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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]

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: Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region., Methods: We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models' discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level., Results: After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766- 0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%)., Conclusion: Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women., (© 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: High burden of chronic cardio-metabolic disorders including type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and cardiovascular disease (CVD) have been reported in the Middle East and North Africa region. We aimed to externally validate a non-laboratory risk assessment tool for the prediction of the chronic cardio-metabolic disorders in the Iranian population., Methods: The predictors included age, body mass index, waist circumference, use of antihypertensive medications, current smoking, and family history of cardiovascular disease and/or diabetes. For external validation of the model in the Tehran lipids and glucose study (TLGS), the Area under the curve (AUC) and the Hosmer-Lemeshow (HL) goodness of fit test were performed for discrimination and calibration, respectively., Results: Among 1310 men and 1960 women aged 28-85 years, 29.5% and 47.4% experienced chronic cardio-metabolic disorders during the 6 and 9-year follow-up, respectively. The model showed acceptable discrimination, with an AUC of 0.72 (95% CI 0.69-0.75) for men and 0.73 (95% CI 0.71-0.76) for women. The calibration of the model was good for both genders (min HL P = 0.5). Considering separate outcomes, AUC was highest for CKD (0.76 (95% CI 0.72-0.79)) and lowest for T2DM (0.65 (95% CI 0.61-0.69)), in men. As for women, AUC was highest for CVD (0.82 (95% CI 0.78-0.86)) and lowest for T2DM (0.69 (95% CI 0.66-0.73)). The 9-year follow-up demonstrated almost similar performances compared to the 6-year follow-up. Using Cox regression in place of logistic multivariable analysis, model's discrimination and calibration were reduced for prediction of chronic cardio-metabolic disorders; the issue which had more effect on the prediction of incident CKD among women. Moreover, adding data of educational levels and marital status did not improve, the discrimination and calibration in the enhanced model., Conclusion: This model showed acceptable discrimination and good calibration for risk prediction of chronic cardio-metabolic disorders in short and long-term follow-up in the Iranian population.

The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: To improve cardiovascular (CV) health of American population, the American Heart Association (AHA) developed definitions of ideal, intermediate, and poor CV health based on 7 accessible health metrics. The applicability of this construct and the distribution of its components in the community-based populations in the Middle East region have not been reported., Design and Settings: A prospective population-based cohort study conducted from 1999 to 2011., Methods: We used data from phase 4 of Tehran Lipid and Glucose Study (2009-2011) (2861 women and 2004 men, aged >= 20 years) to estimate the frequency of CV health levels (ideal, intermediate, and poor) in adults of both genders, and the frequency of each metric at each level of CV health. The median or mean of each CV health metric was also estimated in the whole spectrum of CV health in all subgroups., Results: Only 1 adult participant met all 7 ideal CV health metrics; 25.01% of women and 26% of men had intermediate CV health; 74.8% of women and 74% of men exhibited poor CV health. Only 19.7% of women and 10.3% of men had 5 or more ideal CV health metrics. Nonsmoking was the most frequent ideal health behavior. A total of 89.6% of participants had 1 or 2 ideal CV health behaviors. Ideal smoking and fasting plasma glucose had the highest frequency of CV health factors among others., Conclusion: The frequency of ideal CV health was extremely low in this cohort of adults. The frequency of intermediate CV health was also low, and it may be significantly lower in the general population.

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.

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