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OBJECTIVE: This study aims to explore the association of nutritional intake and aggression among a nationally representative sample of Iranian children and adolescents. METHODS: This nationwide cross-sectional study was conducted on a multi-stage sample of 14880 students, aged 6-18 years, living in 30 provinces in Iran. Parents were asked to report the dietary intake of their children as frequency of food groups and/or items. The validated questionnaire of the World Health Organization-Global School-based Health Survey (WHO-GSHS) was used to measure components related to aggression including physical fight, verbal aggression, and being bullied by other students. RESULTS: Participants consisted of 13486 students (90.6 participation rate) with mean age of 12.47 years (95 CI: 12.40, 12.54); 49.2 were girls, and 75.6 lived in urban areas. Physical fighting was more prevalent among urban boys(48.63%), CI (46.75, 50.5) while bulling was the most common aggressive behavior among boys (29.7%), CI (28.03, 31.42) and girls (25.26%), CI (23.66, 26.93) living in urban areas. Daily consumption of fast foods, sweets, soda, salty snacks and fried foods was higher among those participants who reported frequent experience of physical aggression and bullying. Bullying to others increased significantly with consumption of fast food (Odds ratio: 1.43, CI: 1.07, 1.92) and red meat (Odds ratio: 1.14, CI: 1.02, 1.28). Salty snack consumption showed a significant association with physical fighting (Odds ratio: 1.29, CI: 1.15, 1.44). CONCLUSION: The findings of this study suggest that some unhealthy foods might affect the mental health of children and adolescents. Improving dietary habits should be considered for prevention of violence in the vulnerable pediatric age group. © 2021 - IOS Press. All rights reserved.

Long chain fatty acids (LCFA) of human milk (HM) might be associated with different patterns of weight gain in infancy. This study aims to examine the interaction between maternal dietary fat intake, breast milk content of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) with infant growth during the first year of life.This longitudinal study was conducted among 215 Iranian mother-infant pairs. The infants were followed up from birth to 12 months of age. Trained healthcare providers measured infant anthropometrics including weight, length and head circumference at birth, 2, 4, 6 and 12 months of age. Breast hind milk samples were collected in the morning through hand expression between 6 and 12 weeks postpartum. Maternal dietary intake was assessed using a 3-day dietary record. Linear mixed effects models were performed to determine the interaction between maternal dietary fat intake, the breast milk content of EPA and DHA with infant growth. Further adjustments were applied for potential confounders.Mean and standard deviation (SD) of maternal age and body mass index were 29.70 (5.24) years and 24.47 (4.42) kg/mWe found an inverse interaction between maternal dietary fat intake and breast milk omega-3 fatty acids with infant weight at 4 and 12 months of age. Although longer follow-up of growth indices is recommended, these findings suggest functional relevance of HM composition to infant growth.

Maternal smoking during pregnancy has detrimental effects on fetal development. The current review examined the differences in offspring’s bone mineral density (BMD) between mothers smoked during pregnancy and those who did not. A systematic review and meta-analysis on the studies investigating the influence of maternal smoking during pregnancy on children or neonates’ bone measures published up to October 30, 2018, was performed. BMD results measured at different body sites were pooled and then fixed or random effect models were used based on the presence of heterogeneity. The desired pooled effect size was the offspring’s BMD mean difference with 95% confidence interval between smoker and non-smoker mothers. Sensitivity analysis was performed for birth weight and current weight, two important mediator/confounders causing heterogeneity. Overall, eight studies consisting of 17,931 participants aged from infancy to 18 years were included. According to the fixed effect model, the mean of BMD in offspring whose mothers smoked during pregnancy was 0.01 g/cm2 lower than those with non-smoker mothers (95% CI = − 0.02 to − 0.002). However, subgroup meta-analysis adjusted for birth weight and current weight demonstrated no significant mean difference between BMD of children with smoker and non-smoker mothers (d = 0.06, 95% CI = −0.04 to 0.16, p value = 0.25 and d = − 0.005, 95% CI = − 0.01 to 0.004, p value = 0.28, respectively). According to available studies, it is suggested that maternal smoking during pregnancy does not have direct effect on the offspring’s BMD. Instead, this association might be confounded by other factors such as placental weight, birth weight, and current body size of children.

