Sedentary behavior and neck pain in adults: A systematic review and meta-analysis.

Sedentary lifestyle is an imperative risk for musculoskeletal pain. We sought to investigate the association between different types of sedentary behaviors (SBs) and neck pain (NP) among adults. A systematic search was conducted in PubMed, Web of Science, Embase, Scopus, and Google Scholar up to the end of April 2023. The odds ratio (95% CI) was considered as the desired effect size for the association between SBs and the NP. Among 1881 records found by primary search, 46, and 27 reports were included in the qualitative and quantitative analysis respectively. All included studies qualified as good or fair. Our results indicated that SB is a risk factor for NP among adults (OR = 1.5, [1.29, 1.76]). Computer and mobile phone use were also found to be considerable risk factors for NP (OR = 1.3, [1.12, 1.53], and OR = 2.11, [1.32, 3.42] respectively). However, sitting time showed an insignificant association with NP (OR = 1.33, [0.86, 2.07]). Subgroup analysis revealed that SBs are a significant risk factor for NP among university students (OR = 1.58, [1.27, 1.97]), but the association among office workers was marginally insignificant (OR = 1.36, [0.98, 1.89]). According to the meta-regression results, the male gender was found to increase the risk of NP. Meanwhile, Egger's test revealed the presence of publication bias (p-value <0.0001). A sedentary lifestyle as well as computer and mobile phone use is associated with a considerable risk of NP among adults, especially university students. Further, longitudinal studies are needed to better clarify the causality relationships.

A systematic review on the association of month and season of birth with future anthropometric measures.

BACKGROUND: Prenatal factors might have some health impacts later in life. This study aims to systematically review the current literature on the association between season and month of birth with birth weight as well as with weight status in childhood. METHODS: The search process was conducted in electronic databases, including papers published until April 2019 in ISI Web of Science, PubMed, Scopus, and Google Scholar. The following search strategy was used with MeSH terms: ("Seasons"[Mesh]) AND ("Obesity"[Mesh] OR "Pediatric Obesity"[Mesh] OR "Obesity, Abdominal"[Mesh] OR "Overweight"[Mesh] OR "Birth Weight"[Mesh] OR "Body Height"[Mesh]). After the selection process, 50 papers were included in this systematic review. RESULTS: This review showed that individuals who are born in cold season (winter month) have higher body mass index (BMI) and weight in childhood. Birth in March was associated with lower weight and BMI in boys according to most studies. All studies, except one of them, showed that season/month of birth was not associated with birth weight. CONCLUSIONS: This systematic review confirms a relationship between season and month of birth with birth weight and body size in childhood; however, the impact of confounding factors, for example, vitamin D status, should be considered in the underlying pathway of this association. IMPACT: The results provide evidence for the effect of season and month of birth on body size in childhood. Our systematic review suggests that there is no pattern between birth weight and season/month of birth, and the occurrence of low birth weight was more frequent among infants who were born in summer than others. Further research should focus on identifying the impact of confounding factors, for example, vitamin D status in the underlying pathway of this association. There was response to the controversial findings about the effect of environment factors, such as season and month of birth, and future anthropometric indices, such as obesity, weight, height, and birth weight. Obesity is a complex and multifactorial disorder; the findings of the current study would be useful in determining the relationship pathway between the season and the month of birth with other underlying factors for childhood obesity.

Association between dietary diversity score and anthropometric indices among children and adolescents: the weight disorders survey in the CASPIAN-IV study.

