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Summary: Background: Current evidence available on the association between Dietary Approach to Stop Hypertension (DASH) diet and cardiovascular risk in adolescents is controversial. Objective: The aim of the present study was to assess the association between DASH diet and cardiovascular risk factors after 3 years of follow‐up among Tehranian adolescents. Methods: A population‐based cohort study was conducted on 628 subjects, aged 10–18 years, selected from among participants of the Tehran Lipid and Glucose Study. The DASH score was determined on the basis of eight components using a valid and reliable food‐frequency questionnaire at baseline. Anthropometric and lipid profile data were measured at baseline and after a 3‐year follow‐up. Results: Mean (SD) age of the study population (46.6% men) was 14.1 (2.5) years. After adjustment for potential confounding variables, including sex, age, physical activity and total calorie intake, the risk of general obesity (OR = 0.26, 95%CI: 0.15–0.76) and central obesity (OR = 0.32, 95%CI: 0.14–0.84) in the highest quintile of DASH score were significantly lower than in subjects in the lowest quintile. However, DASH score was not associated with risk of incident dyslipidaemia in our study (OR = 0.81, 95%CI: 0.30–1.82). The higher DASH score was inversely associated with 3‐year changes in body mass index and waist circumference during the study period (P for trend <0.05). However, there was no significant association between the higher score of this diet with 3‐year changes in lipid profiles. Conclusion: Adherence to the DASH diet was associated with decreased risk of central and general obesity, whereas higher DASH diet score was not associated with risk of dyslipidaemia in adolescents. [ABSTRACT FROM AUTHOR]

Objective: Considering the role of anti-Müllerian hormone (AMH) in female fertility and its high levels in women with polycystic ovary syndrome (PCOS), the longer reproductive span of these women is in doubt. In the present study, we aimed to improve earlier predictions using a non-linear model to substantiate the question as to whether PCOS women reach menopause later.Methods: In total, 1162 women aged 20-50 years, comprising 378 PCOS cases and 784 eumenorrheic non-hirsute women, met the eligibility criteria. A scatterplot matrix was drawn to detect the association between age and AMH; this association was explored using a fractional polynomial regression model. Model assumptions were checked by examining the distribution of the residuals and plotting the standardized residuals against the functional form of AMH.Results: The serum concentration of AMH among PCOS participants was significantly higher than in the controls (5.4 ng/ml (IQR 2.8-9.1 ng/ml) vs. 1.4 ng/ml (IQR 0.6-2.7 ng/ml), p < 0.001). The estimated mean age at menopause was 51.4 (95% CI 45-59) years and 49.7 (95% CI 45-55) years in PCOS cases and healthy controls, respectively.Conclusions: These findings provide the insight that, as reflected through significantly higher average levels of AMH in PCOS women, their predicted reproductive lifespan could be 2 years longer than their normo-ovulatory counterparts. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is frequently accompanied by insulin resistance (IR). The aim of the present study was to investigate whether the genetic association between insulin resistance and two single nucleotide polymorphisms (SNPs), namely rs7903146 (C/T) in transcription factor 7-like 2 (TCF7L2) and rs1111875 (A/G) in haematopoietically expressed homeobox (HHEX), is affected by PCOS status in Iranian women. The study participants consisted of 582 women with PCOS (cases) referred to the Reproductive Endocrinology Research Center and 504 subjects without PCOS (controls), randomly selected from the Tehran Lipid and Glucose Study. Cases and controls were further subdivided to two groups according to IR status: those with and without IR. IR was identified on the basis of homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.63. The SNPs in TCF7L2 and HHEX were genotyped by polymerase chain reaction-restriction fragment length polymorphism. There were no significant differences in the distribution of genotypes and alleles between cases and controls (P<0.05). Among cases, the prevalence of the CC, CT and TT genotypes was 37.8%, 46.3% and 15.9%, respectively, whereas the prevalence of the AA, AG and GG genotypes was 13.5%, 46.1% and 40.4%, respectively. In the control grouP< the prevalence of the CC, CT and TT genotypes was 32.2%, 53.9% and 13.9%, respectively, whereas the prevalence of the AA, AG and GG genotypes was 11.3%, 48.6% and 40.0%, respectively. After adjustment for age and body mass index, the probability of IR was decreased by 49% among carriers of the A allele in the control group (95% confidence interval 0.33-0.78; P=0.002). The findings of the present study suggest that the association between IR and diabetogenic polymorphisms may be affected by PCOS status. [ABSTRACT FROM AUTHOR]

Aims To examine the incidence of and risk factors for insulin resistance and β-cell dysfunction in a representative Iranian population over a median follow-up of 9.2 years. Methods In total, 3662 people (1528 men) without known diabetes with a baseline homeostasis model assessment of insulin resistance ( HOMA- IR) level < 75th percentile and, when β-cell dysfunction was the outcome of interest, 3664 people (1530 men) with a homeostasis model assessment of β-cell function (HOMA-β) level ≥ 25th percentile were included in the study ( HOMA- IR < 2.20 and HOMA-β ≥ 64.3 among men, and HOMA- IR < 2.39 and HOMA-β ≥ 81.7 among women). Results The incidence rates of insulin resistance and β-cell dysfunction were 56.3 and 33.6/1000 person-years among men and 48.6 and 50.3/1000 person-years among women, respectively. Applying multivariable Cox regression in both sexes, fasting insulin, triglyceride/ HDL cholesterol ratio and lower education were positive predictors of insulin resistance, whereas age was a negative predictor. Moreover, fasting plasma glucose, waist-to-height ratio, wrist circumference and lower hip circumference were significantly associated with incident insulin resistance only among women (all P < 0.05). Considering β-cell dysfunction in both sexes, age and fasting plasma glucose increased the risk, whereas 2-h post-challenge plasma glucose was a positive predictor only among men, and waist-to-height ratio and triglyceride/ HDL cholesterol ratio were negative predictors only among women (all P < 0.05). Conclusions Modifiable risk factors are related to the incidence of insulin resistance and β-cell dysfunction, which can be prevented with proper strategies although the difference between men and women should be taken into account. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between age-specific anti-Müllerian hormone level, as a predictor of ovarian reserve status, and electrocardiographic silent coronary artery disease in a population-based, prospective cohort, the Tehran Lipid and Glucose Study.Methods: For the present study, 1015 reproductive-aged participants in the Tehran Lipid and Glucose Study met our eligibility criteria. According to the Whitehall criteria, silent coronary artery disease was defined as an electrocardiogram showing possible or probable coronary heart disease using Minnesota codes. By excluding those with a history of coronary heart disease and silent coronary artery disease at the initiation of the study (n = 49), there were 108 events of silent coronary artery disease at electrocardiograms among 752 women followed for 9.5 ± 0.9 years (missing data: n = 214); the association between this outcome with age-specific anti-Müllerian hormone levels was explored after adjustment for confounding variables using logistic regression analysis. Cardiovascular disease risk scores were assessed for all participants using the guidelines of the American College of Cardiology and the American Heart Association.Results: There were 108 events of silent coronary artery disease over the 10-year follow-up. Logistic regression analysis, considering age-specific anti-Müllerian hormone and atherosclerotic cardiovascular disease risk score as independent variables, revealed an odds ratio of 1.146 (95% confidence interval 1.008-1.303) for cardiovascular disease risk score (p = 0.038) and odds ratio of 1.002 (95% confidence interval 0.996-1.009) for age-specific anti-Müllerian hormone (p = 0.526).Conclusion: No association has been found between age-specific anti-Müllerian hormone levels and events of silent coronary artery disease in a 10-year follow-up of reproductive-aged women. [ABSTRACT FROM AUTHOR]

Study Question: Is polycystic ovary morphology (PCOM) associated with metabolic syndrome (MS), insulin resistance (IR) and dyslipidemia?Summary Answer: No associations between PCOM and metabolic disorders were found.What Is Known Already: Polycystic ovary morphology has a prevalence of 21-63% in healthy women of reproductive age. Results of studies focusing on metabolic abnormalities among females with PCOM, are insufficient and controversial.Study Design, Size, Duration: This was a cross-sectional population-based study from five provinces in Iran. A standard questionnaire was filled out during face-to-face interviews and clinical examinations were done. All study subjects were invited to undergo blood sampling and ultrasonographic assessment.Participants/materials, Setting, Methods: From a total of 1772 women, 809 participants met the inclusion criteria of this study, i.e. non-pregnant, reproductive-age, ovulatory, normo-androgenic, without hyperprolactinemia/thyroid dysfunction. Participants were divided into two groups; 126 women with PCOM on ultrasound assessment, as the case and 683 women with normal ovarian morphology, as the control groups. The association of PCOM with MS, IR and dyslipidemia were analyzed using logistic regression models, adjusted for confounding variables.Main Results and the Role Of Chance: Mean systolic blood pressure (SBP), high density lipoprotein (HDL) and androstenedione (A4) serum levels of women with PCOM were significantly higher than in the normal group (P = 0.04, 0.05 and 0.008, respectively). Comparison between groups revealed dyslipidemia to be higher among controls. However the results of logistic regression models, after adjustment for possible confounding variables showed that there were no significant association between prevalence of MS, IR and dyslipidemia with PCOM.Limitations, Reasons For Caution: Due to the study being cross-sectional, blood samples were collected only once thus we did not measure serum concentrations of progesterone in the luteal phase, which determines subclinical anovulation. Moreover, due to budget limitations, enzyme immunoassay was used for androgenic measurements while mass spectrometry-based assays have been known as the gold standard method. However we defined our groups very strictly to overcome these limitations.Wider Implications Of the Findings: It seems that biochemical and metabolic characteristics of women with PCOM do not differ significantly to those of normal women. To clarify the association between PCOM and metabolic characteristics, longitudinal studies investigating long-term metabolic disorders among women with PCOM are highly recommended.Study Funding/competing Interest: No external funding was used for this study. No conflicts of interest are declared. [ABSTRACT FROM AUTHOR]