This systematic review and meta-analysis aims to systematically review the fatty acid (FA) composition of breast milk in different populations. We systematically searched the Medline via PubMed, Scopus and Clarivate till July 2019. We initially retrieved 433 articles. Having removed duplicates, with initial searching of title and abstracts, 317 papers were excluded and 80 remained. A meta-analysis of 80 cross-sectional, cohort studies, including 8793 subjects, was conducted. Meta-regression analysis indicated that factors including maternal age (p-values of SFA: 0.03, omega-3: 0.01, trans fats

Context: Physical environment contamination and in particular, air pollution might cause long-term adverse effects in child growth and a higher risk of catching non-communicable diseases later in life. Objective: This study aimed to overview the human studies on the association of exposure to ambient Particulate Matter (PM) with childhood obesity. Data Sources: We systematically searched human studies published until March 2018 in PubMed, Scopus, Ovid, ISI Web of Science, Cochrane library, and Google Scholar databases. Study Selection: All studies that explored the association between PM exposure and childhood obesity were assessed in the present study, and finally, 5 studies were used in the meta-analysis. Data Extraction: Two independent researchers performed the data extraction procedure and quality assessment of the studies. The papers were qualitatively assessed by STROBE (Strengthening the Reporting of Observational studies in Epidemiology) statement checklist. Results: The pooled analysis of PM exposure was significantly associated with increased Body Mass Index (BMI) (Fisher’s z-distribution=0.028; 95% CI=0.017, 0.038) using the fixed effects model. We also used a random-effect model because we found a significant high heterogeneity of the included studies concerning the PM (I2=94.4%; P

Abstract. Background: Only few food frequency questionnaires (FFQs) have been specifically designed and validated for toddlers. There is no valid instrument to assess usual intakes of Iranian toddlers. The present study was designed to develop a FFQ, and to examine its validity and reliability among toddlers. Material and methods: This cross-sectional study was conducted in 2019 in Iran. Mothers of 100 toddlers completed a semi-quantitative FFQ with 99 items as well as three non-consecutive dietary records. Data on maternal age, education, toddler gender, birth order, birth weight, current weight and height, and the age of beginning complementary foods were collected. By comparing the results obtained from dietary records and the FFQ, we assessed the relative validity. Reliability was evaluated by intra-class correlation coefficients between results of two FFQs administered with four weeks intervals to the same participants (n=20), as well as weighted kappa. The Bland-Altman plots were used to assess the level of agreement between two FFQs. Results: Mean and standard deviation (SD) of age was 32.71 (4.76) years and 22.42 (3.52) months, for mothers and toddlers, respectively. The FFQ showed acceptable validity and reliability. The correlation coefficients for the first FFQ were 0.82 (energy), 0.81 (fats), 0.60 (carbohydrate), 0.96 (calcium), 0.39 (iron) and 0.24 (vitamin C), all P-values were

Background: Dietary fiber intake might have a protective role against obesity. The aim of this study is to explore the association of dietary fiber intake with general and abdominal obesity in Iranian children and adolescents. Material and Methods: This cross-sectional nationwide study was conducted on 5187 students aged 6-18 years, living in 30 provinces of Iran. They were selected randomly through cluster sampling method. Data on demographic and anthropometric indices including weight, height and waist circumference (WC) were collected by trained interviewers. A valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ) was used to assess student's usual dietary intake including total dietary fiber. All dietary reports were converted to daily consumption (g/day) using household measures for different portion sizes. Food items were then converted to their nutrient content. Energy-adjusted dietary fiber intake (g/1000 kcal/day) was also calculated using the energy density method. Multivariate regression models were applied to explore the association between dietary fiber intake and anthropometric indices. Results: The mean and standard deviation (SD) for age of participants were 11.40 (3.20) years. Of 5187 students, 52.6 were boys and 72.5 were from urban areas (participation rate: 79.7). White bread (32.5), white rice (17.1) and potato (11.7) were the most common sources of dietary fiber intake. Each 1 g/1000 Kcal increase in dietary fiber intake was significantly associated with lower weight and waist circumference (P = 0.006 and P = 0.008, respectively). Conclusion: Higher fiber intake was associated with lower anthropometric indices including weight and WC. Increased fiber intake should be encouraged for children and adolescents. © 2018 - IOS Press and the authors. All rights reserved.

Background This study aims to systematically review the effects of maternal vitamin and/or mineral supplementation on the content of breast milk. Methods We systematically searched electronic databases including Medline via PubMed, Scopus and ISI Web of Science till May 24, 2018. The following terms were used systematically in all mentioned databases: (“human milk” OR “breast milk” OR “breast milk composition” OR “human breast milk composition” OR “composition breast milk” OR “mother milk” OR “human breast milk” OR “maternal milk”) AND (“vitamin a” OR “retinol” OR “retinal” OR “retinoic acid” OR “beta-carotene” OR “beta carotene” OR “ascorbic acid” OR “l-ascorbic acid” OR “l ascorbic acid” OR “vitamin c” OR “vitamin d” OR “cholecalciferol” OR “ergocalciferol” OR “calciferol” OR “vitamin e” OR “tocopherol” OR “tocotrienol” OR “alpha-tocopherol” OR “alpha tocopherol” OR “α-tocopherol” OR “α tocopherol” OR “vitamin k” OR “vitamin b” OR “vitamin b complex” OR “zinc” OR “iron” OR “copper” Or “selenium” OR “manganese” OR “magnesium”) and we searched Medline via Medical subject Headings (MeSH) terms. We searched Google Scholar for to increase the sensitivity of our search. The search was conducted on human studies, but it was not limited to the title and abstract. Methodological quality and risk of bias of included studies were evaluated by Jadad scale and Cochrane risk of bias tools, respectively. Results This review included papers on three minerals (zinc, iron, selenium) and 6 vitamins (vitamin A, B, D, C, E and K) in addition to multi-vitamin supplements. Although studies had different designs, e.g. not using random allocation and/or blinding, our findings suggest that maternal use of some dietary supplements, including vitamin A, D, vitamin B1, B2 and vitamin C might be reflected in human milk. Vitamin supplements had agreater effect on breast milk composition compared to minerals. Higher doses of supplements showed higher effects and they were reflected more in colostrum than in the mature milk. Conclusion Maternal dietary vitamin and/or mineral supplementation, particularly fat- soluble vitamins, vitamin B1, B2 and C might be reflected in the breast milk composition. No difference was found between mega dose and single dose administration of minerals.

