Breakfast consumption and mental health: a systematic review and meta-analysis of observational studies.

OBJECTIVE: Several studies have been conducted on the relationship between breakfast consumption and mental health with conflicting results. Therefore, the present systematic review and meta-analysis was undertaken to summarize evidences on the association between skipping breakfast and mental health. METHODS: We searched online databases for all related papers through the comprehensive international data bases of Institute of PubMed/ MEDLINE, ISI/WOS and Scopus up to December 2019, using relevant keywords. Overall, 14 studies were included in this systematic review and meta-analysis. RESULTS: The total sample size of all selected studies was 399,550 individuals with age range of 6 to ≥65 years old. We found a significant positive association between skipping breakfast and Odds Ratio (OR) of depression (pooled OR: 1.39; 95% CI: 1.34-1.44), stress (pooled OR: 1.23; 95% CI: 1.04-1.43) and psychological distress (pooled OR: 1.55; 95% CI: 1.47-1.62). In contrast, there was no significant association between skipping breakfast and anxiety in all age cohort (pooled OR: 1.31; 95% CI: 0.97-1.65). However, subgroup analysis based on age stratification showed that there was a significant positive association between skipping breakfast and anxiety in adolescences (pooled OR: 1.51; 95% CI: 1.25-1.77). CONCLUSION: In conclusion, skipping breakfast was positively associated with odds of depression, stress and psychological distress in all age groups and anxiety in adolescence, underlining impact of breakfast on mental health.

Effects of Aromatherapy with Lavender (Lavandula angustifolia MILL) on Post-Dural Puncture Headache: A Randomized Placebo-Controlled Trial.

Context: Lavender has been proposed as an analgesic agent for different types of headaches in complementary and alternative medicine. However, no documented trial has been performed to investigate the effects of lavender in managing post-dural puncture headache (PDPH). Objective: To evaluate the effects of aromatherapy using lavender essential oil in reducing the severity of PDPH. Design: Randomized, placebo-controlled clinical trial with parallel group design. Setting: Post-operative wards of Kamkar-Arab-Nia and Nekooei Hedayati Hospitals in Qom, Iran. Participants: Patients with PDPH caused by spinal anesthesia (n = 50). Intervention: Patients received 15-minute inhalations of either lavender oil or liquid paraffin as placebo, using the same protocol. Outcome Measures: The severity of headache was scored before (baseline) and five times after the intervention (immediately, 30, 60, 90, and 120 minutes after) using the visual analog scale. Also, dosage and frequency of the received Diclofenac and adverse effects of the intervention were recorded. Results: Both groups showed a reduction in headache scores post intervention. However, the headache scores between the groups was significantly different only immediately after the intervention in favor of lavender oil (difference: 1.60 ± 0.63, P = .015). Furthermore, it was observed that the mean changes of the headache scores compared to baseline were significant at each time interval in favor of the placebo group (P < .05), except immediately after the intervention. No significant difference was observed in diclofenac intake between groups (P = .440). Also, no adverse effects were found from the intervention. Conclusions: Aromatherapy with lavender oil was observed to reduce the severity of PDPH only immediately after the intervention, while only minimal effects were observed at successive time intervals. However, it is noted that the study was likely underpowered and further studies are recommended to better understand the effects of lavender oil on PDPH and compare its effects to other herbal products or pharmacological agents commonly used for managing headaches.

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.

BACKGROUND: The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS: We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS: The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS: In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).

Effect of glutamine supplementation on cardiometabolic risk factors and inflammatory markers: a systematic review and meta-analysis.

