Sumac (Rhus coriaria L.) powder supplementation has beneficial effects on appetite in overweight/obese women with depression: A randomized controlled trial.

BACKGROUND AND PURPOSE: Appetite disturbance is a common problem in obesity and depression. The beneficial effects of polyphenols in promoting satiety have been shown. This study aimed to investigate the effects of sumac supplementation along with calorie restricted diet (CRD) on appetite in overweight and obese women with depression. MATERIALS AND METHODS: In this trial, 60 overweight and obese women with depression were randomly assigned to receive a CRD plus 3 g/day of either sumac or placebo for 12 weeks. The appetite score, serum levels of leptin, neuropeptide Y (NPY), insulin, fasting blood sugar (FBS), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) were assessed at baseline and at the end of the study. RESULTS: Sumac supplementation significantly reduced the appetite score (p = 0.02), serum levels of leptin (p = 0.03), NPY (p = 0.01), insulin (p = 0.03), FBS (p = 0.03), and HOMA-IR (p = 0.02) compared to the placebo group. QUICKI increased significantly in the sumac group compared to the placebo group (p = 0.009). CONCLUSION: Sumac along with a CRD may have some beneficial effects on appetite through possible modulatory effects on leptin resistance, insulin sensitivity, and NPY levels in overweight and obese women with depression.

Interaction of common variants of FTO gene and Dietary Inflammatory Index on obesity measures: Tehran Lipid and Glucose Study.

Background: This study aimed to examine the interaction of Dietary Inflammatory Index (DII) and fat mass and obesity-associated gene (FTO) single-nucleotide polymorphisms (SNPs) on change in obesity measures. Methods: A total of 4480 participants from the Tehran Lipid and Glucose Study were selected. DII was calculated using a Food Frequency Questionnaire. The FTO SNPs rs8050136, rs14211085 and rs1121980 were selected. Changes in obesity measures were calculated. Results: In individuals with risk allele of FTO SNP rs8050136, greater adherence to DII was associated with increased odds of higher waist circumference (WC) (OR, Q1-Q4: 1, 0.87, 0.88, 0.94; P trend=0.01), but deceased odds of waist to hip ratio (WHR) (OR, Q1-Q4: 1, 0.85, 0.76, 0.70; P trend=0.01). Moreover, higher score of DII was significantly related to elevated odds of having high Visceral Adiposity Index (VAI) in individuals with wild-type genotype of FTO SNPs. For changes in WC, a significant interaction was identified between FTO rs1421085 and DII; the second quartile of DII was associated with increased odds of having a high WC in carriers of wild variant (TT genotype) of rs1421085 (OR 1.43; 95% CI 1.04 to 1.97), but not in individuals with risk allele of this SNP (TC CC). Although there are significant relationships between SNPs or genetic risk score and change in WHR or VAI, but there is no significant interaction between FTO SNPs and DII regarding change in body mass index, WHR and VAI. Conclusions: There may be an interactive effect between DII and the FTO rs1421085 genotypes on change in WC.

The combined effects of probiotics and restricted calorie diet on the anthropometric indices, eating behavior, and hormone levels of obese women with food addiction: a randomized clinical trial.

BACKGROUND AND AIM: Food addiction (FA) is an important contributor to obesity. Alterations in gut microbiota (GM) diversity and composition have also been proposed to play a pivotal role in obesity pathogenesis. This trial aimed to assess the effects of probiotic supplementation on the anthropometric indices, eating behavior, and hormone levels of obese women with FA. METHODS: This randomized, double-blind, placebo-controlled clinical trial was conducted among obese women with FA. Participants (n = 62) received a restricted calorie diet (RCD) plus either probiotic, or placebo for 12 weeks. Anthropometric measurements, biochemical markers, eating behavior and appetite were assessed during the study period. RESULTS: Probiotics administration significantly reduced weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), body fat percentage (BFP), and trunk fat percentage (TFP) compared to the placebo group (p < 0.001). Also, a significant improvement was observed in eating behavior in the probiotic group compared to the placebo group (p < 0.001).Serum levels of oxytocin increased and NPY decreased significantly in the probiotic group compared to the placebo group (p = 0.02, p = 0.002, respectively). Moreover, leptin level significantly decreased in the probiotic group compared to the baseline values (p < 0.001), while probiotics did not cause a greater significant reduction in leptin level, compared to the placebo group. CONCLUSION: Multi-probiotic supplementation may have beneficial effects on anthropometric indices, eating behavior, and some appetite-regulating hormones in obese women with FA.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20131228015968N5.

