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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: Nigella sativa (NS) oil has been found to have advantageous benefits in the management of inflammation and obesity. This study investigated the effect of NS supplementation on blood mRNA expressions and serum levels of IL-1β, IL-6, leptin, and insulin concentrations in overweight/obese women., Methods: In a crossover design, participants were randomized to receive either NS supplements(2000 mg/day) or placebo for 2 durations(8 weeks). With between-subject and within-subject components and interactions, a repeated-measure ANOVA model was used considering the treatment, time, and the carryover effects. Cohen's d(d) was used to measure the magnitude of the effects., Results: Forty-six eligible participants were included. NS supplementation significantly reduced the mRNA expressions(d=-0.68, P = 0.03) and serum levels of IL-1β with medium-high effect sizes(d=-1.6, P < 0.001). Significant reductions with large effect sizes were observed in the gene expression and serum levels of IL-6(d=-1.8, d=-0.78, respectively; P < 0.01) and Leptin(d=-1.9, d=-0.89, respectively; P < 0.01, serum leptin P carryover < 0.001). Despite the meaningful carryover effect for serum leptin, results remained significant following the first intervention period analysis(P < 0.001). A significant but low effect size decrease in serum insulin was observed(d=-0.3, P = 0.02)., Conclusions: The clinical significance of present findings regarding improvements in obesity-related pro-inflammatory markers must be interpreted with caution due to some observed medium-low effect sizes., Trial Registration: IRCT20180430039475N1 (Date:25/6/2018)., (© 2023. The Author(s).)

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.)

Introduction: Apelin could be one of the last protective defenses before developing obesity-related disorders, including insulin resistance, type 2 diabetes, and hypertension, which can be modified by dietary intake. The present study investigated the association of habitual intake of total fatty acids (TFAs), saturated-, monounsaturated-, polyunsaturated FAs, n-3, and n-6 FAs with Apelin expression in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT)., Methods: We obtained VAT and SAT from 168 participants (64 nonobese and 104 obese) who had undergone open abdominal surgery. Dietary intake information was gathered with a valid and reliable food frequency questionnaire. The mRNA expression of the Apelin gene was analyzed by real-time PCR., Results: Apelin serum levels were increased in the obese subjects compared to the nonobese group (p = 0.016). The SAT and VAT Apelin mRNA levels were significantly elevated in the obese participants compared to the nonobese ones (p < 0.05). Based on BMI status, only obese subjects indicated a positive association between SAT and VAT Apelin expression and TFA intake (p < 0.001). However, this association was observed between SAT and VAT Apelin gene expression and polyunsaturated fatty acid (PUFA) and n-3 FA intakes in both obese and nonobese groups (p < 0.05)., Conclusion: High Apelin gene expression was associated with TFA intake in obese subjects in both fat tissues. However, habitual intake of PUFA and n-3 FA was associated with Apelin gene expression in obese and nonobese individuals. Our results indicate a determinative role of the quality and quantity of FA intake on adipose tissue., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

The current study aimed to evaluate the interaction of the dietary diversity score (DDS) and FTO polymorphisms concerning obesity phenotypes. The 4480 subjects of this cohort study were selected. The polymorphisms rs1121980, rs14211085 and rs8050136 were selected and genotyped. The weighted method was used to calculate the genetic risk score (GRS). Obesity marker changes were calculated. Those with minor allele carriers of rs1121980 had lower body mass index changes ( Q1: 1.58 ± 0.60 vs. Q4: 0.13 ± 0.59) and visceral adiposity index (VAI) (Q1: -0.00 ± 0.02 vs. Q4: -0.04 ± 0.02) when they had higher DDS (P interaction = 0.05). Carriers of the minor allele of rs8050136 had significant VAI change across DDS quartiles (Q1: -0.01 ± 0.02 vs. Q4: -0.02 ± 0.02, P interaction = 0.05). No significant interaction was found between the GRS and DDS on general obesity. The pattern of dietary diversity may have a mediatory role in improving obesity markers in subjects with a more genetic predisposition to adiposity.

Introduction: We examined the association of adipose triglyceride lipase (ATGL) and hormone-sensitive lipase (HSL) gene expressions, as the key regulators of lipolysis, with dietary fat quantity and composition in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT)., Methods: In this observational study, samples were collected from patients undergoing elective abdominal surgery. Participants were categorized into two groups based on their body mass index (BMI) status. Dietary, anthropometric, and biochemical data were collected before surgery. Linear regression was performed to determine the association of dietary fat content with ATGL and HSL gene expressions in SAT and VAT., Results: 152 individuals with a mean ± SD age of 40.7 ± 13.2 years and a median (inter-quartile range) BMI of 39.4 (26.5-45.3 kg/m 2 ) participated in this study, of whom 54 were non-obese (BMI<30 kg/m 2 ), and 98 were obese (BMI≥30 kg/m 2 ). Among non-obese participants, positive associations were observed between ATGL mRNA expression and reported intakes of total fatty acids (TFA) (β=0.306, P = 0.025), myristic (β=0.285, P = 0.038), palmitic (β=0.417, P = 0.002), oleic (β=0.333, P = 0.017), dairy trans (β=0.374, P = 0.006), and other trans FAs (β=0.369, P = 0.006) in SAT. In contrast, inverse associations between HSL mRNA expression and reported intakes of TFAs (β=-0.377, P = 0.005), myristic (β=-0.282, P = 0.039), palmitic (β=-0.372, P = 0.006), stearic (β=-0.314, P = 0.020), and oleic acid (β=-0.372, P = 0.007) were observed in SAT. No associations were observed among obese participants, nor in VAT among non-obese individuals., Conclusion: ATGL and HSL mRNA expressions in SAT were associated with dietary fat quantity and composition among non-obese adults., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Individuals with normal weight obesity (NWO) are predisposed to having cardiometabolic disorders. This study aims to investigate the circulating levels of vaspin, leptin and their association with glycemic and lipid profiles in women with NWO., Methods: Forty women with body mass index (BMI) = 18.5-24.9 kg/m 2 and fat mass (FM) ≥ 30% were assigned in the NWO group. Thirty age-matched women with identical BMI range, and FM < 30% (normal weight non-obese; NWNO) were considered as a control group. In addition to anthropometric measurements, glycemic and lipid profiles and circulating levels of leptin and vaspin were measured., Results: The mean ± standard deviation (SD) age of participants was 28.76 ± 4.76 years in the NWO group and 29.23 ± 4.50 years in the control group. The NWO group had the higher mean serum levels of insulin (9.02 ± 4.75 vs. 6.24 ± 2.51, P = 0.009), leptin (17.31 ± 8.10 vs. 9.94 ± 4.30, P < 0.001) and homeostatic model assessment of insulin resistance (HOMA-IR) (33.77 ± 20.71 vs. 23.48 ± 10.03, P = 0.009) compared to the NWNO group. The serum level of vaspin was higher in the NWO group compared to the control group (34.82 pg/ml vs. 27.72 pg/ml, respectively, P = 0.12). In NWO group, the serum levels of leptin had positive correlation with FBS (r = 0.45, P = 0.02), insulin (r = 0.51, P = 0.008), and HOMA-IR (r = 0.46, P = 0.02) and vaspin concentration was associated with insulin (r = 0.36, P = 0.02) and HOMA-IR (r = 0.30, P = 0.06), positively., Conclusion: It is concluded that the concentration of insulin and HOMA-IR index were significantly higher in women with NWO compared to NWNO. Higher concentrations of leptin and vaspin in the NWO group were associated with glycemic profile.