BACKGROUND: Evidence exists that glutamine plays multiple roles in glucose metabolism, insulin sensitivity, and anti-inflammatory effects. This systematic review and meta-analysis of controlled trials aimed to assess the effect of glutamine supplementation on cardio-metabolic risk factors and inflammatory markers. METHODS: The processes of systematic reviews and meta-analyses were performed according to the PRISMA checklist. PubMed, Web of Sciences, Cochrane library, and Scopus databases were search for relevant studies without time or language restrictions up to December 30, 2020. All randomized clinical trials which assessed the effect of glutamine supplementation on "glycemic indices", "level of triglyceride, "and "inflammatory markers" were included in the study. The effect of glutamine supplementation on cardio-metabolic risk factors and inflammatory markers was assessed using a standardized mean difference (SMD) and 95% confidence interval (CI). Heterogeneity between among studies was assessed using Cochran Q-statistic and I-square. Random/fixed-effects meta-analysis method was used to estimate the pooled SMD. The risk of bias for the included trials was evaluated using the Cochrane quality assessment tool. RESULTS: In total, 12 studies that assessed the effect of glutamine supplementation on cardio-metabolic risk factors were included in the study. Meta-analysis showed that glutamine supplementation significantly decreased significantly serum levels of FPG [SMD: - 0.73, 95% CI - 1.35, - 0.11, I2: 84.1%] and CRP [SMD: - 0.58, 95% CI - 0.1, - 0.17, I2: 0%]. The effect of glutamine supplementation on other cardiometabolic risk factors was not statistically significant (P > 0.05). CONCLUSION: Our findings showed that glutamine supplementation might have a positive effect on FPG and CRP; both of which are crucial as cardio-metabolic risk factors. However, supplementation had no significant effect on other cardio-metabolic risk factors.

Comparison of psychological symptoms between infected and non-infected COVID-19 health care workers.

BACKGROUND: Studies have shown that health care workers (HCWs), as front liners of the coronavirus (COVID-19) pandemic, are at high risk for psychological symptoms, but few studies have compared these symptoms in infected and non-infected HCWs. This study compares psychological symptoms among these two groups. METHODS: In this cross-sectional study, 938 HCWs from various medical fields working in the leading general hospitals of Alborz province, Iran, were selected using a multistage sampling method. The participants had contact with COVID-19 patients. Post-traumatic stress disorder-8 (PTSD-8) is a validated questionnaire that we used to evaluate PTSD symptoms along with its subscales, including intrusion, avoidance, and hypervigilance. Also, the Depression, Anxiety, and Stress Scale-21 questionnaire was used to assess the severity of the aforementioned conditions in HCWs. Multivariate logistic regression was used to compare psychological symptoms in infected and non-infected HCWs. RESULTS: Among 938 included HCWs, 55 had a history of confirmed COVID-19 infection. Prevalence of stress, anxiety, depression, intrusion, hypervigilance, and avoidance among infected HCWs were significantly higher in comparison to non-infected HCWs. In the multivariate logistic model, history of COVID-19 infection among HCWs was associated with a significantly increased risk of anxiety, depression, stress, intrusion, hyper-vigilance, and avoidance. CONCLUSION: The present study showed that the HCWs with COVID-19 infection were at a high risk of displaying psychological symptoms. Therefore, it is also necessary to develop psychological support and interventions for HCWs, especially those who got infected with the virus.

Association of Vitamin D Concentrations with subjective health complaints in children and adolescents: the CASPIAN-V study.

BACKGROUND: Vitamin D deficiency (VDD) is recognized as a global pandemic. Identification, any association between VDD and subjective health complaints (SHC), can be helpful to realize critical mechanisms and improve psychological and somatic symptoms. Given few studies published on this issue and the importance of its clarification, the main objective of this study was to examine the association between VDD and the SHC in children and adolescents. METHODS: In this national cross-sectional study, 2596 Iranian children and adolescents aged 8-18 years were included. Data on SHC, anthropometric indices, physical activity, and serum levels of vitamin D were collected. Logistic regression models (crude, adjusted) were applied to examine the association between the VDD and the SHC. Statistical analysis was performed using STATA version 11. P-values< 0.05 were considered as statistically significant. RESULTS: Serum levels of vitamin D in approximately 70% of Iranian children and adolescents were lower than 30 ng/mL. Among the SHC, irritability (40.9%) and feeling anxiety (33.7%) were the most prevalent ones. Multiple complaints in students with the VDD was 2.5 times greater than those with sufficient vitamin D concentrations (p <  0.001). Compared to the reference group, the strongest association was found between vitamin D status and difficulties in getting to sleep (OR: 2.5, 95%CI: 1.18, 3.53, p <  0.001). CONCLUSION: VDD was observed in the considerable percentage of the study population. There were no significant differences between the two gender groups. In addition, there were significant associations between vitamin D status and most of the somatic and psychological symptoms, particularly for getting to sleep. It seems national interventional programs for vitamin D supplementation or food fortifications can be helpful.