BACKGROUND: The aim of this study was to determine the association between the dietary diversity score (DDS) and anthropometric indices in a nationally representative sample of Iranian children and adolescents. METHODS: The nationwide cross-sectional study included 5178 students aged 6-18 years. A validated 168-item food frequency questionnaire (FFQ) was used. The DDS was assessed by dividing food items into five groups. RESULTS: An increase of 1 in the total DDS score was associated with 0.08 increase in the body mass index z-score (BMIz), 0.06 increase in waist circumference z-score (WCz), and 0.07 increase in hip circumference z-score (HCz) (P < 0.05) in girls. An increase of 1 in the DDS score of the dairy group was associated with an 0.11 increases in BMIz (P < 0.05). An increase of 1 in the DDS score of the fruit-vegetable group was associated with 0.09 and 0.08 increase in BMIz and HCz among girls respectively (P < 0.05). The odds of excess weight (overweight or obesity) and abdominal obesity increased with each unit increase in total DDS in girls (odds ratio, OR excess weight  = 1.11 (95% confidence interval, CI: 1.003-1.23), OR abdominal obesity  = 1.11 (95% CI: 1.001-1.23)). The odds of excess weight increased with each unit increase in dairy DDS (OR excess weight  = 1.20 (95% CI: 1.002-1.43) among boys. CONCLUSION: Higher DDS was associated with higher anthropometric indices and greater risk of obesity among children and adolescents. Our findings emphasize the importance of increasing the diversity of healthy food items to reduce weight disorders in the pediatric age group. © 2021 Society of Chemical Industry.

Association of serum uric acid concentration with components of pediatric metabolic syndrome: A systematic review and meta-analysis.

BACKGROUND: Hyperuricemia is implicated in the pathogenesis of inflammatory diseases and metabolic disorders. Metabolic syndrome (MetS) in childhood is one of the most important causes of different noncommunicable diseases in adulthood. This study aimed to systematically review the association between serum uric acid (UA) concentration and components of pediatric MetS. MATERIALS AND METHODS: In this meta-analysis and systematic review, related articles were gathered by searching English databases including PubMed, Web of Science, Scopus, and Google Scholar. We used the following keywords: uric acid, metabolic syndrome, hypertension, fasting blood sugar (FBS), hyperglycemia; the search was limited to English language and included observational and cohort studies performed among children or adolescents. Pooled relative risks (odds ratio [OR]) and corresponding 95% confidence interval (95% CI) were extracted. A random-effect model was used. RESULTS: On the basis of 34 eligible studies, the pooled correlation between UA with metabolic components including FBS (r = 0.24, 95% CI = 0.09-0.40), fasting insulin (r = 0.26, 95% CI = 0.15-0.37), and hyperglycemia (r for triglyceride and UA = 0.23, 95% CI = 0.19-0.38) (r for high-density lipoprotein and UA = -0.28, 95% CI = -0.37 to -0.20) was statistically significant. The association of both diastolic blood pressure (DBP) and systolic blood pressure (SBP) was statistically significant with UA (r for SBP and UA = 0.34, 95% CI = 0.24-0.43; r for DBP and UA = 0.18, 95% CI = 0.11-0.25). The OR between risk of abdominal obesity with UA was statistically significant (OR = 2.62, 95% CI = 1.41-3.84). CONCLUSION: Serum UA concentration is associated with major components of the pediatric MetS. Its measurement and control should be underscored in at-risk children and adolescents.

Association of Postpartum Depression with Maternal Serum Magnesium Levels, Infant Growth, and Neurodevelopmental Indices.

Background: Postpartum depression (PPD) can exert both short-term and long-term effects on a child's health. Offspring born to mothers who suffer from PPD face an elevated susceptibility to encountering psychological disturbances and developmental delays. Moreover, there has been conjecture surrounding a plausible connection between maternal magnesium (Mg) levels and psychiatric manifestations. This study aims to investigate the relationship between maternal Mg levels and PPD and the correlation between PPD and an infant's growth and neurodevelopment at 6 and 12 months. Methods: This longitudinal study is a sub-study derived from the "PERSIAN Birth Cohort Study," encompassing 224 mother-infant pairs randomly enlisted during 2019-2020 in Isfahan. Maternal serum magnesium (Mg) levels were measured at 38 weeks of gestation. PPD was evaluated employing the Edinburgh Postpartum Depression Scale (EPDS) four weeks postpartum. Measurements of birth size were undertaken, adhering to standardized protocols at birth, 6 months, and 12 months. Anthropometric parameters and the Persian version of the validated Ages and Stages Questionnaires (ASQ) were employed to assess infant neurodevelopmental status at 6 and 12 months. Results: Overall, 22.3% of mothers grappled with PPD. The mean (standard deviation) maternal magnesium levels (Mg) were 1.95 ± 0.23 mg/dL. No statistically significant association was detected between maternal serum magnesium (Mg) levels and the incidence of PPD. Correspondingly, no significant association emerged between PPD and indices of growth. However, a noteworthy distinction materialized in the communication scores of offspring born to depressed and non-depressed mothers following adjustments for confounding variables at 12 months (ß = 1.81; 95% confidence interval: 0.32-3.30). Furthermore, a substantial regression in communication skills became apparent between 6 and 12 months. Conclusions: This study failed to establish a significant association between maternal serum magnesium (Mg) levels and PPD. Nevertheless, research lends credence to an inverse correlation between maternal depression and subsequent behavioral difficulties in offspring, such as communication skills. Thus, the imperative nature of screening for PPD should be underscored to facilitate its early detection and intervention, thereby enhancing infant well-being.