Background: The present study aims to explore the association of anthropometric indices and cardio-metabolic risk factors in normal-weight children and adolescents. Methods: This cross-sectional nationwide study was conducted in 2015 among 4200 Iranian school students aged 7–18 years. They were selected using a multi-stage cluster random sampling method. Anthropometric indices and cardio-metabolic risk factors including fasting blood glucose (FBG), lipid profile and blood pressure (BP) were measured using standard protocols. Results: The response rate was 91.5%. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) had a significant positive correlation with waist circumference (WC), hip circumference (HC) and body mass index (BMI) in boys and girls. HDL-C had a significant inverse correlation with WC, HC and BMI in boys. For each unit increase in WC, HC and BMI, the risk of elevated DBP significantly increased by 2%, 1% and 11%, respectively. Likewise, for each unit increase in WC, HC and BMI, the risk of elevated BP significantly raised by 2%, 1% and 10%, respectively. For each unit increase in WC, the risk of metabolic syndrome increased by 7%. Conclusions: Anthropometric indices are considered an easy, non-invasive tool for the prediction of cardio-metabolic risk factors in normal-weight children and adolescents.

Objective: This study aims to assess the relationship between body mass index (BMI) of children and that of their parents in a nationally-representative sample of Iranian population. Methods: This cross-sectional nationwide study was conducted in 2011-2012 among 6-18-year-old students and their parents living in 30 provinces of Iran. Socio-demographic information was collected. The BMI values of the children/adolescents were categorized according to the World Health Organization reference curves. Association between parental and student weight status was examined using ordinal regression models after adjustment for potential confounders. Results: Overall, 23043 children and adolescents and one of their parents participated in this study (50.7 boys, 73.4 urban status). Mean age of the subjects was 12.55±3.31 years. Mean BMI values of parents and children/adolescents were 27.0±4.57 and 18.8±4.4 kg/m2, respectively. After adjusting for confounders, overweight and/or obesity in students of both genders was found to be significantly associated with parental overweight and/or obesity. In those students who had obese parents, the odds ratio (OR) of being obese was 2.79 for boys OR=2.79; 95% confidence interval (CI)=2.44-3.20 and 3.46 for girls (OR=3.46; 95% CI=3.03-3.94) compared to their peers with normal-weight parents. Boys with overweight parents were 1.7 times more overweight than their counterparts with normal-weight parents (OR=1.70; 95% CI=1.15-1.92). Similarly, girls who had overweight parents were more overweight compared to those with normal-weight parents (OR=2.00; 95% CI=1.77-2.25). Conclusion: Our findings highlight the importance of the shared family environment as a multi-factorial contributor to the childhood obesity epidemic and the necessity of implementing family-centered preventive programs. © 2017 by Turkish Pediatric Endocrinology and Diabetes Society.

Introduction: The aim of the present study is to explore the prevalence and mean of cardio-metabolic risk factors and liver enzymes of Iranian adolescents living in regions with different socioeconomic status (SES). To the best of our knowledge this is the first study reporting these data at sub-national level in Iran. Methods: This multi-centric study was performed in 2009-2010 on a stratified multi-stage probability sample of 5940 students aged 10-18 years, living in urban and rural areas of 27 provinces of Iran. Trained healthcare professionals measured anthropometric indices, systolic and diastolic blood pressures (SBP, DBP) according to standard protocols. Fasting venous blood was examined for fasting blood sugar (FBS), lipid profile and liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We classified the country into four sub-national regions based on criteria of the combination of geography and SES. Mean and frequency of risk factors were compared across these regions. Results: The mean of body mass index had linear rise with increase in the regions’ SES (P for trend