Association of dietary acid load with anthropometric indices in children and adolescents.

PURPOSE: High dietary acid load (DAL) may have an influence on anthropometric indices. Given that there was no study on the association between DAL and anthropometric indices children and adolescents, the current study was aimed to examine the association between DAL and anthropometric indices in Iranian children and adolescents. METHODS: Students aged 6-18 years were recruited using a multi-stage, cluster sampling method from 30 provinces of Iran. Dietary intake was assessed through a validated food frequency questionnaire. Height (Ht), weight (Wt), neck circumference (NC), waist circumference (WC), wrist circumference, and hip circumference (HC) were measured. WC-to-HC ratio (WHR), WC-to-Ht ratio (WHtR), body mass index (BMI) z-score, tri-ponderal mass index (TMI), and parental BMI were computed. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were used to estimate DAL. The association between DAL and anthropometric indices was evaluated using linear regression models. RESULTS: In total, 5326 students (46.92% girls), with mean (standard deviations (SD)) age of 12.50 (3.14) years participated in the study (response rate: 98.13%). After adjusting for confounders, there was a significant association between NEAP and NC (P < 0.05). Also, an inverse association was observed between PRAL and NEAP with parental BMI (P < 0.05). CONCLUSION: Our findings showed a direct association between diet-induced acid load and NC and an inverse association between DAL indices and parental BMI. More well-designed clinical studies are warranted to confirm our results and the underlying mechanisms. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Obesity researches in youth: A scientometrics study in Middle East countries.

BACKGROUND: The alarming trends of obesity/overweight in youth have been interested policy makers and other stakeholders to exact follow and analysis of related scientific evidence. The present paper quantify the trends of outputs of youth obesity/overweight researches in Middle East countries. MATERIALS AND METHODS: The Scopus database systematically searched as the most comprehensive multidisciplinary database, for all related obesity/overweight that focused on youth age groups concerns, from 2000 to 2017. These scientometrics analysis included the trends of scientific products, citations, and other scientometric index in Middle East countries. RESULTS: During 2000-2017, in the field of youth obesity, 2350 papers published (0.40% of total 591,105 indexed paper of this region) by Middle East countries. In this regard, Iran with 574 publication (24.43%) had the first rank. After that Turkey and Saudi Arabia, respectively, with 489 (20.81%) and 313 (13.32%) papers, had the next ranks. Over 18-year period, based on the findings all of Eastern Mediterranean countries follow the progressive plans for topics related to youth obesity. Between them, Iran and Turkey have significant growth rates (0.77% and 0.40%, respectively). Scientometric indicators such as "number of published papers," "number of citations" confirmed that during the 2000-2017 the P-trends of total number of related published papers and the correspond citations, in region countries, were significant (2168 papers and 34,132 citations, P < 0.001). CONCLUSION: Most of countries at global and regional levels follow ascending trends in publications and citations in obesity/overweight fields. Iran's position has grown significantly among them. Maintaining and promoting this position requires careful planning and special attention. The findings also could be used for better health policy and complementary researches.

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

BACKGROUND: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

Global prevalence of cardiometabolic risk factors in the military population: a systematic review and meta-analysis.