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 level of serum 25-hydroxyvitamin D (25(OH)D) at which intact parathyroid hormone (iPTH) is maximally suppressed (suppression point) and below which PTH begins to rise (inflection point) has been used to define optimum 25(OH)D concentration. We aimed to study the association of circulating iPTH with 25(OH)D concentrations and to determine a 25(OH)D threshold associated with a significant iPTH suppression. This cross-sectional study was conducted on 198 boys and 180 girls, aged 6-13 years with BMI ≥ 1SD (WHO criteria) recruited from primary schools. Adjusted iPTH for BMI z-score, pubertal status, and dietary calcium was used. Nonlinear regression was used to model the relationship between 25(OH)D and iPTH and identify a suppression point for 25(OH)D at which iPTH reached a plateau. Piecewise regression analysis with a single knot for all possible values of 25(OH)D were fitted. Furthermore, 95% confidence intervals (95%CI) for those point had been calculated. The mean age (SD) of girls and boys was 9.1 (1.6) and 9.4 (1.7) years, respectively. Median 25(OH)D and iPTH were 13.8 ng/mL and 33.9 pg/mL in boys and 9.9 ng/mL and 47.8 ng/mL in girls, respectively. The equation in girls was: log-iPTH = 3.598+0.868 exp[(-0.190×25(OH)D. The point for near maximal suppression of iPTH by 25(OH)D for girls occurred at a 25(OH)D concentration of 20 ng/mL (95% CI: 7.1 to 32.2). No point of maximal suppression was found for boys. We also found a 25(OH)D threshold of 10 ng/mL (95% CI: 4.6 to 22.5) for girls (f: 9.8) by linear piecewise regression modeling of adjusted iPTH. No significant inflection point for boys was observed. In overweight/obese girls, when the concentration of 25(OH)D was higher than 20 ng/mL, an iPTH mean plateau level is reached, and when its concentrations approach 10 ng/mL, the slope of iPTH concentration has been accelerated., Competing Interests: The authors have declared that no competing interests exist.

Background: Obese women with polycystic ovary syndrome (PCOS) may face additional barriers in achieving weight loss. We aimed to compare the effects of the hypocaloric low glycemic index (LGI) diet on anthropometric variables and insulin resistance in women with and without PCOS and investigate the effect of this diet on the clinical and hormonal features of PCOS women., Methods: This interventional study was carried out at the Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Of 108 women invited for the purpose of the present study, 62 participants (PCOS = 28, non-PCOS = 34) followed a 24-week energy restricted LGI diet. Anthropometric, biochemical, hormonal and clinical measurements were documented at baseline, 12 weeks and 24 weeks with intervention., Results: The percentages of weight loss achieved by both the PCOS and non-PCOS groups did not differ significantly (PCOS: -8.04% vs. non-PCOS: -8.09%). No significant difference in decrease of homeostatic model assessment of insulin resistance (HOMA-IR) was observed between the two groups (PCOS = - 0.83 ± 0.33, non PCOS = - 0.79 ± 0.28, P = 0.83). In PCOS women, significant reduction in total testosterone (- 0.91 ± 0.33 nmol/L, P = 0.006), FAI (- 4.47 ± 1.1, P < 0.001) and increase in SHBG (38.98 ± 11.02 nmol/L, P < 0.001) were observed. Menstrual irregularity was improved in 80% of women with PCOS and a significant decrease (32.1%) in occurrence of acne was reported., Conclusions: This diet has equally beneficial effects on anthropometric and metabolic characteristics of overweight women with and without PCOS., Trial Registration: This study is registered in the Iranian Randomized Clinical Trials Registry (IRCT, code: IRCT2016092129909N1 ).

Objectives: The aim of the present study was to investigate the association of dietary carbohydrates with fat mass and obesity-associated gene (FTO) expression in visceral and subcutaneous adipose tissue., Methods: In this cross-sectional study, visceral and subcutaneous adipose tissues were gathered from 58 obese (body mass index ≥30 kg/m 2 ) and 44 non-obese (body mass index ≤18 to<30 kg/m 2 ) participants, aged ≥20 y, who had undergone elective abdominal surgery with minimal effect on dietary intake. Dietary intake was collected using a valid and reliable food frequency questionnaire, and daily intake of total carbohydrates, total sugar, sucrose, glucose, fructose, lactose, and maltose were calculated. The mRNA expression of the FTO gene in visceral and subcutaneous adipose tissues was measured by real-time quantitative polymerase chain reaction., Results: No significant difference was observed for FTO gene expression in subcutaneous and visceral fat mass between non-obese and obese participants. After adjusting for age and sex, total carbohydrate intake was inversely associated with FTO gene expression in subcutaneous (β = -0.403; P = 0.003) adipose tissues among obese participants. Furthermore, higher intake of total sugars, sucrose, glucose, and lactose was inversely and higher intake fructose was directly associated with FTO mRNA expression in subcutaneous adipose tissue among participants with obesity., Conclusion: Dietary intake of total sugars, sucrose, glucose, and lactose in obese participants only was inversely and dietary fructose was positively associated with FTO gene expression from the subcutaneous adipose tissue., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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.)

