The Epigenetic Overlap between Obesity and Mood Disorders: A Systematic Review.

(1) Background: Obesity and mood disorders are considered as the most prevalent morbidities in many countries. We suppose that epigenetic mechanisms may induce higher rates of obesity in subjects who suffer from mood disorders. In this systematic review, we focused on the potential roles of DNA methylation on mood disorders and obesity development. (2) Methods: This systematic review was conducted in accordance with the PRISMA statement and registered in Prospero. A systematic search was conducted in MEDLINE, Scopus, Web of Science, Cochrane Central database, EMBASE, and CINHAL. We also conducted a Grey literature search, such as Google Scholar. (3) Results: After deduplication, we identified 198 potentially related citations. Finally, ten unique studies met our inclusion criteria. We have found three overlap genes that show significant DNA methylation changes, both in obesity and depression. Pathway analysis interaction for TAPBP, BDNF, and SORBS2 confirmed the relation of these genes in both obesity and mood disorders. (4) Conclusions: While mechanisms linking both obesity and mood disorders to epigenetic response are still unknown, we have already known chronic inflammation induces a novel epigenetic program. As the results of gene enrichment, pathways analysis showed that TAPBP, BDNF, and SORBS2 linked together by inflammatory pathways. Hypermethylation in these genes might play a crucial rule in the co-occurrence of obesity and mood disorders.

Whole milk consumption and risk of cardiovascular disease and mortality: Isfahan Cohort Study.

BACKGROUND: The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population. METHODS: We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders. RESULTS: During a median 10.9 years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29). CONCLUSIONS: Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.

Isfahan Twins Registry (ITR): An Invaluable Platform for Epidemiological and Epigenetic Studies: Design and Methodology of ITR.

Twin studies are one of the main tools for studying the interaction between genes and the environment in the development of complex diseases such as cancers, cardiovascular diseases and diabetes. The Isfahan Twin Registry (ITR) was launched in Isfahan in 2017 as a pilot study to establish a nationwide twin registry in Iran and aims to obtain comprehensive information about complex diseases and their risk factors from twins and multiples living in Isfahan. ITR will continue to recruit twins and multiples until all twins residing in Isfahan are registered in the registry. Twins are identified from welfare agencies, public health homes, maternity hospitals, Persian Twins Association and the local media. Demographic information, twin similarities, lifestyle, family history of diseases and past medical history are collected using validated questionnaires. Anthropometric measurements and blood pressure are measured by health professionals. Hematology panel, fasting blood sugar, total cholesterol, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase, alanine aminotransferase and quantitative C-reactive protein are measured by an automated analyzer. Extra samples are obtained for future studies. For twins aged under 6 years, parents complete the questionnaires for their children and a brief questionnaire for themselves. Currently, 998 persons (395 pairs and 67 multiples) are registered in the ITR and have provided their data. Results of preliminary data analysis are discussed in this article. We plan to carry out longitudinal assessments. ITR can play an important role in future epigenetic, biomarkers and omics studies using the biobank materials.

ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up.

BACKGROUND: The present study aimed to compare postoperative complications commonly revealed after sternotomy closure by new sternal ZipFix™ (Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire. METHODS: Among the initial 360 subjects, 326 patients enrolled in this randomised control trial who were candidates for cardiac surgery from April 2014 to March 2015. After the surgery, the sternal closure was randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix (ZF) on the sternal body (n=168) or with conventional wires (CWs) (n=158). Patients were followed postoperatively as well as 1, 3, 6, and 12 months after discharge regarding postoperative complications such as pain severity, dehiscence, and infection including incisional infections (superficial or deep), and organ/space infection (mediastinitis or osteomyelitis). RESULTS: The mean age of the ZF and CW groups were 63.58±10.9 and 62.42±7.1years, respectively (p=0.262). In addition, there was no significant difference between the two groups' baseline characteristics (p>0.05). Our study showed higher mean pain severity score in the conventional closure group compared with ZipFix closure group at all study time points (p<0.001). Infection was seen in 2.76% of the overall participants with no significant difference of incisional and organ infection between the two groups throughout the study. After 1-month follow-up, five patients in the CW group had sternal dehiscence whereas no patients in ZF had dehiscence (p<0.001). CONCLUSIONS: Our trial demonstrates greater clinical advantages in terms of pain and sternal dehiscence post surgery by using sternal ZipFix compared to conventional steel wire.

