Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis.

BACKGROUND: Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence. METHODS: This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors. RESULTS: Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90). CONCLUSIONS: Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Oxidative balance score and risk of cancer: a systematic review and meta-analysis of observational studies.

BACKGROUND: The oxidative balance score (OBS) has been utilized to assess the overall pro- and antioxidant exposure status in various chronic diseases. The current meta-analysis was carried out to pool the association between OBS and the risk of cancer. METHODS: We systematically searched the Web of Science, PubMed, Scopus, Embase, and Google Scholar up to August 2023. All observational studies which evaluated the association of OBS with the risk of cancers were included. There was no time of publication or language restrictions. Heterogeneity between studies was assessed using the Chi-square-based Q-test and the I2. A random-effects model meta-analysis was conducted to estimate the pooled effect sizes. Possible sources of heterogeneity were explored by subgroup and meta-regression analysis. RESULTS: Totally, 15 studies (9 case-control and 6 cohorts) were eligible for meta-analysis. Random effect model meta-analysis of case-control studies showed that higher OBS significantly decreases the odds of cancers (pooled OR: 0.64, 95% CI: 0.54, 0.74). In the cohort studies, the association of OBS with the risk of cancers was not significant (pooled HR: 0.97, 95% CI: 0.80,1.18). The subgroup analysis showed that cancer type and gender were the potential sources of heterogeneity. CONCLUSION: Our results show an inverse and significant association between higher OBS and odds of colorectal cancers in case-control and cohort studies. In the case of prostate cancer in cohort studies, our results did not align with the hypothesis. Considering the importance of diet and antioxidant balance in the conditions of malignancy, it is suggested to conduct more comprehensive studies with standard measurement methods to obtain conclusive results.

Association of quality of life with medication adherence and glycemic control in patients with type 1 diabetes.

Background and objectives: Psychological factors and patients' health-related quality of life (HRQOL) affect the outcome of patients with type 1 diabetes mellitus (T1DM). In this study, we aimed to determine the HRQOL status in patients with T1DM and its association with glycemic control and medication adherence. Methods: In this cross-sectional study, 227 T1DM patients were selected from the diabetes clinic, Imam Ali Hospital, Alborz University of Medical Sciences, and the Gabric database registry from 2020 to 2022. Demographic and diabetes characteristic checklist, medication adherence questionnaire (8-item Morisky Medication Adherence Scale (MMAS)), and QOL questionnaires (Short-Form-12 and PedsQL) were filled. Independent sample T-test was used to assess mean of QOL subscales with glycemic control and medication adherence. A logistic regression model was used to evaluate the association between glycemic control and medication adherence with QOl. Results: Overall QOL scores in adults and children were 33.4 ± 7.1 based on Short-Form-12 and 76.2 ± 17.8 based on PedsQL, respectively. It was demonstrated that adults with Moderate/High adherence had higher QOL (p-value = 0.007). Likewise, Children with good glycemic control had higher psychosocial health scores (0.048). Logistic regression analysis did not reveal a significant association between adherence and QOL or Glycemic control and QOL in both adjusted and crude models. Conclusion: Better glycemic control and medication adherence in children and adults, respectively, are related to the psychological aspects of QOL. We suggest that emotional intelligence, which is replaced by other predictors during adulthood, may contribute to glycemic control in children in the early years following diagnosis.

Association between Gut Microbiota Compositions with Microvascular Complications in Individuals with Diabetes: A Systematic Review.

BACKGROUND: Diabetes is one of the chronic and very complex diseases that can lead to microvascular complications. Recent evidence demonstrates that dysbiosis of the microbiota composition might result in low-grade, local, and systemic inflammation, which contributes directly to the development of diabetes mellitus and its microvascular consequences. OBJECTIVE: The aim of this systematic review was to investigate the association between diabetes microvascular complications, including retinopathy, neuropathy, nephropathy, and gut microbiota composition. METHODS: A systematic search was carried out in PubMed, Scopus, and ISI Web of Science from database inception to March 2023. Screening, data extraction, and quality assessment were performed by two independent authors. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. RESULTS: About 19 articles were selected from 590 retrieved articles. Among the included studies, nephropathy has been studied more than other complications of diabetes, showing that the composition of the healthy microbiota is changed, and large quantities of uremic solutes that cause kidney injury are produced by gut microbes. Phyla, including Fusobacteria and Proteobacteria, accounted for the majority of the variation in gut microbiota between Type 2 diabetic patients with and without neuropathy. In cases with retinopathy, an increase in pathogenic and proinflammatory bacteria was observed. CONCLUSION: Our results revealed that increases in Bacteroidetes, proteobacteria and fusobacteria may be associated with the pathogenesis of diabetic nephropathy, neuropathy, and retinopathy. In view of the detrimental role of intestinal dysbiosis in the development of diabetes-related complications, gut microbiota assessment may be used as a biomarker in the future and interventions that modulate the composition of microbiota in individuals with diabetes can be used to prevent and control these complications.