We aimed to illustrate determinants of VDR gene expression in visceral and subcutaneous adipose tissue among individuals without diabetes. We gathered visceral and subcutaneous adipose tissues during an elective abdominal surgery form 33 morbidly obese (BMI > 40 kg/m 2 ), 23 obese (BMI = 30-40 kg/m 2 ), and 35 non-obese (BMI<30 kg/m 2 ) participants who were free of diabetes. Participants were classified according to their degree of obesity. Before the surgery, habitual dietary intake, physical activity, 25(OH)D, body mass index (BMI), waist circumference (WC), and HOMA-IR was gathered. Non-obese participants had significantly lower mean VDR gene expression in visceral adipose tissues than both the obese and morbidly obese ones and had also lower expression in subcutaneous adipose tissues than the morbidly obese participants. In multiple linear regression models, BMI and HOMA-IR were the independent positive predictors of VDR gene expression in subcutaneous fat. Among non-obese subjects, WC and 25(OH)D were the positive and negative independent predictors of visceral adipose tissue VDR gene expression, respectively. Among obese participants, 25(OH)D was negatively, and BMI and HOMA-IR were positively associated with VDR mRNA levels in visceral adipose tissue. In morbidly obese participants, the independent positive predictors of VDR gene expression in visceral fat were BMI and HOMA-IR, and negative predictors were 25(OH)D and calcium intake. Our findings suggested that 25(OH)D concentrations are the fundamental elements to determine VDR gene expression in visceral fat which by increasing fat depots, the subsequent insulin resistance became another predictor of VDR gene expression., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In 1976, an animal model of type 2 diabetes (T2DM) was described by Cameron et al. using injection of monosodium glutamate (MSG) in KK mice during the neonatal period. Some years later, similar models have been developed by various doses and durations and the main of these models exhibited obesity and features of diabetes mellitus, including glycosuria, hyperglycemia, hyperinsulinemia, decreased glucose tolerance, and insulin sensitivity. Studies indicated that MSG treatment of newborn animals generates necrosis of neuronal cells of the hypothalamic ventromedial nucleus and arcuate nucleus. Neonatal MSG-treatment was related to normoglycemic-normoinsulinemic state at young ages and development of obesity and hyperinsulinemia at adult ages. Following observation of a severe hypertrophy of pancreatic islets due to the proliferation of β-cells in MSG-treated mice, this model has been proposed as a useful animal model of human T2DM. A higher dose of MSG (≥4 mg/g body weight) accompanied by a longer follow-up duration (>6 months) are needed to establish a typical animal model of T2DM.

Studies have indicated that 25-hydroxyvitamin D (25(OH)D) level in obese is lower than normal weight subjects; however, results of studies that investigated relationship between 25(OH)D and fat mass are inconsistent. In addition, several randomized clinical trials (RCTs) have studied the influence of cholecalciferol supplement on percentage fat mass (PFM) but their results are conflicting. The objectives were to investigate the association between vitamin D3 and PFM pooling together observational studies and RCTs. PubMed/MEDLINE, Cochrane, and Scopus were comprehensively searched from inception to September 2016. The Fisher's Z (SE) of correlation coefficient and mean (SD) of changes in PFM from baseline were used to perform meta-analysis in observational studies and RCTs, respectively. To determine potential source of heterogeneity, subgroup and meta-regression analyses were conducted. Pooling correlation coefficients showed an inverse association between PFM (Fisher's Z: - 0.24, 95% CI: - 0.30 to -0 .18) and FM (Fisher's Z: - 0.32, 95% CI: - 0.43 to - 0.22) and 25(OH)D. Subgroup analysis revealed continent but not gender influence on the effect size. Meta-regression analysis indicated that age, latitude, and longitude are not sources of heterogeneity. Combining trials showed vitamin D3 supplementation had a mild but insignificant effect on PFM (- 0.31%, 95% CI: - 1.07 to 0.44). Subgroup analyses indicated that type of cholecalciferol and treatment regimens explain source of heterogeneity. Age, baseline body mass index, dose of cholecalciferol, length of study, female (%), and baseline 25(OH)D are not source of heterogeneity. In conclusion, our results state that 25(OH)D level is inversely correlated with PFM but cholecalciferol supplementation had no effect on PFM.

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.

Overproduction of apelin in obesity could be one of the last protective defenses before type 2 diabetes develops. To summarize the existing evidence on the association between dietary intake and apelin gene expression and concentration. We systematically searched MEDLINE, EMBASE, and google scholar and hand-searched bibliographies, including peer-reviewed articles with English abstracts, without restriction in publication date, updated until 21 February 2016 that reported the association between dietary intake and apelin gene expression or concentration. From a total of 1075 articles, we identified 12 relevant studies. There were 6 clinical trials in human and 6 studies in animals. Overall, two of three studies conducted in humans showed that calorie-restriction diet in obese subjects decreases apelin concentration. Five animal studies reported that higher intake of fatty acids and eicosapentaenoic acid (EPA) increased apelin expression and concentration. Given the paucity of data available, the heterogeneity of study designs used, and exposures tested, no quantitative meta-analysis was justified. Based on human studies, hypocaloric diet can reduce apelin concentration in obese individuals. In addition, higher intakes of total fatty acids and EPA may increase apelin gene expression and concentration.

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.

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: 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 perform a systematic review of the effect of interaction between Melanocortin-4 receptor (MC4R) single nucleotide polymorphisms and diet on the development of obesity and Type 2 diabetes., Background: Environmental factors, such as nutrient intakes or feeding behaviours, can modulate the association of polymorphism in the MC4R gene with obesity and Type 2 diabetes mellitus., Methods: A systematic literature search was conducted in the PubMed, Scopus and Google Scholar databases, with a combination of the following keywords: Diet*, nutr*, melanocortin receptor, melanocortin 4 receptor and MC4R. To assess the quality of observational studies, we used a 12-item quality checklist, derived from the STREGA statement., Results: A total of 14 articles were selected based on the inclusion and exclusion criteria. Consumption of highly salty foods and adherence to a Mediterranean dietary pattern can modulate the association between MC4R polymorphisms and the risk of obesity or Type 2 diabetes. Despite the highly contradictory results of intervention studies, after short-term lifestyle interventions, children with variant alleles of MC4R single nucleotide polymorphisms can lose more body weight, compared with non-carriers, although they may have difficulty in maintaining this weight loss in the long-term. To interpret the results of studies on adults, we need further studies., Conclusions: The interaction between MC4R genes with dietary factors plays a significant role in the development of obesity or Type 2 diabetes phenotypes. Early detection of MC4R risk alleles in individuals and modification of their diet based on these results could be an efficient strategy to prevent obesity or diabetes in these subgroups., (© 2015 Diabetes UK.)

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.)

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.)