Effects of selenium supplementation on expression of SEPP1 in mRNA and protein levels in subjects with and without metabolic syndrome suffering from coronary artery disease: Selenegene study a double-blind randomized controlled trial.

Selenoprotein P (SePP) is involved in the protection against diseases. The present study is the first investigation of the effect of selenium supplementation on plasma selenium and expression of SEPP1 in mRNA and protein levels based on metabolic syndrome (MetS), in individuals suffering from coronary artery diseases. In this clinical trial, 160 patients with angiographically documented stenosis of more than 75% in each vessel were enrolled. Patients received either 200-mg selenium yeast tablets or placebo tablets orally after a meal, once daily for 60 days. The mRNA and protein levels of the selenium and SePP1 products were determined before and after the study. From the initial 160 participants, 145 subjects (71 MetS-affected individuals, 74 MetS-unaffected individuals) enrolled in this study. Comparing the selenium and placebo groups, no significant percentage changes of plasma selenium, △Ct SEPP1, or SePP were shown (P > 0.05). Moreover, beyond a significant difference for the expression of SePP in the selenium group compared to its baseline level (P < 0.05), no other significant differences were revealed for plasma selenium and △Ct SEPP1 after the intervention in either group (P > 0.05). Selenium supplementation did not affect plasma selenium or the mRNA or protein level of SePP in either groups after a 2-months intervention beyond a significant increase of SePP in the MetS group. This trial suggests that further studies should investigate the long-term use of selenium supplementation and the effect of a SePP increase on MetS as a potential therapeutic effect.

Association of expression of selenoprotein P in mRNA and protein levels with metabolic syndrome in subjects with cardiovascular disease: Results of the Selenegene study.

BACKGROUND: Selenoprotein P (SeP) is involved in transporting selenium from the liver to target tissues. Because SeP confers protection against disease by reducing chronic oxidative stress, the present study aimed to assess the level of SeP in the serum of patients with metabolic syndrome (MetS) with a history of cardiovascular disease (CVD). METHODS: A cross-sectional study was conducted in 63 and 71 subjects with and without MetS in the presence of documented CVD. All demographic, anthropometric and cardiometabolic variables (lipids, blood glucose, blood pressure) were assessed. Lifestyle-related factors and personal history and familial CVD risk factors were recorded. The expression of SELP in mRNA and protein levels in the serum was measured, and MetS was determined using ATPIII criteria. Binary logistic regression analysis demonstrated MetS and SeP to be dependent and independent variables, respectively. RESULTS: Mean of systolic and diastolic blood pressure, triglyceride, high-density lipoprotein-cholesterol, fasting blood sugar, body mass index and waist circumference were higher among subjects with MetS (p = 0.05). The mean of selenium was higher among subjects with MetS, whereas the mean of SeP was lower among subjects with MetS (p < 0.001). In the unadjusted model, the SeP had decreased odds for MetS [odds ratio (OR) = 0.995; 95% confidence interval (CI) = 0.989-1.00] (p < 0.04). Furthermore, the association between MetS and SeP levels remained marginally significant even after adjusting for potential confounders such as age, gender, family history, smoking status and nutrition. SeP and waist circumference show a significant relationship (OR =0.995; 95% CI = 0.990-1.00) (p < 0.033). CONCLUSIONS: We have demonstrated a significant decrease in circulating SeP levels according to MetS status in patients with documented cardiovascular disease.

Does the impact of metabolic syndrome on cardiovascular events vary by using different definitions?

BACKGROUND: Metabolic Syndrome (MetS) is a complex disorder which increases the risk of chronic diseases, including cardiovascular diseases and diabetes mellitus. As a result of modern lifestyles, the prevalence of MetS has been rising globally. This study aims to investigate whether overall prevalence of MetS varies when using different definitions of MetS and to identify the best and most predictive definition of the MetS for cardiovascular disease (CVD) events over 10 years in a cohort of an Iranian population. METHOD: Adults aged ≥ 35 years from urban and rural regions in central Iran were selected at baseline and followed up for more than 10 years. Data on socio-demographic characteristics, anthropometry, blood pressure and smoking status were collected at baseline. In addition, various biochemical indices were assessed. MetS was defined based on five available definitions, and cardiovascular events during 10 years follow up were confirmed by an expert group. The hazard ratios were calculated by the Cox proportional hazards model. RESULTS: The highest prevalence of MetS was observed by using AHA-NHBI definition (36.9%), followed by JIS definition (31.2%). On the other hand, EGIR (8.8%) provided the lowest prevalence. The risk of developing CVD, irrespective of definitions, was approximately two fold higher in the presence of MetS. After controlling for possible confounders, AHA-NHBI definition was found to be the best predictor of CVD. CONCLUSION: This study demonstrated a great variability in the prevalence of MetS among Iranian adults when using different definitions of MetS. CVD risk was significantly higher in MetS participants, as well as in participants with any risk factors of MetS; however, the AHA-NHBI definition was found to be the best predictor of CVD. Thus protective measures, including lifestyle modifications, plus control of individual risk factors is necessary to prevent cardiovascular events.