BACKGROUND: Over the last decades, childhood obesity has become a worldwide epidemic health problem. Identifying the barriers to a healthy lifestyle among children and adolescents is necessary for further effective intervention to prevent overweight and obesity. This study aims to assess the barriers to healthy lifestyle habits, including physical activity (PA), eating, and sleep among adolescents from the perspective of their parents. METHODS: In this cross-sectional study, the parents of obese and overweight middle school students were enrolled. Data were collected using a questionnaire about barriers of healthy nutrition and PA. RESULTS: Overall, 172 parents completed the questionnaire. Lack of access to affordable facilities for PA, lack of access to the appropriate place for PA, and lack of sufficient information on how to do or increase PA were the main barriers to PA. The barrier factors for healthy eating were media advertisement of unhealthy foods, lack of motivation to use healthy nutrition, and lack of adequate information about healthy eating. Regarding poor sleep, lack of knowledge about the benefits of sleep, prolonged watching television, and late sleep time of family members were reported as the main barriers. These findings were not statistically different according to the family socioeconomic level. CONCLUSION: Our findings propose that for improving healthy lifestyle in obese children and adolescents, access to facilities, and appropriate places for PA should be provided at the community level. Moreover, training parents and students about healthy lifestyle behaviors is necessary for families of all socioeconomic levels.

Maternal smoking during pregnancy has detrimental effects on fetal development. The current review examined the differences in offspring's bone mineral density (BMD) between mothers smoked during pregnancy and those who did not. A systematic review and meta-analysis on the studies investigating the influence of maternal smoking during pregnancy on children or neonates' bone measures published up to October 30, 2018, was performed. BMD results measured at different body sites were pooled and then fixed or random effect models were used based on the presence of heterogeneity. The desired pooled effect size was the offspring's BMD mean difference with 95% confidence interval between smoker and non-smoker mothers. Sensitivity analysis was performed for birth weight and current weight, two important mediator/confounders causing heterogeneity. Overall, eight studies consisting of 17,931 participants aged from infancy to 18 years were included. According to the fixed effect model, the mean of BMD in offspring whose mothers smoked during pregnancy was 0.01 g/cm

The aim of this study was to propose a simple practical diagnostic criterion for pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group. This study was conducted on a nationally representative sample of 14,880 students, aged 6-18 years. HTN and pre-HTN were defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95 and 90-95th percentile for age, gender, and height, respectively. By using the area under the curve (AUC) of the receiver operator characteristic curves, we estimated the diagnostic accuracy of two indexes of SBP-to-height ratio (SBPHR) and DBP-to-height (DBPHR) to define pre-HTN and HTN. Overall, SBPHR performed relatively well in classifying subjects to HTN (AUC 0.80-0.85) and pre-HTN (AUC 0.84-0.90). Likewise, DBPHR performed relatively well in classifying subjects to HTN (AUC 0.90-0.97) and pre-HTN (AUC 0.70-0.83). Two indexes of SBPHR and DBPHR are considered as valid, simple, inexpensive, and accurate tools to diagnose pre-HTN and HTN in pediatric age group.

Background and aim Little information is available on the use of text messages through mobile phones to address overweight/obesity in children. This study aims to evaluate the impact of a text message-based intervention for weight control and health-promoting lifestyle behaviors of overweight/obese children. Materials and methods This quasi-experimental study was conducted among overweight/obese school students. Data on sociodemographic, dietary intake, sleep, sedentary behavior, physical activity (PA), and anthropometry were collected before and after the intervention. Weight and height were examined according to the standard protocols. The intervention was consisted of tailored messages for weight control and healthy lifestyle, including diet, PA, sedentary behavior, and sleep. Child attitude and his practice were asked before and after the intervention. The paired t-test was performed to compare means of continuous variables before and after the intervention for normal distribution data. The Wilcoxon test was also used for nonnormal data. Results A total of 71 boy students were included in the study (62% obese). The mean age was 10.07 years. The means of attitude score for PA, nutrition, and sleep after intervention were greater than before it, but it was significant only for PA. The mean of nighttime sleep duration of students after the intervention was significantly less. Furthermore, unhealthy score decreases after the intervention. Conclusion Three-month lifestyle intervention as text messages had positive effects on the nutritional intake of obese children and their attitudes toward PA, but no effect on child body mass index.

This study aims at systematically reviewing the observational and interventional studies on the association of maternal macro- and micronutrient intake with breast milk content.We systematically searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till October 2016 with the following search strategy: ("human milk" OR "breast milk" OR "breast milk composition" OR "human breast milk composition" OR "composition breast milk" OR "mother milk" OR "human breast milk") AND ("maternal diet" OR "maternal nutrition"). We also searched Google scholar for increasing the sensitivity of our search. The search was not limited to title and abstract due to the possibility that the desired outcome might have been considered a secondary aim. We excluded conference papers, editorials, letters, commentary, short survey, and notes. The search was refined to English language, and we did not consider any time limitation. To increase the sensitivity and to select more studies, the reference list of the published studies was checked as well.This review included 59 observational and 43 interventional studies on maternal diet related to breast milk composition. Different studies determined the associations and effects of some maternal dietary intake of micro and macronutrients and its reflection in human milk.Maternal dietary intake, particularly fatty acids, and some micronutrients, including fat soluble vitamins, vitamin B