Dietary diversity modifies the association between FTO polymorphisms and obesity phenotypes.

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

Association of sleep duration and snack consumption in children and adolescents: The CASPIAN-V study.

OBJECTIVES: The relationship between sleep deprivation and the risk of overweight and obesity is somewhat known in children and adolescents. This study aimed to investigate the relationship between sleep duration and eating snacks in a national sample of children and adolescents aged 6-18 years old. METHODS: This cross-sectional study was carried out on the data of the fifth survey of the national school-based surveillance system entitled the "Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease" (CASPIAN-V) study. Short sleeping duration was defined 10 hr per day for children under 10 years and 9 hr per day for children ≥ 10 years. To assess food habits, the consumption frequency of some food groups including sweets, salty snacks, carbonated beverages, diet soft drinks, soft beer, fresh fruits, dried fruits, fresh juices, vegetables, packed juices, dairy products (milk, yogurt, and cheese), fast foods, tea, sugar along with tea, and coffee was asked using Likert scale ( never, rarely, weekly, and daily). RESULTS: In multivariate model, short sleep versus long sleep in students was associated with increased chance of eating salty snacks (OR = 1.49 [95% CI: 1.38-1.61]; p = .001), soft drinks (OR = 1.12 [95% CI: 1.04-1.20]; p = .002), fast foods (OR = 1.66 [95% CI: 1.54-1.79]; p < .001), tea (OR = 1.49 [95% CI: 1.39-1.61]; p < .001), and tea with sugar (OR = 1.13 [95% CI: 1.05-1.22]; p < .001). In addition, short sleep in students was associated with a decreased odds of daily intake of soft drinks without sugars (OR = 0.64 [95% CI: 0.58-0.70]; p < .001), soft beer (OR = 0.92 [95% CI: 0.85-0.99]; p < .001), fresh fruit (OR = 0.83 [95% CI: 0.76-0.90]; p < .001), dried fruit (OR = 0.43 [95% CI: 0.39-0.46]; p < .001), fresh fruit juice (OR = 0.66 [95% CI: 0.62-0.72]; p < .001), packed juice (OR = 0.91 [95% CI: 0.84-0.98]; p < .009), milk (OR = 0.51 [95% CI: 0.47-0.55]; p < .001), yogurt (OR = 0.86 [95% CI: 0.79-0.93]; p ≤ .001), and coffee (OR = 0.82 [95% CI: 0.76-0.89]; p ≤ .001). CONCLUSIONS: The findings of this study indicate a significant relationship between sleep duration and unhealthy food habits. Therefore, increasing awareness of families in this area may reduce obesity and its complications.

Effects of Zinc Supplementation on Cardiometabolic Risk Factors: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The prevalence of cardiometabolic risk factors has been increasing worldwide. The results of reported studies on the effects of zinc supplementation on cardiometabolic risk factors are unequivocal. This systematic review and meta-analysis of randomized controlled trials was conducted to evaluate the effects of zinc supplementation on cardiometabolic risk factors. A systematic search was conducted through international databases (PubMed/Medline, Institute of Scientific Information, and Scopus) until December 2018 to include all randomized controlled trials (RCT), quasi-RCT, and controlled clinical trials which assessed the effect of zinc supplementation on cardiometabolic risk factors including lipid profile, glycemic indices, blood pressure, and anthropometric indices. Random- or fixed-effects meta-analysis method was used to estimate the standardized mean difference (SMD) and 95% confidence interval (CI). A total of 20 studies were included in the meta-analysis, which included a total of 1141 participants in the intervention group. Meta-analysis showed that zinc supplementation significantly decreased plasma levels of triglyceride (SMD - 0.66, 95% CI - 1.27, - 0.06), very-low-density lipoprotein (SMD - 1.59, 95% CI - 2.86, - 0.31), and total cholesterol (SMD - 0.65, 95% CI - 1.15, - 0.15). Similarly, zinc supplementation significantly decreased fasting blood glucose (SMD - 0.52, 95% CI - 0.96, - 0.07) and HbA1c (SMD - 0.64, 95% CI - 1.27, - 0.02). The effects of zinc supplementation on blood pressure and anthropometric indices were not statistically significant (P > 0.05). Zinc supplements had beneficial effects on glycemic indices and lipid profile. Thus, it appeared that zinc supplementation might be associated with a decrease in cardiometabolic risk factors contributing to a reduction in risk of atherosclerosis.