Isfahan Twin Cohort: A Ten-Year Longitudinal Prospective Study Based on A Twin Registry.

BACKGROUND: The Isfahan Twin Cohort (ITC) aims to provide a comprehensive understanding of the interplay between genetics and environment in the development of Non-Communicable Diseases (NCDs). As a type of specialized epidemiological investigation, twin studies are designed to quantify the contribution of genetics to a particular phenotype when confronted with environmental factors. In this context, the present study aims to present a detailed overview of the ITC methodology. METHOD: The ITC is a prospective longitudinal study started in 2020. Data collection, including the demographics, socioeconomic status, health-related habits, medical history, and zygosity of the participants, was performed using validated questionnaires. Moreover, anthropometric measurements and blood pressure assessments were performed by a trained nurse. Also, fasting blood and morning urine samples were collected during a morning visit, and biochemical investigations were conducted at the central laboratory of the Isfahan Cardiovascular Research Institute. The participants underwent follow-up telephone interviews biannually, in which brief questionnaires were filled out on the changes in the lifestyle factors of the participants, such as diet, physical activity, psychological factors, and smoking habits. The second and final follow-up visit will include complete assessments, including blood and biological sample collections, similar to the baseline assessment. RESULTS: The ITR has registered a total of 112 (n=224) monozygotic and 291 (n=582) dizygotic twin pairs during two years. The age range of the participants is 1 month to 56 years. Until November 2020 / 2021, the registered twins were categorized by age and included 48 pairs (n=96) in the infant group (monozygotic: 7 pairs, dizygotic: 41 pairs); 283 pairs (n=566) in the early childhood, late childhood, and adolescent groups (monozygotic: 74 pairs, dizygotic: 209 pairs); and 72 pairs (n=144) in the adult group (monozygotic: 31 pairs, dizygotic: 41 pairs). CONCLUSIONS: The cohort is being prospectively followed with plans to investigate the clinical utility of the newly developed biomarkers and gene-environmental interactions in the future.

Possible effects of melatonin on reperfusion injury following coronary artery bypass graft surgery.

BACKGROUND: Although coronary artery bypass graft (CABG) surgery has been reported to be one of the most effective internentions in terms of myocardial salvage, reperfusion itself can cause additional damage to the myocardium. Since there is strong evidence that free radicals are the principal offender in ischemia-reperfusion (I/R) injury, it has been suggested that treatment with antioxidant agents can be protective. Investigations have shown that melatonin secretion is partially disturbed in CABG patients. The aim of this study was to evaluate the protective effect of melatonin as an antioxidant agent on I/R injury. METHODS: 164 elective CABG candidates participated in this randomized clinical trial during the preoperative period. The candidates were randomized to receive 3 mg of melatonin tablets (physiologic dose) from 3 days before surgery until the day of discharge. Cardiac biomarkers [troponin and creatine kinase myocardial band (CKMB)] were assessed once before surgery (24 hours before surgery), and 8 and 24 hours after surgery. RESULTS: Finally, 130 patients, 65 (50%) patients in the melatonin group and 65 (50%) in the control arm finished our study. Mean age of melatonin and control groups was 59.90 ± 9.59 and 60.80 ± 8.00 years, respectively; moreover, 47 (72.30%) in melatonin and 45 (69.23%) in control group were men. No significant difference was seen in baseline cardiac biomarkers between two groups (P > 0.05). In both groups, cardiac biomarkers (CKMB and troponin) elevated after surgery in comparison to their preoperative values. There was no statistically significant difference between the control and melatonin groups regarding the 8-hour and 24-hour troponin and CKMB when adjusted for interacting factors (P > 0.05). CONCLUSION: Although physiological concentration of melatonin is protective against I/R injury, substitution of endogenous melatonin with the oral supplement which creates physiologic concentration may not prevent I/R injury. In order to have antioxidant effect, pharmacologic doses of melatonin should be employed.