BACKGROUND: Although there are numerous studies on the global prevalence of cardiometabolic risk factors (CMRFs) in military personnel, the pooled prevalence of CMRFs in this population remains unclear. We aimed to systematically review the literature on the estimation of the global prevalence of CMRFs in the military population. METHODS: We simultaneously searched PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS with using standard keywords. All papers published up to March 2018 were reviewed. Two independent reviewers assessed papers and extracted the data. Chi-square-based Q test was used to assess the heterogeneity of reported prevalence among studies. The overall prevalence of all CMRFs, including overweight, obesity, high low-density lipoprotein (LDL), high total cholesterol (TC), high triglyceride (TG), low high-density lipoprotein (HDL), hypertension (HTN) and high fasting blood sugar (FBS) was estimated by using the random effects meta-analysis. A total of 37 studies met the eligibility criteria and were included in the meta-analysis. RESULTS: According the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of MetS, high LDL, high TC, high TG, low HDL and high FBS were 21% (17-25), 32% (27-36), 34% (10-57), 24% (16-31), 28% (17-38) and 9% (5-12), respectively. Moreover, global pooled prevalence of overweight, generalized obesity, abdominal obesity and HTN were estimated to be 35% (31-39), 14% (13-16), 29% (20-39) and 26 (19-34), respectively. CONCLUSIONS: The overall prevalence of some cardio-metabolic risk factors was estimated to be higher in military personnel. Therefore, the necessary actions should be taken to reduce risk of developing cardiovascular diseases. SYSTEMATIC REVIEW REGISTRATION NUMBER IN PROSPERO: CRD42018103345.

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis.

BACKGROUND AND AIMS: The association of Wrist Circumference (WrC) with cardio-metabolic risk factors is still contradictory. We aimed to systematically review the association of WrC with cardio-metabolic diseases among the general populations. METHODS: We systematically searched electronic databases such as PubMed/Medline, Web of Sciences, and Scopus without language restriction until March 2017. Observational studies that examined the association of WrC with any cardio-metabolic risk factors were included. Pooled association of WrC with metabolic syndrome (MetS) was estimated using a random-effect model, and heterogeneity among studies was assessed by I2 index and Q test. RESULTS: A total of 14 papers including cohort study (n = 9), cross-sectional study (n = 4), and case-control study (n = 1) met the criteria and included. The eligible papers have been examined the association of WrC with any cardiovascular disorders (n = 8), metabolic syndrome (n = 4), insulin resistance (IR) (n = 5), diabetes mellitus (n = 2), impaired glucose tolerance (n = 1), cardio-metabolic risk factors (n = 2) and obesity/overweight (n = 1). In the whole population (both adults and pediatric population), high WrC increased the risk of MetS by 33% (Pooled OR = 1.33; 95% CI 1.20, 1.48; I2 = 60.2%, p = 0.04), while the pooled OR in adult populations was 1.27 (95% CI 1.15-1.41; I2: 32.8%, p = 0.21). Qualitative synthesis showed that associations of WrC with other cardio-metabolic risk factors are conflicting. CONCLUSION: High WrC increased the risk of MetS and other cardio-metabolic risk factors. However, due to limited studies, particularly in children, results should be declared with great caution. Further cohort studies are needed to clarify whether WrC is a suitable anthropometric index to predict cardio-metabolic disorders in adult and children populations in different societies. LEVEL OF EVIDENCE: Level 1, systematic review and meta-analysis.

Association of Dietary Inflammatory Index with anthropometric indices in children and adolescents: the weight disorder survey of the Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN)-IV study.

