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Background: This study assesses the long-term effectiveness of a lifestyle intervention on cigarette, passive, and hookah smoking in adolescent boys and girls. Methods: One thousand one hundred and fifty-nine adolescent participants of Tehran Lipid and Glucose Study (TLGS) (2001-2004) were followed for 12 years. Participants in the intervention area received lifestyle interventions in family, schools, and community settings, with the largest part implemented in schools. After excluding those with missing baseline parental data (n = 66), complete parental data of 1093 adolescents was used for cluster analysis. Families were classified as low- and high-risk. Two hundred and ninety-six individuals who did not complete intervention/follow-ups were excluded, GEE was performed on 797 adolescents (369 boys, 192 intervention) to assess the intervention effect on tobacco-related habits. Results: Adolescents' mean baseline age was 15.21 ± 1.95. Those living in high-risk families were more at risk of cigarette, passive, and hookah smoking. Intervention decreased odds of cigarette and passive smoking by 38% and 57%, respectively. Intervention did not reduce hookah smoking in adolescents. After sex-specific analysis, the intervention reduced current cigarette smoking by 40% only in boys and passive smoking in both sexes. Conclusions: Targeting lifestyle behaviors in school-aged adolescents and their families reduces cigarette smoking in boys and protects both sexes from secondhand smoke.

Introduction: Targeting adolescents' smoking reduces its burden on health systems. We investigated the effects of the first multidisciplinary community-based lifestyle intervention in the Eastern Mediterranean region, on smoking initiation, continuation, and risk of current smoking in Iranian adolescents.Methods: The current analyses were conducted on 945 nonsmoker adolescents (12-18 years) who participated in Phase II of Tehran Lipid and Glucose Study (TLGS) and were examined four times in 12 years. The lifestyle intervention including school-based and public programs was implemented, focusing on all components of healthy lifestyle. Using a two-step cluster analysis, families were classified as high and low risk, based on parental risk factors of adolescents' smoking. Participants who failed to complete all the follow-ups (n = 99) and those with missing smoking data were excluded. Subsequently, 872 adolescents (538 control, 334 intervention) were included in the Cox model on smoking initiation, and 674 adolescents (414 control, 260 intervention) were included in the logistic regression on smoking status.Results: Mean age of adolescents was 15.08 ± 1.94 years at baseline. The hazard of the smoking initiation was significantly lower in the intervention (hazard ratio = 0.71, 95% confidence interval: 0.51-0.99; p = .044) compared with control group. At the end of the fourth follow-up, intervention reduced the odds of current cigarette smoking by 29%. Within the intervention group, the high-risk cluster was at a 35% lower risk of initiating smoking and had 37% lower odds of becoming a current smoker. However, the intervention could not make a difference in preventing those who initiated smoking from maintaining it during the follow-ups.Conclusions: Our results demonstrate that lifestyle modification programs targeting at-risk populations could reduce risk of smoking initiation and current smoking in adolescents in long term.Implications: Experiencing cigarette smoking at the critical period of adolescence could result in adulthood habitual smoking. Therefore, identifying adolescents who are more at risk of smoking initiation and implementing targeted interventions are of great importance in public health. Our findings highlight the long-term effectiveness of a multidisciplinary community-based behavioral intervention on forming smoking behaviors in adolescents. The current intervention was successful in reducing smoking uptake in adolescents living in high-risk families. [ABSTRACT FROM AUTHOR]