Background/objectives: We aimed to investigate the associations of colors of fruit and vegetable (FV) subgroups, with 3-year changes of cardiometabolic risk factors.Subjects/methods: This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study, between 2006-2008 and 2009-2011, on 1272 adults. Total intake of FV and their subgroups have been assessed by a validated semi-quantitative food frequency questionnaire at baseline (2006-2008) and again at the second examination (2009-2011). Demographics, anthropometrics and biochemical measures were evaluated at baseline and 3 years later. The associations of anthropometric and lipid profile changes with FV subgroups were estimated.Results: The mean age of men and women at baseline was 39.8±12.7 and 37.3±12.1 years, respectively. Mean total intake of FV, red/purple, yellow, green, orange and white FV was 706±337, 185±95, 141±91, 152±77, 141±87 and 22±18 g/day, respectively. In men, 3-year changes of weight (β=-0.13, P=0.01) and waist circumference (β=-0.14, P=0.01) were related to intake of red/purple FV; the yellow group was inversely associated with 3-year changes of total cholesterol (β=-0.09, P=0.03) and High-density lipoprotein cholesterol (β=-0.11, P=0.03). Consumption of green and white FV was inversely related to abdominal fat gain, and atherogenic lipid parameters in men (P<0.05). In women, higher intake of red/purple FV was associated to lower weight and abdominal fat gain, fasting serum glucose and total cholesterol (P<0.05); yellow FV was also related to 3-year weight gain (β=-0.11, P=0.01).Conclusions: Various colors of FV subgroups had different effects on cardiometabolic risk factors; higher intake of red/purple FV may be related to lower weight and abdominal fat gain, and yellow, green and white FV may be related to lipid parameters. [ABSTRACT FROM AUTHOR]

Aims To examine the independent impacts of the homeostasis model assessment of insulin resistance ( HOMA- IR) and the updated model ( HOMA2- IR) on incident cardiovascular /coronary heart disease in a Middle Eastern population with a high prevalence of cardiovascular disease risk factors. Methods We examined 3777 Iranian people, aged ≥ 30 years, without history of cardiovascular disease and without use of antidiabetic medication at baseline. Both HOMA- IR and HOMA2- IR were log-transformed and categorized into quartiles. The multivariable Cox proportional hazard regression model, adjusted for traditional cardiovascular disease risk factors, was applied to examine the association between HOMA- IR/ HOMA2- IR with incident cardiovascular/coronary heart disease, considering the lowest quartile as reference. Results During a median follow-up of > 10 years, 197 cardiovascular disease and 181 coronary heart disease events occurred. Among the covariates, we found a significant interaction between hypertension and HOMA- IR/ HOMA2- IR for incident coronary heart/cardiovascular disease (all P ≤ 0.01). Among the population without hypertension, the risk of cardiovascular disease significantly increased in the second [hazard ratio 1.96 (95% CI 1.04-3.68)], third [hazard ratio 1.93 (95% CI 1.00-3.75)] and fourth [hazard ratio 2.34 (95% CI 1.15-4.75)] quartiles of HOMA- IR, and the risk of coronary heart disease increased significantly in the fourth quartile of HOMA- IR [hazard ratio 2.30 (95% CI 1.12-4.73)], but no significant association was detected between HOMA- IR and cardiovascular/coronary heart disease in the population with hypertension. Among the populations both with and without hypertension, no risk was found to be associated with HOMA2-IR quartiles however, a 1-unit increase in HOMA2- IR was associated with a significant risk of cardiovascular disease among the non-hypertensive group [hazard ratio 1.60 (95% CI 1.03-2.48); P = 0.03]. Conclusions The presence of hypertension modified the impact of HOMA- IR/ HOMA2- IR on incident cardiovascular/coronary heart disease. The presence of insulin resistance highlighted a significant and independent risk for cardiovascular disease/coronary heart disease only in the population without hypertension. [ABSTRACT FROM AUTHOR]

Background The present study aimed to determine whether total fibre or specific fibre food sources are associated with the incidence of the metabolic syndrome (MetS) after 3 years of follow-up in the Tehran Lipid and Glucose Study. Methods This population-based prospective study, conducted within the framework of the Tehran Lipid and Glucose Study, included 1582 adults, who were aged 19-84 years and free of MetS at baseline. Usual dietary fibre intake was assessed at baseline using a 168-item food frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipid profiles were measured at baseline and 3 years later. The MetS was defined according to the definition of the revised Adult treatment Panel III. Results During the 3-year follow-up, there was 15.2% incidence of MetS. Among sources of dietary fibre, fruit fibre was significantly and inversely associated with the occurrence of MetS, after adjustment for confounding factors, with a 21% lower risk [odds ratio ( OR) = 0.79, 95% confidence interval ( CI) = 0.60-0.97] in the highest tertile of intake compared to the lowest tertile. Subjects in the highest tertile of cereal fibre intake had lower odds of MetS compared to those in the lowest tertile ( OR = 0.73, 95% CI = 0.52- 0.97) and this association disappeared after adjustment for confounders. No significant association was found between intakes of vegetables, legumes and nut fibre with the incidence of MetS. Conclusions Among specific fibre food sources, fruit fibre had a protective effect against the risk of MetS. [ABSTRACT FROM AUTHOR]

Aims To examine the association of fasting insulin, insulin resistance and reduced β-cell function with incident Type 2 diabetes and pre-diabetes (isolated impaired fasting glucose/isolated impaired glucose tolerance and combined impaired fasting glucose/impaired glucose tolerance). Methods An Iranian population comprising 1532 men and 2221 women, aged ≥ 20 years, with normal fasting glucose and normal glucose tolerance at baseline, were enrolled in the study. Multivariable Cox proportional hazard models were used to calculate the hazard ratios and 95% CIs of fasting insulin, updated homeostasis model assessments of insulin resistance and β-cell function for incident Type 2 diabetes, isolated impaired fasting glucose, isolated impaired glucose tolerance and combined impaired fasting glucose/impaired glucose tolerance. Results During a median follow-up of 9.2 years, the annual incidence rates (95% CI) of diabetes were 3.73 (2.74-4.94) and 4.06 (3.21-5.06) per 1000 person-years in men and women, respectively. In both men and women, fasting insulin and homeostasis model assessment of insulin resistance (≥ 75th percentile) were significantly associated with incident diabetes and combined impaired fasting glucose/impaired glucose tolerance; however, reduced β-cell function as measured by homeostasis model assessment of β-cell function (< 25th percentile) was associated with incident isolated impaired fasting glucose solely in men [hazard ratio 1.35 (95% CI 1.02-1.78)] in multivariable analysis including waist-hip ratio). Hyperinsulinaemia, insulin resistance and β-cell dysfunction were not related to the incidence of isolated impaired glucose tolerance in either gender. Conclusions Fasting hyperinsulinaemia and insulin resistance were strong risk factors for progression to diabetes and combined impaired fasting glucose/impaired glucose tolerance in a population with normal fasting glucose/normal glucose tolerance. In addition, impaired β-cell function at baseline was related to the development of isolated impaired fasting glucose only in men and, in both men and women, neither insulin resistance nor β-cell dysfunction were associated with incident isolated impaired glucose tolerance. [ABSTRACT FROM AUTHOR]

Aims This study aimed to compare the diagnostic impact of four definitions of the metabolic syndrome for detection of poor health status in adults without diabetes living in Tehran. Methods A representative sample of 950 individuals (64% women), aged ≥ 20 years, participants of the Tehran Lipid and Glucose Study in 2005-2007, were recruited for the study. Health status was assessed using the Iranian version of the 36-item Short Form Health Survey. We assessed the detectability of poor health status by definitions of the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation, the American Heart Association/National Heart, Lung, and the Blood Institute and the Joint Interim Statement. Results Compared with other definitions, the Joint Interim Statement identified more participants (46.9%) having the metabolic syndrome. Using the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation and the Joint Interim Statement, the metabolic syndrome was significantly related to poor physical health status, even after adjustment for confounding variables, in women, but not in men. None of the four definitions of the metabolic syndrome was related to the mental health status in either gender. The receiver operating characteristic curves showed no significant difference in the discriminative power of the metabolic syndrome definitions in detecting poor health status in either gender. However, women showed a higher area under the curve for all definitions, in comparison with men. Conclusion There was no difference in the four different definitions of the metabolic syndrome in detecting poor health status among Iranian adults . [ABSTRACT FROM AUTHOR]

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 ( Met S) 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 Met S 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 Met S, national nutrition policies must be developed accordingly for the modification of dietary fatty acid intake with respect to causation and prevention. [ABSTRACT FROM AUTHOR]

