Cardiometabolic Profile in Young Adults With Diverse Cigarette Smoking Histories: A Longitudinal Study From Adolescence.

BACKGROUND: For the first time, the present study investigated smoking trajectory and cardiometabolic profile from adolescence to young adulthood in a middle-income developing country facing a high prevalence of smoking and cardiovascular disease-related outcomes. METHODS AND RESULTS: Data on 1082 adolescents (12-18 years of age) who participated in the TLGS (Tehran Lipid and Glucose Study) were gathered, and participants were followed for a median of 12.5 years (baseline: 1999-2002, last follow-up: 2014-2017). Participants were categorized as non/rare smokers, experimenters, and escalators using group-based trajectory models. Statistical analysis was used to compare the trajectory groups' cardiometabolic components, clinical characteristics, and cardiometabolic changes due to the individuals' placement in experimenter and escalator groups compared with non/rare smokers. The smoking trajectory groups in young adulthood differ significantly in blood pressure, triglycerides, high-density lipoprotein cholesterol, waist circumference, and body mass index, with the escalator group having the highest risk values for each component. Significant differences were observed in blood pressure (P=0.014), triglycerides (P<0.001), and waist circumference (P<0.001) status after using clinical cut points. The adjusted linear regression revealed that the escalator group had 3.16 mm Hg-lower systolic blood pressure SBP (P=0.016), 2.69 mm Hg-lower diastolic blood pressure (P=0.011), and 4.42 mg/dL-lower high-density lipoprotein cholesterol (P=0.002), compared with the non/rare smoker group. CONCLUSIONS: Despite elevated risks in unadjusted analyses for all cardiometabolic components among smokers, our study identified a modest protective link between early smoking and blood pressure in addition to a remarkable harmful association with high-density lipoprotein cholesterol levels exclusively in the escalator group during the developmental stage to young adulthood, using adjusted analyses.

Risk of recurrence at the time of withdrawal of short- or long-term methimazole therapy in patients with Graves' hyperthyroidism: a randomized trial and a risk-scoring model.

PURPOSE: In Graves' disease, administration of low-dose methimazole for more than 60 months induces higher remission rates compared with the conventional duration of 12-18 months. However, the risk of recurrence and its predictors beyond 48 months of drug withdrawal are not known. The aims of this study were to determine the risk of recurrence during 84 months after withdrawal of short- or long-term methimazole therapy and a risk stratification for recurrence of hyperthyroidism. METHODS: A total of 258 patients were treated with methimazole for a median of 18 months and randomized to discontinuation of the drug(conventional short-term group; n = 128) or continuation of the treatment up to 60-120 months(long-term group; n = 130). Patients were followed for 84 months after methimazole withdrawal. Cox proportional hazards modeling was performed to identify factors associated with relapse and develop a risk-scoring model at the time of discontinuing the treatment. RESULTS: Hyperthyroidism recurred in 67 of 120(56%) of conventionally-treated patients versus 20 of 118(17%) of those who received long-term methimazole treatment, p < 0.001. Age, sex, goiter grade, triiodothyronine, thyrotropin, and thyrotropin receptor antibodies were significant predictors of recurrence in both "conventional" and "long-term" groups but free thyroxine just in the "long-term" group. The risk-scoring model had a good discrimination power (optimism corrected c-index = 0.78,95%CI = 0.73-0.82) with a range of 0-14 and sensitivity of 86% and specificity of 62% at the risk-score of eight. CONCLUSION: A relapse-free state was achieved in 83% of patients with Graves' hyperthyroidism 84 months after cessation of long-term methimazole treatment which could be predicted by some significant predictors in a simple risk-scoring system.

The association between leisure-time physical activity and blood pressure changes from adolescence to young adulthood: Tehran Lipid and Glucose Study.