Association study of polymorphism in Thrombomodulin gene [rs1042579] with cardiovascular disease.

BACKGROUND AND AIM: Thrombomodulin (THBD) gene plays an important role in activation and control of protein C. Regulation protein C levels as an important risk factor for cardiovascular disease. Mutations in this gene can affect Thrombomodulin levels. In this study, we aimed to investigate the role of single nucleotide polymorphism (SNP) in rs1042579 THBD gene in patients with cardiovascular disease. METHODS: The samples of this case-control study consisted of 105 Iranian patients with cardiovascular disease and 95 healthy controls who enrolled from March 2017 to December 2018 in this study.  Demographic data, medical history, and para-clinical were measured, and Sanger sequencing was used for allelic discrimination. Control samples were identified and then selected for genotyping of other ARMS-PCR technique. RESULTS: Data analysis revealed that the rs1042579 polymorphism of the THBD gene was associated with a risk of coronary heart disease. Sequencing results confirmed the existence of CC homozygous, heterozygous TC and TT homozygous genotypes. TT genotype is a risk factor in patients compared to healthy controls. CONCLUSION: The results of this study showed that the rs1042579 polymorphism was associated with an increased risk of cardiovascular disease.

Development and validation of a socioeconomic status short-form questionnaire (SES-SQ).

BACKGROUND: Evaluation of socioeconomic status (SES) is an important aspect in community-based health studies and it is a major predictor of health and nutritional status as well as mortality and morbidity from many diseases. This study aimed to construct and validate socioeconomic status short-from questionnaire (SES-SQ) in Iranian population. METHODS: This cross-sectional methodological study was conducted among 1437 Iranian general population. Face and content validity of the developed questionnaire was evaluated qualitatively. Internal consistency, construct validity using exploratory factor analysis (EFA) and latent class analysis (LCA), and convergent and known-group validity were also evaluated. RESULTS: The SES-SQ consisted of 6 items. The overall Cronbach's alpha was 0.64, showing acceptable internal consistency. EFA resulted in two factors explaining 47.78% of total variance. Three SES classes (low/middle/high) were extracted by LCA. The score of SES-SQ ranged from 0 to 17; two cutoff scores of 4.5 and 8.5 were determined by receiver operating characteristic (ROC) analysis for differentiating low from middle and middle from high SES classes, respectively. CONCLUSION: An efficient, reliable, and valid short-form questionnaire was developed for evaluating SES in Iranian general population. The relevancy of questionnaire items is not lost over time.

Effects of selenium intake on the expression of prostaglandin-endoperoxide synthase 2 (cyclooxygenase-2) and matrix metallopeptidase-9 genes in the coronary artery disease: Selenegene study, a double-blind randomized controlled trial.

BACKGROUND: The oxidative stress is regarded as one of the main contributors to the health problem. Cyclooxygenase-2 (COX-2) and matrix metallopeptidase-9 (MMP-9) are two of the important genes that are reported to be involved in the cardiovascular disease (CVD) development in the molecular and genetic association studies. The aim of this study was to evaluate the level of expression of COX-2 and MMP-9 after selenium supplementation in patients with coronary artery disease (CAD). METHODS: In this sub-study of Selenegene study, subjects were randomly divided into groups, 19 subjects who received selenium and 22 patients with CAD who received placebo. Patients received either 200-mg selenium yeast tablets or placebo tablets after a meal, once daily for 60 days. The messenger ribonucleic acid (mRNA) levels of the selenium and prostaglandin-endoperoxide synthase 2 (PTGS2) (COX-2) and MMP-9 genes products were determined before and after the study. RESULTS: In this sub-study, 41 Iranian patients with CVD were enrolled (placebo group: n = 22, selenium intervention: n = 19). Fasting blood sugar (FBS) was higher among placebo group than selenium group (93.4 ± 12.7 vs. 124.4 ± 40.6 mg/dl, P = 0.03). Triglyceride (TG) level was higher among selenium group versus placebo group (123.3 ± 34.0 vs. 184.8 ± 69.4 mg/dl, P = 0.006). The data analysis demonstrated that the expression of MMP-9 and COX-2 genes did not change significantly in both selenium and placebo groups. CONCLUSION: This study showed a positive association between the expression of MMP-9 and COX-2 in the patients with CAD who received selenium but not the placebo groups. Yet, these findings need to be confirmed in further details and expanded sample size.