This study aimed to assess the relationship between the Dietary Inflammatory Index (DII®), a validated tool for evaluating diet-associated inflammation, and anthropometric indices in children and adolescents. This multicentre survey was conducted on 5427 school students selected via multistage cluster sampling from thirty provinces of Iran. This survey was conducted under the framework of the weight disorders survey, which is part of a national surveillance programme entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases-IV. For calculating the DII scores, twenty-five dietary factors were obtained from a validated 168-item FFQ. Height, weight, wrist circumference, neck circumference (NC), waist circumference (WC) and hip circumference (HC) were measured. BMI z-score, waist circumference:hip circumference ratio (WHR), waist circumference:height ratio (WHtR) and parental BMI were computed. Linear regression models were used to evaluate the association of DII and anthropometric indices. Significant trends were observed across quartiles of DII score for all anthropometric indices in all participants (P <0·05), except for WHR and WHtR. After adjustment for potential confounders, the multiple linear regression analysis for each anthropometric index revealed that participants in the highest DII quartile had higher BMI z-score, WC, HC and parental BMI compared with those in the first (or lowest) quartile. In summary, we found that a pro-inflammatory diet was associated with higher BMI z-score, wrist circumference, NC, WC, HC and parental BMI. The large sample size of the present study may influence the statistical significance of observed associations. Hence, the findings should be clinically interpreted with caution.

Association of screen time and physical activity with health-related quality of life in Iranian children and adolescents.

BACKGROUND: Health-related quality of life (HRQoL) is a multidimensional concept with significant effects and children and adolescence; while physical activity (PA) and screen time (ST) have been suggested as its probable predictors. Present study aims to investigate the association of PA, ST and their combination, with HRQoL in a nationally-representative sample of Iranian children and adolescents. METHODS: As for the estimated sample size, 25,000 students aged 6-18 years were selected via multi-stage cluster sampling from 30 provinces of Iran. Sociodemographic data was obtained by using the questionnaire of the World Health Organization-Global school based student health survey (GSHS). Persian Pediatric Quality of Life inventory (PedsQL) and Physical Activity Questionnaire for the pediatric age group (PAQ-A) were applied for evaluating HRQoL and PA, respectively. PA scores 1-1.9 and 2-5 were respectively considered as low and high PA. The average duration of time spent on watching TV and leisure time computer use were considered as ST behaviors. ST of less than 2 h was considered low. RESULTS: Out of 25,000 invited individuals, 23,043 students (mean age: 12.5) completed the study (response rate: 92.17%). In linear regression models, ST duration had significant inverse association with total QoL (ß: - 0.49, p < 0.05). PA showed positive significant associations with HRQoL total score (ß: 1.8, p < 0.05). Joint association of PA and ST revealed the strongest association of "high PA-low ST" category with total HRQoL (ß: 2.2, p < 0.05); while "high PA-high ST" showed better total HRQoL score (ß: 1.3) compared to "low PA-low ST" subgroup. CONCLUSION: Both PA and ST are significantly and independently associated with HRQoL in Iranian children and adolescents; while the adverse effect of prolonged ST could be diminished by a high PA.

Association of Physical Activity and Screen Time with Psychiatric Distress in Children and Adolescents: CASPIAN-IV Study.

BACKGROUND: There are limited studies about the association of physical activity (PA) and screen time (ST) with psychiatric distress (PD) among children and adolescents including Iranian populations. OBJECTIVE: We aimed to examine the independent and combined associations of PA and ST with PD among children and adolescents. METHOD: This school-based nationwide survey was carried out among 14 880 students (50.8% boys and 75.6% urban inhabitants), of age 6-18 years by cluster and the stratified multistage sampling method from 30 provinces of Iran. The students and their parents completed two sets of questionnaires obtained from Global School Health Survey with several questions about the PD. The time spent on watching TV/video and computer games and PA were assessed by self-administered validated questionnaires. RESULTS: The study had a participation rate of 90.6%. Of the studied students, 45.85%, 83.62%, 37.81% and 23.92% had depression, anger, insomnia and worthlessness, respectively. The prevalence of confusion, anxiety and worry was reported in 19.6%, 55.17% and 75.31% of the students, respectively. The combined effect of PA and that of ST showed that students with high PA and low ST had the lowest prevalence of PD, while the highest prevalence of these PD was observed among students with low PA combined with high ST (p < 0.05 for all). CONCLUSIONS: Increasing PA and reducing ST should both be considered for improving the mental health status of children and adolescents.