The effectiveness of long-term leisure time physical activity (LTPA) on blood pressure (BP) changes is still under debate. Since adolescence lifestyle behaviors shape the adulthood health profile, this study aimed to investigate the sex-specific impact of LTPA on BP changes from adolescence to young adulthood. This longitudinal study uses the data of 1412 adolescents (52% females) aged 12-18 years through a median follow-up of 12.2 years in the Tehran Lipid and Glucose Study (TLGS) framework. LTPA was calculated using the reliable and valid Iranian version of the modified activity scale (MAQ), and BP was measured at least twice by trained physicians. The linear mixed model was used to examine the study variables, considering individual and intrapersonal differences during the study. The majority of participants consistently demonstrated insufficient LTPA throughout the follow-up assessments, ranging from 54.7 to 67.1% for males and 77.7-83.4% for females. Despite a declining trend in LTPA (ß = - 2.77 for males and ß = - 1.43 for females), an increasing trend was noticeable in SBP, DBP, and BMI (ß = 1.38, ß = 1.81, ß = 0.97 for males, and ß = 0.10, ß = 0.20, ß = 0.97 for females, respectively). The unadjusted model revealed a significant trend in all variables for both sexes, except for female BP (P = 0.45 for SBP and P = 0.83 for DBP). Using the adjusted model, no significant association was observed between LTPA and changes in BP over time in both sexes. Our study indicates no association between LTPA and BP changes from adolescence to young adulthood. Insufficient LTPA levels, particularly among Iranian females, are likely the primary factor. Further research is crucial to identify appropriate LTPA levels to promote cardiovascular health and implement targeted interventions to achieve optimal LTPA levels in the Iranian population.

How Do Active and Passive Cigarette Smokers in Iran Evaluate Their Health? A Sex-Specific Analysis on the Full-Spectrum of Quality of Life.

INTRODUCTION: This study aimed to determine the sex-specific effects of active and passive cigarette smoking on the full spectrum of health-related quality of life (HRQoL) among a sizeable adult population. METHODS: This study was conducted within the Tehran Lipid and Glucose Study (TLGS) framework. Participants included 7478 adults in the last examination of the TLGS. We used a quantile regression model to compare sex-specific HRQoL distributions among non-, current, and passive smokers. Two-step cluster analysis was used to consider the synergic effects of confounder variables. RESULTS: In men, current smoking was negatively associated with only mental HRQoL in all percentiles of its distribution with a decrease in absolute estimation values from the lowest (5 th: ß=-6.59, p<0.001) to the highest (90 th: ß=-0.93, p=0.027). Also, passive smoking was negatively associated with men's physical HRQoL in the upper percentiles of its distribution (75 th: ß=-1.12, p=0.010; 90 th: ß=-1.26, p=0.016). In women, the current (ß= -4.17 to -4.45 for 25 th to 90 th percentiles) and passive smokers (ß= -2.05 to -4.25 for 10 th to 90 th percentiles) had lower mental HRQoL in the mentioned percentiles. Also, the current smoking had a negative association with the 5 th percentile (ß=-2.04, p=0.008), and a positive association with the 50 th (ß=1.94, p< 0.008) and 75 th percentile of physical HRQoL (ß=2.25, p=0.004). CONCLUSIONS: The present study showed the harmful effect of smoking on mental HRQol in all participants. In contrast, the physical effect of smoking was only observed in female active smokers and at the extreme levels of the physical HRQoL spectrum. IMPLICATIONS: According to the harmful effect of smoking on HRQoL, understanding active and passive smokers' perceptions of how smoking impacts their health is critical for tobacco control programs. Since most previous studies of smoking and HRQoL have mainly focused on the extreme parts or central values of the HRQoL distribution, the use of a multiple regression approach enables the evaluation of other parts of the conditional distribution of the outcome variable. This study demonstrated the prominent effect of smoking on the mental HRQoL as well as the more serious public health burden of passive smoking in women.

Health-related quality of life in women with various levels of spiritual health.

This study investigates for the first time the relationship between spiritual health (SH) and health-related quality of life (HRQoL) in different periods of life in healthy women, which could be important in the current critical post-pandemic situation. We recruited data from 2238 healthy women in the Tehran Lipid and Glucose Study (TLGS) framework, performed a cross-sectional study, and divided them into four age groups: 1) 20-34, 2) 35-44, 3) 45-54, and 4) 55≤ years. HRQoL and SH were measured using Short-Form 12-Item Health Survey version 2 and spiritual health inventory in Muslim adults (SHIMA-48). We defined low and high SH as the first and third tertile of SHIMA-48 scores. Most participants were in the first age group (39 percent), were married (74.7 percent), and were housewives (74.7 percent). The mean mental component summary score and its domains were directly associated with age. This subscale was significantly higher in individuals with high SH scores in all age groups. However, except for general health, other physical subscales did not differ significantly between the two levels of SH among the age groups studied. Results indicate higher HRQoL, especially mental health, in healthy women with increased spiritual well-being. This finding can be used in programs to improve psychological health in women.