Dose-response association between dietary patterns and gestational diabetes mellitus risk: A systematic review and meta-analysis of observational studies.

Although dietary factors are relevant modifiable risk factors for gestational diabetes mellitus (GDM), the exact association between dietary patterns and GDM remains controversial. Therefore, a systematic review and dose-response meta-analysis of observational studies were conducted to summarize the association between dietary patterns and risk of GDM. PubMed, Scopus, Web of Science, Cochrane Library, and EMbase databases were systematically searched for publications up to March 10, 2020. All observational studies which assessed the risk of GDM according to the categories of healthy or unhealthy dietary patterns derived by either a priori or a posteriori methods were eligible to be included. Pooled effect sizes for the highest vs. lowest categories of healthy/unhealthy dietary patterns were calculated using the random-effects model. Linear and nonlinear dose-response analyses were performed to determine dose-response associations. Thirty-one studies were included, of which 26 studies (80,849 participants) assessed healthy dietary pattern and 15 studies (32,965 participants) assessed the unhealthy dietary pattern. Individuals with a higher adherence to the healthy dietary pattern were less likely to be affected by GDM (RR = 0.86; 95% CI: 0.76-0.96; I 2 = 56.2%). There was a marginally significant association between unhealthy dietary patterns and GDM risk (RR = 1.28; 95% CI: 0.99-1.67; I 2 = 74.7). Significant linear associations were observed between healthy (p = .011) and unhealthy (p = .009) dietary patterns and GDM risk. Pregnant women with a healthier dietary pattern (a diet rich in fruits, vegetables, and whole grains) had lower risk for GDM. In contrast, higher adherence to an unhealthy dietary pattern was associated with increased risk of GDM. Further longitudinal studies are needed to confirm the results.

Determinants of Weight Disorders in Two- Year- Old Children in Isfahan, Iran.

Background: Considering the importance of weight disorders in childhood and its impact until adulthood, this study was conducted to assess the determinants of weight disorders in 2-year-old Iranian children. Materials and Methods: This cross-sectional study was conducted in 2020 among on 2300 children registered in Comprehensive Health Centers of Isfahan, Iran. Weight disorders, including underweight and overweight were defined according to the standardized National Center for Health Statistics (NCHS)/Centers for Disease Control (CDC) growth charts. Demographic data including gender, birth weight, maternal educational levels and occupation, duration of breastfeeding and the age of beginning complementary food were gathered. Results: In the present study, 750 children (i.e., 32.6%) had weight disorders. Among them, 53.6% were underweight, 26.3% were overweight, and 12.9% were obese, 7.2%had severe underweight. Female gender, university education of mothers and higher levels of socio-economic status significantly increased the chance of overweight by 14.79%, 22.28%, 27.33% and 24.48%, respectively. Although with the increase in the duration of breastfeeding and the increase of family members, overweight, respectively, decreased by 0.86 and 0.93 fold, but it was not statistically significant. There was an inverse, significant relationship between the duration of breastfeeding with overweight versus underweight. Conclusion: Underweight and overweight were the two most common weight disorders among 2-year- children, respectively. Control of modifiable risk factors for weight disorders in early life should be underscored in the primary health care system.

Thalamic asymmetry in Multiple Sclerosis.