Background Phytochemicals are natural non-nutritive bioactive compounds found in fruits, vegetables, whole grains, nuts and legumes, as well as other plant foods. In the present study, we assessed the dietary phytochemical index (PI) in relation to cardiometabolic risk factors among Iranian adults. Methods This cross-sectional study was conducted within the framework of third phase of Tehran Lipid and Glucose Study 2006-2008. For the present study, 2567 subjects aged 19-70 years (1129 men and 1438 women) were selected randomly. Dietary data were collected using a validated semi-quantitative food frequency questionnaire with 168 food items. The PI was calculated based on daily energy derived from phytochemical-rich foods. The odds ratios of abdominal obesity, impaired fasting glucose, hypertriglyceridaemia, low high-density lipoprotein-cholesterol and hypertension were assessed across PI quartile categories. Results The mean (SD) age of participants was 39.4 (13.2) years. Participants in the upper quartile of PI were older, and had a lower weight and waist circumference. The mean (SD) of the PI was 17.3 (5.6), 25.5 (6.4), 32.7 (8.3) and 42.8 (10.5) in the first, second, third and fourth quartiles, respectively. Compared with those in the lower quartile of PI, participants in the upper quartiles had a 66% lower risk of abdominal obesity [95% confidence interval ( CI) = 0.23-0.51] and a 36% lower risk of hypertriglyceridaemia (95% CI, 0.47-0.86), after adjustment for potential confounders. Conclusions Higher intakes of phytochemical-rich foods are associated with a lower risk of abdominal obesity and hypertriglyceridaemia as the main cardiometabolic risk factors. [ABSTRACT FROM AUTHOR]

What is already known about this subject Little is known about the predictive ability of anthropometric indices in adolescence for prediction of early adulthood metabolic syndrome ( MetS)., There are controversies about the predictive power of body mass index ( BMI) vs. waist circumference ( WC) for prediction of MetS in late adolescence; some of the studies did not support the need to measure WC in mid-adolescence, in addition to BMI; on the other hand, some other studies proposed either similar predictability or superiority of WC to identify MetS in late adolescence., What this study adds This is the first study to evaluate the adolescent anthropometric indices in relation to early adulthood MetS incidence one decade later in the Middle East region., There is an important sex difference regarding the incidence of MetS in Tehranian adolescents., It is interesting to know that all anthropometric indices in the pubertal age group (11-14 years) had better predictive ability compared to late-pubertal (15-18 years) adolescents., In addition, adolescent abdominal obesity surrogates, including WC and waist-to-height ratio, predicted adulthood MetS better than BMI in boys., It seems that WC had an independent role beyond BMI in identification of adulthood MetS in Tehranian boys (11-18 years old)., Background Little is known about the predictive ability of anthropometric indices in adolescence for prediction of early adulthood metabolic syndrome ( MetS). Objective Our purpose was to explore incidence of MetS and the optimal anthropometric indicator to predict early adulthood MetS in Tehranian adolescents. Methods Using data from the population-based, prospective, Tehran Lipid and Glucose Study, the utility of four anthropometric indices of adolescents in predicting early adulthood MetS (2009 Joint Scientific Statement definition) was examined among 1100 participants, aged 11-18 years, who were free of MetS at baseline, during a mean of 10.2 years of follow-up. Results The cumulative incidence of MetS was 25.5% (95% confidence interval [ CI]: 21.8-29.2%) for young men and 1.8% (95% CI: 0.6-3%) for young women. In boys, waist circumference ( WC) had the highest odds ratio ( OR) for the MetS risk, followed by waist-to-height ratio ( WHtR). Adjusting body mass index ( BMI) in addition to WC did not change the results in the 11-14-year age group ( OR for WC: 2.28 [1.64-3.16] without BMI adjustment vs. 1.98 [1.05-3.73] with BMI adjustment), suggesting that WC may predict MetS risk beyond BMI. None of the anthropometric indices were found to have significant associations with subsequent MetS risk in girls. Conclusions Measures of abdominal obesity including WHtR and WC predicted early adulthood MetS better than BMI in Tehranian male adolescents (11-18 years old). [ABSTRACT FROM AUTHOR]

Background Metabolic syndrome (MS) has an increased risk for developing cardiovascular disease (CVD); however, whether the concept of MS, applying the new joint interim statement definition, has a greater impact on incident CVD than its individual components is debated. Methods The authors related MS and its components to CVD incidence in 1856 men and 2392 women, Iranian adults aged ≥40 years, free of CVD at baseline, using Cox proportional hazards models. To examine whether MS would improve prediction of CVD beyond that achieved by its components; model fitness, discrimination and integrated discrimination improvement (IDI) statistics were used Results During a median follow-up of 8.6 years, there were 244 CVD events in men and 189 in women. MS resulted in HRs (95% CIs) of 1.97 (1.50 to 2.57) in men and 2.25 (1.57 to 3.21) in women after adjusting for CVD risk factors; in another model including all the five MS components, high blood pressure in both genders [men: 1.99 (1.48 to 2.67), women: 1.62 (1.14 to 2.30)), high waist circumference (≥94.5 cm) in men (1.47 (1.12 to 1.93)) and high fasting plasma glucose (FPG) in women (1.88 (1.39 to 2.55)) remained as independent predictors of CVD after adjusting for CVD risk factors. Adding the MS variable to this model did not yield any improvement in model fitness, C-statistic or significant IDI value Conclusion In the Middle East population, MS did not provide CVD predictive risk information beyond its individual components; clinical focus should remain on hypertension in both sexes, high FPG in women and central adiposity in men rather than MS. INSETS: What is already known on this subject;What this study adds. [ABSTRACT FROM AUTHOR]

Elevated blood pressure (BP) may lead to incident diabetes. However, data about the effect of different BP components on incident diabetes in Middle Eastern women is lacking. We evaluated systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP) as independent predictors of diabetes in Iranian women. We performed a population-based prospective study among 3028 non-diabetic women, aged 20 years. Odds ratios (ORs) of diabetes were calculated for every 1 s.d. increase in SBP, DBP, PP and MAP. During ≈6 years of follow-up, 220 women developed diabetes. There were significant interactions between family history of diabetes and SBP, PP and MAP (P0.01) in predicting incident diabetes. In women without a family history of diabetes, all BP components were significantly associated with diabetes in the age-adjusted model; the risk factor-adjusted ORs were significant (P<0.05) for SBP, PP and MAP (1.30, 1.34 and 1.27, respectively) with similar predictive ability (area under the receiver operating characteristic curve ≈83%). In women with family history of diabetes, in the age-adjusted model, SBP, DBP and MAP were associated with diabetes; in multivariable model, they were not independent predictors of diabetes. In conclusion, in women without family history of diabetes, SBP, PP and MAP, were independent predictors of diabetes with almost similar predictive ability; hence, in the evaluation of the risk of BP components for prediction of diabetes, the presence of family history of diabetes should be considered. [ABSTRACT FROM AUTHOR]

Background and Objective: Malnutrition in hospital increases the mortality of patients. The aim of this study was to investigate the prevalence of malnutrition and related risk factors in hospitalized patients. Materials and Methods: This descriptive study was carried out on 446 patients (217 males, 229 females) during 6 months, admitted to the Taleghani hospital in Tehran, Iran during 2005. Anthropometric measurements and previous admission to hospital in previous 6 months for each patient was recorded. Mild, moderate and severe malnutrition were considered as BMI=18-20 kg/m² and TSF, or MAMC<10th, or weight loss<5%; as BMI=16-18kg/m² and TSF, or MAMC<5th, or weight loss 5-10% and severe as BMI<16kg/m² and TSF, or MAMC<5th or weight loss>10% in previous 6 months respectively. Results: The prevalence rate of malnutrition as a general was 52% with following subdivision: 14%, 10% and 28% in mild, moderate and severe, respectively. The highest prevalence of malnutrition observed in gastrointestinal ward, males, those aged 18-29 year and patients with secondary and high school education. In malnourished patients, the prevalence of TSF, MAC and MAMC <5th were significantly more than of well-nourished subjects (P<0.05). Increase BMI per unit decreased the risk of malnutrition by 17% (OR: 0.83; CI: 0.79-0.87). Malnutrition was 64% higher in patients with 1⩾ gastrointestinal disturbances, compared with those without it and 2.1 higher in patients with 2⩾-hospitalized readmission, compared with subjects without readmission in previous 6 month. Odds ratio of at least one hospitalized admission in previous 6 month was 1.64 in patients with MAC <5th, compared with those with MAC 50-75th (P<0.017). Conclusion: This study showed that Malnutrition upon hospitalization is common in Tehran. BMI, gastrointestinal disturbances, and readmission were associated with malnutrition. [ABSTRACT FROM AUTHOR]

Diabet. Med. 28, 1330-1336 (2011) Abstract Aim To investigate the effects of height and hip circumference, individually and in combination with waist circumference, on incident diabetes. Methods A total of 1589 men and 2132 women, free of diabetes at baseline aged ≥ 20 years participated in a 6-year follow-up examination. The standard 2-h post-challenge plasma glucose test was performed at baseline and during follow-up. The Cox model was used to regress the hazard of diabetes on height and hip circumference individually and in combination with waist circumference. Results Median follow-up was 6 years, with a total of 9433 and 12 607 person-years follow-up among men and women, respectively. The incidence rate of diabetes (95% CIs) was 9.0 (7.6-11.5) and 11.0 (9.6-−13.4) per 1000 persons per year in men and women, respectively. Among men, after multiple adjustments, the anthropometric measures were no longer associated with incident diabetes. Among women, the age-adjusted hazard ratio (95% CIs) of diabetes was 0.80 (0.61-1.04) for height, 1.39 (1.21-1.60) for hip circumference and 1.86 (1.59-2.17) for waist circumference. After further adjustment for waist circumference, the hazard ratios were 0.69 (0.53-0.90) for height and 0.76 (0.61-0.96) for hip circumference. These inverse associations resisted multiple adjustments. The hazard ratio for waist circumference increased by 7 and 54% when height and hip circumference were included in the models. Conclusion We observed that height and hip circumference were inversely associated with incident diabetes among women and that these associations could be explored by considering the effect of waist circumference. The risk of diabetes attributable to waist circumference might be underestimated were the effects of height and hip circumference not considered. [ABSTRACT FROM AUTHOR]