Background Vitamin A deficiency (VAD) is considered as one of the most serious public health concerns in developing countriesand the leading cause of mortality in under-five-year-old children.A large number of young children and pregnant women especially in low-income, non-industrialized communities are more susceptible to VAD. This study aims to report the burden of disease (BOD) attributable to VAD in Iranian population aged less than 5 years by using data of the Global Burden of Disease (GBD) study 2010. Methods The GBD 2010 study calculated the proportion of deaths, years of life lost (YLLs), and years lived with disability (YLDs) and disability-adjusted life years (DALYs) attributable to VAD by using the comparative risk assessment (CRA). VAD defined as low serum retinol concentrations (plasma retinol concentration

Objectives This study aimed to evaluate the association of neck circumference (NC) with obesity to determine the sex-specific and age-specific optimal cut-off points of this measure in association with obesity in a national sample of the Iranian paediatric population. Methods This survey on weight disorders was conducted among a national sample of Iranian children and adolescents, aged 6–18 years. Using the area under the curve (AUC) of the receiver operator characteristic curves, we evaluated the association of NC with general and abdominal obesity. Results This national survey was conducted among 23 043 school students (50.8% boys) with a mean age (SD) of 12.55 (3.31) years. A significant association was documented between NC and other anthropometric measures in both sexes and in the whole population. In all age groups and genders, NC performed relatively well in classifying participants to overweight (AUC: 0.67 to 0.75, p

Herbal medicines with high amounts of phytochemicals have been shown to have beneficial effects on blood pressure (BP), endothelial function and anthropometric measures. This study aimed to determine the effect of herbal treatment on BP, endothelial function and anthropometric measures in patients with type 2 diabetes mellitus (T2DM). This clinical trial included 204 T2DM patients randomly assigned to four intervention groups receiving 3 g cinnamon, 3 g cardamom, 1 g saffron or 3 g ginger with three glasses of black tea, and one control group consuming only three glasses of tea without any herbals, for 8 weeks. Intercellular adhesion molecule-1 (ICAM-1), systolic and diastolic BP and anthropometric measures were collected at baseline and after 8 weeks. No significant difference was found between various medicinal plants in terms of influencing BP, serum soluble (s)ICAM-1 concentrations and anthropometric measures. However, in within-group comparison saffron and ginger intakes significantly reduced sICAM-1 concentrations (340.9 ± 14.4 vs 339.69 ± 14.4 ng/ml, p = 0.01, and 391.78 ± 16.0 vs 390.97 ± 15.8 ng/ml, p = 0.009, respectively) and ginger intake affected systolic BP (143.06 ± 0.2 vs 142.07 ± 0.2 mmHg, p = 0.02). Although administration of these herbal medicines as supplementary remedies could affect BP and sICAM-1 concentrations, there was no significant difference between the plants in terms of influencing anthropometric measures, BP and endothelial function.

BACKGROUND The aim of the study was to provide the age- and sex-specific percentile values of anthropometric measures for Iranian children and adolescents. METHODS This cross-sectional nationwide survey was conducted on a representative sample of 14,880 school students, selected by multistage random cluster sampling from urban and rural areas of 30 provinces in Iran. Anthropometric measures including body mass index (BMI), waist circumference (WC), hip circumference (HC), and wrist circumference were measured under standard protocols by using calibrated instruments. Age- and gender-specific reference values were developed for anthropometric measures by the maximum penalized likelihood approach [Cole's least mean square (LMS) method]. RESULTS In the present study, 13,486 out of the 14,880 invited subjects completed all the required data of the study (participation rate: 90.6%). Participants consisted of 6640 girls (49.2%) and 75.6% urban residents; their mean and standard deviation (SD) age was 12.47±3.36 years. The BMI percentile curves of girls had a sharp increase from 14 to 18 years, and then began to plateau, but among boys, these curves had a consistent increase until the age of 18 years. In addition, the higher percentiles were higher in adolescent boys than girls. The HC percentile curves of both sexes had a persistent increase and the percentiles for HC were higher in adolescent girls than in boys. WC had a sharp increase from 7 to 18 years of age for boys, whereas for girls, these curves had a less sharp increase with age. In all ages, the percentiles for wrist circumference were higher in adolescent boys than girls. CONCLUSIONS The findings of this study highlight the necessity of paying special attention to developing age- and gender-specific percentiles of anthropometric measures in children and adolescents.