BACKGROUND: Multiple Sclerosis (MS) is a chronic neuroinflammatory disease that affects the central nervous system. Asymmetry is one of the finding in brain MRI of these patients, which is related to the debilitating symptoms of the disease. This study aimed to investigate and compare the thalamic asymmetry in MS patients and its relationship with other MRI and clinical findings of these patients. METHODS: This cross-sectional study conducted on 83 patients with relapse-remitting MS (RRMS), 43 patients with secondary progressive MS (SPMS), and 89 healthy controls. The volumes of total intracranial, total gray matter, total white matter, lesions, thalamus, and also the thalamic asymmetry indices were calculated. The 9-hole peg test (9-HPT) and Expanded Disability Status Scale (EDSS) were assessed as clinical findings. RESULTS: We showed that the normalized whole thalamic volume in healthy subjects was higher than MS patients (both RRMS and SPMS). Thalamic asymmetry index (TAI) was significantly different between RRMS patients and SPMS patients (p = 0.011). The absolute value of TAI was significantly lower in healthy subjects than in RRMS (p < 0.001) and SPMS patients (p < 0.001), and SPMS patients had a higher absolute TAI compared to RRMS patients (p = 0.037). CONCLUSIONS: In this cross-sectional study we showed a relationship between normalized whole thalamic volume and MS subtype. Also, we showed that the asymmetric indices of the thalamus can be related to the progression of the disease. Eventually, we showed that thalamic asymmetry can be related to the disease progression and subtype changes in MS.

Pharmacological treatment of tremor in multiple sclerosis; a systematic review.

BACKGROUND: Tremor is a relatively common symptom in Multiple Sclerosis (MS). It can negatively affect several aspects of the patients' life and is one of the most disabling symptoms in MS. Pharmacological treatment of MS-related tremor was studied for several years, though treatment is still challenging. This study will review all studies on the pharmacological treatment of tremor in MS and update the treatment recommendations. METHODS: Any relevant English-language clinical trial that investigated the pharmacological treatment of MS-related tremor in adults was eligible in this study. We searched Medline (PubMed), Scopus, EMBASE, and Web of Science. Bias assessment was performed by the CASP (Critical Appraisal Skills Programme) checklist. All methods followed PRISMA guidelines. RESULTS: The initial search resulted in 3024 articles; 26 articles were included as eligible studies, 13 articles had a low risk of bias, and remained for full manuscript review. The results of studies on 5-HT3 receptor antagonists as a single dose treatment were inconsistent. Botulinum toxin A had significant effects on MS-related tremor, but adverse effects and injection procedures limited its application. The application of cannabis-based medicine to treat MS-related tremor could not be recommended due to inconclusive therapeutic effects and several side effects. Levetiracetam had inconsistent results, and other anti-epileptic drugs were not studied precisely. Isoniazid has minor therapeutic effects and possible adverse effects in the treatment of MS-related tremor. CONCLUSION: Further well-designed comparative clinical trials with a large sample size can improve clinical management of tremor in patients with MS.

Association of selenium, zinc and copper concentrations during pregnancy with birth weight: A systematic review and meta-analysis.

BACKGROUND: Normal fetal growth is associated with maternal nutrition. Trace elements play important roles in fetus growth. This review aims to provide a summary of the literature evaluating the relation between selenium, zinc and copper levels during pregnancy with birth weight. METHOD: A systematic literature search was conducted in Medline database (PubMed), Scopus, Web of science and Google scholar up to September 2020. Fifty observational studies were included in the final analyses. The desired pooled effect size was considered as standardized mean differences with 95 % CI or correlation. Cochran's Q statistic was used to test the heterogeneity between the included studies (I2). RESULT: A significant differences were found between pooled standardized mean differences (SMD) of umbilical cord blood copper levels in small-for-gestational age birth weight (SGA) and appropriate-for-gestational age birth weight (AGA) (SMD: 0.34 µg/L, 95 % CI: 0.13 to 0.56). There was a significant pooled correlation between umbilical cord blood selenium concentrations and birth weight (r: 0.08, 95 % CI: 0.01 to 0.16). A significant pooled correlation was found between umbilical cord blood zinc concentrations and birth weight (r: 0.09, 95 % CI: 0.04 to 0.15), with significant heterogeneity (I2 % = 0.63). There was significant positive association between maternal blood zinc concentrations and birth weight. CONCLUSION: Findings showed the association of trace elements including selenium, zinc and copper during pregnancy with birth weight. There was significant correlation between umbilical cord and maternal blood selenium and zinc levels with birth weight. The umbilical cord blood copper levels in SGA birth weight was higher than copper levels in AGA birth weight.