Association of thyroid hormones with resting energy expenditure and complement C3 in normal weight high body fat women.

BACKGROUND: A high body fat percentage has a specific effect on activation of the hypothalamic-pituitary-thyroid axis. On the other hand, a slight change in thyroid hormones can affect metabolism and body composition as well as immune function. This study aims to examine the relationship between adiposity, thyroid hormone levels and immunity by comparing resting energy expenditure (REE), serum thyroid hormone levels and complement C3 in normal-weight high body fat (normal weight obesity) women and normal-weight normal body fat women. METHODS: In this case-control study, 40 women with normal body weight (BMI < 24.9 kg/m2) and body fat mass (FM) ≥ 30% (normal-weight obesity (NWO) group), and 30 non-obese women (BMI < 24.9 kg/m2) and FM < 30% (non-normal weight obesity (non-NWO) group) were recruited from a sport club in Tehran. Body composition was analyzed using bioimpedance analyzer. Blood samples were collected and analyzed for fasting serum concentration of thyroid hormones (including total T3 and total T4), thyroid-stimulating hormone (TSH), and serum complement C3. REE was measured by an indirect calorimetry. RESULTS: Serum T3 and T4 and also complement C3 were higher in the NWO group than in the non-NWO group. Body fat percentages had significant positive correlation with T3 (r; 0.344, P <  0.05), T4 (r; 0.294, P <  0.05), and complement C3 (r; 0.417, P <  0.05). Serum T3 and T4 were also positively correlated with C3 concentration (r; 0.417, p <  0.001) and (r; 0.349, p <  0.05); respectively, but there was no significant correlation between TSH and C3. REE was not significantly different between the two groups. REE only had a significant positive correlation with fat-free mass (r; 0.421, P <  0.001). CONCLUSION: An increase in body fat even in the presence of a normal body weight can be accompanied by the changes in thyroid function and inflammatory markers such as complement C3.

Empirical dietary inflammatory pattern and risk of metabolic syndrome and its components: Tehran Lipid and Glucose Study.

BACKGROUND: The rising incidence of metabolic syndrome (MetS) is a major public health problem. The inflammatory potential of diet contributes to the development of MetS. The aim of this study was to investigate the relationship between empirical dietary inflammatory pattern (EDIP) and risk of MetS among the Tehranian population. Our hypothesis was that high EDIP would increase the risk of MetS and its components. METHODS: In this prospective study, 2216 adults were selected from among the Tehran Lipid and Glucose Study participants. The usual dietary intakes were estimated using a valid and reliable food frequency questionnaire. Biochemical and anthropometric measurements were assessed at baseline and over 6.2 years of follow up. MetS components were defined according to the modified national Cholesterol Education Program Adult Treatment Panel III. The inflammatory potential of diet was calculated using EDIP score; more positive scores means higher pro-inflammatory diet. Adjusted logistic regression models were used to estimate the occurrence of MetS and its components across quartiles of EDIP score. RESULTS: Mean ± SD for EDIP score was 0.61 ± 0.40 (range - 2.3 to 6.9). Participants with the highest EDIP scores, had a higher risk of MetS incidence compared to those with the lowest score (OR: 1.75, 95% CI 1.21-2.54, Ptrend = 0.003). Among the MetS components, hyperglycemia, abdominal obesity, and low HDL-C had a significant positive association with EDIP score; (OR: 1.46, 95% CI 1.03-2.08, Ptrend = 0.026), (OR: 1.43, 95% CI 1.03-1.97, Ptrend = 0.046), and (OR: 1.57, 95% CI 1.34-2.19, Ptrend = 0.015), respectively. No significant association was found between EDIP score, hypertension and hypertriglyceridemia. CONCLUSION: Our finding indicated that higher intake of the pro-inflammatory diet may be an independent risk factor for the development of MetS, hyperglycemia, low HDL-C and abdominal obesity in Tehranian adults.