Summary Objective Delivery of iodine to the foetus depends not only on maternal dietary iodine intake but also on the presence of a functioning placental transport system. A role for the placenta as an iodine storage organ has been suggested, and this study compares the iodine content of placentas from women giving birth at term in Ireland and Iran, areas with median urinary iodine of 79 and 206 μg/l respectively. Design Placental cotyledon iodine was measured using an alkaline ashing technique with Sandell-Kolthoff kinetic colorimetry. Samples were taken from six sites from the centre and periphery of each cotyledon. Placentas (Ireland n = 58; Iran n = 45) were obtained from consecutive euthyroid women delivering at term. Results The median placental iodine (μg/g wet weight) was significantly higher in Iranian than in Irish women (187·2 μg/g vs 34·3 μg/g; P < 0·001). The distribution of individual placental iodine values showed that values >50 μg/g were found in 71·0% of Iranian and in only 21·0% of Irish samples. In Irish subjects, the relationship of placental iodine to pregnant population urinary iodine (UI) (ng/g:μg/l) was 1:2 (40:79), while in Iranians this ratio is closer to 1:1 (211:206). Conclusions These findings, by demonstrating an apparent ability of the placenta to store iodine in a concentration-dependent manner, suggest a hitherto undetected role for the placenta. Whether placental iodine has a role in protecting the foetus from inadequacies in maternal dietary iodine intake is as yet unknown. [ABSTRACT FROM AUTHOR]

Aims: Medullary thyroid carcinoma accounts for 5-10% of total types of thyroid cancers. An important role of mutations in the RET proto-oncogene in MTC has been well identified. The purpose of this study was to determine the prevalence of seven common germ-line mutations of the RET proto-oncogene in exon 10 in Iranian MTC patients. Materials & Methods: This descriptive study was performed in year 2009-2010. The study population was 217 MTC patients and their first-degree relatives who were selected by simple sampling method. Genomic DNA content of peripheral blood was extracted according to standard salting out/Proteinase K method. Mutation detection in RET proto-oncogene in exon 10 was assessed through PCR-RFLP method. Results: In 217 individuals (Female: Male 1.4:1, mean age 33.4±15.8 years), 9 mutations were identified at codons 618 (7 mutations) and 620 (2 mutations) in RET proto-oncogene exon 10. The most common amino-acid change was Cys618Phe. In addition, no mutation was found in codon 611. Conclusion: The mutations frequency of the RET proto-oncogene in exon 10 is 6% in the studied population. Accordingly, existence of the common mutations in the RET proto-oncogene in all MTC patients and their families is recommended particularly in other exons (11, 12, 13, 14, 15, 16) with a direct DNA sequencing method. [ABSTRACT FROM AUTHOR]

Background/Objectives:To determine which component of the metabolic syndrome (MetS) is the best predictor of its development.Subjects/Methods:In this cohort study, 2279 subjects aged 20-87 years without MetS selected from among the participants of the cross-sectional phase of the Tehran Lipid and Glucose Study (TLGS) were followed up for development of MetS.Results:After a mean interval of 6.5 years, 462 and 602 new cases of MetS were diagnosed on the basis of the modified Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria, respectively. The adjusted odds ratio for development of MetS by ATP III criteria was highest for central obesity in men, 2.8 (2.2-3.7), and for triglycerides (TGs) in women, 2.8 (2.0-4.1). The adjusted odds ratio for the development of MetS by IDF criteria was highest for TGs in both men and women: odds ratio 2.8 (2.2-3.7) and 2.9 (1.9-4.3), respectively. A model that included waist circumference (WC) and TGs or WC and high-density lipoprotein (HDL) predicted MetS similar to a model that included all five MetS components.Conclusion:Screening for the timely prediction of the development of MetS should include measurement of WC, TGs and plasma HDL. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality pertaining to the various structural components and aspects of research articles published in Iranian journals of dentistry in the first six months of the year 2006. Methodology: This descriptive study assessed the quality of 100 original articles published in Iranian Journals of dentistry in terms of their various structural components including abstracts, introductions, methodology, results, discussions and references. Based on 52 variables the articles were classified into three categories of "adequate", "relatively adequate" and "inadequate". Data analysis was done using Chi-square statistical test. Results: The mean number of authors for each article was 2.9+0.84. Failure rate to report the "reliability" of the instrument of measurement was 96%, followed by failure to justify the sample size (93%). Justification for publication was not reported in 73% of the articles and 87% didn't cite the limitations and valuable findings of the study. No statistically significant association was found between the quality of published articles and study designs, number of authors and references (P<0.3). Conclusion: Significant quality related issues of concern were observed in articles published in Iranian dental journals. Attention to and rectification of these, by authors, reviewers and editors will improve the quality of future publications. [ABSTRACT FROM AUTHOR]

Lead is a relatively ubiquitous heavy metal with particular features such as resistance to corrosion, high malleability and wide variety of industrial applications. In medicine, however, it is considered as a slow-acting toxic substance affecting multiple body systems, specifically functioning as a potent neurotoxin in the central nervous system. Lead poisoning may be acute or chronic and can be due to occupational or environmental exposures. The history of lead poisoning dates back to ancient times. The present paper briefly describes the world- wide historical accounts of lead poisoning with a special focus on Iran. [ABSTRACT FROM AUTHOR]

Background: Diabetes and dysglycemia have a high prevalence in Iranian population but the information about their impact on the cardiovascular disease (CVD) risk is scarce in this population. This study aimed to determine the risk of CVD according to glucose tolerance status. Methods: We ascertained cases with incident CVD in a population of 1752 men and 2273 women, 40 years old and over and free of CVD at the beginning of study, during a follow up with a median of 7.6 years. To calculate hazard ratio (HR) for CVD, we controlled traditional risk factors, including age, body mass index, waist, total cholesterol, HDL-cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, education, smoking, hypertension medication, lipid lowering medication and family history of premature CVD and diabetes. Results: Cardiovascular events occurred in 197 men and 143 women. Its incidence density was 11.8 per 1000 person-years (95% confidence interval: 10.6 to 13.1) totally. Multiple adjusted HR in women with known diabetes was 3.88 (95%CI: 2.40 to 6.27) and with newly diagnosed was 2.34 (95%CI: 1.39 to 3.95) and the corresponding values for men were 1.72 (95%CI: 1.00- 2.95) and 1.52 (95%CI: 1.01- 2.31) respectively. Impaired fasting glucose and impaired glucose tolerance increased 56% the risk of CVD in women (HR: 1.56 with 95% CI, 1.00 to 2.45), just in the age adjusted model. Conclusion: All diabetic patients should receive primary prevention for CVD intensively, regardless of whether they are newly diagnosed or are known cases; specially, females who have abnormal glucose metabolism. [ABSTRACT FROM AUTHOR]

Background/Aim: Several epidemiologic studies have shown that many nutritional and non-nutritional risk factors for non-communicable diseases are modifiable. This study was conducted to determine the effectiveness of nutrition intervention on non-communicable disease risk factors among Tehranian urban adults. Methods: In the Tehran Lipid and Glucose Study (TLGS), 1,474 subjects, aged 3 years and over, were selected for dietary assessment; nutrition intervention was implemented for one third through pamphlets, posters, nutritional consultations, educational courses, and demonstration of films in the community health medical centers, schools, and other public places. After a 3.8-year follow-up period, data were collected for 578 subjects, aged 18–74 years, who participated in the second phase of the study; there were 356 subjects in the control group and 222 in the intervention group. Mean body mass index, energy intake, macronutrients, fibre, micronutrients, serum lipids, fasting blood sugar, and systolic and diastolic blood pressures were determined in both groups. Results: The mean fasting blood sugar concentrations increased significantly in the control group and decreased significantly in the intervention group. Mean diastolic blood pressure and total cholesterol and low-density lipoprotein cholesterol levels decreased in both groups. However, the body mass index showed a significant increase in both groups. Adjusted for age, sex, and baseline variables, the cholesterol intake (214 vs. 232 mg/day, p < 0.05) was significantly lower in the intervention as compared with the control group. Conclusions: The present study shows decreases in fasting blood sugar, total serum cholesterol, and daily cholesterol intake after nutrition interventions. Specific intervention measures, keeping in mind cultural and socio-economic factors, could modify dietary patterns and are effective in the primary pre- vention of non-communicable diseases. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background and Aim: This study aimed to determine dietary patterns in district 13 of Tehrani adults and evaluate its association with socio-demographic and lifestyle factors Materials and Methods: This cross-sectional study was conducted on 343 male and 453 female aged 18-65 years who participated in Tehran Lipid and Glucose study. Usual dietary intakes were assessed with food frequency questionnaire. Dietary patterns were determined by factor analysis based on 24 food groups identified by similarity of nutrients. Three major dietary patterns were identified: healthy (HDP), western (WDP) and traditional (TDP). Lifestyle and socio-demographic characteristics gathered with pre-tested questionnaires. Multiple regression models separately for men and women were fitted to assess the relationships. Results: The mean age(SD) of men and women were 40(13) and 36(12) respectively. WDP characterized by a higher consumption of salty snacks, sauces, sweetened beverages, processed meats and refined grains, and the HDP characterized by greater intakes of vegetables, low fat meats, tea and coffee, legumes and nuts.WDP had the most variance among 3 dietary patterns. The mean factor score of HDP was higher in women than in men (P<0.05) after adjusting for age and total energy intake. Adherence to a WDP was higher among younger participants (men: β=-0.46, women:-0.34, P<0.001). The percent of married individuals were the most in fourth quartiles of HDP score among the other quartiles (P<0.01) and married men were less likely to follow WDP (β=-0.25, P<0.01). Conclusion:Three major dietary patterns were found with factor analysis: western, healthy and traditional. Younger and single individuals had more adherence to WDP and women had higher score in HDP. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between occupation and cardiovascular risk factors in women in Tehran. Study design and methods: A cross-sectional study of 566 working women and 561 age-matched housewives selected from among the 15 005 Tehran Lipid and Glucose Study (TLGS) participants. All cardiovascular risk factors were assessed. Results: The means of body mass index, waist circumference, waist to hip ratio, systolic and diastolic blood pressures, triglycerides and total cholesterol were significantly higher in housewives as compared to working women (P<0.05). Nine percent of working women and 17% of housewives had 4-6 cardiovascular risk factors; 1% of housewives had 7-8 cardiovascular risk factors. Conclusion: An increase in some cardiovascular risk factors was seen in housewives as compared to working women, and the percentage of housewives with 4-6 risk factors was found to be twice that of working women [ABSTRACT FROM AUTHOR]