Sedentary behavior and neck pain in children and adolescents; a systematic review and meta-analysis.

Background: Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. We aimed to explore the association of sedentary behavior indicators with neck pain among children and adolescents. Methods: A comprehensive review was performed in different databases until the end of January 2022. Odds ratios (ORs) with 95% confidence intervals were used as desired effect sizes to evaluate the association between prolonged screen time or mobile phone (MP) usage and neck pain risk. Results: Among 1651 records, 15 cross-sectional studies were included in the systematic review, and 7 reports were included in the meta-analysis. Our results suggested a significant relationship between prolonged MP use and neck pain (OR=1.36, 95% CI=1.001-1.85, I2=40.8%, P value for heterogeneity test=0.119). Furthermore, a marginally insignificant association was found between prolonged screen time and neck pain (OR=1.13, 95% CI=0.98-1.30, I2=60.3%, P value=0.01); however, after sensitivity analysis and removing one study, this association became significant (OR=1.30, 95% CI=1.03-1.64). Moreover, a significant association between prolonged sitting time and neck pain was reported in two studies. Conclusion: Available good-quality evidence reveals a significant mild association between sedentary behavior and the risk of neck pain among children and adolescents. However, longitudinal studies with objective measurement tools are warranted. In particular, potential preventive educational programs are suggested for pediatrics to reduce sedentary behavior and neck pain.

Risk Factors for In-Hospital Mortality among Patients with Coronavirus-19 in Isfahan City, Iran.

Background: The aim of the study is to explore the risk factors of mortality for hospitalized patients in three designated hospitals in Isfahan province. Materials and Methods: This retrospective cohort study was conducted on all positive coronavirus disease (COVID)-19 patients admitted to Khorshid, Isabn Maryam, and Amin hospitals in Isfahan province. The demographic, clinical, laboratory, and outcome data of patients who were died or discharged from February 24, 2020, to April 18, 2020, were extracted from patient's medical records. Results: Overall 1044 COVID-19 patients were included in this analysis. Based on the findings of this study, older age (≥65 years) (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI]: 1.13-3.76), chronic obstructive pulmonary disease (COPD) history (aHR: 2.52; 95% CI: 1.09-5.83), white blood cell (WBC) counts more than 10 × 10^3/L (aHR: 3.05; 95% CI: 1.42-6.55), Hb level <13 gr/L (aHR: 2.82; 95% CI: 1.34-5.93), bilateral pulmonary infiltrates (aHR: 2.02; 95% CI: 1.12-3.64) at admission, development of acute respiratory distress syndrome (ARDS) (aHR: 1.87; 95% CI: 1.01-3.47), and intensive care unit (ICU) admission (aHR: 2.09; 95% CI: 1.04-4.18) during hospitalization were risk factors for in-hospital mortality in patients with COVID-19. Conclusions: Multiple factors were found related to the severity and death among COVID-19 patients. We were found that older age (≥65 years) with COPD history, high level of WBC, low level of Hb (<13 g/L), bilateral pulmonary infiltrates at admission, development of ARDS, and ICU admission during hospitalization were identified as risk factors of death among COVID-19 patients. More related studies are needed in the future.

Association between sedentary behavior and low back pain; A systematic review and meta-analysis.