Background: The aim of this study was to investigate the ability of diet quality indices in predicting obesity and abdominal obesity in a population in nutrition transition., Methods: This study explored the association of the Mediterranean Diet Scale (MDS), Healthy Eating Index-2005 (HEI-2005), and Diet Quality Index-International (DQI-I) with body mass index (BMI) and waist circumference (WC) in a cross-sectional study after 6.7 years of follow-up in the Tehran Lipid and Glucose Study (TLGS) population., Results: Out of 192 subjects who had BMI < 25kg/m(2) and of 283 subjects who were free of abdominal obesity at baseline, 39.6% developed overweight and obesity and 43.1% developed abdominal obesity, respectively during 6.7 years of follow-up in the study population. In cross-sectional analysis, after adjusting for age, sex, energy intake, physical activity and smoking status, multivariate analysis of covariance did not show any significant results regarding the relation of the diet quality indices, BMI and WC. According to follow-up analysis, none of the indices had significant associations with BMI and WC after adjustments for confounders and baseline values of BMI and WC., Conclusion: Adherence to MDS, HEI-2005, and DQI-I could not predict BMI and WC in Iranian participants after 6.7 years of follow-up.

Accurate and comprehensive data on the extent of the problem of childhood obesity is lacking in countries of the Middle East. This review, based on a Medline search, summarizes the prevalence of obesity among children and adolescents in the region during 1990-2007. The highest rates of obesity and overweight were reported from Bahrain and the lowest from the Islamic Republic of Iran. Studies from Saudi Arabia, Islamic Republic of Iran and Kuwait showed an upwards trend in childhood obesity compared with a decade ago. Lack of uniformity in reference standards and reporting systems renders comparisons difficult. Nevertheless, the I high prevalence of childhood obesity in the Middle East should stimulate policy-makers in the region to set up effective national and regional surveillance systems.

Aims: Comparing waist circumference (WC) role in diabetes risk prediction and diagnosis of metabolic syndrome (MS) in different populations., Methods: Population-based samples from Australia (n=9026) and Iran (n=8259) were studied in 2000 and followed for approximately 4 years. Follow-up attendance was approximately 58% and mean age was 51 vs. 47. Pearson correlations calculated between WC and other MS components. ROC for the role of WC in the prediction of incident diabetes was used., Results: Prevalences of MS (48% vs. 28%), an increased WC (58.5% vs. 54.5%), low HDL-C (35% vs. 11.2%), high triglyceride (52.2% vs. 29.6%) were significantly higher in Iran. Fasting glucose >or=5.6mmol/L was higher in Australia (26% vs. 23%). Hypertension was no different ( approximately 38%). Pearson correlations between WC and other MS components were stronger in Australians: FPG (0.32 vs. 0.2), HDL (0.47 vs. 0.16), TG (0.38 vs. 0.30) and SBP (0.38 vs. 0.36). Among women, area under ROC curve for WC as a predictor for diabetes was significantly higher for Australians (0.76 vs. 0.68, p<0.001) with no difference among men (0.69 vs. 0.71, p=0.4)., Conclusion: WC was more strongly related to other components of MS in Australia. Association between WC and MS or incident diabetes varies between ethnicities.

Objective: To examine the association between dietary patterns and obesity indices (BMI, WC, WHR) among Tehranian adults in a 6-year follow-up study., Methods: Within frame of a cohort study in Tehran (mean follow up 6.6+/-0.9 years), 141 adults were recruited with: two 24 hour dietary recalls at the beginning, as well as obesity indices at the beginning and end of the study period. Dietary intakes were converted into grams of intakes of food items and categorized into 16 groups. Reduced rank regression analysis derived five patterns with total and polyunsaturated-to-saturated fat intake, cholesterol, fiber and calcium intake as response variables. Factors (dietary patterns) were generated retaining a corresponding factor loading > or = |0.17| on the food groups. Changes in obesity indices were scrutinized within quintiles of factor scores., Results: There were high loadings on refined carbohydrates, whole grain, starchy vegetables, other vegetables, red and refined meat, saturated/trans fat, and egg for the first factor named "traditional". All obesity indices had increasing trend across quintiles of pattern score. The fifth pattern (namely egg pattern) had high loading for eggs, salty snacks, as well as fruits and dry fruits, and negative loadings for red and processed meat, saturated and trans fat, plant oils, and dairy products. This pattern showed increasing trends for WC and WHR after adjustment for potential confounders. Other patterns showed non-significant trends for obesity indices., Conclusions: The results were indicative of a traditional pattern which is dominated in the Tehran region and associated with increase in obesity indices.

Background: Considering the increasing trend of obesity reported in current data, this study was conducted to examine trends of obesity and abdominal obesity among Tehranian adults during a median follow-up of 6.6 years., Methods: Height and weight of 4,402 adults, aged 20 years and over, participants of the Tehran Lipid and Glucose Study (TLGS), were measured in 1999-2001(phase I) and again in 2002-2005(phase II) and 2006-2008 (phase III). Criteria used for obesity and abdominal obesity defined body mass index (BMI) >or= 30 and waist circumference >or= 94/80 cm for men/women respectively. Subjects were divided into 10-year groups and the prevalence of obesity was compared across sex and age groups., Results: The prevalence of obesity was 15.8, 18.6 and 21% in men and 31.5, 37.7 and 38.6% in women in phases I, II and III respectively (p < 0.001). The prevalence of abdominal obesity in men was 36.5, 57.2 and 63.3% and in women was 76.7, 83.8 and 83.6% in the three periods mentioned (p < 0.001). Men aged between 20-29 years had highest increase rates of obesity and abdominal obesity in phase III in comparison with phase I (with a respective rates of 2.2- and 3.3-fold). In both sexes, an increased trend was observed between phases I and II, whereas between phases II and III, this trend was observed in men, but not in women., Conclusion: This study demonstrates alarming rises in the prevalences of both obesity and abdominal obesity in both sexes especially in young men, calling for urgent action to educate people in lifestyle modifications.

The cost to developing countries, for current and future generations, of not eradicating hunger and poverty - in terms of recurrent conflicts and emergencies, widening inequalities, depleted resources, ill health, and premature death - is enormous. Although strategies are underway to address certain problems in Africa and the Middle East, much remains to be done. Breaking the poverty cycle in these regions demands both local and international attention. Nutrition transition is a key factor, since many countries in the region also suffer the consequences of the excessive and unbalanced diets that are typical of developed countries. This paper reviews the experiences with facing malnutrition in Sub-Saharan and North Africa and the Middle East.