Objective:To examine the relationship between variety scores of food groups (between and within food groups) and the probability of nutrient adequacy in Tehranian men.Design:A cross-sectional study assessing food intake by two 24-h recall questionnaires. Dietary diversity was defined according to diet quality index revised, which was used by Haines et al in 1999. The mean probability of adequacy across 14 nutrients was calculated using the Dietary Reference Intakes.Setting:District 13 of Tehran, Iran.Subjects:A total of 295 males, aged 18 y and over.Results:Whole grain variety mostly correlated with protein and vitamin B2 (r=0.3, P<0.05). Fruit variety was correlated with vitamin C (r=0.4, P<0.05). Dairy variety was correlated with calcium intake (r=0.4, P<0.05). Meat variety was correlated with protein intake (r=0.3, P<0.05). Most subjects failed to meet vitamin B6, zinc, magnesium, calcium, copper, and vitamin B12 adequacy. Energy intake was a strong predictor of the mean probability of adequacy in models controlled for age, body mass index, education level and job status (model R2=0.48). Adding the number of servings from each of the food group to the models significantly improved the model fit (model R2=0.55). Adding the dietary variety improved the model fit significantly (model R2=0.61). Dairy variety and meat variety had the strongest association with improved nutrient adequacy.Conclusion:Variety of different food groups is a useful indicator of specific nutrient adequacy. Hence, to determine the adequacy of a specific nutrient, the variety scores of specific food groups should be taken into account.European Journal of Clinical Nutrition (2005) 59, 1233–1240. doi:10.1038/sj.ejcn.1602234; published online 13 July 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE:Assessing overall diet instead of the effects of a single nutrient on diet–disease relations may be more informative. This study was conducted to evaluate the relationship between dietary diversity score (DDS) and metabolic syndrome in Tehranian adults.DESIGN:Cross-sectional study.SUBJECTS:A representative sample of 581 healthy subjects aged over 18 y selected randomly from among participants of the Tehran Lipid and Glucose Study.MEASUREMENTS:Usual dietary intake was assessed using a validated semi quantitative food frequency questionnaire. DDS was calculated based on scoring to the five-food group. The DDS range was 0–10. Weight and height were measured according to standard protocols and body mass index (BMI) was calculated. Fasting blood samples were taken for biochemical measurements and blood pressure was assessed according to standard methods. Metabolic syndrome was defined according to ATPIII. Subjects were categorized based on quartile cut-points of DDS.RESULTS:Means (±s.d.) of age and BMI were 37±12 y and 25.7±4.3 kg/m2, respectively. Mean (±s.d.) of DDS was 6.15±1.02. The probability of having metabolic syndrome decreased with quartiles of DDS (odds ratios among quartiles: 1.00, 0.82, 0.76, 0.70, P<0.05, and odds ratios among quartiles after further adjustment for BMI: 1.00, 0.88, 0.80, 0.77, P<0.05). After controlling for confounders, a significantly decreasing trend was observed for the risk of having high blood pressure, impaired glucose homeostasis and high triglyceride levels.CONCLUSION:DDS had inverse association with metabolic syndrome and some of its features in this cross-sectional study. A higher dietary diversity, therefore, might be associated with lower possibility of having some metabolic disorders.International Journal of Obesity (2005) 29, 1361–1367. doi:10.1038/sj.ijo.0803029; published online 23 August 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To assess the relationship between consumption of dairy products and body mass index (BMI) in Tehranian adults. DESIGN:: Cross-sectional study. SUBJECTS:: A total of 462 healthy subjects (223 men and 239 women) aged over 16?y selected randomly from among participants of the Tehran Lipid and Glucose Study (TLGS). MEASUREMENTS:: Dietary data were collected by means of a food frequency questionnaire for 1?y and two 24-h dietary recalls. Height and weight were measured and BMI was calculated. Physical activity was assessed by the Lipid Research Clinic (LRC) questionnaire. RESULTS:: Consumption of dairy products was 3.7±1.0 and 2.9±1.2 servings per day in men and women, respectively. As the servings of dairy consumption increased per day, the proportion of normal-weight subjects rose and that of obese ones declined. As BMI increased, the proportion of subjects with lower consumption of dairy products increased, whereas that of those with higher consumption decreased. There was a significant inverse correlation between the servings of dairy consumption per day and BMI after controlling for the effect of age, physical activity, energy, carbohydrate, dietary fiber, protein and fat intake (r=-0.38, P<0.05). After adjustment for potential confounding variables, men and women in the top quartile of dairy consumption had lower chances for being overweight (OR=0.78, 95%CI=0.43-0.92 for men and OR=0.89, 95%CI=0.53-0.95 for women) and obese (OR=0.73, 95%CI=0.40-0.83 for men and OR=0.69, 95%CI=0.34-0.80 for women) compared to those in the first quartile. CONCLUSION:: The results suggest an inverse relationship between dairy consumption and BMI. It is recommended that further studies address this issue by focusing on the dairy components responsible for this effect.International Journal of Obesity (2005) 29, 115-121. doi:10.1038/sj.ijo.0802838 Published online 9 November 2004 [ABSTRACT FROM AUTHOR]

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 4449 men aged 18–74y, 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 18–34y age category, cutoff points for BMI, WHpR, WHtR and WC were 24kg/m2, 0.86, 0.47 and 81 cm, respectively. In the 35–54y age category these cut points were 26kg/m2, 0.91, 0.52 and 89cm, and in the 55–74y age category 26kg/m2, 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 ≥126mg/dl or 2hPG >200mg/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±15.4y. Mean BMI, WHpR, WC and WHtR for subjects were 25.6±4.2kg/m2, 0.91 ±0.07, 87.7±11.7cm 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. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To determine optimal cutoff points of anthropometric measures as cardiovascular indicators in an Iranian adult population. DESIGN:: Population-based cross-sectional study. SETTING:: Tehran, the capital of Iran. SUBJECTS:: A total of 10?522 subjects (4449 men and 6073 women) aged 18-74?y. METHODS:: Demographic data were collected and anthropometric indices were measured. Blood pressure was evaluated and hypertension was defined based on JNC VI. Biochemical measurements were done. Diabetes was considered as FBS=126?mg/dl (=7.0?mmol/l) and dyslipidemia was defined according to ATP II. Risk factors were considered as: hypertension, diabetes, dyslipidemia, ‘hypertension or diabetes’, ‘hypertension and diabetes’, ‘hypertension or dyslipidemia’, ‘hypertension and dyslipidemia’, ‘ diabetes or dyslipidemia’, ‘diabetes and dyslipidemia’, ‘at least one risk factor’ and ‘at least two risk factors’. ROC curve analysis was performed to determine optimal cutoff values-where the sensitivity approximates specificity. RESULTS:: Younger men (the age category of 18-34?y) had higher WC than women. Men had higher waist-to-hip ratio (WHpR) and lower waist-to-height ratio (WHtR) than women in all age categories. Dyslipidemia, ‘hypertension or dyslipidemia’, ‘diabetes or dyslipidemia’ and ‘at least one risk factor’ were more prevalent risk categories in both genders. Range of areas under ROC curves for BMI and WC was 0.55-0.94 and 0.56-0.93 for men and 0.41-0.94 and 0.53-0.92 for women in various age groups, respectively. Range of areas for WHpR and WHtR in men was between 0.58-0.87 and 0.56-0.94, respectively, and for women varied between 0.53-0.91 and 0.53-0.90 in various age groups, respectively. Cutoff points of BMI for various risk factors were between 24 and 29?kg/m2 in men and 25-31?kg/m2 in women. Range of WHpR was between 0.86 and 0.97 in men and between 0.78 and 0.92 in women. Cutoff points for WC and WHtR were between 80 and 93?cm and 0.47 and 0.56 for men and between 79 and 96?cm and 0.50 and 0.63 for women in different age groups to detect various risk factors, respectively. In general, values were lowest for the most prevalent risk factors and highest for less prevalent conditions. CONCLUSION:: The results suggested cutoff points of anthropometric measures as indicators of cardiovascular risk factors. It seems that these cut-points are higher for Iranians than for other Asian populations. SPONSORSHIP:: Endocrine Research Center, Shaheed Beheshti University of Medical SciencesEuropean Journal of Clinical Nutrition (2004) 58, 1110-1118. doi:10.1038/sj.ejcn.1601936 [ABSTRACT FROM AUTHOR]