A 10-Year Cardiovascular Risk in Adults with Different Levels of Spiritual Health: Tehran Lipid and Glucose Study.

Background: Previous studies have shown that spiritual experience may reduce cardiovascular disease (CVDs). However, little is known about the relationship between spiritual health and the gender-specific risk of CVDs in communities with different cultures. Methods: A total of 3249 individuals (53.7% female, 75.0% middle-aged) participated in the Tehran Lipid and Glucose Study (TLGS) from 2015 to 2017 were included. Based on the ACC/AHA pooled cohort equation, CVD risk over ten years was examined. Spiritual health was measured using a developed tool for measuring spiritual health in Muslim populations (SHIMA-48). Linear regression models were used to assess the association between spiritual health and ACC/AHA risk scores. The natural logarithm scale was calculated to consider the normal distribution hypothesis of the regression model. Results: The current results suggest a slight but significant increase in the mean of spiritual health in women compared to men in both cognitive/emotional and behavioral dimensions (P < 0.001). In both sexes, a higher prevalence of smoking was observed in participants with lower levels of spiritual health (P < 0.004). In men, compared to those with a low level of spiritual health (the first tertile), the logarithm of the ACC-AHA risk score was reduced by 0.11 (P = 0.004) and 0.18 (P < 0.001) for those in the second and third tertiles of spiritual health, respectively. This result may be attributed to higher cigarette smoking among the latter group. Similar results were not observed in women. Conclusions: Current results indicate a gender-specific association between spiritual health and cardiovascular disease risk. Our findings imply that promoting spiritual health can be considered an effective strategy in future preventive interventions, primarily by controlling the desire to smoke in men.

Health-Related Quality of Life in Those with Persistent or Transient Obesity Phenotypes during Two Decades: Tehran Lipid and Glucose Study.

INTRODUCTION: The current study aimed to investigate the association of three stable obesity phenotypes (persistent metabolically healthy normal weight [P MHNW], persistent metabolically healthy obese [P MHO], persistent metabolically unhealthy obese [P MUO]), and one transient (MHO to MUO) obesity phenotype throughout 18 years with health-related quality of life (HRQoL). METHODS: 1,932 participants (649 men and 1,283 women) who completed the HRQoL questionnaire during 2016-2019 were recruited in the current investigation. Based on the body mass index and metabolic status, participants were classified into four obesity phenotypes, including (1) P MHNW, (2) P MHO, (3) P MUO, and (4) transient from MHO to MUO. The HRQoL was compared between groups using analysis of covariance. Participants' age, marital status, occupation status, education level, physical activity, and smoking were adjusted. RESULTS: After adjustment for confounder variables, a significant difference among obesity phenotypes was indicated in (physical component summary) PCS scores of both sexes and (mental component summary) MCS scores just in women (p value = <0.001). The P MUO had the lowest scores in PCS and MCS, and P MHO had the highest MCS scores compared to other obesity phenotypes in either sex. CONCLUSION: The results of the present study indicate the negative effect of long-term concurrence of obesity and metabolic disorders on the HRQoL of adults. However, long-term obesity alone or loss of metabolic health in the short term did not affect individuals' assessment of their physical and mental health. These findings highlight the importance of preventive interventions in people with obesity; also indicate the need for awareness-raising strategies about healthy lifestyles to improve the quality of life in society.

Active and Passive Smoking in Adults Undergoing a Long-Term Multi-Setting Healthy Lifestyle Education: Tehran Lipid and Glucose Study.