Background: Sedentariness is a substantial risk for many chronic diseases. We aimed to investigate the correlation of sedentary behavior and its indicators with low back pain (LBP) among adults and children. Methods: Original articles published up to April 28, 2020, using PubMed, Embase, Web of Science and Scopus were evaluated. Odds ratio (OR, 95% CI) was considered the overall effect size for desired associations. Results: We reviewed 49 English articles with analytical observational study design, of which, 27 studies with cross sectional/survey design were retained in the meta-analysis. Among adults, sedentary lifestyle was a considerable risk factor for LBP (OR=1.24, 1.02-1.5); prolonged sitting time (OR=1.42, 1.09-1.85) and driving time (OR=2.03, 1.22-3.36) were the significant risk factors. Sedentary behavior was associated with LBP in office workers (OR=1.23). Moreover, excess weight (OR=1.35, 1.14-1.59) and smoking (OR=1.28, 1.03-1.60) were associated with LBP. Among children, sedentary lifestyle was a remarkable risk factor for LBP (OR=1.41, 1.24- 1.60); prolonged TV watching (OR=1.23, 1.08-1.41) and computer/mobile using and console playing time (OR=1.63, 1.36-1.95) were significant risk factors for LBP. Consumption of coffee, however, has yield conflicting results to be considered as a risk factor. Moreover, the researches on the correlation between sedentariness and high-intensity LBP are scarce and inconclusive. Conclusion: Sedentary behavior, whether in work or leisure time, associates with a moderate increase in the risk of LBP in adults, children and adolescents.

Bisphenol A exposure and abnormal glucose tolerance during pregnancy: systematic review and meta-analysis.

In the present work, a systematic review and meta-analysis were performed to examine the probable relation between maternal exposure to bisphenol A (BPA), as estrogen-disrupting compounds, and gestational diabetes mellitus (GDM), and impaired glucose tolerance (IGT). We comprehensively searched three electronic databases to retrieve published studies on maternal exposure to BPA and GDM/IGT, through February 2021. Cochran's Q test and I2 statistics were employed for testing heterogeneity across studies. DerSimonian and Liard random-effects model was used to determine the pooled estimates. Otherwise, the fixed-effects model with inverse-variance weights was applied. Sensitivity analysis was performed to determine the robustness of the results by excluding each study from the pooled estimate. The potential publication bias was examined using Begg's and Egger's tests. The pooled odds ratio did not show BPA exposure to be a significant risk factor for GDM (OR = 0.90, 95% CI = 0.62-1.33, I2: 50.7%). Also, no significant association was observed between BPA exposure and risk of IGT (OR = 0.93, 95% CI = 0.40-2.18, I2: 11.5%). Based on the findings of this study, no association was found between exposure to BPA during pregnancy and the risk of GDM/IGT. Albeit no heterogeneity was found between studies.

Prenatal and perinatal factors associated with developing multiple sclerosis later in life: A systematic review and meta-analysis.

OBJECTIVE: Both genetic and environmental factors play roles in Multiple Sclerosis (MS) etiopathogenesis. The relationship between prenatal/perinatal factors/exposures and future MS occurrence in the offspring remains controversial. Here, we aimed to review the available evidence on prenatal/perinatal factors associated with later MS occurrence. METHOD: We performed systematic search of PubMed, Web of Science, and Scopus from inception to October 2020. We included original observational studies conducted on human participants addressing the association between prenatal/perinatal factors and MS occurrence. Data were extracted according to the PRISMA guideline. The adjusted odds ratio (OR) with 95% confidence interval (CI) was considered as the desired effect size. The heterogeneity was evaluated by Cochran's Q and I2 and the publication bias was assessed. We excluded gestational/neonatal vitamin D level, season of birth, and latitude because of recently published systematic reviews/meta-analyses on these subjects. RESULTS: Overall, 2306 records were identified in the primary search. After excluding irrelevant studies, we evaluated 34 studies with contributing data on 100 prenatal/perinatal factors associated with an increased or decreased risk of MS occurrence. In the meta-analyses, we found no statistically significant associations between later MS occurrence in offspring and prenatal smoking exposure (OR = 1.01, 95% CI = 0.77-1.34), mode of delivery (OR = 0.90, 95% CI = 0.52-1.56), birth order (OR = 0.85, 95% CI = 0.72-1.00), and maternal age (OR = 1.34, 95% CI = 0.88-2.04). Paternal age and parents' marital status at the time of childbirth, maternal preeclampsia/ toxemia, forceps use, birth weight, plurality, and preterm birth were the other most studied factors, and none reported to affect MS risk. CONCLUSION: We found that prenatal smoking exposure, mode of delivery, birth order, and maternal age do not affect risk of future MS development. Moreover, most of the other investigated factors were reported not to affect MS risk in the offspring.