Is the association of weight disorders with perceived health status and life satisfaction independent of physical activity in children and adolescents? The CASPIAN-IV Study.

BACKGROUND: Physical activity (PA) and weight status have been suggested as predictors of life satisfaction (LS) and perceived health status (PHS). Therefore the present study aims to investigate and compare the impacts of body mass index (BMI) and PA on LS and PHS in a population of Iranian children and adolescents. MATERIAL AND METHODS: This study was conducted in 2011-12 as a nationwide population-based study among 14 880 students of age 6-18 years. Students were selected via a multistage cluster sampling method from 30 provinces of Iran. Information on demographics, PA, PHS and LS was obtained using the World Health Organization Global School-based Student Health Survey (WHO-GSHS) questionnaire. PA values were considered as low (<2 /week), moderate (2-4 h/week) and high (>2 h/week). RESULTS: The current study has a participation rate of 90.6% (50.8% boys). PA was significantly associated with both LS and PHS [odds ratio (OR), 1.37 in both), while in BMI, this association was significant for only PHS (in underweight: OR, 0.65; 95% CI, 0.57-0.75; in excess weight: OR, 0.82; 95% CI, 0.73-0.93). In the combined group of BMI-PA, the influence of PA prevailed over the impact of BMI on PHS and LS, and therefore, PA was found to be the stronger factor. CONCLUSION: Although BMI and PA could both significantly impact LS and PHS, the stronger influence of PA on LS and PHS suggests that upgrading the 'activity level' of children and adolescents should be underscored and included on the agenda, rather than merely focusing on their BMI and weight status.

Association of adolescents' weight status with life satisfaction: role of self, peers, family and school perception; the CASPIAN-IV Study.

BACKGROUND: Although many public health programs have focused on prevention and control of obesity, their efficacy mostly depends on personal factors including perception of weight and personal understanding of the concept of being overweight. This study aims to investigate the association of adolescent's weight status with life satisfaction and explore the role of self, peers, family and school perception in this association. METHODS: Data were obtained from the fourth school-based survey entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease" (CASPIAN) Study. This survey was conducted among 14,880 urban and rural students aged 6-18 years. Two sets of valid and reliable questionnaire obtained from Global School Health Survey (GSHS) were completed by students and their parents. The students' questionnaire had several questions including life satisfaction and the perception of weight, peers, family and school. RESULTS: The study had a participation rate of 90.6% including 50.8% boys and 76% urban residents. Significant differences existed in Body Mass Index (BMI) and in perception of weight among girls and boys. Moreover, the prevalence of depression and being bullied were higher among girls and boys, respectively. Significant association was documented between life satisfaction and all variables including perception of weight, peers, family and school; the only exception was for BMI (P<0.05). In addition, students with normal weight had significantly higher life satisfaction in comparison with their obese counterparts (P<0.05). CONCLUSIONS: The present study documented significant association between life satisfaction and perception of self, peer, family and school with the exception of BMI in both genders.

Association of healthy foods intake with anthropometric measures and blood pressure in a national sample of Iranian children and adolescents: the CASPIAN-IV Study.

BACKGROUND: This study aims to evaluate the association of consuming healthy foods with anthropometric measures and blood pressure (BP) in a national sample of Iranian children and adolescents. METHODS: This nationwide study was conducted in 2011-2012 among 13,486 students, aged 6-18 years, selected by multistage cluster sampling from 30 provinces. Weight, height, waist circumference (WC), hip circumference (HC), wais to height ratio (WHtR), waist to hip ratio (WHR), as well as systolic and diastolic blood pressures (SBP, DBP) were measured. Healthy foods were considered as four categories including fresh fruits, dried fruits, vegetables, and dairy products. The frequency consumption of each of these foods was recorded as daily, weekly, and seldom. RESULTS: The intake of fruits was significantly associated with anthropometric indices. Moreover, a significant association was found between vegetables consumption, DBP levels, and anthropometric indices (except for WHtR and WHR). Milk consumption was significantly associated with anthropometric indices (except for WHtR and WHR). The odds of general obesity among participants who seldom consumed dried fruits was less than those who consumed daily (OR: 0.84, 95%CI: 0.74-0.96). We did not find any significant association for the frequency of fresh fruits and vegetables consumption with obesity, abdominal obesity, DBP and SBP. CONCLUSIONS: Consumption of dried fruits was associated with general obesity in children and adolescents. These results highlight the effect of dietary quality and food choices on weight control in children and adolescents.