Objective: To determine the nutritional behaviour of Tehranian adolescents., Subjects and Methods: This study was undertaken on 7669 adolescents (4070 boys and 3599 girls) of 22 junior high schools and high schools as a representative sample of Tehranian adolescents. A validated knowledge, attitudes and practices (KAP) questionnaire and a food-frequency questionnaire (FFQ) were used. Factor analysis was used to determine the key questions., Results: The mean ( +/- standard deviation) age and body mass index of the adolescents was 14 +/- 1 years and 27.2 +/- 11 kg m- 2. Although 82% of girls and 75% of boys had good nutritional knowledge, only 25% of boys and 15% of girls had good nutritional practice. Eighty-five per cent of adolescents knew that drinking too many soft beverages resulted in overweight or obesity, but only 4.5% of them did not drink soft beverages. Although 89% of adolescents knew that crisps and corn balls are not healthy snacks, 45% of them used such snacks during their break time. Thirty-seven per cent of adolescents preferred whole-grain biscuits to creamy wafer ones but only 10% of adolescents used whole-grain biscuits as a snack. The most frequently consumed snacks among Tehranian adolescents were sausage sandwiches, cocoa cola, crisps and corn balls, creamy wafers, cakes, chocolate and toffee., Conclusion: A low percentage of Tehranian adolescents have good nutritional behaviour and in most of them their nutritional practice does not accord with their nutritional knowledge. These results indicate the necessity of nutritional intervention in Tehranian adolescents.

The objective of the present study was to determine the effects of a long-term moderate-fat diet (30 % energy from fat) v. a low-fat one (20 % energy from fat) on metabolic risks. The study was a randomised, prospective 14-month trial on overweight and obese patients (eighty-nine overweight and obese men and women). The intervention was a moderate-fat diet (30 % energy) or a low-fat diet (20 % energy). The main outcome measurements were change in body weight, waist circumference, LDL-cholesterol, HDL-cholesterol, total cholesterol, TAG, and systolic and diastolic blood pressure. Forty-five subjects on the moderate-fat diet and forty-four subjects on the low-fat one were studied. Characteristics of all randomised participants were similar in both groups. After 7 months, the moderate- and low-fat diets had similar effects on cardiovascular risks. The moderate-fat diet was more successful after 14 months in reducing weight ( -5.0 (SD 2.5) kg in the moderate-fat group v. -1.2 (SD 1.1) kg in the low-fat one; P < 0.0001), waist circumference (-5.5 (SD 2.4) cm in the moderate-fat group v. - 2.3 (SD 1.3) cm in the low-fat one; P < 0.0001), and other cardiovascular risk factors as well (LDL, TAG, total cholesterol and systolic blood pressure). In conclusion, a moderate-fat energy-restricted diet in the long term might have more beneficial effects on weight maintenance and cardiovascular risk factors compared with a low-fat diet. Better dietary adherence with the moderate-fat diet may be the reason for its successful effects.

In this study the association between beta3-adrenoceptor gene polymorphism and serum concentration of leptin with body mass index (BMI) is investigated. Using subjects in the Tehran Lipid and Glucose Study, genotyping of the Trp64Arg polymorphism of the beta3-adrenoreceptor gene was performed using a restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) technique was used and the association with obesity was investigated. At total of 197 men and 204 women were divided into four groups (BMI<20, 20< or =BMI<25, 25< or =BMI<30, BMI< or =30) and 97, 98, 104 and 102 subjects, respectively, were placed randomly in the four groups. Leptin level was determined by an enzyme immunoassay (EIA) method and FBS, HDL-C, triglyceride and total cholesterol levels were determined by an enzyme colorimetric method. Body mass index (BMI) was also measured. The A (Arg) allele frequency was 0.08 among the population and its presence was significantly associated with increase of leptin level (AA/TA, 30.5+/-24.8 ng/mL; TT, 22.6+/-20.9 ng/mL; P=0.014) but there was no significant association with increased BMI (AA/TA, 27+/-5.6 kg/m2; TT, 25.4+/-5.5 kg/m2; P=0.072). These data show that the presence of the Arg64 allele at the beta3-adenoceptor gene locus is related to increase in leptin level in this population, but is not related to body mass index.

Aim: To evaluate the relationship between dietary diversity score (DDS) and cardiovascular risk factors in Tehranian adults., Methods: In this population-based cross-sectional study, a representative sample of 581 subjects (295 males and 286 females) aged over 18 years, residents of Tehran, participated. Hypercholesterolaemia, hypertriglyceridaemia and low high-density lipoprotein cholesterol were defined according to the Adult Treatment Panel III guidelines of the National Cholesterol Education Program. Diabetes was defined as fasting plasma glucose concentration > or = 126 mg dl(-1) or 2-h post challenge glucose concentration > or = 200 mg dl(-1). Hypertension was defined on the basis of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Dietary diversity was defined according to the Diet Quality Index revised., Results: Mean (+/- standard deviation) DDS was 6.15 +/- 1.02. The probability of having diabetes (odds ratio (OR) among quartiles: 1.45, 1.26, 1.11 and 1.00, respectively; P for trend = 0.04) and hypertriglyceridaemia (OR = 1.41, 1.23, 1.05 and 1.00, respectively; P for trend=0.04) decreased with increasing quartile of the diversity score for whole grains. The probability of having obesity (OR among quartiles: 1.39, 1.06, 1.03 and 1.00, respectively; P for trend = 0.03), hypercholesterolaemia (OR = 1.46, 1.28, 1.11 and 1.00, respectively; P for trend = 0.03), hypertension (OR = 1.32, 1.17, 1.13 and 1.00, respectively; P for trend = 0.03) and high low-density lipoprotein cholesterol (LDL-C) (OR = 1.25, 1.12, 1.07 and 1.00, respectively; P for trend = 0.04) decreased with increasing quartile of the diversity score for vegetables. The probability of having hypercholesterolaemia, high LDL-C, hypertension and diabetes decreased with quartile of the DDS. But the probability of being obese increased with quartile of the DDS (P for trend = 0.03)., Conclusion: DDS was inversely associated with cardiovascular risk factors in this cross-sectional study. Increased diversity scores of diets, to increase the variety score for vegetables, may be emphasised in programmes attempting to bring about changes in lifestyle.