Neck circumference and its association with cardiometabolic risk factors: a systematic review and meta-analysis.

BACKGROUND: Recently, neck circumference (NC) has been used to predict the risk of cardiometabolic factors. This study aimed to perform a systematic review and meta-analysis to examine: (i) the sensitivity (SE) and specificity (SP) of NC to predict cardiometabolic risk factors and (ii) the association between NC and the risk of cardiometabolic parameters. METHODS: A systematic search was conducted through PubMed/Medline, Institute of Scientific Information, and Scopus, until 2017 based on the search terms of metabolic syndrome (MetS) and cardio metabolic risk factors. Random-effect model was used to perform a meta-analysis and estimate the pooled SE, SP and correlation coefficient (CC). RESULTS: A total of 41 full texts were selected for systematic review. The pooled SE of greater NC to predict MetS was 65% (95% CI 58, 72) and 77% (95% CI 55, 99) in adult and children, respectively. Additionally, the pooled SP was 66% (95% CI 60, 72) and 66% (95% CI 48, 84) in adult and children, respectively. According to the results of meta-analysis in adults, NC had a positive and significant correlation with fasting blood sugar (FBS) (CC: 0.16, 95% CI 0.13, 0.20), HOMA-IR (0.38, 95% CI 0.25, 0.50), total cholesterol (TC) (0.07 95% CI 0.02, 0.12), triglyceride (TG) concentrations (0.23, 95% CI 0.19, 0.28) and low density lipoprotein cholesterol (LDL-C) (0.14, 95% CI 0.07, 0.22). Among children, NC was positively associated with FBS (CC: 0.12, 95% CI 0.07, 0.16), TG (CC: 0.21, 95% CI 0.17, 0.25), and TC concentrations (CC: 0.07, 95% CI 0.02, 0.12). However, it was not significant for LDL-C. CONCLUSION: NC has a good predictive value to identify some cardiometabolic risk factors. There was a positive association between high NC and most cardiometabolic risk factors. However due to high heterogeneity, findings should be declared with caution.

Socioeconomic inequality in screen time frequency in children and adolescents: the weight disorders survey of the CASPIAN IV study.

BACKGROUND: This study aimed to assess the socioeconomic inequality and determinants of screen time (ST) frequency in Iranian children and adolescents. METHODS: This nationwide study was conducted as part of a national school-based surveillance program among 36,486 students consisting of 50.79% boys and 74.23% urban inhabitants, aged 6-18 years, living in urban and rural areas of 30 provinces of Iran. Socioeconomic inequality in ST, including the time spent for ST, watching TV and leisure-time working with computer, was assessed across quintiles of SES using concentration index (C) and slope index of inequality (SII). RESULTS: Overall, 36,486 students completed the study (response rate 91.25%). Their mean (SD) age was 12.14 (3.36) years. The national estimation of frequency of ST was 31.66% (95% CI 31.16-32.17) with ascending change from 20.80% (95% CI 19.81-21.82) to 36.66% (95% CI 35.47-37.87) from the first to the last quintal of SES. Estimated C value at national level was positive (0.08), which indicate inequality was in favor of low SES groups. Considering the SII values, at national level [- 0.16 (- 0.39, 0.06)], the absolute difference in ST frequency between the bottom and top of the socioeconomic groups had descending trends. In multivariate logistic regression model, family history of obesity, generalized obesity and age were the main significant determinants of prolonged ST, watching TV, and computer working (P < 0.001). CONCLUSIONS: Socioeconomic inequality in ST frequency was in favor of low SES groups. These findings are useful for health policies, better programming and future complementary analyses.

Burden of disease attributable to vitamin A deficiency in Iranian population aged less than five years: findings from the global burden of disease study 2010.