Objectives: The menopause is associated with an increased incidence of coronary heart disease (CHD). Assessing CHD risk factors in menopausal women can shed more light on the pathogenesis of accelerated atherosclerosis after the cessation of ovarian function. Design: In this study, 1980 women aged 44-69 years were selected from among 15 005 participants in the Tehran Lipid and Glucose Study (TLGS) and assessed for CHD risk factors. They were classified into three groups: premenopausal women (n = 483), aged between 44 and 50 years, without any history of menstrual irregularities; menopausal women (n = 310), with permanent cessation of menses for at least 12 months and a duration of less than 3 years; and postmenopausal women (n = 1187), with at least a 3-year history of cessation of menses. Demographic information including waist size, height, weight and systolic and diastolic blood pressures was recorded, and body mass index, low-density lipoprotein/high-density lipoprotein ratio (LDL/HDL) and waist/hip ratio were calculated. Serum total cholesterol, triglycerides and HDL were measured and an oral glucose tolerance test was performed. The LDL level was calculated using the Friedwald formula. Results: Mean systolic blood pressures were 121 ± 18, 125 ± 20 and 136 ± 23 mmHg (p < 0.001) and mean diastolic blood pressures were 80 ± 10, 81 ± 11 and 82 ± 11 mmHg (p < 0.001) in premenopausal, menopausal and postmenopausal women, respectively. For premenopausal, menopausal and postmenopausal women, mean cholesterol levels were 215 ± 42, 238 ± 45 and 245 ± 46 mg/dl (p < 0.001), respectively. HDL and LDL levels were 44 ± 11, 48 ± 12 and 47 ± 11 mg/dl and 138 ± 38, 156 ± 41 and 161 ± 42 mg/dl (p < 0.001) for premenopausal, menopausal and postmenopausal women, respectively. Mean LDL/HDL ratios were 3.4 ± 1.4, 3.5 ± 1.3 and 3.6 ± 1.2 (p < 0.01) and mean waist measurements were 92 ± 11, 93 ± 12 and 95 ± 12 cm (p < 0.001) for the same groups of women, respectively. However, body mass index, waist/hip ratio and triglycerides showed no significant differences between the three groups. Conclusion: These data demonstrate an increase in CHD risk factors in a group of Tehranian women after the menopause. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if systolic blood pressure (SBP) by itself is sufficient for the JNC-VI (Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure)-based classification of blood pressure of Tehranian adult population. Clinically, SBP and diastolic blood pressure (DBP) are sometimes at different stages in the same individual and the higher stage is considered to classify blood pressure level. The prevalence of disparate levels of SBP and DBP has only recently been noticed. Some researches have reported the importance of SBP level, and not DBP, in determining the appropriate classification of hypertension even in those undergoing treatment. Data were collected for 3823 men and 5159 women aged 20-69 years who were not using antihypertensive medication, in the Tehran Lipid and Glucose Study (TLGS), a cross-sectional phase of a large epidemiological study first established in 1999. The study used the mean of two separate blood pressure measurments in each individual. High blood pressure is defined according to the highest level of SBP or DBP. In 86.3% of the subjects, blood pressure stage was determined according to SBP and in 90.0% of them according to DBP. In 77.4% of the subjects (75.7% of men and 78.7% of women), SBP determined blood pressure in the same stage as DBP did. The role of SBP was the most prominent in age groups 20-29 and 60-69 years (91.4 and 90.8%, respectively) and the least in age group 40-49 years (80.4% of the subjects). DBP had a more prominent role in younger ages and the least significance in older ages. In conclusion, SBP has a more prominent role than DBP in determining blood pressure stage according to JNC-VI only in the 60-69-year-old group. The role of DBP is more prominent in other age groups.Journal of Human Hypertension (2003) 17, 287-291. doi:10.1038/sj.jhh.1001539 [ABSTRACT FROM AUTHOR]

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/m2) 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.International Journal of Obesity (2002) 26, 1617–1622. doi:10.1038/si.ijo.0802120 [ABSTRACT FROM AUTHOR]

The purpose of this study was to estimate the current prevalence and distribution of hypertension in an adult Tehranian population. Data were collected for 3343 men and 5148 women aged 20-69 years in the Tehran Lipid and Glucose Study (TLGS), which is a cross-sectional phase of a large epidemiologic study, first established in 1999. The study used the mean of two separate blood pressure (BP) measurements in each individual. Twenty-two percent (23% of women vs 20% of men, P = 0.01) had hypertension according to 'JNC-VI' and 'WHO-ISH' criteria. The average systolic BP (SBP), diastolic BP (DBP) and pulse pressure of hypertensive participants were 31, 16, and 15 mm Hg higher than the corresponding value for normotensives, respectively. Thirty-six percent of participants with JNCVI-based hypertension were using antihypertensive medication (23% of men and 43% of women). Of these, 40% (45% of men and 39% of women) had normal BP. Hypertension awareness was 50% in these participants (57% in men vs 37% in women, P < 0.001). Data for 3179 men and 4646 women aged 20-69 years with no antihypertensive treatment were used for analysis of BP measures. Of these, 15% (16% of men and 14% of women, P = 0.006) had high and 85% (84% of men and 86% of women) normal or high-normal BP levels according to JNC-VI. Prevalence of optimal BP was 49% (47% of men and 51% of women). Mean SBP was 117.8 ± 16.6 and 116.4 ± 16.4 mm Hg in men and women, respectively (P < 0.001). The equivalent values were 77.4 ± 10.7 and 77.3 ± 9.9 mm Hg for DBP (P = 0.5) and 40.4 ± 12 and 39.1 ± 11.7 mm Hg for pulse pressure (P < 0.001). A relatively high prevalence of JNC-VI/WHO-ISH defined hypertension was found in the TLGS adult population with 50% undiagnosed and 60% uncontrolled hypertension. These findings emphasise further considerations for detection and better management of hypertension in the urban population of Tehran. [ABSTRACT FROM AUTHOR]

To examine the association between educational level and chronic kidney disease (CKD) among the Iranian population. This is a prospective cohort study conducted in the framework of the Tehran Lipid and Glucose Study. A total of 8173 Iranians (men = 3659) aged ≥20 years were included in the study. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. The association between educational status and CKD was explored using multivariate Cox proportional regression analyses, adjusted for age, gender, current smoking, marital status, body mass index, waist circumference, baseline eGFR, diabetes, hypertension, physical activity, history of cardiovascular diseases and dyslipidaemia. During a median follow-up of 13.14 years, 2609 cases of incident CKD were identified; the corresponding incidence rate was 26.35 (range 25.39–27.34) per 1000 person-years. Compared to low educational level, middle and high educational levels showed lower risks for incident CKD in the crude model [hazard ratio (HR) 0.37 (95% confidence interval {CI} 0.34–0.40) and HR 0.40 (95% CI 0.35–0.45), respectively]; however, these HRs changed direction after further adjustment for age and gender [HR 1.26 (95% CI 1.14–1.39) and HR 1.40 (95% CI 1.22–1.61), respectively]. The increased risk of incident CKD for those at higher educational levels remained significant in the fully adjusted model. In addition, results from the gender stratified analyses were in the same direction as those found among the whole study population (P -value for interaction of gender and education >0.8). Higher educational levels were associated with incident CKD during more than a decade of follow-up; this finding may be attributed to unhealthy lifestyle behaviours among this population group. [ABSTRACT FROM AUTHOR]

To investigate the incidence rates for different malignancies and assess the risk factors for all-cancer incidence in Tehran. Cohort study. 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/m2 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. 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/m2 (IRR [95% CI]: 1.38 [1.01–1.90]) had a statistically significant association with incident cancer. 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. • The age-standardized rate was 356.1 per 100,000 person-years in men during 14 years. • The age-standardized rate was 243.6 per 100,000 person-years in women during 14 years. • Gastrointestinal and hematopoietic were the two most incident cancers among men. • Breast and gastrointestinal were the two most incident cancers among women. [ABSTRACT FROM AUTHOR]