We aimed to investigate the effects of a multi-setting lifestyle education on men's cigarette, hookah, and passive smoking, and women's passive smoking, in Iran. Data of Tehran Lipid and Glucose Study (TLGS) were used. TLGS started in 1999 with every-3-year follow-ups. Multi-stage cluster random sampling was used to recruit participants under the coverage of three health centers. One health center implemented multi-setting lifestyle education at school, family, and community setting. Our analytic sample for generalized estimating equation was restricted to 1322 and 3593 adults (respectively as intervention and control) who were followed for 15.8 years. Intervention reduced the odds of men's cigarette smoking by 27%. The estimated mean cigarettes/day was 1.58 lower in intervention men. The intervention reduced the odds of men's hookah use by 42% in short term. Intervention women had 33% lower odds of passive smoking. Lifestyle education with community outreach can help achieve pragmatic tobacco control goals.

Body mass index trajectories from childhood concerning emotional states in young adulthood: Tehran Lipid and Glucose Study.

This study aimed to identify body mass index (BMI) trajectories from childhood and their relationships with depression, anxiety, and stress symptoms in young adulthood. A total of 687 children aged 4-18 years were recruited from the Tehran Lipid and Glucose Study. Throughout 18 years of follow-up, BMI was measured every 3 years for a maximum of 6 data points. Participants completed the depression, anxiety, and stress scale in their young adulthood (aged 22-36). The group-based trajectory modelling was applied to identify BMI patterns. The logistic regression model was used to assess the association between BMI trajectories and depression, anxiety, and stress symptoms in adulthood. Two BMI trajectories were identified from childhood to young adulthood: healthy weight (HW = 69.6%) and persistent increasing overweight/obesity (PIO = 30.4%). After adjusting for potential confounders, compared with the HW group, men in the PIO group were more likely to experience higher stress levels (OR: 1.62, 95% CI: 0.99-2.63; p = 0.05). No significant association was observed between the PIO trajectory and depression and anxiety among both sexes and stress symptoms in females. Our results highlight that developing overweight and obesity from childhood may be related to increased stress in males.

Self-rated Health in Youth with Different Screen Time in Their Adolescence: Tehran Lipid and Glucose Study.

BACKGROUND: The long-term effects of childhood screen time on health-related quality of life (HRQoL) are still unclear. This study aimed to investigate the relationship between screen time during adolescence and sex-specific HRQoL in early youth. METHODS: We studied the data from 642 adolescents aged 13-19 years, who participated in the Tehran Lipid and Glucose Study from 2005 to 2011 (baseline) with complete data on HRQoL in their early adulthood (22-28 years at the last follow-up). Physical and Mental HRQoL were assessed using the Iranian version of the short-form 12-item health survey version 2 (SF-12v2). Screen time and leisure-time physical activity were evaluated using the Iranian Modifiable Activity Questionnaire (MAQ). All analyses were conducted in Stata (version 14); MI used the mi impute command. RESULTS: The mean±SD of age, body mass index (BMI), and physical activity in childhood were 16.33±1.27, 23.27±4.63 and 13.77±16.07, respectively. Overall, 35% of boys and 34% of girls had high screen time (HST) in childhood. In general, the HRQoL scores in male participants were higher than in females in both the mental and physical domains. HST in males in childhood was associated with decreased mental health (ß=-6.41, 95% CI: -11.52, -1.3 and P=0.014), social functioning (ß=-5.9, 95% CI: -11.23, -0.57 and P=0.03) and mental component summary (MCS) (ß=-2.86, 95% CI: -5.26, -0.45 and P=0.02). The odds of poor MCS were significantly higher in those with HST compared to their counterparts with low screen time (LST) after adjusting for all potential cofounders. CONCLUSION: The results of the present study showed the negative effect of screen time during adolescence on HRQoL in early youth. This effect was observed in men, mainly in the mental dimension. Investigating the long-term consequences of screen-time behaviors on self-assessed health in other populations with the aim of effective primary prevention is also suggested.

Cigarette smoking trajectories among adolescents and young adults in the Islamic Republic of Iran.