Aim We aimed to explore the effect of lactation on development of metabolic syndrome in a prospective population-based study. Methods From among 4028 female participants of the Tehran Lipid and Glucose Study, aged 15-50 years, without metabolic syndrome at the initiation of the study, 925 women were randomly selected to fill out the lactation questionnaire. Women were assigned to five groups based on lactation duration including: none, 1-6 months, 7-12 months, 13-23 months and 24 months or more. Over a 9-year follow-up, metabolic syndrome was compared between these groups, before and after adjustment for possible confounding variables. Results Metabolic syndrome was developed in 12.1% of non-lactating women; it was 28.6%, 34.0%, 26.2% and 26.7% in women with 1-6, 7-12, 13-23 and 24 months or more of lifetime duration of lactation, respectively ( P < 0.002). Adjustment for confounders revealed that women with 1-6 and 7-12 months of duration of lactation had significantly higher odds of metabolic syndrome in comparison to 24 months or more (1.4 and 1.3 times, respectively). Conclusion It seems that the longer duration of lactation up to 12 months may protect women against metabolic syndrome, in a dose-response manner. [ABSTRACT FROM AUTHOR]

Background: Few studies have used lifestyle modification to prevent obesity at the community level. The aim of this study was to determine the effects of lifestyle modification education on the prevalence of general and central obesity in adults. Methods: We studied 3270 men (1205 and 2065 individuals in the intervention and control groups, respectively) and 4464 women (1670 and 2794 individuals in the intervention and control groups, respectively). They participated in Tehran Lipid and Glucose Study during 1999-2011. Demographic characteristics, behavioral habits, and obesity status of the participants were assessed through four cross-sectional surveys with 3-year intervals. The intervention included education for improving diet and physical activity and decreasing smoking through counseling, lectures, and publications. Findings: The mean age of men and women was 44.2 ± 14.9 and 42.1±13.7 years, respectively. During a median follow-up of 9.9 years, the intervention had no significant impact on the odds of becoming obese in non-obese men and women. However, it resulted in 0.27 and 0.38 decreases in the odds of continuing to be obese in obese men and women, respectively. The changes were only significant in women (P = 0.003). In addition, the intervention reduced the odds of central obesity by 0.34 in the women with central obesity (P = 0.002). However, it had no significant effects on central obesity among other participants. Conclusion: Population-based interventions can be beneficial in reducing the prevalence of general and central obesity in adults. These effects are stronger in women than in men. Thus, implementing interventional programs among non-obese individuals is necessary. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to evaluate the validity and reliability of a Persian translation of the Modifiable Activity Questionnaire (MAQ) in a sample of adults from Tehran, Iran. Methods: There were 48 adults (53.1% males) enrolled to test the physical activity questionnaire. A sub-sample included 33 participants (45.5% males) who assessed the reliability of the physical activity questionnaire.The validity was tested in 25 individuals (48.0% males). The reliability of two MAQs was calculated by intraclass correlation coefficients. The validation study was evaluated with the Spearman correlation coefficients to compare data between the means of 2 MAQs and the means of 4 physical activity records. Results: Intraclass correlation coefficients between 2 MAQs for the previous year's leisure time was 0.94; for occupational, it was 0.98;and for total (leisure and occupational combined) physical activity, it was 0.97. The Spearman correlation coefficients between the means of the 2 MAQs and means of the 4 physical activity records was 0.39 (P = 0.05) for leisure time, 0.36 (P = 0.07) for occupational, and 0.47 (P = 0.01 ) for total (leisure and occupational combined) physical activities. Conclusions: High reliability and relatively moderate validity were found for the Persian translated MAQ in adults from Tehran. However, further studies with larger sample sizes are suggested to more precisely assess the validity of the MAQ. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess leisure time physical activity and its determinants among adults in Tehran. Methods: This cross-sectional study comprised adults (n &equals; 7285), aged 20 years and older. The subjects were participants of the Tehran Lipid and Glucose Study between 2002 and 2004. Information on the number of days spent on different activities during a week and the time devoted to each activity on a typical day was recorded. In addition, each activity, weighted by its relative intensity, was referred to as a metabolic equivalent. Results: The prevalence of inactivity was 69.8% (95% CI: 68.7−70.8) in the whole population and 30.2% (95% CI: 27.2−33.1%) of men and 30.3% (95% CI: 27.7−32.8%) of women were considered as active. Leisure time physical activity less than 30 min/week was scored in 1590 (50.6%) men and 1803 (43.5%) women. The most frequent leisure time physical activity performed by men (96.1%) and women (95.2%) was walking. A negative association was observed in men between leisure time physical activity and increased work hours, older age, more cigarette smoking and higher body mass index (69.8% were overweight and 75.3% were obese; P < 0.05). Leisure time physical activity was more likely to be associated with high educational levels in men. In addition, there was a statistically significant relationship between physical inactivity and occupation in both men and women. Conclusions: The prevalence of physical inactivity among adults in Tehran was high. Leisure time physical inactivity was more likely to be associated with older age, more cigarette smoking, more working hours, and higher body mass index. Public health efforts are needed to improve people's participation in physical activities in Iran. [ABSTRACT FROM AUTHOR]