Objectives: To establish the distribution of 10-year risk for coronary heart disease (CHD) and eligibility for therapeutic approaches among Tehranian adults within the framework of the Tehran Lipid and Glucose Study (TLGS). Study design: Cross-sectional study conducted on data from Phase III of the TLGS (12,521 people aged ≥3 years). Methods: The modified Framingham algorithm adopted by the National Cholesterol Education Program Adult Treatment Panel III was used to estimate participants' 10-year risk of developing CHD; only participants aged 20-79 years were included. Following the exclusion of subjects without full relevant data, 9483 participants (42.6% men) were enrolled in the final analysis. The distributions of the population needing therapeutic lifestyle changes (TLCs) and additional drug therapy were calculated. Results: Overall, the mean (standard deviation) age was 43.7 (15.4) years; 44.6 (15.9) for men and 43.0 (14.9) for women. Ten-year risk for CHD of <10%, 10-20% and >20% was observed in 86.0%, 12.0% and 2.0% of participants with at least two risk factors and without CHD or a CHD risk equivalent, respectively. For subjects with less than two risk factors and without CHD or a CHD risk equivalent, these values were 14.0%, 8.3% and 14.7%, respectively; 63.1% of subjects had less than two risk factors. The need for TLCs and additional drug therapy was observed in 12% and 12.5% of subjects, respectively. Conclusions: Regarding the estimated 10-year risk for CHD, about one-quarter of Tehranian adults are eligible for therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background/aim: Familial resemblance in dietary patterns has been a subject of interest, with both genetic and environmental factors playing crucial roles. This study aims to investigate trends in macronutrient intake correlations over a 9-year period among different familial pairs, including parent-offspring, siblings, and spouses, using data from the Tehran Lipid and Glucose Study (TLGS)., Methods: This longitudinal study, conducted within the framework of the TLGS, analyzed data from 1,814 families over a 9-year period. Dietary intakes were assessed using a validated 168-item food frequency questionnaire. Macronutrient intakes were calculated and adjusted for age. Familial correlations were estimated using intraclass correlation coefficients for various familial pairs (parent-offspring, siblings, and spouses) across four consecutive surveys. Changes in correlations were analyzed over 3-year, 6-year, and 9-year intervals, as well as across all four surveys, to determine overall trends in macronutrient intake correlations., Results: The results revealed diverse trends in intake correlations for carbohydrates, proteins, fats, and specific fatty acids across familial relationships. Parent-offspring dyads exhibited varied patterns, with some nutrients showing regression to the mean. Sister-sister pairs demonstrated strengthening correlations for energy, carbohydrates, fats, and saturated fatty acids over time. Conversely, brother-sister pairs displayed weakening correlations for most macronutrients, particularly energy, proteins, cholesterol, and fiber. Spouse correlations tended towards regression to the mean for energy, carbohydrates, and fats, and fiber., Conclusions: The present study illuminates the dynamic nature of familial dietary correlations over time. The contrasting trends between sister-sister and brother-sister dyads suggest a significant influence of gender on shared dietary patterns. These findings underscore the complex interplay of genetic and environmental factors in shaping family dietary behaviors and highlight the importance of considering both gender and relationship type when examining familial nutritional habits., (© 2024. The Author(s).)

Aim: We investigated the association of a 3-year change in body weight (BW) and regression to normal glucose regulation (NGR) among different phenotypes of pre-diabetes (Pre-DM), i.e., isolated impaired glucose tolerance (iIGT), isolated impaired fasting glucose (iIFG) and combined IFG-IGT., Research Design and Methods: 1458 Pre-DM subjects (iIFG = 618, iIGT = 462, and IFG-IGT = 378) were assessed for 3-year change-percent in BW (2006-2008 to 2009-2011) and then followed up to 2015-2017, within the national cohort of Tehran Lipid and Glucose Study (TLGS). Binary logistic regression models were used to estimate the probability (odds ratio, ORs) of regression to NGR across categories of 3-year BW change (i.e., ≥5% BW loss, <5% BW loss, BW gain) in different phenotypes of Pre-DM., Results: The mean age of the participants was 53.0 ± 13.7, and 46.8% were men. Over a median of 6 years of follow-up, the rate of regression to normoglycemia was 50.6, 43.2, and 12.7% in iIGT, iIFG, and combined IFG-IGT, respectively. The baseline-adjusted mean of 3-year BW change was not significantly different across Pre-DM phenotypes (0.68 ± 0.19, 0.32 ± 0.22, and 0.23 ± 0.24 kg, in iIFG, iIGT, and IFG-IGT). Three-year BW loss ≥5% was associated with a greater NGR probability in iIGT than other phenotypes (OR = 4.29 vs. 3.90 and 2.84 in IFG-IGT and iIFG, respectively). A modest reduction (<5% of initial BW) resulted in an increased chance of Pre-DM regression among subjects with iIGT (OR = 1.61, 95% CI = 1.03-2.52) but not iIFG or IFG-IGT phenotypes., Conclusion: Short-term intensive BW loss (≥5% of initial BW) increased NGR probability in all Pre-DM phenotypes, with an order of iIGT > combined IFG-IGT > iIFG. Only iIGT takes advantage of moderate BW loss (<5% of initial BW) to increase the chance of Pre-DM regression., Competing Interests: Declaration of competing interest All authors declare that they have no competing interests., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

The incidence of hypertension (HTN) and consumption of ultra-processed foods are increasing worldwide. However, only a limited amount of research has assessed the causality between ultra-processed foods and the risk of HTN. Therefore, the present study aimed to determine the association between ultra-processed foods and the risk of HTN in a prospective cohort study. In the present study, we included 2399 individuals, aged approximately 19 years, who participated in the Tehran Lipid and Glucose Study (TLGS). The participants had complete dietary data and were free from HTN at baseline. We used the Cox proportional hazards model to determine the association between ultra-processed food intake and the risk of HTN occurrence, reporting the results as the hazard ratio (HR) and 95% confidence interval (95% CI). The mean age of participants was 37.6 years, and we followed them up for an average of 9.21 years. Our results indicated that participants in the highest tertile of ultra-processed foods had a 48% higher risk of HTN development (HR: 1.48; 95% CI: 1.23, 1.79) than those in the lowest tertile. We found a significant association between age and ultra-processed food intake in relation to the risk of HTN. The HR for developing HTN in participants aged <47 years was 1.99 (95% CI: 1.53, 2.58) and in participants aged ≥47 years was 1.26 (95% CI: 0.95, 1.68). Among the ultra-processed food components, consumption of industrial fat products had a positive correlation with the risk of HTN (HR: 1.04; 95% CI: 1.02 to 1.06). Our results suggest that consuming ultra-processed foods is associated with an increased incidence of HTN in adults. This association varied by age and was significant for adults younger than 47 years.

This study aims to assess the effect of familial structures on the still-missing heritability estimate and prediction accuracy of Type 2 Diabetes (T2D) using pedigree estimated risk values (ERV) and genomic ERV. We used 11,818 individuals (T2D cases: 2,210) with genotype (649,932 SNPs) and pedigree information from the ongoing periodic cohort study of the Iranian population project. We considered three different familial structure scenarios, including (i) all families, (ii) all families with ≥ 1 generation, and (iii) families with ≥ 1 generation in which both case and control individuals are presented. Comprehensive simulation strategies were implemented to quantify the difference between estimates of [Formula: see text] and [Formula: see text]. A proportion of still-missing heritability in T2D could be explained by overestimation of pedigree-based heritability due to the presence of families with individuals having only one of the two disease statuses. Our research findings underscore the significance of including families with only case/control individuals in cohort studies. The presence of such family structures (as observed in scenarios i and ii) contributes to a more accurate estimation of disease heritability, addressing the underestimation that was previously overlooked in prior research. However, when predicting disease risk, the absence of these families (as seen in scenario iii) can yield the highest prediction accuracy and the strongest correlation with Polygenic Risk Scores. Our findings represent the first evidence of the important contribution of familial structure for heritability estimations and genomic prediction studies in T2D., (© 2024. The Author(s).)

Objectives: This study aimed to investigate the association between age-specific and sex-specific continuous metabolic syndrome severity score (cMetS-S) and the risk of developing type 2 diabetes mellitus (T2DM). Additionally, the study aimed to assess the added value of cMetS-S in predicting T2DM compared with traditional MetS criteria., Design: The study used a longitudinal cohort design, following participants for 18 years., Setting: The research was conducted within the Tehran Lipid and Glucose Study, a community-based study in Tehran, Iran., Participants: A total of 6957 participants aged 20-60 years were included in the study., Interventions/exposures: The cMetS-S of each participant was determined using age-specific and sex-specific equations and Cox proportional hazard regression models were used to analyse the association between cMetS-S and T2DM using continuous and quantile approaches., Primary and Secondary Outcome Measures: The outcome measure was the association between cMetS-S and the development of T2DM during the 18-year follow-up., Results: A total of 1124 T2DM cases were recorded over 18 years of follow-up. In the fully adjusted model, a 1-SD increase in the cMetS-S was associated with future T2DM (HR 1.72; 95% CI 1.54 to 1.91). Men and women had HRs of 1.65 (95% CI 1.40 to 1.95) and 1.83 (95% CI 1.59 to 2.10) for T2DM per 1-SD increase in cMetS-S, respectively. Higher cMetS-S was associated with increased risk of diabetes in both prediabetic (HR 1.42;95% CI 1.23 to 1.64) and normoglycaemic individuals (HR 2.11;95% CI 1.76 to 2.54); this association was more significant in normoglycaemic individuals. Unlike the traditional-based MetS definitions, the cMetS-S improved diabetes prediction (p<0.001)., Conclusions: The cMetS-S is strongly associated with future diabetes in prediabetic and normoglycaemic individuals independent of MetS components during a long term. As the relationship between cMetS-S and T2DM is more pronounced in normoglycaemic individuals than in those with pre-diabetes, implementing the evaluation of cMetS-S can serve as an early identification tool for individuals at risk of T2DM prior to the onset of pre-diabetes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: The impact of life-course different adiposity indices on diabetes mellitus (DM) is poorly understood. We aimed to do trajectory analysis with repeated measurements of adiposity indices in the development of DM among women across the lifespan., Methods: This study prospectively investigated the 1,681 population of Tehran Lipid and Glucose Study. At baseline, all individuals were free of diabetes. Trajectory analysis was used to identify homogeneous distinct clusters of adiposity indices trajectories and assign individuals to unique clusters., Results: Of the 1681 healthy women, 320 progressed to the DM. Three distinct body mass index (BMI) trajectories and 2 distinct trajectories of other adiposity indices (waist circumstance (WC), conicity index (C-index), and body roundness index (BRI)) were chosen as the best fitting of the latent class growth mixture model. In the adjusted model, total participants [HR (CI 95%): 2.83 (2.05, 3.91); p < 0.001], and menopause [1.35 (1.10, 2.11); p = 0.001] and reproductive-age women [2.93 (1.80, 4.78); p = 0.003] of the high BMI trajectory compared to the ones in the low trajectory of BMI were more likely to develop DM. The high BRI in menopause had a significantly higher risk of DM compared to the low trajectory. In menopause (1.80 (1.26, 2.58)) and reproductive-age women (4.32 (2.49, 7.47)) with high trajectory of C-index, the DM risk decreased after adjustment., Conclusions: The risk of DM was greater for high BMI, WC, C-index, and BRI trajectories than for lower trajectories. Hence, the development of general, abdominal, and visceral obesity trajectories in the prevention of DM should be considered by clinicians., (© 2024. The Author(s).)