Background: Cigarette smoking follows a progressive pattern throughout the lifetime; most adult smokers started smoking during adolescence. Aim: To understand the cigarette smoking trajectories and their predictors among adolescents and young adults in the Islamic Republic of Iran. Methods: Using data from the Tehran Lipid and Glucose Study, we followed 1169 adolescents (12-18 years old) into their young adulthood (28-32 years old), from 2002 to 2016. We used cigarette smoking as the outcome variable for group-based trajectory modelling. After detecting the trajectories, we investigated the effects of independent variables, namely, individual employment; education; physical activity; and paternal smoking, employment and education, on the trajectories. We analysed the data using STATA version 16 and SPSS version 26. Results: Three trajectories were detected: non-smokers (79%), experimenters (12%) and escalators (9%). Boys were approximately 3 times (OR = 2.94, 95% CI: 2.32-3.24, P < 0.001) and 25 times (OR = 25.00, 95% CI: 23.92-26.08, P < 0.001), respectively, more likely than girls to be in the experimenter and escalator groups. Receiving a university education decreased the odds of being in the escalator trajectory for 18% (OR = 0.82, 95% CI: -0.04-0.96, P = 0.002) of the study participants. Employment after high school increased the odds by approximately two folds for the experimenter (OR = 2.00, 95% CI: 1.42-2.50, P = 0.01) and escalator (OR = 2.33, 95% CI: 1.33-2.93, P = 0.03) trajectories. Paternal smoking was associated with 1.88 and 2.23, respectively, increased odds of experimenting and escalating smoking among the adolescents. Conclusion: Iranian adolescents follow 3 cigarette smoking trajectories into young adulthood: non-smokers, experimenters and escalators. Male sex, employment after high school, and living with a smoker father were associated with unfavourable smoking patterns. Findings from this study provide valuable insights for designing targeted interventions to reduce cigarette smoking among adults and adolescents in the Islamic Republic of Iran.

Mean versus variability of lipid measurements over 6 years and incident cardiovascular events: More than a decade follow-up.

Background: Lipid variability (LV) has emerged as a contributor to the incidence of cardiovascular diseases (CVD), even after considering the effect of mean lipid levels. However, these associations have not been examined among people in the Middle East and North Africa (MENA) region. We aimed to investigate the association of 6-year mean lipid levels versus lipid variability with the risk of CVD among an Iranian population. Methods: A total of 3,700 Iranian adults aged ≥ 30 years, with 3 lipid profile measurements, were followed up for incident CVD until March 2018. Lipid variability was measured as standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of mean (VIM). The effects of mean lipid levels and LV on CVD risk were assessed using multivariate Cox proportional hazard models. Results: During a median 14.5-year follow-up, 349 cases of CVD were recorded. Each 1-SD increase in the mean levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), TC/high-density lipoprotein cholesterol (HDL-C), and non-HDL-C increased the risk of CVD by about 26-29%; for HDL-C, the risk was significantly lower by 12% (all p-values < 0.05); these associations resisted after adjustment for their different LV indices. Considering LV, each 1-SD increment in SD and ARV variability indices for TC and TC/HDL-C increased the risk of CVD by about 10%; however, these associations reached null after further adjustment for their mean values. The effect of TC/HDL-C variability (measured as SD) and mean lipid levels, except for LDL-C, on CVD risk was generally more pronounced in the non-elderly population. Conclusion: Six-year mean lipid levels were associated with an increased future risk of incident CVD, whereas LV were not. Our findings highlight the importance of achieving normal lipid levels over time, but not necessarily consistent, for averting adverse clinical outcomes.

Effectiveness of a practical multi-setting lifestyle intervention on the main BMI trajectories from childhood to young adulthood: A community-based trial.

BACKGROUND: Preventing overweight in childhood and subsequent stages of life is still a global challenge. Despite numerous relevant lifestyle interventions, data on their impact on different BMI change pathways over time is rare. The present study aimed to investigate the effect of a multi-setting lifestyle intervention on BMI trajectories from childhood to young adulthood. METHODS: A multi-setting lifestyle intervention at the school, family, and community levels have been conducted in the Tehran Lipid and Glucose Study framework. A total of 2145 children (4-18 years, 49% boys, and 18% intervention) were recruited for the baseline assessment and were followed through five follow-up examinations during a median of 16.1 years. Using a group-based trajectory model, BMI trajectories from childhood to young adulthood were identified, and their association with the implemented intervention was assessed. RESULTS: Four trajectory groups of BMI from childhood to young adulthood were identified, including Normal weight (41%), Young adulthood overweight (36%), Early childhood increasing overweight and adulthood obesity (19%), and Early childhood increasing obesity (4%). Only Young adulthood overweight and Early childhood increasing obesity were affected by the intervention and were concomitant with lower BMI levels than the control group, with the highest estimated effect in the latter (ß=-0.52 and p = 0.018; ß=-1.48 and p < 0.001, respectively). CONCLUSION: The current findings indicate the highest effectiveness of a practical, healthy lifestyle intervention on those whose obesity started in the early years of life or youth. Our results could help policymakers and planners design more targeted lifestyle modification and weight control interventions. TRIAL REGISTRATION: This study is registered at Iran Registry for Clinical Trials, a WHO primary registry ( http://irct.ir ). The Iran Registry for Clinical Trials ID and date are IRCTID:IRCT138705301058N1, 29/10/2008.