To identify risk-groups adhering to weight-changing plans for body dissatisfaction in a National sample of Iranian students. Cross-sectional. Primary, Middle and high-schools. 13486 students (mean age, 12.5 y). Demographic and anthropometric characteristics were collected via valid instruments. Body image and adherence to weight- changing diets were assessed by using validated questionnaires. 46.5% students were satisfied with their weight and12.5% declared that they had attempts for weight control, this was significantly higher among adolescent girls (13.8%, P=0.0005). Participants who perceived themselves as overweight and obese, were more likely (OR= 5.32) to follow weight-reduction diets than their peers with normal-weight perception. Actual overweight-BMI and obese-BMI individuals had greater odds for being on a diet (1.3 and 1.47, respectively) compared to their normal-BMI counterparts. Promoting strategies to improve body image concerns and prevent adverse outcomes of chronic dieting among adolescents are necessary.

Background: Excess weight in children and adolescents is a multi-factorial phenomenon and associated with earlier risk of obesity- related diseases. Th is study aims to assess the prevalence of weight disorders and the mean values of anthropometric indices according to regional, socioeconomic, and urban-rural variations among Iranian children and adolescents. Materials and Methods: Th is nationwide study was performed in 2011-2012 among a representative multi-stage cluster sample of 14,880 Iranian students aged 6-8 years. Th e World Health Organization (WHO) reference curves were used to defi ne weight disorders. Abdominal obesity was defi ned as the waist-to-height ratio (WHtR) of more than 0.5. Iran was classifi ed into four regions according to the socioeconomic status (SES). Results: Th e mean (95% confi dence interval) of body mass index (BMI), waist circumference (WC), and hip circumference (HC) was 18.8 (18.7, 18.9) kg/m 2 , 67.0 (66.7, 67.3) cm, and 80.8 (80.3, 81.2) cm, respectively. Th e prevalence of underweight was 12.2%. A total of 9.7%, 11.9%, and 19.1% of students overweight, obese, and abdominally obese, respectively. Th e highest mean of BMI, WC, wrist circumference, HC, and WHtR were related to the second high SES (North-northeast) area (19.2 (18.8, 19.5), 68.3 (67.3, 69.4), 14.8 (14.7, 15.0), 82.6 (81.1, 84.0), and 0.464 (0.460, 0.468)). In contrast, the lowest SES (Southeast) region had the lowest mean of these anthropometric indices (17.6 (17.1, 18.2), 63.2 (61.7, 64.8), 14.5 (14.2, 14.8), 76.9 (74.9, 79.0), and 0.439 (0.434, 0.444)). Conclusion: We found considerable diff erences in the prevalence of anthropometric measures throughout the country by SES of the region. Health policy making and implementing health strategies should consider SES of regions.

Background: Hypovitaminosis D is highly prevalent and has several adverse health effects. This study aims to assess the relationship of serum concentrations of 25-hydroxyvitamin D (25[OH] D) and liver enzymes in adolescents. Methods: This population-based cross-sectional survey was conducted among a nationally representative multistage sample of 1095 adolescents (52% boys), aged 10–18 years, living in different provinces of Iran. Serum 25(OH)D concentration 40 U/L was considered as high level. To determine the association between serum 25(OH)D categories and elevated levels of liver enzymes, multiple regression models and linear regression analysis were applied, after adjustment for potential confounders. Odds ratios (95% confidence interval) of serum 25(OH)D and elevated liver enzymes were assessed by logistic regression analysis. Results: Higher rates of Vitamin D deficiency were documented among individuals with increased levels of liver enzymes. Compared to boys, median of 25(OH)D was lower in girls with elevated levels of liver function tests (12.75 vs. 25.60 ng/mL for ALT and 13 vs. 14.10 ng/mL for AST), with marginally significant gender differences regarding AST. Conclusions: We found a relatively high frequency of hypovitaminosis D among adolescents with abnormal liver function. Further prospective studies are needed to examine these associations from early life.

AIM: This nationwide study aims to investigate the prevalence of psychiatric distress and violent behaviors in a nationally-representative sample of Iranian children and adolescents according to the socioeconomic status (SES) of their living region. METHODS: In this study, 14880 school students, aged 6-18 years, were selected from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used. Data were compared at national and subnational levels according to the SES of the living region. RESULTS: Overall, 13486 students (49.2% girls) with mean (SD) age of 12.47(3.36) years completed the study. At national level, the prevalence of psychiatric distress ranged between 9 to 38%; the most and least prevalent psychiatric distresses were angriness (37.73%, 95%CI: 36.5, 38.99) and confusion (8.65%, 95%CI: 8.04, 9.29), respectively. Students living in regions with highest SES experienced angriness (41.24%, 95%CI: 38.94, 43.59) more than in those from the regions with lowest SES (31.18%, 95%CI: 26.71, 36.02). The prevalence of bully, victim and physical fight was 17.56% (95% CI: 16.73, 18.42), 27.36% (95% CI: 26.34, 28.42), and 39.94% (95% CI: 38.69, 41.20), respectively. The prevalence of violent behavior did not differ significantly in various regions of Iran. CONCLUSION: The relatively high prevalence of psychiatric distress in Iranian children and adolescents necessitates paying more attention to mental health of this vulnerable age group. Differences in the prevalence of such disorders according to the SES of the living area should be considered in planning evidence-based preventive programs and in international comparisons. Language: en