Polymorphisms of LPA gene, rs1801693 and rs7765781, are not associated with premature myocardial infarction in the Iranian population.

BACKGROUND: Myocardial infarction (MI) is one of the leading causes of mortality globally. Although it is most prevalent in the elderly, it may occur in young adults (men ≤ 55 years or women ≤ 65 years) as premature MI (PMI). As awareness of genetic risks may lead to effective prevention of PMI, we aim to investigate the association of two susceptible single nucleotide polymorphisms (SNPs) in the LPA gene with PMI in the Iranian population, rs1801693 and rs7765781, identified in previous genome-wide association studies (GWAS). METHODS: A total number of 85 patients with PMI and 85 healthy controls were recruited from December 2015 to March 2016 from Isfahan, Iran. Peripheral blood samples were collected from all individuals. Deoxyribonucleic acid (DNA) was extracted and genotyped at rs1181693 and rs7765781 polymorphisms, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results were statistically analyzed to find any possible association of the two polymorphisms with PMI by SPSS software and P-values less than 0.05 were considered to be statistically significant. RESULTS: Statistical analysis displayed no significant difference between rs1801693 (P = 0.815)/rs7765781 (P = 0.746) alleles in patients with PMI and healthy control subjects. CONCLUSION: There is no meaningful association between rs1801693/rs7765781 and PMI incidence in the Iranian population.

Validity and reproducibility of a semi-quantitative food frequency questionnaire for Iranian adults.

AIM: To validate a semi-quantitative food frequency questionnaire (SFFQ) and assess the dietary intake of Iranian adults. METHODS: This study was conducted among 113 healthy adults in Iran. We administered twelve 24-hour dietary recalls (24DRs) during a year as a reference method. The 165-item SFFQ was administered twice, along with the first and last 24DRs. To examine validity and reproducibility of SFFQ, the correlation coefficients (r) and de-attenuated correlation coefficients and intra-class correlation coefficient (ICC) between 24DRs and SFFQ were calculated. The Bland-Altman method was used to assess agreement between the two methods. RESULTS: De-attenuated correlations varied from 0.42 (polyunsaturated fatty acids) to 0.62 (energy) (all P < .001) for nutrients and from 0.48 (oils and fats) to 0.65 (sweets) for food groups (all P < .05). We found reasonable reproducibility of SFFQ for both nutrients and food groups. ICC (95%CI) varied from 0.47 (0.15-0.74) for saturated fatty acids to 0.64 (0.47-0.76) for energy and from 0.43 (0.15-0.62) for oils and fats to 0.58 for grains (0.31-0.69). According to the Bland-Altman plots, we observed an acceptable level of agreement between the two methods. CONCLUSIONS: We found reasonable relative validity and acceptable reproducibility of SFFQ. This SFFQ can be used to classify individuals based on their dietary intake in our population.

Association of Selenoprotein S Expression and its Variants with Metabolic Syndrome in Subjects with Cardiovascular Disease.

BACKGROUND: Selenoproteins S (SELS or VIMP) may regulate cytokine production, and thus play a key role in the control of the inflammatory response. METHODS: This study consisted of 136 Iranian patients with cardiovascular disease (65 MetS-affected and 71 MetS un-affected individuals) in the selengene study. Expression of two variants of VIMP including VIMP I and II were analyzed in all subjects using Real-Time PCR and ELISA. RESULTS: The level of VIMP was lower in MetS+ compared to the MetS- subjects (p <0.05). We found no significant differences in quantitative expression of VIMP I and VIMP II in both groups. VIMP I reveal a reverse correlation with fasting blood sugar (FBS) (r = -0.45, p = 0.009). Moreover, SELS in protein level has negative correlation with WC (r = -0.171, p = 0.049) and positive correlation with HDL (r = 0.176, p = 0.046). CONCLUSIONS: Our study suggests that VIMP in protein level is significantly lower in MetS and shows a reverse correlation with WC and positive correlation with HDL. Therefore, with regard to the functional role of this protein, it is possible to deduce that its lower expression leads to the higher secretion of unfolded proteins into the cytosol and outside the cell, where they cannot play their exact roles in the different pathways. Moreover, the reverse correlation of VIMP I with FBS suggests further consideration of VIMP and its variant VIMP I expression in regards to potential development of major CVD risk factors.

The Association between Occupational Categories and Incidence of Cardiovascular Events: A Cohort Study in Iranian Male Population.