BMI variability and incident diabetes mellitus, Tehran Lipid and Glucose Study (TLGS).

Previous epidemiologic studies debated the association of body mass index (BMI) trends with cardiovascular disease and mortality. This study aimed to evaluate the association of BMI variability and slope with the incidence of Type 2 diabetes mellitus (T2DM) in a sex-stratified 15.8-year follow-up in the population-based Tehran Lipid and Glucose Study (TLGS). Of 10,911 individuals aged 20-60 years, 4981 subjects were included and followed for 15.8-years. The slope coefficient of BMI in the linear regression model represented individuals' BMI trends up to the incidence of DM. The root mean squared error (RMSE) of the BMI linear trend was selected to reflect BMI variability through six follow-ups. Cox proportional hazards regression was used to investigate the association of the baseline BMI, BMI slope and RMSE with the incidence of T2DM among men and women. Multivariable-adjusted HRs of T2DM for each SD increment in BMI slope was 1.18 (95% CI: 0.94-1.48, p = 0.161) in normal weight men and 1.26 (95% CI: 1.10-1.44, p = 0.001) in overweight and obese men. However, in women, each SD increment in BMI slope increased the risk of T2DM with a HR of 1.19 (95% CI: 1.01-1.40, p = 0.039) in normal weight, and 1.14 (95% CI: 1.08-1.19, p < 0.001) in women with BMI ≥ 25 kg/m2. In men with a baseline BMI ≥ 25 kg/m2, BMI-RMSE was associated with a decreased risk of T2DM (HR: 0.71, 95% CI: 0.53-0.93, p = 0.015). Baseline BMI was not associated with the risk of diabetes in men and women. Positive BMI slope is associated with the development of diabetes in both sexes. The association of BMI variability with incident T2DM differs according to sex and baseline BMI. BMI variability is associated with a lower risk of T2DM in overweight and obese men. BMI variability in women and baseline BMI in both gender are not related to the risk of T2DM.

A pragmatic multi-setting lifestyle intervention to improve leisure-time physical activity from adolescence to young adulthood: the vital role of sex and intervention onset time.