Evaluation of Arterial Stiffness and Its Relation to Innovative Anthropometric Indices in Persian Adults.

Background: BMI has been evaluated as an old criterion to evaluate obesity in individuals, but it does not assess abdominal obesity and lean mass. We aimed to evaluate the possible relationship of new anthropometric indices (namely, a body shape index (ABSI), the body roundness index (BRI), the visceral adiposity index (VAI), the visceral fat area (VFA), and waist-hip ratio (WHR)), with one of the known critical factors of atherosclerosis, arterial stiffness. Methods: Overall 5921 individuals were enrolled and were divided into four groups according to BMI. Novel anthropometric parameters including, ABSI, BRI, VAI, VFA, and WHR were calculated. The carotid-femoral pulse wave velocity (cf-PWV) was used to evaluate arterial stiffness. Multiple regression analysis was performed to assess the relationship between cf-PWV and innovative Anthropometric indices. Results: This study population consisted of 3109 women and 2812 males. In men with overweight, cf-PWV was significantly related to BMI, ABSI, BRI, WC, VAI, VFA, and WHR. However, among men with obesity, cf-PWV was associated with BRI, VAI, and VFA. Among women with overweight, cf-PWV was also related to all mentioned indices except ABSI; although, cf-PWV was only associated with VFA and WHR in women with obesity. Conclusion: Our results showed that VFA in women and VAI in men are strongly related to arterial stiffness and can be used to identify predictors of vascular disease or organic vascular dysfunction.

Relationship between anthropometric indices and arterial stiffness: Insights from an epidemiologic study.

Background: Obesity and arteriosclerosis are both independently associated with cardiovascular disease risk. Obesity also may increase arterial stiffness. Aims: This study aimed to investigate the association between anthropometric indices and non-invasive arterial stiffness parameters, using data from a large population-based cohort of seemingly healthy women and men. Methods: A total of 5023 eligible participants were included in the study. The pulse wave velocity (PWV), central blood pressures, and bio-impedance measures were obtained at the time of enrollment. Multiple regression analysis was performed to assess the relationship between anthropometric indices with arterial stiffness parameters. Results: The mean age of participants was 45.3 ± 8.8 years, 2368 (47.1%) were males and 2655 (52.8%) were females. The prevalence of participant with underweight, normal weight, overweight, and obesity were 0.73%, 33.2%, 48.7%, and 17.2% respectively. Systolic and diastolic blood pressure, fatty liver, and hypertension were significantly higher in overweight/obesity participants. The overweight/obesity participants had significantly higher PWV than the normal-weight group (471.5 ± 42.6/496.7 ± 47.5 cm/s vs. 448.1 ± 41.4 cm/s, p < 0.001). Conclusion: The prevalence of diabetes, hypertension, fatty liver disease, chronic lung disease, and also kidney stones were significantly higher in overweight and individuals with obesity. Body mass index, body fat mass, waist-hip ratio abdominal circumference, neck circumference, visceral fat area, total body water, 50-kHz whole body phase angle are positively correlated with PWV. Augmentation index had no significant correlation with body mass index, arm, hip, and abdominal circumferences.

Body mass index, lipid profile, and hypertension contribute to prolonged QRS complex.

BACKGROUND AND AIMS: QRS prolongation is one of the most common findings in patients with underlying cardiac diseases. Recent studies have shown that QRS prolongation can be accompanied by obesity, hypertension, and hyperlipidemia, which are known risk factors for cardiovascular events. This study aimed to evaluate how obesity, hypertension, and hyperlipidemia could affect QRS duration. METHODS: A total of 4033 eligible subjects aged between 35 and 70 years were included from the Persian Cohort Study in Mashhad. ECG intervals, blood pressures, lipid profile, and BMI measures were obtained at the time of enrolment. Multiple regression analysis was performed to assess the relationship between QRS duration and BMI, hypertension, and lipid profile. RESULTS: This study population consisted of 2047 females and 1986 males with a mean age of 46.05 ± 9.50 years. Higher BMI values and heart rate were observed in women (27.12 ± 4 and 74.66 ± 8.54; P < 0.001), while height, weight, and QRS duration showed a significant increase in men (172.60 ± 7.18, 79.44 ± 12.55, and 97 ± 11.05; P < 0.001). Except for total cholesterol (P = 0.317), blood pressures and lipid profile differed significantly among women and men (P < 0.001). Furthermore, univariate analyses indicated that QRS duration was associated with age, sex, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic blood pressure, diastolic blood pressure, categorical blood pressure, categorical BMI, and continuous BMI. On the backward multivariate model, TG, LDL, HDL, DBP, SBP, categorical blood pressure, categorical BMI, and continuous BMI were independently correlated with QRS duration. CONCLUSIONS: Hypertension, increased BMI, and high levels of LDL, TG, and lower HDL, as well-known risk factors of cardiovascular disease, were associated with prolonged QRS duration. These findings could be beneficial in future investigations regarding establishing the underlying heart problems.