Health-Related Quality of Life according to the Socioeconomic Status of Living Areas in Iranian Children and Adolescents: Weight Disorders Survey.

BACKGROUND: Health-related quality of life (HRQoL) has become a major concern in the field of children's health research. We assessed HRQoL among Iranian children and adolescents according to the socioeconomic status (SES) of their living region. METHODS: Via multistage cluster sampling from rural and urban school students aged 6 to 18 years, this nationwide study was conducted from 2011 to 2012. HRQoL was assessed using the adolescent core version of the Pediatric Quality of Life questionnaire. Through survey data analysis methods, the data were compared according to the SES of the living region, sex, and the living area. RESULTS: Overall, 23043 students participated in the survey (participation rate=92.2%). The mean age of the participants was 12.55±3.31 years. Boys accounted for 50.8% of the study population, and 73.4% were from urban areas. At national level, the mean of the HRQoL total score was 81.7 (95% CI: 81.3 to 82.1) with a mean of 83.5 (95% CI: 83.0 to 84.1) for the boys and 79.8 (95% CI: 79.1 to 80.5) for the girls. The highest and the lowest scores, respectively, belonged to social functioning (90.0 [95% CI: 89.7 to 90.3]) and emotional functioning (78.2 [95% CI: 77.7 to 78.7]). The highest total HRQoL score belonged to the second highest SES region of the country (mean=83.1; 95% CI: 82.5 to 83.7). The association between total HRQoL and the score of all the subscales and SES in the living area was statistically significant (P<0.001). CONCLUSION: The results of the present study showed that in the children and adolescents, SES was associated with HRQoL. Accordingly, HRQoL and the related SES differences should be considered one of the priorities in health research and health policy.

Effect of Selenium Supplementation on Lipid Profile: A Systematic Review and Meta-Analysis.

Selenium is an essential mineral that plays a key role in plenty of major metabolic processes. A growing body of literature has shown that selenium deficiency leads to an increase in plasma TC and TG levels. This study explores the effect of selenium supplementation on serum level of lipid profile [total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low density lipoprotein (VLDL)]. We systematically searched PubMed/MEDLINE, ISI/WOS, and Scopus (from their commencements to Jan 2016) to identify the papers investigating the association between the intake of selenium and lipid profile. Data extracted from the relevant studies were screened. The pooled standardized mean difference was estimated using the random or fixed effects model. Heterogeneity among the studies was assessed using Q-test. Of the potentially relevant articles screened, 11 articles including 1221 participants were included in this meta-analysis. Results of meta-analysis showed that intake of selenium resulted in a statistically significant improvement in TC, [(SMD): -0.13, 95% CI: (-0.24, -0.02)], TG [(SMD): -0.19, 95% CI: (-0.38, -0.01)] and VLDL [(SMD): -0.34, 95% CI: (-0.63, -0.05)]. The selenium supplementation did not significantly improve lipid profile such as LDL [(SMD): -0.08, 95% CI: (-0.036, 0.19)], HDL [(SMD): 0.01, 95% CI: (-0.164, 0.18)], HDL/TC ratio [(SMD): 0.025, 95% CI: (-0.11, 0.16)], non-HDL-C [(SMD): 0.018, 95% CI: (-0.13, 0.16)]. This meta-analysis suggests that the effect of selenium supplementation on the serum levels of TG and VLDL is marginally significant. However, the supplementation has no effect on other serum lipids. Moreover, the study shows that the effect of selenium supplementation on lipid profile is negative.