BACKGROUND: The long-term effectiveness of healthy lifestyle interventions on improving leisure-time physical activity (LTPA) in adolescents and its factors in low- and middle-income communities is unclear. This study is the first to investigate LTPA trends in a population of Iranian adolescents who underwent a multi-setting lifestyle intervention, considering sex and the time of intervention onset. METHODS: Participants were 2374 adolescents (57.2% girls), aged 12-18 years, who participated in the Tehran Lipid and Glucose Study (TLGS) during 1999-2001 and followed for a median follow-up of 15.9 over five data points every 3 years. Adolescent participants were assigned to the intervention or control groups based on their residential areas. Boys and girls were categorized into 12-15 or 16-18 years old to minimize participants' bio-psychological differences, facilitate environmental interventions by more compliance with the Iranian educational system and identify the best time to start the intervention. All adolescents in the intervention area received healthy lifestyle interventions via the school-, family-, and community-based programs. LTPA was assessed using the reliable and validated Iranian Modifiable Activity Questionnaire (MAQ) version over the five data points. The Generalized Estimating Equations method was used to evaluate educational intervention's effect on LTPA in adolescents during the follow-up. RESULTS: In boys who experienced the early onset of intervention (12-15 years), the interaction effect of follow-up examinations and the intervention was significant where the impact of the intervention differed over time. In this group, LTPA was higher in the control group than in the intervention group at the first follow-up examination (ß = - 1088.54). However, an increasing trend of LTPA was observed in the intervention group until the third follow-up examination (ß = 1278.21, p = 0.08, and ß = 1962.81, p = 0.02, respectively), with borderline significance levels at the 2nd (P = 0.08) and the 4th (P = 0.08) measurements. The interaction terms and main effects of intervention and follow-up examinations were not significant in boys with late intervention onset. Although older boys in the intervention group had higher LTPA than the control group, there were no significant differences among study groups in all follow-up examinations. Regarding girls, LTPA did not differ significantly between intervention and control groups in all follow-up examinations (P > 0.05). CONCLUSION: Our results showed that a multi-setting practical lifestyle intervention could improve long-term energy expenditure in LTPA in adolescent boys who have experienced an early onset intervention. Findings emphasized the vital role of gender and the onset of these interventions. The current results would be valuable to plan tailored interventions to improve LTPA and community health. TRIAL REGISTRATION: This study is registered at Iran Registry for Clinical Trials (IRCT), a WHO primary registry ( http://irct.ir ). The TLGS clinical trial was the very first registration in the IRCT (Iran Registry of Clinical Trials). it was registered on 2008-10-29 by the registration number IRCT138705301058N1 . Based on the international committee of medical journal Editors (ICMJE), "retrospective registration" is acceptable for trials that began before July 1, 2005.

The Long-Term Effectiveness of a Multisetting Lifestyle Intervention on Tobacco-Related Habits in Adolescent Boys and Girls: Tehran Lipid and Glucose Study.

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

Developmental trajectories of body mass index since childhood and health-related quality of life in young adulthood: Tehran Lipid and Glucose Study.

PURPOSE: The association between long-term BMI changes since childhood and health-related quality of life (HRQoL) in adulthood is still unclear. This study aimed to examine the association between identified BMI trajectories and HRQoL. METHODS: A population-based cohort of 1938 eligible children (3-18 years) and their parents have been repeatedly followed up for 18 years. Offspring BMI trajectories were identified using group-based trajectory models. HRQoL was evaluated in offspring aged 21-36 years using SF-12V2. Using quantile regression analysis, the associations of the identified BMI trajectories and HRQoL in young adulthood were examined. RESULTS: In males, persistent increasing overweight/obese group was negatively associated with 30th, 40th, 50th, and 60th percentiles of physical component summary (PCS) score distribution (ß = - 2.60, p = 0.006; ß = - 2.01, p = 0.005; ß = - 1.86, p = 0.001; ß = - 1.98, p = 0.009, respectively). A similar result was observed only in the 40th percentile of PCS distribution for the progressive overweight group (ß = - 1.03, p = 0.022). In addition, the progressive overweight group in males showed a positive association with the upper tail of mental component summary (MCS) score distribution specifically for the 90th percentile (ß = 1.15, p = 0.036). Regarding females, the current results indicated that the 90th percentile of MCS distributions was decreased in the persistent increasing overweight/obese group for females (ß = - 1.83, p = 0.024). In addition, the progressive overweight group in females had a positive association with lower (30th and 40th) percentiles of PCS distribution (ß = 1.29, p = 0.034, and ß = 1.15, p = 0.030, respectively). CONCLUSION: A sex-specific conditional association between developmental BMI trajectories from childhood and HRQoL in young adulthood was observed in physical and mental HRQoL.

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study.