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 < 0.70 umole/L) among children aged less than five. The VAD outcomes consisted of mortality due to diarrhea, measles, malaria, neglected infectious diseases, morbidity due to malaria (children < 5 years), low birth weight and other perinatal conditions. Uncertainty in the estimates is presented as 95% uncertainty interval (UI). RESULTS: In 1990, there were 371 (95% UI: 166,665) DALYs due to VAD per 100,000 under five-year-old Iranian children in both sexes. The DALYs rate had a downward trend throughout the following years and reached to 76 (95% UI: 33-139)in 2010.The DALYs in children aged under 5 years was 378 (95% UI: 153-747) years for boys and 363 (95% UI: 148-692) years for girls in 1990 which fell to 79 (95% UI: 32-149) and 73 (95% UI: 29-138) in boys and girls in 2010, respectively. The rates of YLDs attributable to VAD changed in both sexes from 87(95% UI: 34-162) in 1990 to 46 (95% UI: 17-69) in 2010. The highest rate of YLDs attributed to VAD was observed in children aged 1-4. On the other hand, the YLLs were mostly in the 0-1-year-oldchildren in all years except 2010. CONCLUSION: It was found that DALYs attributable to VAD in 1990, followed by a considerable reduction rate after a period of two decades, in 2010. Additional studies on the burden of diseases particularly at sub-national level with more accurate data are recommended.

Methodology and Early Findings of the Fifth Survey of Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease: The CASPIAN-V Study.

BACKGROUND: This paper presents the methodology and early findings of the fifth survey of a school-based surveillance program in Iran. METHODS: This nationwide study was conducted in 2015 as the fifth survey of a surveillance program entitled "Childhood and Adolescence Surveillance and PreventIon of Adult Non- communicable disease" (CASPIAN-V) study. The protocol was mainly based on the World Health Organization-Global School student Health Survey. We studied 14400 students, aged 7-18 years, and their parents living in 30 provinces in Iran. Fasting blood was obtained from a sub-sample of 4200 randomly selected students. RESULTS: The participation rate for the whole study and for blood sampling were 99% and 91.5%, respectively. The mean (SD) age of participants was 12.3 (3.2) years, consisting of 49.4% girls and 71.4% urban residents. Overall, 16.1% were underweight (17.4% of boys and 14.8% of girls), and 20.8% had excess weight consisting of 9.4% (8.7% of boys and 10.2% of girls) of overweight and 11.4% (12.5% of boys and 10.3% of girls) of obesity. Abdominal obesity was documented in 21.1% of students (21.6% of boys and 20.5% of girls). Low HDL-C was the most prevalent abnormality of the lipid profile (29.5%) followed by high serum triglycerides (27.7%). Of students, 59.9% consumed whole wheat bread; and 57% reported that they never or rarely added salt to table. The reported daily consumption of fresh fruits, vegetables, and milk was about 60%, 32% and 40%, respectively. 13.7% of participants had at least 30-min daily leisure-time physical activity. CONCLUSIONS: The current findings provide an overview of the current health status and lifestyle habits of children and adolescents. This surveillance program would help planning preventive programs at individual and community levels.

Gender Differences in Major Dietary Patterns and Their Relationship with Cardio-Metabolic Risk Factors in a Year before Coronary Artery Bypass Grafting (CABG) Surgery Period.

BACKGROUND: Previous studies reported the association between dietary patterns and prevalence of diabetes, cardiovascular disease and other chronic disease. However, there are no studies reporting major dietary patterns in patients awaiting coronary artery bypass graft surgery (CABG). The aim of this study was to obtain the major dietary patterns and their association with demographic, dietary factors and biochemical parameters in these patients. MATHERIALS AND METHODS: This was a cross-sectional study on 454 patients aged 35 - 80 years as candidates of CABG and hospitalized in the Tehran Heart Center. Anthropometric and demographic characteristics were obtained from all participants and a 138-item semi-quantitative food frequency questionnaire (FFQ) was used to evaluate dietary patterns by factor analysis. Biochemical parameters including HbA1c, serum lipids, hematocrit (HCT), albumin, creatinine and CRP were assessed by commercial laboratory methods. RESULTS: Five major dietary patterns, including: healthy, intermediate, neo-traditional, western and semi-Mediterranean patterns were extracted. Top quartile of healthy pattern was associated with higher educational attainment and lower serum low-density lipoprotein cholesterol (LDL), and total cholesterol (TC) in men, as well as  higher high-density lipoprotein cholesterol (HDL) concentrations in women (P < 0.001). Individuals in top quartiles of intermediate and neo-traditional pattern were more likely to be male, had higher smoking and drinking habits, as well as the lower prevalence of diabetes, hyperlipidemia and hypertension (P < 0.05). They also had higher serum triglyceride (TG) concentrations. Patients in the western pattern also had a higher prevalence of a family history of cardiovascular disease and higher serum TG concentrations. Top quartiles of semi-Mediterranean pattern were associated with lower C-reactive protein (CRP) concentrations in women. CONCLUSIONS: There were five major dietary patterns using FFQ among patients awaiting CABG surgery. Significant associations were observed between major dietary patterns and risk of diabetes and hypertension. Top quartiles of healthy eating patterns were associated with lower cardio-metabolic risk factors.