Background: The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based program for prevention of non-communicable disorders (NCD) by development of a healthy lifestyle and reduction of NCD risk factors. The study begun in 1999, is ongoing, to be continued for at least 20 years. A primary survey was done to collect baseline data in 15005 individuals, over 3 years of age, selected from cohorts of three medical heath centers. A questionnaire for past medical history and data was completed during interviews; blood pressure, pulse rate, and anthropometrical measurements and a limited physical examination were performed and lipid profiles, fasting blood sugar and 2-hours-postload-glucose challenge were measured. A DNA bank was also collected. For those subjects aged over 30 years, Rose questionnaire was completed and an electrocardiogram was taken. Data collected were directly stored in computers as database software- computer assisted system. The aim of this study is to evaluate the feasibility and effectiveness of lifestyle modification in preventing or postponing the development of NCD risk factors and outcomes in the TLGS population. Design and methods: In phase II of the TLGS, lifestyle interventions were implemented in 5630 people and 9375 individuals served as controls. Primary, secondary and tertiary interventions were designed based on specific target groups including schoolchildren, housewives, and high-risk persons. Officials of various sectors such as health, education, municipality, police, media, traders and community leaders were actively engaged as decision makers and collaborators. Interventional strategies were based on lifestyle modifications in diet, smoking and physical activity through face-to-face education, leaflets & brochures, school program alterations, training volunteers as health team and treating patients with NCD risk factors. Collection of demographic, clinical and laboratory data will be repeated every 3 years to assess the effects of different interventions in the intervention group as compared to control group. Conclusion: This controlled community intervention will test the possibility of preventing or delaying the onset of non-communicable risk factors and disorders in a population in nutrition transition. Trial registration: ISRCTN52588395 [ABSTRACT FROM AUTHOR]

Background: Lipid abnormalities are major risk factors for cardiovascular diseases. In addition to age and sex, other variables can affect serum lipid levels, warranting the determination of population-specific reference values. This study aimed to determine age- and sex-specific reference values for serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides (TG) in healthy Tehranian adults. Methods: TC, TG, and HDL-C were measured using the enzymatic colorimetric method and the Friedewald equation (LDL-C = TC - HDL-C - TG/5) was used to calculate LDL-C concentrations in individuals with TG <400 mg/dL. After applying the exclusion criteria, 1147 participants (548 men and 599 women) aged ≥20 years were included. For determining reference values, the International Federation of Clinical Chemistry guidelines (non-parametric method) and the robust method were used for sample sizes ≥120 and <120, respectively. Results: Reference values for serum TC, LDL-C, HDL-C, and TG were 121.0-261.0, 54.1-175.2, 30.9-71.9, and 46.9-301.2 mg/dL in men and 117.8-235.9, 49.9-160.9, 36.0-83.9, and 38.1-184.2 mg/dL in women, respectively. All parameters except HDL-C were higher in men than women and showed an increasing trend with age. Conclusion: Reference values for serum TC, LDL-C, HDL-C, and TG in healthy Tehranian adults were determined, and these values could provide the basis for better decision making in both prevention and clinical settings. [ABSTRACT FROM AUTHOR]