Background: It remains unknown whether the hypertriglyceridemic waist (HW) phenotype, an appropriate screening tool in adults, can also be used to screen for metabolic abnormalities in adolescents., Objective: We aimed to evaluate metabolic risk factors identified by the HW phenotype in adolescents., Design: Anthropometric and biochemical measurements were assessed in a population-based cross-sectional study of 1413 male and 1623 female Iranian adolescents aged 10-19 y. The HW phenotype was defined as serum triacylglycerol concentrations > or = 110 mg/dL and concurrent waist circumference > or = 90th percentile for age and sex. Elevated fasting glucose (> or = 110 mg/dL), high LDL (> or = 130 mg/dL) and low HDL (< or = 40 mg/dL) cholesterol, hypercholesterolemia (total cholesterol > or = 200 mg/dL), and hypertension (systolic or diastolic blood pressure > or = 95th percentile for age, sex, and height) were considered as risk factors., Results: Adolescents with the HW phenotype had significantly higher prevalences of all metabolic risk factors except elevated fasting glucose than did those without the HW phenotype. After control for potential confounding variables, adolescents with the HW phenotype were significantly more likely to have high LDL cholesterol (odds ratio: 1.8; 95% CI: 1.3, 2.7), low HDL cholesterol (1.6; 1.3, 2.0), hypercholesterolemia (2.9; 2.0, 4.2), and > or = 1 (1.4; 1.1, 1.7) and > or = 2 (2.2; 1.6, 3.0) risk factors than were those without the HW phenotype. The HW phenotype had a significantly higher percentage of correct prediction of metabolic abnormalities than did overweight, elevated triacylglycerol concentration, or enlarged waist circumference., Conclusion: This study shows a clustering of metabolic abnormalities in adolescents with the HW phenotype and suggests this phenotype as a simple marker for identifying adolescents at risk of metabolic syndrome and other metabolic abnormalities.

Human studies investigating the relationship between macronutrients intake and obesity, have failed to achieve consistent findings. This study was undertaken to assess the relationship between macronutrients intake and body mass index in a group of Tehranians. From 15,005 participants of the Tehran Lipid and Glucose Study, 1290 subjects aged over 10 years (565 males and 725 females) were selected randomly for dietary survey. Anthropometric indices were measured according to standard protocols and BMI was calculated. Dietary data were collected by trained interviewers using two non-consecutive 24-hour dietary recalls. Data on smoking habits, educational level and physical activity were compiled. Under- and over-reporting of energy intake were defined as EI: BMR < 1.35 and > or = 2.4, respectively. Calorie-adjusted amounts of macronutrients were calculated by the residual method, following which energy intakes from all calorie-adjusted macronutrients were simultaneously included in the multiple regression models controlling for age, physical activity, educational level and smoking and mutual effects of macronutrients. Total energy intake was not included to avoid collinearity. BMI increased with age in either gender. Controlling for confounding variables, energy intake from fat was positively associated with BMI in males in the 10-18, 19-24, 25-50 and 51+ year age categories (beta = 0.06, 0.13, 0.33, 0.48, P<0.05 for all, respectively) and females in the 19-24, 25-50 and 51+ age categories (beta = 0.17, 0.43, 0.52, P<0.05 for all, respectively). This relationship remained after excluding misreporters (beta = 0.06, 0.15, 0.36, 0.50 for males and beta = 0.21, 0.46, 0.54 for females in the corresponding age categories, respectively). The correlation of fat intake to BMI was not significant in younger females (10-18 year). No association was seen between energy intake from protein and carbohydrate with BMI in subjects before and after exclusion of misreporters. In conclusion, energy from fat was found to be independently and positively associated with obesity in adults. No other association was observed between energy from protein and carbohydrate with BMI.

This study was conducted to evaluate the waist circumference (WC) cut-off points to predict cardiovascular risk factors in the overweight Tehranian population. Anthropometric measures, blood pressure, and biochemical analyses were evaluated for the 15,005 participants of the Tehran Lipid and Glucose Study. Three thousand sixty-five subjects aged 18-74 years with a body mass index of 25-29.9 were enrolled in this study. Abdominal obesity was defined as WC > or =102 cm for men and > or =88 cm for women. Sensitivity of WC > or =102 cm to detect various cardiovascular risk factors for men aged 35-54 years was between 5% and 14%, and for men aged 55-74 years, was between 12% and 19%. The specificity of this cut-off point was between 93% and 98% and between 86% and 96% for corresponding age-categories, respectively. WC > or =88 cm had a sensitivity of between 28% and 41 % for identifying cardiovascular risk factors in women aged 18-34 years. Sensitivity tended to increase with age and specificity tended to decrease with age in both genders. These cut-off points had the highest positive predictive value for the more prevalent risk factors in both genders. The negative predictive values were different for various risk factors among age groups. The classic cut-off points of WC failed to provide adequate evidence for the use of WC in detecting cardiovascular risk factors. Further studies should be conducted to determine optimal WC cut-off points for Iranians.

Aims: To determine the prevalence and associations of general and central obesity in adults residing in district 13 of Tehran and to examine the associations of obesity with certain factors., Design: Population-based cross sectional study., Setting: Tehran, the capital of Iran., Subjects: A total of 9984 subjects (4164 men and 5820 women) aged 20-70 years., Methods: Demographic data were collected and anthropometric indices including weight, height, and waist and hip circumference were measured, according to standard protocols. Dietary intake was assessed by means of two 24-hour dietary recall forms. To determine the prevalence and association of general and central obesity, the suggested cut-off for Tehranian people, adjusted for their age group, was used. A body mass index (BMI) of > or =24 for men and > or =25 for women was used to determine the characteristic of obesity. Central obesity was determined as a waist-hip ratio (WHR) of > 0.86 for men and WHR > or = 0.78 for women. To determine the associations between general and central obesity and other factors, logistic regression was used., Results: The means of BMI, waist circumference (WC), and WHR were 25.8 +/- 4.1 kg/m2, 88.3 +/- 11.4 cm, and 0.91 +/- 0.07 in men and 27.3 +/- 5.4 kg/m2, 87.5 +/- 12.9 cm, and 0.83 +/- 0.08 in women, respectively. Obesity and central obesity were higher in women than in men; 67% vs. 29% for obesity and 93% vs. 74.1% for central obesity, respectively. Illiteracy (OR = 1.65; 95% CI = 1.13-2.41 in men; OR = 1.87, 95% CI = 1.59-2.21 in women), marriage (OR = 3.84, 95% CI = 3.63-4.29 in men; OR = 3.20, 95% CI = 3.63-4.19 in women), and very low physical activity (OR = 1.35, 95% CI = 1.09-1.53 in men; OR = 1.39, 95% CI = 1.10-1.76 in women) were factors associated with obesity. The risk of being centrally obese for men in the fourth quartile of legumes intake was lower than men in other quartiles (p < 0.05). Women in the first quartile of dairy consumption had the highest risk of being generally and centrally obese (OR = 2.16, 95% CI = 1.72-2.48 for general obesity and OR = 3.01, 95% CI = 2.36-3.67 for central obesity). The risk of obesity for women in the fourth quartile of energy and saturated fatty acid consumption was higher than for those in the first quartile (OR = 2.69, 95% CI = 2.39-3.11 for energy and OR = 1.36, 95% CI= 1.10-1.64 for saturated fatty acids). The risk of being centrally obese was higher for women in the first quartile of protein intake compared with women in the fourth quartile (OR = 1.71, 95% CI = 1.02-2.32)., Conclusions: The results from this national population-based study in Iran show high prevalence of obesity in Tehranian adults. The strong associations between obesity and certain life style factors confirm the necessity of multifactorial intervention.