Burden of Ischemic Heart Disease Attributable to Low Omega-3 Fatty Acids Intake in Iran: Findings from the Global Burden of Disease Study 2010.

BACKGROUND: Dietary risk factors constitute some of the leading risk factors for cardiovascular disease in Iran. The current study reports the burden of ischemic heart disease (IHD) attributable to a low omega-3 fatty acids intake in Iran using the data of the Global Burden of Disease (GBD) Study 2010. METHODS: We used data on Iran for the years 1990, 2005, and 2010 derived from the GBD Study conducted by the Institute for Health Metrics and Evaluation (IHME) in 2010. Using the comparative risk assessment, we calculated the proportion of death, years of life lost, years lived with disability, and disability-adjusted life years (DALYs) caused by IHD attributable to a low omega-3 fatty acids intake in the GBD studies from 1990 to 2010. RESULTS: In 1990, a dietary pattern low in seafood omega-3 fatty acids intake was responsible for 423 (95% uncertainty interval [UI], 300 to 559), 3000 (95% UI, 2182 to 3840), and 4743 (95% UI, 3280 to 6047) DALYs per 100000 persons in the age groups of 15 to 49 years, 50 to 69 years, and 70+ years - respectively - in both sexes. The DALY rates decreased to 250 (95% UI, 172 to 331), 2078 (95% UI, 1446 to 2729), and 3911 (95% UI, 2736 to 5142) in 2010. The death rates per 100000 persons in the mentioned age groups were 9 (95% UI, 6 to 12), 113 (95% UI, 82 to 144), and 366 (95% UI, 255 to 469) in 1990 versus 6 (95% UI, 4 to 7), 76 (95% UI, 53 to 99), and 344 (95% UI, 241 to 453) in 2010. The burden of IHD attributable to diet low in seafood omega-3 was 1.3% (95% UI, 0.97 to 1.7) of the total DALYs in 1990 and 2.0% (95% UI, 1.45 to 2.63) in 2010 for Iran. CONCLUSION: The findings of the GBD Study 2010 showed a declining trend in the burden of IHD attributable to a low omega-3 fatty acids intake in a period of 20 years. Additional disease burden studies at national and sub-national levels in Iran using more data sources are suggested for public health priorities and planning public health strategies.

Association of Mental Disorders and Consultation with Family Members and Friends in Children and Adolescents: The CASPIAN-IV Study.

BACKGROUND: Behavioral disorders are common in the pediatric age group. This study aims to assess the relationship between the frequency of behavioral and mental disorders and counseling with family members and friends in a representative sample of Iranian children and adolescents. METHODS: In this nationwide study, 14880 school students, aged 6-18 years, were selected by cluster and stratified multi-stage sampling method from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used. RESULTS: Overall, 13486 students (49.2% girls) with the mean (standard deviation) age of 12.47 (3.36) years completed the study. According to the students' self-report, 56.1% of boys and 42.2% of girls shared their problems with their fathers. All behavioral disorders were less prevalent in children and adolescents who consulted with their father compared with those who did not (P < 0.001). In addition, 84.6% of boys and 84.0% of girls shared their problem with their mother. All behavioral disorders were less prevalent in children and adolescents who consulted with their mother compared with those who did not (P < 0.001). 45.6% of boys and 44.8% of girls shared their problem with their brother or sister. Some behavioral disorders were less prevalent in children and adolescents who consulted with their brother or sister (P < 0.01); however, the prevalence was not statistically different for most disorders (P > 0.05). Moreover, 60.4% of boys and 66.0% of girls shared their problems with their friends. The prevalence of most behavioral disorders was lower in those who consulted with their friends (P < 0.001). CONCLUSIONS: Children and adolescents should be encouraged to consult with their parents and friends about their problems. Parents should offer their children an opportunity to express their views and wishes about their problems.