BACKGROUND: Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence. OBJECTIVE: To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population. METHODS: We followed 2134 men aged 35-65 years for 14 years during the Isfahan Cohort Study (2001-2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor. RESULTS: The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables. CONCLUSION: There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.

Cardiovascular Disease Risk Assessment: Triglyceride/High-Density Lipoprotein versus Metabolic Syndrome Criteria.

BACKGROUND: As finding subjects at risk of cardiovascular diseases based on the presence of metabolic syndrome (MetS) is time-consuming for physicians, we aimed to compare the effectiveness of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) compared to MetS criteria in identifying high-risk individuals. STUDY DESIGN: A prospective cohort study. METHODS: Isfahan cohort study was a longitudinal population-based study conducted on adults aged 35 yr or older, living in three districts in central part of Iran from Jan 2, 2001 to Sep 28, 2001. After 10 years of follow-up, participants were re-evaluated. The hazard ratio (HR) for cardiovascular disease events based on TG/HDL-C, sex-specific cut-off points, and MetS were also estimated. Akaike's information criteria (AIC) were used as indicators of the goodness of fit of the model and prediction error. RESULTS: TG/HDL-C alternate cut-off points of 3.76 and 4.42 had a strong predictive value for CVD events but did not perform as well as MetS criteria. The unadjusted HR was greatest in the high-risk individuals by the MetS criteria (HR=2.08, 95% CI: 1.80, 2.41) compared to those identified as high-risks by the TG/HDL cut-off points and continued to be greatest after adjustments in different models. Based on the AIC, the best model is adjusted for sex, age, diabetes, total cholesterol levels, current smoker, diet, physical activity, and BMI. CONCLUSION: MetS criteria appears to be a superior marker compared to TC/HDL-C to identify patients at cardiovascular risk, though lipid ratio also shows a remarkable predictive value and could be considered to achieve this goal when appropriate.

Anthropometric indices predicting incident hypertension in an Iranian population: The Isfahan cohort study.

OBJECTIVE: The aim of the present study was to assess different obesity indices, as well as their best cut-off point, to predict the occurrence of hypertension (HTN) in an Iranian population. METHODS: In a population-based study, subjects aged 35 years and older were followed for 7 years. Blood pressure was measured at baseline and after the follow-up. Anthropometry indices included body mass index (BMI), body adiposity index (BAI), the waist-to-height ratio (WHtR), the waist-to-hip ratio (WHpR), and waist and hip circumferences (WC and HC). Logistic regression was employed to calculate the odds ratio (OR) and 95% confidence intervals (CI) per standard deviation (SD) increment. The operating characteristic analysis was used to derive the best cut-off value for each index. RESULTS: Among original 6504 participants, 2450 subjects who had no cardiovascular diseases (CVD) and HTN at baseline were revisited, and 542 (22.1%) new cases of HTN were detected. There were minimal differences between most indices in the adjusted models; however, the best HTN predictors were BMI (OR per SD 1.32; 95% CI 1.12-1.56) and almost equally WC (1.35; 1.13-1.60) in men and WC (1.20; 1.04-1.39) in women. As a binary predictor, BMI with a cut-off point of 24.9 kg/m2 in men (1.91; 1.40-2.62) and WC with a cut-off point of 98 cm in women (1.57; 1.17-2.10) were the best in adjusted models. WC, WHpR, and WHtR were significantly associated with an increased risk of HTN only in participants whose weight was normal (BMI, 18.5-24.9 kg/m2). CONCLUSION: Therefore, BMI in men and WC in women were the best predictors of HTN, both as continuous and binary factors at their appropriate cut-off points.

The relationship between serum vitamin D levels and ankle-brachial index in patients with metabolic syndrome.

BACKGROUND: Vitamin D deficiency is a prevalent condition in Iran and previous studies have shown that a low level of serum vitamin D is related to low ankle-brachial index (ABI). In the present study, the relationship of the serum level of vitamin D with ABI, as an index for atherosclerosis of peripheral arteries, was evaluated. METHODS: In this cross-sectional study, data on 91 patients with metabolic syndrome (Mets) from the Isfahan Cohort Study (ICS) were analyzed in order to evaluate the association between serum 25(OH) vitamin D level and ABI. The participants were divided into two groups; group A with desirable serum vitamin D level and group B with abnormal serum vitamin D level. ABI was measured and compared between these groups. RESULTS: A crude and adjusted model showed no association between vitamin D level and ABI in patients with MetS. CONCLUSION: It can be concluded that serum vitamin D level could not affect ABI in patients with MetS.