Background: This study was conducted to evaluate the relationship between waist-to-hip ratio (WHR) and cardiovascular risk factors in overweight and obese women and to determine a point of WHR above which the chances of having cardiovascular risk factors increased., Methods: In this cross-sectional study, 2892 pre- and postmenopausal women aged 20-78 years with body mass index (BMI) > or = 25 selected from among 5791 women of the Tehran Lipid and Glucose Study (TLGS) population (n = 15,005), by multistage cluster random sampling method, were included. Anthropometric indices were measured and BMI and WHR were calculated. Blood pressure was evaluated according to standard protocols. Biochemical indices were measured in the fasting state. Subjects were placed into the high-risk categories for cardiovascular disease on the basis of population-defined norms. Women were divided into quartiles based on their WHR: quartile 1: < 0.78, quartile 2: 0.78- < 0.83, quartile 3: 0.83- < 0.88, quartile 4: > or = 0.88 for premenopausal women, and quartile 1: < 0.84, quartile 2: 0.84- < 0.9, quartile 3: 0.9- < 0.94 and quartile 4: > or = 0.94 for postmenopausal women., Results: A lower proportion of pre- and postmenopausal women with BMI > or = 35 were in quartile 1 and a higher proportion in quartile 4. A significant increasing trend was observed for odds ratio of having low HDL-C, high triglyceride, high total-/HDL-cholesterol and high fasting blood sugar (FBS) with increasing WHR. Controlling for BMI and simultaneously adjusting for confounding variables had no effect on this trend. Although no significant increasing trends were seen for having high total cholesterol, LDL-cholesterol, systolic and diastolic blood pressure with quartiles of WHR in both pre- and postmenopausal women, subjects with higher quartiles of WHR still had higher chances for having high total cholesterol. In the case of postmenopausal women having of higher odds for high LDL-cholesterol and high systolic blood pressure in the fourth quartile of WHR should also be added to the high total cholesterol., Conclusion: The results showed that in overweight and obese women, chances of having cardiovascular risk factors increased with WHR > or = 0.78 for premenopausal and with WHR > or = 0.84 for postmenopausal women.

Aims: Recent estimates show the prevalence of obesity to be increasing at alarming rates. This study was conducted to examine trends of prevalence in overweight, obesity and central fat accumulation among Tehranian adults between 1998 and 2002., Methods: Height and weight of 2,102 adults, aged 20-80 years, participants of the Tehran Lipid and Glucose Study, were measured in 1998-1999 and remeasured in 2001-2002, after 3 years. Criteria used to state prevalence of overweight and obesity were body mass index (BMI) 25-29.9 and > or =30, respectively. Central fat accumulation was defined as waist-hip ratio (WHR) > or =0.8 in women and > or =0.9 in men. Individuals were divided into 10-year groups and the prevalence of obesity was compared according to sex and age., Results: In 1998-1999 and 2001-2002, mean BMI was 26.1 +/- 4.1 and 26.7 +/- 4.1 kg/m(2) in men (p < 0.001) and 27.8 +/- 4.9 and 28.7 +/- 5.9 kg/m(2) in women (p < 0.001), respectively. Mean WHR in women was 0.84 +/- 0.08 in 1998-1999 and 0.88 +/- 0.08 in 2001-2002 (p < 0.001). The prevalence of overweight in men was 42.5 and 46% and 40 and 39.5% in women in the two mentioned periods. The prevalence of obesity was 32.7 and 40.3% in men and 16.5 and 20.8% in women in 1998-1999 and 2001-2002 respectively. In both sexes the fastest increasing trends in obesity and central fat accumulation were seen in the 30- to 40- and 20- to 30-year-old age groups. Comparison of the 50th percentile of BMI in all age groups showed a significant increase in 2001-2002 as compared to 1998-1999 (p < 0.01)., Conclusion: The findings demonstrate significant rises in the prevalence of both total and central fat accumulation, calling for urgent action to educate people in lifestyle modifications., (Copyright 2005 S. Karger AG, Basel.)

Background: It is essential to identify the best anthropometric index in any population to predict chronic disease risk., Objective: To compare the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) to predict cardiovascular risk factors in an urban adult population of Tehranian men., Design: Population-based cross-sectional study., Subjects: A representative sample of 4,449 men aged 18-74 y, participants of the Tehran Lipid and Glucose Study, Methods: Demographic data were collected; anthropometric indices and blood pressure were measured according to standard protocol. In the 18-34 y age category, cutoff points for BMI, WHpR, WHtR and WC were 24 kg/m(2), 0.86, 0.47 and 81 cm, respectively. In the 35-54 y age category these cut points were 26 kg/m(2), 0.91, 0.52 and 89 cm, and in the 55-74 y age category 26 kg/m(2), 0.95, 0.54 and 91 cm, respectively. Hypertension was defined based on JNC VI. Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose > or =126 mg/dl or 2hPG > or =200 mg/dl and dyslipidemia based on ATP III. The presence of 'at least one risk factor' from the three major cardiovascular risk factors (hypertension, dyslipidemia and diabetes) was also evaluated., Results: Mean age of men was 41.8+/-15.4 y. Mean BMI, WHpR, WC and WHtR for subjects were 25.6+/-4.2 kg/m(2), 0.91+/-0.07, 87.7+/-11.7 cm and 0.51+/-0.02, respectively. Dyslipidemia and 'at least one risk factor' are more prevalent risk categories. Although all anthropometric indicators had a significant association to cardiovascular risk factors, WHpR had the highest correlation coefficients compared to other anthropometric measures. For all risk factors in all age categories, the highest odds ratios were pertained to WHpR. Of the four individual indicators, WHpR had the highest sensitivity, specificity and accuracy to predict cardiovascular risk factors. Cutoff points for WHpR were seen to have a higher percentage of correct prediction than BMI, WC and WHtR in all age categories., Conclusion: It is concluded that WHpR is a better predictor for cardiovascular risk factors than BMI, WC and WHtR in Tehranian adult men.