Association between serum uric acid level and metabolic syndrome components.

BACKGROUND: Serum uric acid levels is reported to be associated with a variety of cardiometabolic risk factors; however, its direct association with metabolic syndrome (MetS) remains controversial. Thus, we examined the association of serum uric acid concentrations with the MetS components. METHODS: MetS was defined according to the National Cholesterol Education Program (NCEP) criteria. This case-control study comprised 101 non-smoking individuals (41 in the MetS group and 60 in the non-MetS group). Blood pressure, fasting plasma glucose, insulin, HOMA-IR, lipid profiles, uric acid, and anthropometric measures were determined, and body composition was assessed by using bioelectrical impedance analysis (BIA). RESULTS: After adjustment for confounding factors, serum uric acid was significantly higher in MetS group than non-MetS group (5.70 ± 1.62 vs 4.97 ± 1.30 mg/dL, respectively, P = 0.001). After controlling for age, sex and body mass index in partial correlation analysis, uric acid was positively correlated with triglycerides, and negatively with HDL-C. In multiple logistic regression analysis, every 1 mg/dl elevation in the serum uric acid level increased the risk of MetS approximately by 2-folds (OR: 2.11, 95 % CI: 1.30-3.41). CONCLUSION: This study showed that those individuals with MetS have higher uric acid levels; the association of uric acid and MetS components supports that it might be an additional components of MetS.

Is the association of continuous metabolic syndrome risk score with body mass index independent of physical activity? The CASPIAN-III study.

BACKGROUND/OBJECTIVES: Although the association of body mass index (BMI) with metabolic syndrome (MetS) is well documented, there is little knowledge on the independent and joint associations of BMI and physical activity with MetS risk based on a continuous scoring system. This study was designed to explore the effect of physical activity on interactions between excess body weight and continuous metabolic syndrome (cMetS) in a nationwide survey of Iranian children and adolescents. SUBJECTS/METHODS: Data on 5,625 school students between 10 and 18 years of age were analyzed. BMI percentiles, screen time activity (STA), leisure time physical activity (LTPA) levels, and components of cMetS risk score were extracted. Standardized residuals (z-scores) were calculated for MetS components. Linear regression models were used to study the interactions between different combinations of cMetS, LTPA, and BMI percentiles. RESULTS: Overall, 984 (17.5%) subjects were underweight, whereas 501 (8.9%) and 451 (8%) participants were overweight and obese, respectively. All standardized values for cMetS components, except fasting blood glucose level, were directly correlated with BMI percentiles in all models (P-trend < 0.001); these associations were independent of STA and LTPA levels. Linear associations were also observed among LTPA and standardized residuals for blood pressure, high-density lipoprotein, and waist circumference (P-trend < 0.01). CONCLUSIONS: Our findings suggest that BMI percentiles are associated with cMetS risk score independent of LTPA and STA levels.

The association of vitamin D deficiency with psychiatric distress and violence behaviors in Iranian adolescents: the CASPIAN-III study.

BACKGROUND: Subtle effects of vitamin D deficiency on behavior have been suggested. We investigated the association of vitamin D status with mental health and violence behaviors in a sample of Iranian adolescents. METHODS: This nationwide study was conducted in 2009-2010 in 1095 Iranian school students with mean age 14.7 ± 2.6 years. Items were adapted from the Global School-based Student Health Survey (GSHS). Psychiatric distress was considered as the self-reported anger, anxiety, poor quality sleep, confusion, sadness/depression, worry, and violence-related behaviors (physical fight, having bully, or getting bullied). RESULTS: Forty percent had serum 25(OH)D values below 10 ng/mL (vitamin D deficient), and 39 % had levels 10-30 ng/mL (vitamin D insufficient). The prevalence of self-reported anger, anxiety, poor quality sleep, sadness/depression, and worry was significantly lower (P < 0.05) in vitamin D sufficient participants compared with their other counterparts. The odds of reporting anger, anxiety, poor quality sleep, and worry, increased approximately 1.5 to 1.8 times in vitamin D insufficient compared with normal children and adolescents (P < 0.05). Risk estimates indicated that vitamin D insufficient and deficient subjects had higher odds of reporting worry compared to normal vitamin D group [OR = 2.417 (95 % CI: 1.483-3.940) for vitamin D insufficient students, and OR = 2.209 (95 % CI: 1.351-3.611) for vitamin D deficient students] (P-trend = 0.001). Violence behaviors did not show any association with vitamin D status (P > 0.05). CONCLUSION: Some psychiatric distress such as anger, anxiety, poor quality sleep, depression, and worry are associated with hypovitaminosis D in adolescents. The clinical significance of the current findings should be determined in future longitudinal studies.