BACKGROUND: Cardiovascular diseases (CVDs) are among the most common causes of death worldwide, including in Iran. Considering the adverse effects of CVDs on physical and psychosocial health; this study aims to investigate the association between experience of CVDs and health-related quality of life (HRQoL) in adult participants of the Tehran Lipid and Glucose Study (TLGS). METHODS: The participants of this cross-sectional study were 7009 adults (≥ 20 years) who participated in the TLGS during 2014-2017. Demographic information and HRQoL data was collected through validated questionnaires by trained interviewers. HRQoL was assessed by the Iranian version of the SF-12 questionnaire. Data was analyzed using the SPSS software. RESULTS: The mean age of participants was 46.8 ± 14.6 years and 46.1% of them were men. A total of 9.0% of men and 4.4% of women had CVDs. In men, the mean physical HRQoL summary score was significantly lower in those with CVDs compared to those without CVDs (46.6 ± 0.8 vs. 48.5 ± 0.7, p > 0.001). In women, the mean mental HRQoL summary scores was significantly lower in those with CVDs compared to those without CVDs (42.8 ± 1.0 vs. 45.2 ± 0.5, p = 0.009). In adjusted models, men with CVDs were more likely to report poor physical HRQoL compared to men without CVDs (OR(95%CI): 1.93(1.32-2.84), p = 0.001); whereas for women, the chance of reporting poor mental HRQoL was 68% higher in those with CVDs than those without CVDs (OR(95%CI): 1.68(1.11-2.54), p = 0.015). CONCLUSION: The findings of the current study indicate poorer HRQoL in those who experienced CVDs compared to their healthy counterparts with a sex specific pattern. While for men, CVDs were associated with more significant impairment in the physical dimension of HRQoL, women experienced a similar impairment in the mental dimension of HRQoL.

Risk of hypertension in school-aged children undergoing a long-term community-based lifestyle intervention: Tehran Lipid and Glucose Study.

Childhood hypertension which increases the risk of cardiovascular diseases in adulthood is becoming more prevalent. For the first time in the Middle-East region, this study aimed to assess the long-term effectiveness of a community-based lifestyle intervention on the incidence of hypertension in school-aged children during 16 years of follow-up. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were 2080 children aged 8-18 years with normal blood pressure who were under the coverage of three health care centers selected using multistage cluster random sampling method. One of the health care centers far from the other two was selected for implementing lifestyle intervention (1053 children, 48.2% boys). Triennial examinations were conducted, and survival Cox models were used to assess intervention effects on the incidence of hypertension in boys and girls. Crude incidence rates (per 1000 person-years) of hypertension were 8.11, 3.7, and 5.8 among boys, girls, and the total sample, respectively. Our results showed that HTN has occurred significantly less (P = 0.025) in the intervention group than in the control group, only in female participants. These results remained significant even after adjusting for individuals' and parental characteristics (P = 0.033). Although the risk of hypertension in boys was more than twice that observed in girls, the effectiveness of the recent community-based healthy lifestyle intervention was observed only in girls and not in boys. Further studies are needed to understand gender differences in promoting the effectiveness of similar future programs. The TLGS is registered at Iran Registry for Clinical Trials, a WHO primary registry (http://irct.ir; IRCTID: IRCT138705301058N1).

Endogenous estrogen exposure and chronic kidney disease; a 15-year prospective cohort study.

BACKGROUND: Despite strong evidence demonstrating the role of estrogen as a protective factor for kidney function in women, limited data are available regarding the influence of endogenous estrogen exposure (EEE) on chronic kidney disease (CKD). The present study aimed to assess the incidence of CKD in women with various levels of EEE. METHODS: In a prospective population-based study over a 15-year follow-up, a total of 3043 eligible women aged 30-70 years, participating in Tehran-Lipid and Glucose-Study were recruited and divided into two groups (EEE < 11 and EEE ≥ 11 years). EEE calculated based on age at menarche, age at menopause, number and duration of pregnancies, lactation, and duration of oral contraceptive use after excluding the progesterone dominant phase of the menstrual cycle. Cox's proportional hazards model was applied to estimate the hazard ratio of CKD between the study groups, after adjusting for confounders. RESULTS: The total cumulative incidence rate of CKD was 50.1 per 1000 person years; 95% CI: 47.7-52.6); this was 53.9 (95%CI, 50.2-57.8) and 47.1 (95%CI, 44.0-50.4) per 1000 person years in women with EEE < 11 and EEE ≥ 11 years, respectively. The model adjusted for age, BMI, smoking, hypertension, and diabetes showed that the hazard ratio (HR) of incidence CKD in women with EEE < 11 compare to those with EEE ≥ 11 years in the subgroup of women aged< 45 years was 2.66(95% CI, 2.2, 3.2), whereas, in the subgroup aged ≥45 years, it was 1.22 (95% CI, 1.04, 1.4). CONCLUSION: This study shows a higher HR of CKD incidence in women with low EEE levels in their later life. Screening of these women for CKD may be recommended.