Background: This paper presents the methodology and primary findings of a national project on determinants of weight disorders among Iranian children and adolescents at national and sub-national levels. Methods: This nationwide study was conducted in 2011-2012 in Iran as part of the fourth phase of a national surveillance program entitled Childhood and Adolescence Surveillance and PreventIon of Adult Noncommunicable disease-IV study. It had two phases of qualitative and quantitative study. This multicentric study was conducted among 25,000 students aged 6-18 years, living in urban and rural areas of 30 provinces of Iran. Students were selected by multistage cluster sampling method. Data regarding weight disorders including sociodemographic variables, perinatal factors, lifestyle factors, family and student dietary habits, quality of life, and family history of chronic diseases as well as body image were gathered via validated questionnaires. Results: Overall, 23043 students completed the survey (participation rate: 92.17%). The mean age of participants was 12.55 ± 3.31 years; 50.8% were boys, and 73.4% were from urban areas. Underweight was found in 10.4% of boys and 9.2% of girls, the corresponding figure for overweight and obesity was 21% and 18.3%. Abdominal obesity was found in 17.6% of students. Among parents, obesity was more frequent than other weight disorders, with higher prevalence in parents of girls than boys (24.5% vs. 21.5%, respectively, P < 0.001). Overweight and obesity were more prevalent in urban than in rural parents (66.7% vs. 59.7%, respectively, P < 0.001). Conclusions: This survey serves as confirmatory evidence on the prevalence of dual burden of weight disorders in Iran. Its findings on determinants of weight disorders would help policymakers to implement relevant programs at national and sub-national levels.

Background: Pediatric obesity is one of the predisposing risk factors for many non-communicable diseases. Objectives: The purpose of this study was to estimate the national prevalence of general and abdominal obesity among Iranian children and adolescents. Patients and Methods: This cross-sectional nation-wide study was performed in 30 provinces in Iran among 14880 school students aged 6 – 18 years, selected by multistage random cluster sampling. The World Health Organization growth curve was used to categorize Body Mass Index (BMI). Obesity was defined as BMI equal to or higher than the age- and gender-specific 95th percentile; abdominal obesity was considered as waist-to-height ratio of more than 0.5. Results: Data of 13486 out of 14880 invited students were complete (response rate of 90.6%). They consisted of 6543 girls and 75.6% urban residents, and had a mean age of 12.45 (95% CI: 12.40 - 12.51) years. The prevalence rate of general and abdominal obesity was 11.89% (13.58% of boys vs. 10.15% of girls) and 19.12% (20.41% of boys vs. 17.79% of girls), respectively. The highest frequency of obesity was found in the middle school students (13.87% general and 20.84% abdominal obesity). The highest prevalence of general obesity was found in Boushehr (19%) followed by Guilan and Mazandaran (18.3%, 18.3%), while the lowest prevalence was observed in Hormozgan (2.6%). The highest frequency of abdominal obesity was found in Mazandaran (30.2%), Ardabil (29.2%) and Tehran (27.9%). Provinces such as Sistan-Baloochestan (8.4%), Hormozagan (7.4%), and Kerman (11.4%) had the lowest prevalence of abdominal obesity. The Southern and South Eastern provinces had the lowest prevalence of general obesity (2.6% and 5.6%) and abdominal obesity (7.4% and 8.8%). Moreover, the highest prevalence of obesity was found in North and North West Iran by maximum frequency of 18.3% general obesity and 30.2% of abdominal obesity. Conclusions: The results showed a high prevalence of general and abdominal obesity among boys living in the Northern provinces of Iran. The present study provides insights that policy makers should consider action-oriented interventions for prevention and control of childhood obesity at national and sub-national level.

BackgroundThis study aims to assess the prevalence of growth disorders among a nationally representative sample of Iranian adolescents according to the socioeconomic status (SES) of their living area.MethodsThis nationwide cross-sectional survey was conducted among a representative sample of 5624 adolescents aged 10–18 years. They were selected by multistage cluster sampling from 27 provinces of Iran. Subnational classification of the country was based on geography and social class of each region. Analysis of variance and Chi-square tests were used to compare the prevalence of growth disorders according to sex and SES of the living regions.ResultsThe mean and standard deviation for body mass index was 19.42 (4.09) kg/m2, with a significant trend from the Southeast region with lowest SES to the Central part with highest SES (ptrend