Prevention of Postpartum Weight Retention during One Year after Childbirth by Prenatal Nutrition Education: A Randomized Controlled Trial.

BACKGROUND: It seems that 14-25% of the women retain at least 5 kg weight from 6 to 12 months after delivery and gestational weight gain is the most important reason of weight retention. Thus, we assessed the effect of prenatal nutrition education program on the retained weights at 8, 26, and 52 weeks after delivery in primiparous women. METHODS: This randomized controlled trial was implemented among 192 primiparous pregnant women in five hospitals, fifteen community health centers, and fifteen private offices. Self-developed questionnaire was used to collect the participants' characteristics. A 72-hr dietary recall was applied to evaluate the food intakes before and after intervention. The pregnancy physical activity questionnaire determined the physical activity score. The participants' weights at 8, 26, and 52 weeks after delivery were measured by a digital beam. RESULTS: The means of postpartum weight decreased in both groups, but nutrition education was significantly effective on reducing postpartum weight in intervention group (ß = -3.112, SE =. 7384, P < 0.001). Also, the women in intervention group had less retained weight compared to control during the follow-up (ß = -3.35, SE = 0.75, p < 0.001). The proportion of pregnant women in intervention group who reached to their pre-gravid weight was more than control during the follow-up (OR = 2.86, 95% CI: 1.62, 5.07). CONCLUSIONS: Nutrition education considering an individualized calorie-appropriate diet for each pregnant woman and based on the national guideline is effective on postpartum weight retention and reaching to pre-gravid weight.

Association of phthalate exposure with precocious and delayed pubertal timing in girls and boys: a systematic review and meta-analysis.

Exposure to phthalate derivatives has adverse effects on the health and development of humans, especially for children. A growing body of evidence supports the idea that exposure to phthalates can change an individual's physiological set point and the time of puberty in both genders. In this systematic review and meta-analysis, recent studies were evaluated to obtain systematic and regulation results in relation to puberty status and phthalate exposure in girls and boys. We searched English-language papers using Scopus, ISI, and PubMed databases as search engines, with no restriction of time, until the end of July 2019. A comprehensive literature search for an association between phthalate exposure and signs of puberty as well as levels of different types of hormones was carefully performed. Of the 67 studies retained for full-text screening, 39 studies were eligible for data management and extraction. For conducting a meta-analysis, four studies had appropriate effect size and metrics for pooling in the meta-analysis. Our findings revealed that low and high exposure to phthalates could alter pubertal development in both genders; the effects were either early or delayed puberty such as changes in the pubarche, thelarche, and menarche time, as well as in testicular volume. We statistically analyzed the association of pubic-hair development, breast development, and menarche time with exposure to phthalates in girls. For example, the pooled odds ratios of mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) in relation to breast development were (OR: 1.48, 95% CI: 1.11-1.85) and (OR: 1.52, 95% CI: 1.15-1.58) (P-value < 0.001), respectively. In addition, we analyzed the correlation between pubic-hair development and testicular volume with exposure to phthalates in boys. To the best of our knowledge, this is the first systematic review and meta-analysis of its kind for girls and boys. In conclusion, we found that a positive association exists between phthalate exposure and pubertal timing in the pediatric age group. Therefore, prevention of exposure to phthalates and reduction of their use should be underscored in the strategies for primordial prevention of pubertal timing and related consequences.

The associations between noise annoyance and psychological distress with blood pressure in children and adolescents: The CASPIAN-V Study.