Dietary diversity as a proxy measure of blood antioxidant status in women.

OBJECTIVE: Dietary diversity is recognized as a key indicator of dietary quality. However, its association with blood antioxidant levels has not been investigated. The aim of this study was to assess the association of the dietary diversity score (DDS) with blood antioxidant status in women who attend the sports clubs of a municipality in western Tehran, Iran. METHODS: A cross-sectional survey was conducted with 397 randomly selected women from the sport clubs of a Tehran municipality. Sociodemographic data were recorded and the women's weight and height were measured. Body mass index (BMI) was calculated by dividing the weight (kg) by height squared (m(2)). A 24-h recall questionnaire was used to estimate food intake. Biochemical indices, including serum total antioxidant capacity (TAC) and erythrocyte activities of glutathione peroxidase (GPx) and superoxide dismutase (SOD), were measured in 90 women selected randomly from all participants. DDS was computed according to the guidelines of the Food and Agriculture Organization. The mean of SOD, TAC and GPx were compared across DDS quartiles after adjustment for age, education level, physical activity, energy intake, and BMI using analysis of covariance test. RESULTS: The mean of TAC, SOD, and GPx was linearly increased with increasing the quartile of DDS, after adjustment for age, education level, physical activity, energy intake, and BMI (Ptrend < 0.001). Significant differences were observed for intake of different food groups, except cereals and white roots, between the DDS quartiles. CONCLUSION: DDS is associated with blood antioxidant markers. Increasing the dietary diversity might be associated with a reduction in oxidative stress.

Joint Association of Active and Passive Smoking with Psychiatric Distress and Violence Behaviors in a Representative Sample of Iranian Children and Adolescents: the CASPIAN-IV Study.

BACKGROUND: Mental health and smoking have been receiving increasing attention in adolescents all over the world. Although some studies have assessed the independent association of active/passive smoking with mental health, joint association of active and passive smoking with mental health remains unclear. PURPOSE: This study was designed to evaluate the joint association of smoking status (active and passive smoking) with psychiatric distress and violent behaviors in Iranian children and adolescents. METHOD: In this national survey, 13,486 students, aged 6-18 years, living in rural and urban areas of 30 provinces of Iran were selected via multistage, cluster sampling method. Psychiatric distress (including worthless, angriness, worrying, insomnia, confusion, depression, and anxiety), violence behaviors (including bullying, victim, and physical fight), and smoking status (nonsmoker, only passive smoker, only active smoker, and active and passive smoker) were assessed. The questionnaire was prepared based on the World Health Organization Global School-based Student Health Survey (WHO-GSHS). Data were analyzed by the Stata package. RESULTS: Psychiatric distress and violent behaviors had linearly positive association with smoking status (p trend < 0.001). Compared to "nonsmoker" group, participants who were exposed to passive smoking besides active tobacco use were at increased risk of having angriness (odds ratio (OR) 2.55, 95 % confidence interval (CI) 1.86-3.48), worrying (OR 1.66, 95 % CI 1.24-2.20), and anxiety (OR 1.99, 95 % CI 1.52-2.61) and victim (OR 1.77, 95 % CI 1.34-2.33) and bully behaviors (OR 3.08, 95 % CI 2.33-4.07). CONCLUSION: The current findings suggest that active and passive tobacco smoking has synergistic effect on psychiatric distress. Since majority of smokers with psychiatric distress do not receive mental health services or counseling on smoking, strategies to address mental health problems and smoking prevention should be included as a part of school health services.