The Association between Anthropometry Indices and Serum Concentrations of Gamma-Glutamyl Transferase, Alkaline Phosphatase, Alanine Aminotransferase, and Aspartate Aminotransferase.

BACKGROUND: Nowadays, metabolic syndrome (MetS) has become a great public health crisis that threatens too many lives worldwide. Many previous studies have been investigated the association between MetS and anthropometric indices. This study is aimed at investigating the association between anthropometric indices with gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). We were using data from a large population-based cohort of seemingly healthy women and men. METHODS: A total of 7216 participants were included in this study. The serum levels of GGT, ALP, ALT, and AST with bioimpedance measures were obtained at the time of enrollment. Multiple regression analysis was performed to assess the relationship between anthropometric indices and serum levels of the aforementioned laboratory tests. RESULTS: Serum levels of GGT, ALP, ALT, and AST significantly correlated with body mass index (BMI). Only ALP had a significant association with visceral fat area (VFA). AST, ALT, and ALP levels had a positive correlation with 50 kHz whole-body phase. CONCLUSION: From the findings of this study, body mass index consistently appeared a good predictor of elevated hepatic enzymes and triglycerides. Thus, it can be helpful in clinical settings to identify patients at risk of nonalcoholic fatty liver disease, which is closely related to metabolic syndrome.

Association between Clinical Characteristics and Laboratory Findings with Outcome of Hospitalized COVID-19 Patients: A Report from Northeast Iran.

Coronavirus disease 2019 (COVID-19) was first discovered in December 2019 in China and has rapidly spread worldwide. Clinical characteristics, laboratory findings, and their association with the outcome of patients with COVID-19 can be decisive in management and early diagnosis. Data were obtained retrospectively from medical records of 397 hospitalized COVID-19 patients between February and May 2020 in Imam Reza Hospital, northeast Iran. Clinical and laboratory features were evaluated among survivors and nonsurvivors. The correlation between variables and duration of hospitalization and admission to the intensive care unit (ICU) was determined. Male sex, age, hospitalization duration, and admission to ICU were significantly related to mortality rate. Headache was a more common feature in patients who survived (p=0.017). It was also related to a shorter stay in the hospital (p=0.032) as opposed to patients who experienced chest pain (p=0.033). Decreased levels of consciousness and dyspnea were statistically more frequent in nonsurvivors (p=0.003 and p=0.011, respectively). Baseline white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were significantly higher in nonsurvivors (p < 0.001). Patients with higher WBC and CRP levels were more likely to be admitted to ICU (p=0.009 and p=0.001, respectively). Evaluating clinical and laboratory features can help clinicians find ways for risk stratifying patients and even make predictive tools. Chest pain, decreased level of consciousness, dyspnea, and increased CRP and WBC levels seem to be the most potent predictors of severe prognosis.

Socioeconomic inequalities and diabetes: A systematic review from Iran.

Socioeconomic factor is a determinant of health may contribute to diabetes. We conducted a systematic review to summarizing evidences on associations between socioeconomic factors and diabetes in Iranian population. We systematically searched international databeses; ISI, PubMed/Medline, Scopus, and national databases Iranmedex, Irandoc, and Scientific Information Database (SID) to retrieve relevant articles to socioeconomic factors and diabetes without limitation on time. All identified articles were screened, quality assessed and data extracted by two authors independently. From 74 retrieved articles, 15 cases were relevant. We found increased diabetes prevalence among female sex, over 50 years' old age, illiterate population, retired status, unemployed, urban residents, and low economic status. There was a negative association between social capital and diabetes control. Diabetes complications were more frequent in upper age group, higher education levels and low income populations. Socioeconomic factors were associated with diabetes that leads to inequality. Improving modifiable factors through priority based interventions helps to diabetes prevention and control.