This systematic review and meta-analysis was performed on the relationship of serum 25-hydroxy-vitamin D [25(OH)D] and lipid profile in the pediatric age group. Electronic search was conducted in international databases. Our search yielded to 3213 articles, with initial searching of title and abstracts, 3192 of them were excluded and 21 remained. A meta-analysis of 17 cross-sectional studies, including 25 394 subjects, was conducted according to Strobe guideline. We found an inverse weak significant association between 25(OH)D and triglycerides (r = -0.135, CI; -0.243, -0.025), total cholesterol (r = -0.086, CI; -0.0205, 0.035) and LDL-C (r = -0.025, CI; -0.22, 0.17), and direct association with HDL-C (r = 0.156, CI; -0.021, 0.324). In the pooled analysis, we used a random effects model as the heterogeneity between studies was significant (I²= 97.04%, p 0.001 for triglycerides; I²= 96.09%, p 0.001 for total cholesterol; I²= 96.14%, p 0.001 for LDL-C; I²= 99%, p 0.001 for HDL-C). This study indicates that higher serum 25(OH)D is related to a more favorable lipid profile in the pediatric age group.

Objective: Snacks play an important role in child health and nutritional status. Schools are considered as the preferred place to encourage healthy eating among children. The aim of this study was to evaluate the effect of buffet school-based intervention on acceptance and satisfaction of parents and students in Iran. Materials and Methods: Primary school students (n = 1120, 68.83% girls) from first to third grade, with one of their parents, participated in this prospective field trial study conducted in Isfahan, Iran. The study was consisted of three phases; schools selection, kitchen selection, implementation including two different parts, getting order and distribution. We provided hot snacks as traditional and healthy fast food according to taste and food preferences of children. Acceptance and satisfaction of parents and students were evaluated via a researcher made questionnaire before and after the intervention in one-third of participants as a representative sample of students who ordered the snacks. Results: Most of the students usually ate snack in the break-time at school, the eagerness of provided snacks was 98.8% and 63.6% in girls and boys, respectively. The most interesting tastes were Ashe Reshteh and Tahchin, (45.1% girls vs. 36.8% boys), while bean (among girls) and Ashe Jo (among boys) were ranked as the lowest. More than half of parents (66.7%) evaluated the price of snacks as “acceptable,” showing their satisfaction. Conclusion: Results of this study indicate that school-based interventions accompanied with parental and principals’ support is considered as a practical approach to promote healthful eating at an early age. Developing effective interventions for youth might, therefore, help to prevent unhealthy dietary choices becoming habitual.

Background: The consumption of nutritional supplements is high in various sports, whereas, there are not enough documents supporting the beneficial effects of supplements in athletes. In addition, there is no information about taking supplements by Iranian students who participate in sports. Therefore, the goals of this study were to assess the type and prevalence of supplement use, the frequency of use, and relationships between consumption and age, body mass index, training load and type of sport. Methods: One hundred ninety two male students from "Isfahan University of Medical Sciences" participated in this study, voluntarily. A questionnaire that included questions about type and effects of supplements, recommendation resources, place of obtaining, and type of sports were sent to students. Descriptive data were calculated as frequencies (%). Chi-square (χ2) analysis was used to analyze the correlation between supplement use and the study variables. Results: Forty-five percent of respondents used some forms of supplements. Supplement users consumed 14 different supplements and each used as many as 1.8 ± 1.2 various supplements during the past six months. Multivitamins (64%) and vitamin C (42%) were the most popular supplements. Students, who participated in individual sports, were more likely to consume dietary supplements ( P < 0.05) and ergogenic aids ( P < 0.01), but "team sports" athletes, took more recovery nutrients ( P < 0.01). Fifty seven point five percent of student bought their products from pharmacies, 40% from "sport supplements stores" and 2.5% from their friends. Conclusions: It can be concluded that less than half of these students consumed supplements and their information resources were inappropriate.

Background: This study aims to explore the frequency of aggressive behaviors among a nationally representative sample of Iranian children and adolescents. Methods: This nationwide study was performed on a multi-stage sample of 6-18 years students, living in 30 provinces in Iran. Students were asked to confidentially report the frequency of aggressive behaviors including physical fighting, bullying and being bullied in the previous 12 months, using the questionnaire of the World Health Organization Global School Health Survey. Results: In this cross-sectional study, 13,486 students completed the study (90.6% participation rate); they consisted of 49.2% girls and 75.6% urban residents. The mean age of participants was 12.47 years (95% confidence interval: 12.29, 12.65). In total, physical fight was more prevalent among boys than girls (48% vs. 31%, P < 0.001). Higher rates of involvement in two other behaviors namely being bullied and bulling to other classmates had a higher frequency among boys compared to girls (29% vs. 25%, P < 0.001 for being bullied) and (20% vs. 14%, P < 0.001 for bulling to others). Physical fighting was more prevalent among rural residents (40% vs. 39%, respectively, P = 0.61), while being bullied was more common among urban students (27% vs. 26%, respectively, P = 0.69). Conclusions: Although in this study the frequency of aggressive behaviors was lower than many other populations, still these findings emphasize on the importance of designing preventive interventions that target the students, especially in early adolescence, and to increase their awareness toward aggressive behaviors. Implications for future research and aggression prevention programming are recommended.