOx concentrations in categories of BMI in women. Women with a waist circumference (WC) ≥ 90 cm had significantly higher serum NOx concentration even after multivariate adjustment. Women with waist-to-hip ratio (WHR) ≥ 0.90 had significantly higher serum NOx concentration; however, the association was not significant after multivariable adjustment. None of the parameters were significantly associated with NOx in men., Conclusion: A positive association between BMI and WC and serum NOx concentration was found in women which might be a reflection of increased NO production.

Objective: To assess the impact of short-term changes in body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio on the risk of future coronary heart disease (CHD) among women., Participants and Methods: The study sample consisted of 2468 women aged 30 years or older without cardiovascular disease at baseline who underwent 2 consecutive examinations, the first between January 31, 1999, and August 21, 2001, and second between October 20, 2001, and September 22, 2005, and were followed up until March 31, 2010. Cox proportional hazard regression was performed to estimate the hazard ratios (HRs) of the anthropometric measures for CHD events., Results: During a mean follow-up of 6.6 years, CHD occurred in 127 of the study participants (5.1%). There were significant interactions between a BMI of 30 kg/m(2) or greater and anthropometric changes in prediction of CHD events (all P<.04). Among nonobese individuals, a 1-SD increase in HC changes, independent of WC and BMI changes, was inversely associated with risk of CHD events (HR, 0.60 [95% CI, 0.44-0.83]). Among obese individuals, a 1-SD increase in WC, independent of other changes, increased the risk of CHD. Conversely, a 1-SD increase in BMI decreased the risk of CHD by 35% (HR, 0.65 [95% CI, 0.45-0.94])., Conclusion: In this study, the impact of changes in anthropometric measures on CHD was modified by obesity at baseline. Among nonobese women, increases in HC could significantly reduce the risk of CHD events. Among obese individuals, although increases in WC were associated with a higher risk of CHD, increases in BMI decreased the risk., (Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

With the imminent threat of a global health crisis of obesity and diabetes or "diabesity" as it is referred to today, healthcare professionals urgently need an effective range of treatment options for management of these two epidemics. After many decades in obscurity, bariatric surgery has emerged as an impressive treatment of obesity and type 2 diabetes. The field of bariatric surgery has seen a rapid evolution over the last 30 years and current procedures are safe, effective, less invasive, and relatively cost- effective. Bariatric procedures produce durable weight loss, long -term remission of type 2 diabetes, and beneficial effects on other comorbidities; they lead to a significant reduction in mortality in the long term. The adverse events after surgery are not uncommon but in majority of cases are not fatal. Bariatric surgery is costly, but cost-efficacy analysis consistently shows that the additional years of lives gained through bariatric surgery can be obtained at a reasonable and affordable cost. However, universal surgical treatment of obesity is not achievable with the world's current healthcare and surgical resources. The conclusion of this review is that although bariatric surgery is a good addition to management of obesity and diabetes, these epidemics must be addressed by more comprehensive and long-term health policy efforts and appropriate research to determine the most effective ways of prevention and nonsurgical alternatives to treat obesity and type 2 diabetes.

Aims: Considering the key role played by the apolipoprotein E (Apo E) gene in the regulation of lipid metabolism and obesity, the current study has evaluate the association between abdominal obesity and Apo E gene polymorphism in a population of Tehran., Materials and Methods: A cross-sectional study was performed on 345 men and 498 women, aged 19-86 years, selected from among participants of the Tehran Lipid and Glucose Study. The RFLP-PCR technique was employed to investigate polymorphism in the gene fragments. Based on the national survey of risk factors for non-communicable diseases of Iran, waist circumference (WC) cut off was set at 89 cm for men and 91 cm for women. The risk effect of obesity related variables and lipid profiles in two groups of WC were examined by logistic regression. For body mass index (BMI), waist to hip ratio (WHR), high-density lipoprotein-cholesterol (HDL-C), triglyceride (TG), fasting blood sugar (FBS), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and blood pressure (BP), the standard risk cut-offs were applied., Results: Frequencies of E2, E3, and E4 alleles were 9.7, 73, and 14.6%, respectively. The presence of the E3 allele was significantly associated with higher TG level in subjects with high WC, while, the presence of E4 allele decreased the plasma HDL-C (E2:52.1±13.1 vs., E3:48.9±11.2 vs., E4:44.6±10.6 mg/dl, p<0.05), HDL-C2 (E2:20.4±9.2 vs., E3:19.1±8.8 vs., E4:16.3±7.9 mg/dl, p<0.05), and HDL-C3 (E2:32.1±7.4 vs., E3:30.3±6.2 vs., E4:28.3±6.1 mg/dl, p<0.05) in normal WC subjects. The presence of the E3 carrier increased the risk of having higher plasma TG, compared with the E2 carrier (95% CI OR=1.91, 1.02-3.57; p=0.04)., Conclusion: According to the results of this study, the E3 carrier, caused an approximately 90% increase in the levels of TG in the group with abdominal obesity., (Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.)

Objectives: To determine whether changes in food patterns over a period of 6 years were related to obesity in Tehranian adults., Design: Data on dietary intake, using the food frequency questionnaire, and anthropometry were obtained in 2 periods of the survey (1999-2001 and 2005-2007)., Setting: Participants of the Tehran Lipid and Glucose Study., Participants: Two hundred six adults., Main Outcome Measures: Waist circumference, body mass index, and waist-to-hip ratio., Analysis: Food patterns were derived using factor analysis., Results: Three dietary patterns, the healthful (HDP), the western (WDP), and the mix, were identified. Increased WDP score was directly related to change in body mass index (β = .41, R(2) = 0.22, P < .001) among overweight/obese individuals. Alterations in waist circumference was better predicted by increased WDP score (β = .49, R(2) = 0.21, P < .01) than by increased HDP score (β = -.20, R(2) = 0.11, P < .05). Subjects in the higher quartile of increased HDP score had lesser change in waist-to-hip ratio (β = -.77, R(2) = 0.43, P < .01)., Conclusions and Implications: Results of this study indicate that increased adherence to the WDP and decreased adherence to the HDP could contribute to obesity., (Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)