Although blood pressure (BP) tracks from childhood to adulthood, and the prevalence of pediatric primary hypertension is increasing, related determinants are not well understood. The role of noise pollution and psychological distress in increasing BP is well documented in adults, but it remains elusive in children. This study aims to investigate the association of noise annoyance and psychological distress with BP in a pediatric population. This national cross-sectional study was conducted in 2015 on a sample of 14400 Iranian students, aged 7-18 years. Information regarding noise annoyance and psychological distress were assessed using questionnaires, and BP values were measured. Levels of noise annoyance and psychological distress were classified based on tertiles to no/low, moderate, and high. Data of 14274 students were completed. The mean age of participants was 12.28 (0.05), with 51% boys and 71.4% urban inhabitant. Diastolic BP and mean arterial BP (MAP) had positive correlations with noise annoyance (regression coefficient: 0.028, 95 % CI: 0.005 - 0.05 and 0.025, 95 % CI: 0.002 - 0.04, respectively). Participants with higher psychological distress were 15 % more likely to experience abnormally high BP compared to those with normal psychological status or mild distresses (OR: 1.15, 95 % CI: 1.003 - 1.34). Here, we found significant positive relationships between the level of noise annoyance and values of diastolic BP and MAP. Moreover, high psychological distress showed to increase the chance of abnormally high BP. The clinical impact of these findings should be assessed in further longitudinal studies.

Early Detection of Gestational Trophoblastic Neoplasia Based on Serial Measurement of Human Chorionic Gonadotrophin Hormone in Women with Molar Pregnancy.

BACKGROUND: The majority of studies which investigate the predicted power of Human chorionic gonadotropin (hCG) levels to the occurrence of Gestational trophoblastic neoplasia (GTN) considered the effect of a single measurement of hCG or used classical statistical methods without considering the endogenous marker. The aim of this study is to investigate the association between weekly measurements of ß-hCG with time to GTN occurring, using a robust Bayesian joint modeling. METHODS: Data of 201 women with a molar pregnancy were considered for this retrospective cohort study. After the first measurement of ß-hCG in 48 hours post evacuation of mole, the other titration was performed on a weekly basis until three consecutive normal titers. The association between serial measurements of ß-hCG and risk of GTN occurring were assessed by the classic and Bayesian joint modeling and in separate analysis the mixed linear effect and Cox-PH model were used. RESULTS: The mean age (SD) of participants was 26.6 (6.55) year. The GTN was occurred among 14.9% of patients. The association parameter using Bayesian approach was estimated as 1.30 (95% CI: 0.44 to 2.20) which showed one unit increase in the log ß-hCG corresponds to the 2.80-times increase in the hazard for the occurrence of GTN (Hazard Ratio: 2.80, 95% CI: 1.55 to 8.98). CONCLUSIONS: Findings of this study revealed that weekly measurements of ß-hCG are an important and reliable biomarker to early detection of developing of molar pregnancy to persistent GTN.

Healthy eating index in a nationally representative sample of children and adolescents by socio-demographic characteristics: the Weight disorders survey of the CASPIAN-IV Study.

BACKGROUND: To date, the diet quality of Iranian students in relation to socio-demographic characteristics was not studied. The present study aimed to explore the association between the healthy eating index and sociodemographic characteristics among a nationally representative sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 5187 children and adolescents, aged 6-18 years. Data regarding socio-demographic variables, lifestyle factors, family and student dietary habits, and quality of life were gathered via validated questionnaires. The Alternate Healthy Eating Index-2010 (AHEI-2010) was used to calculate diet quality scores. RESULTS: The odds of high diet quality was 24% lower in adolescents (13-18years) compared to children aged 6-12 years (OR 0.76, CI 0.64-0.89, p= 0.001). Students in families with moderate (OR 1.30, CI 1.13-1.49, p < 0.001) and high socioeconomic status (OR 1.36, CI 1.18-1.57, p < 0.001) were 30% and 36% more likely to have a higher diet quality score, respectively. Lower mean AHEI-2010 scores (CI) were found for low socio-economic status (46.18-47.10), adolescents 47.40 (46.94-47.82), boys 47.51 (47.14-47.88) and South-East area 47.19 (46.54-49.15) (p < 0.05) due to lower intake of fruits and vegetables and high intake of sodium and sugar-sweetened beverages. CONCLUSIONS: The overall diet quality of Iranian children and adolescents was low with disparities across sociodemographic variables notably age and familial socio-economic status.