Background and Aims: Little is known about the association of parental cardiovascular risk factors with the risk of obesity in offspring. We aimed to investigate whether parental ideal cardiovascular health (ICVH) status was associated with the risk of general and central obesity in their young/adult offspring., Methods and Results: Of individuals who participated in the 2012-15 phase of the Tehran Lipid and Glucose Study, 2395 pairs of parent-unmarried offspring aged ≥6 years were selected in this cross-sectional study. General and central obesity were defined based on Iranian BMI percentile reference data for offspring aged ≤18 years. For subjects aged ≥19 years, central obesity was defined based on the introduced cut-off points for Iranian adults. We employed the American Heart Association's 2020 impact goal criteria of ICVH. The mean ± SD age of fathers and mothers were respectively 55.4 ± 9.79 and 48.4 ± 9.88. About 55% of offspring were older than 19 years. Higher adherence to ICVH score in mothers was associated with lower risk of overweight/obesity in female offspring (OR for Q1-Q4: 1, 0.56, 0.57, 0.37, P < 0.05 for all quartiles). Among ICVH components, only ideal BMI status in fathers was observed to be associated with a lower risk of overweight/obesity in their male offspring. The risk of abdominal obesity decreased in female offspring with increasing total ICVH score in mothers., Conclusion: Higher adherence of parents to ICVH and its components was positively associated with a lower risk of general and abdominal obesity in their offspring. Our findings demonstrate that maternal-offspring relationship was stronger than paternal-offspring association., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Obesity and hypothyroidism are common medical conditions that are associated with each other. Bariatric surgery (BS) is a common approach used to achieve substantial weight loss in obese patients. However, there is limited evidence regarding the need for postsurgery levothyroxine (LT4) dose adjustment in patients with hypothyroidism undergoing BS. Methods: This was a three-year prospective cohort study assessing postsurgery LT4 requirements with attention to body composition changes. The current study included 1030 patients with hypothyroidism, who underwent sleeve gastrectomy (SG) ( n = 707, 88.3% women) or one anastomosis gastric bypass (OAGB) ( n = 323, 92% women). Patients were followed for 36 months after surgery. A bioelectrical impedance analyzer was used for body composition assessment. LT4 requirements were assessed by generalized estimating equation (GEE) methods adjusted for weight as a time-varying covariate. Results: During the follow-up, TSH (mIU/L) and T4 (ng/dL) measurements did not significantly change in the OAGB group over time. However, in the SG group, TSH measurement decreased over time ( p trend = <0.001). In the third year of the follow-up, 56.1% and 33.3% of patients in the SG and OAGB groups experienced LT4 (μg/day) dose reduction, while 24.4% and 9.1% of the participants experienced LT4 dose increments, respectively. GEE analysis showed a significant increase in the LT4/fat mass (FM) (μg/kg) ratio after 36 months of follow-up compared with the baseline in both the SG [1.8 (1.5-2.2) to 2.7 (2.0-3.5), p trend = 0.039)] and OAGB [1.7 (1.4-2.2) to 3.2 (2.7-4.8), p trend = <0.001)] groups. Moreover, patients who underwent OAGB experienced greater LT4/FM (μg/kg) dose adjustments compared to those undergoing SG ( p between = 0.060). In both groups, after the first year, the increase in LT4/FM (μg/kg) plateaued ( p interaction = 0.009). Conclusion: Most hypothyroid patients experienced either a reduction or no change in LT4 (μg/day) dosage after 36 months in both surgical groups. The LT4/FM (μg/kg) was significantly increased in patients undergoing either SG or OAGB with greater alterations in the latter. Further studies on larger populations and with longer duration of follow-up are needed to confirm our results.

Background: The association between baseline triglyceride glucose index (TyG index) and incident non-communicable diseases, mainly in Asian populations, has been reported. In the current study, we aimed to evaluate the association between index-year, average, and visit-to-visit variability (VVV) of the TyG index with incident type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), and all-cause mortality among the Iranian population., Methods: The study population included 5220 participants (2195 men) aged ≥ 30 years. TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). Average values of the TyG index and also VVV (assessed by the standard deviation (SD) and variability independent of mean) were derived during the exposure period from 2002 to 2011 (index-year). Multivariable Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the TyG index for incident different health outcomes., Results: During more than 6 years of follow-up after the index year, 290, 560, 361, and 280 events of T2DM, hypertension, CVD, and all-cause mortality occurred. 1-SD increase in the TyG index values at the index-year was independently associated with the incident T2DM [HR (95% CI) 2.50 (2.13-2.93)]; the corresponding values for the average of TyG index were 2.37 (2.03-2.76), 1.12 (0.99-1.26, p value = 0.05), 1.18 (1.01-1.36), and 1.29 (1.08-1.53) for incident T2DM, hypertension, CVD, and all-cause mortality, respectively. Compared to the first tertile, tertile 3 of VVV of the TyG index was independently associated with incident hypertension [1.33 (1.07-1.64), P trend <0.01]. Likewise, a 1-SD increase in VVV of the TyG index was associated with an 11% excess risk of incident hypertension [1.11 (1.02-1.21)]. However, no association was found between the VVV of the TyG index and other outcomes. Moreover, the impact of index-year and average values of the TyG index was more prominent among women regarding incident CVD (P for interactions < 0.05)., Conclusion: Although the higher TyG index at index-year and its VVV were only associated with the incident T2DM and hypertension, respectively, its average value was capable of capturing the risk for all of the health outcomes., (© 2024. The Author(s).)

Background: The association between macronutrient consumption and the risk of type 2 diabetes (T2D) remains equivocal. Here, we investigated whether the quantity and quality of macronutrient intake are associated with T2D incidence in a West Asian population., Methods: T2D-free adults (n = 2457, mean age 38.5 ± 13.6 years, 54.2% women) who participated in the third examination cycle (2005-2008) of the Tehran Lipid and Glucose Study were followed for a median of 8.6 years. We estimated the macronutrient quality index (MQI), its individual sub-indices (carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate protein quality index (HPPQI)), as well as the macronutrient quantity. The risk of T2D in relation to macronutrient quantity, quality, and their combined effects was examined using Cox proportional hazard models adjusted for known risk factors for T2D., Results: During the study follow-up, 257 incident cases of T2D were documented. Individuals in the highest tertiles of MQI and CQI had a 27% (HR = 0.73, 95% CI = 0.54, 0.98) and 29% (HR = 0.71, 95% CI = 0.51-0.99) lower T2D risk than those in the lowest tertiles. The T2D incidence was 35% lower in the middle HPPQI tertile than in the lowest (HR = 0.65, 95% CI = 0.47, 0.89). The multivariable adjusted model showed that individuals in the middle and highest tertiles of carbohydrate intake had 32% (HR = 0.68, 95% CI = 0.49-0.95) and 26% (HR = 0.74, 95% CI = 0.55-1.00) lower risks of T2D than individuals in the lowest tertile. A high-quantity, high-quality carbohydrate diet (≥ 58.5% of energy from carbohydrate with a CQI ≥ 13) and a low-glycemic index (GI), high-fiber diet (GI < 55 and fiber ≥ 25 g/d) were related to a reduced risk of T2D by 34% (HR = 0.66, 95% CI = 0.47, 0.93) and 42% (HR = 0.58, 95% CI = 0.38, 0.90), respectively., Conclusion: A diet with a higher carbohydrate quality may be associated with a lower T2D incidence, particularly when the carbohydrate quantity is also high., (© 2024. The Author(s).)

Maturity-onset diabetes of the young (MODY) is an uncommon monogenic type of diabetes mellitus. Detecting genetic variants for MODY is a necessity for precise diagnosis and treatment. The majority of MODY genetic predisposition has been documented in European populations and a lack of information is present in Iranians which leads to misdiagnosis as a consequence of defects in unknown variants. In this study, using genetic variant information of 20,002 participants from the family-based TCGS (Tehran Cardiometabolic Genetic Study) cohort, we evaluated the genetic spectrum of MODY in Iran. We concentrated on previously discovered MODY-causing genes. Genetic variants were evaluated for their pathogenicity. We discovered 6 variants that were previously reported in the ClinVar as pathogenic/likely pathogenic (P/LP) for MODY in 45 participants from 24 families (INS in 21 cases, GCK in 13, HNF1B in 8, HNF4A, HNF1A, and CEL in 1 case). One potential MODY variant with Uncertain Risk Allele in ClinVar classification was also identified, which showed complete disease penetrance (100%) in four subjects from one family. This is the first family-based study to define the genetic spectrum and estimate the prevalence of MODY in Iran. The discovered variants need to be investigated by additional studies., (© 2024. The Author(s).)