Objective: This study was conducted to determine the energy intake of adult residents of district 13 of Tehran and compare the results with their energy requirements., Design: In this cross-sectional study, 403 subjects were selected by random sampling, including 145 men and 151 women aged 25-50 years and 57 men and 50 women over 50 years old in the framework of Tehran Lipid and Glucose Study (TLGS)., Measurements: Height, body weight, waist and hip circumferences were measured, and the body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Mean energy requirements for each sex-age group were estimated by multiplying specific coefficients (allocated to each group) by body weight and resting energy expenditure (REE), and the results of both methods were compared with mean energy values recommended by Food and Agriculture Organization (FAO)/World Health Organization (WHO) and the U.S. recommended dietary allowance (RDA). Dietary assessment was performed by 48-hour diet recall. A ratio of energy intake to basal metabolic rate lower than 1.27 was considered as under-reporting. Physical activity was evaluated by standard questionnaire of the Lipid Research Clinics (LRC)., Results: Women were significantly more overweight and obese than men (p < 0.001) and older women were more obese than younger ones (p < 0.05). Only one-third of the study population had adequate physical activity. Women had significantly lower physical activity than men (p < 0.01). Energy requirements for both age and sex groups were lower than recommended daily allowances for energy: men 25-50; 2576 vs. 2900; men > 50: 2155 vs. 2300; women 20-50: 2045 vs. 2200 and women > 50: 1817 vs. 1900 kilocalories (kcal). Reported energy intake of men was higher and that of women was lower than the RDA. Forty percent of women and 14% of men under-reported their energy intake., Conclusion: The energy requirement of the average Tehranian is lower than daily allowances; conditions of obesity and overweight are more prevalent in women. There is high frequency of under-reporting of energy intake in women. Lifestyle modifications to improve dietary habits and to increase physical activity are recommended to decrease overweight and obesity in urban population of Tehran.

Background and Aim: In order to investigate gender differences in health indices, dietary intakes and obesity in urban Iranian adults, we considered a sub-sample of the adult population of the Tehran Lipid and Glucose Study., Methods and Results: The randomly selected sub-sample consisted of 483 subjects aged 25-50 years (229 men and 254 women) and 153 aged more than 50 years (81 men and 72 women). Their anthropometrical variables were recorded, and their body mass index (BMI) and waist/hip ratio were calculated. Dietary intake was assessed by means of two-day dietary recall and the completion of dietary habit questionnaires during face-to-face interviews. Underreporting was defined as a ratio of energy intake (EI)/basal metabolic rate (BMR) < 1.27. The mean BMI of the women in both age groups was significantly higher than that of the men (p < 0.05). Central obesity was more frequent in the women and among older subjects. The women had higher plasma concentrations of high-density lipoprotein cholesterol, but lower levels of total and low-density lipoprotein cholesterol. Underreporting of EI was more frequent in the women than the men: 34.0% vs 15.4% in the younger group, and 40.3% vs 17.3% in the older group (p < 0.01). There were major gender differences in the mean daily intakes of energy, protein, carbohydrate, fat, fibre, cholesterol, iron, calcium and phosphorus. A higher proportion of women met the cholesterol intake guidelines. Data from the dietary habit questionnaires showed that more men than women usually sprinkle salt on their food., Conclusions: The results of this study partially support the hypothesis of gender differences in dietary intakes, and the prevalence of obesity and some health-related indices, and suggest the need for gender-specific, targeted nutrition messages and behavioural interventions in developing prevention strategies for cardiovascular risk factors.

Objective: To clarify the hypothesis that parent's dietary intakes are associated with their offspring's body mass index., Design: Observational analytical cross-sectional survey among inhabitants of district 13 in the east of Tehran., Subjects: A total of 117 healthy families comprising 474 subjects including 240 offspring (3-25 y old)., Measurements: Weight and height were measured by a standard protocol and body mass index (kg/m(2)) was calculated. Dietary intakes were assessed by means of a 2 day dietary recall questionnaire., Results: The prevalence of overweight was 11.8% in offspring of normal-weight parents, 19.0% in offspring of overweight fathers and normal-weight mothers, 25.4% in offspring of overweight mothers and normal-weight fathers and 40.8% in offspring with both parents overweight. The Offspring's overweight was significantly and independently associated with high-energy intake of both parents (odds ratio; 95% CI 2.7; 1.6-4.5). Adjusted for the sex of parents, the chances of offspring being overweight were higher in overweight (3.8; 1.5-9.2) and high-energy-intake mothers (2.6; 1.2-5.6) and high-energy-intake fathers (2.0; 1.1-3.9) as compared with children of normal-weight parents. High fat intake of husbands was an independent risk factor increasing the chances of their wives being overweight (2.1; 1.5-3.6) and vice versa (1.8; 1.2-2.8)., Conclusion: The observed familial obesity pattern was shown to be associated with the familial dietary intakes. Hence, familial intervention seems essential to stop the accelerated rise in the prevalence of overweight and obesity in our community.

Objective: To study the prevalence of overweight and obesity in an adolescent population in Tehran and to determine possible association with energy and nutrient intake and distribution of energy over the day., Method: A cross-sectional study on 177 boys and 244 girls between 10-19 years old was performed. Overweight and obesity were defined by using recommended body mass index (BMI) cut-off values for adolescents. Total energy intake, percent of energy derived from protein, carbohydrate and fat and percent of energy supplied by each meal and snack were assessed by means of two 24-hour dietary recalls., Results: Prevalence of overweight and obesity was 10.7 and 5.1 in boys and 18.4 and 2.8 in girls, respectively. The composition of diet was not different between overweight/obese and normal weight subjects. BMI was related with breakfast energy percentage in girls (r = -0.18, p < 0.01), with total energy intake in boys (r = 0.23, p < 0.01), and with lunch energy percentage in both sexes. In boys (r = 0.16, p < 0.05) and in girls (r = 0.22, p < 0.01)., Conclusion: High prevalence of overweight and obesity among adolescents was seen. In boys some relationship between total energy intake, distribution of energy over the day and BMI was seen. In girls BMI was only related with distribution of energy over the day.

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 (beta = 0.41, R[superscript 2] = 0.22, P less than 0.001) among overweight/obese individuals. Alterations in waist circumference was better predicted by increased WDP score (beta = 0.49, R[superscript 2] = 0.21, P less than 0.01) than by increased HDP score (beta = -0.20, R[superscript 2] = 0.11, P less than 0.05). Subjects in the higher quartile of increased HDP score had lesser change in waist-to-hip ratio (beta = -0.77, R[superscript 2] = 0.43, P less than 0.01). Conclusions and Implications: Results of this study indicate that increased adherence to the WDP and decreased adherence to the HDP could contribute to obesity. (Contains 2 figures and 4 tables.)

Abstract 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.