Burden of Hemoglobinopathies (Thalassemia, Sickle Cell Disorders and G6PD Deficiency) in Iran, 1990-2010: findings from the Global Burden of Disease Study 2010.

BACKGROUND: Hemoglobinopathies are known as the most common genetic disorders in Iran. The paper aims to provide global estimates of deaths and disability adjusted life years (DALYs) due to hemoglobinopathies in Iran by sex and age during 1990 to 2010 and describe the challenges due to limitations of the Global Burden of Disease Study 2010 (GBD 2010). METHODS: GBD 2010 estimates of the numbers of deaths and years of life lost (YLLs) due to premature mortality were calculated using the Cause of Death Ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplication of prevalence, the disability weight for occurrence of sequelae, and the duration of symptoms. Prevalence was estimated through a systematic search of published and available unpublished data sources, with a Bayesian meta-regression model developed for GBD 2010. Disability weights were produced using collected data from population-based surveys. Uncertainty from all inputs was incorporated into the computations of DALYs using simulation methods. We aim to prepare and criticize the results of GBD 2010 and provide some recommendations for reaching better conclusions about the burden of hemoglobinopathies in Iran. RESULTS: Between 1990 and 2010, the overall deaths attributed to hemoglobinopathies decreased from 0.51% to 0.36% of total deaths, with the corresponding burden declining from 1% to 0.82% of total DALYs. There was a reduction in deaths and DALYs rates for all ages and the rates attributed to all ages followed the same pattern in Iranian men and women. The highest DALYs for hemoglobinopathies, thalassemia, sickle cell disorder, and glucose-6-phosphate dehydrogenase deficiency (G6PD-D) were found in those aged less than 5 years. The collective burden of all of these hemoglobin disorder was lower in 2010 than in 1990. CONCLUSION: Although the screening programs in Iran have been very successful in reducing the number of thalassemia patients between 1990 to 2010, in order to provide a better estimation of the burden of hemoglobin disorders, it is necessary to perform a national and sub-national study of hemoglobinopathies using multiple national and sub-national surveys.

Prevalence of diabetic peripheral neuropathy in Iran: a systematic review and meta-analysis.

Diabetic peripheral neuropathy (DPN) is an important microvascular complication of diabetes mellitus (DM). It is a major contributor to foot ulceration and lower limb amputation in persons with DM and have also a significant negative effect on patient's quality of life. This meta-analysis reviews prevalence of DPN among patients with type 1 and 2 DM in Iran. Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iranmedex, Irandoc, and Scientific Information Database (SID), as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of DPN (between January 1991 to February 2013). Heterogeneity of reported prevalence's between studies was assessed by the Chi-square-based Q test and due to heterogeneity; overall prevalence of DPN was estimated using random-effect meta-analysis model. We found 304 records; from them a total of 21 studies comprising 5540 diabetic patients were included. The prevalence of diabetic neuropathy (reported) from 16% to 87%. In overall the prevalence of DPN estimated 53% (95% CI: 41-65) by using random-effect. This study show that the prevalence of DPN seems very high among the population with diabetes in Iran and more than half of the patients with DM has any type of diabetic neuropathy.

National and sub-national burden of visual impairment in Iran 1990-2013; study protocol.

BACKGROUND: Although Visual impairment (VI) and its prevention is a public health issue, sub-optimal information about its magnitude in national level and its distribution is one of the impediments for visual health advocacy. In this article, we are detailing the approaches which will be taken to estimate the magnitude (prevalence, incidence, and burden), distribution, and trend (1990 to 2013) of low vision and blindness in Iran. Besides that, an attempt will be made to describe inequalities and their determinants. METHODS: After finalizing the list of diseases, a systematic search will be started using confirmed search terms and all published and unpublished data will be extracted. Other data sources, including data from hospital records will be added to the data extraction sheet. Using distinct statistical models including spatio-temporal model and multilevel autoregressive model, we will estimate rate of burden measures of eye disease and their uncertainty interval by sex, age, year, and province as well as social determinants of visual impairment inequality. The results are to be reported in separated analyses of meta-analysis, trend, risk factors and diseases burden, inequality, Bayesian prediction modeling, and map for visualizing the results. CONCLUSION: The results of the current study will address gaps in different regions and have implication for evidence-based policy making in Iran.

National and sub-national burden of chronic diseases attributable to lifestyle risk factors in Iran 1990 - 2013; study protocol.

BACKGROUND: Non-communicable diseases, as the major public health problem, are caused by different risk factors. The main leading lifestyle risk factors for most diseases burden in Iran are unhealthy diet, physical inactivity, and smoking. The aim of this study is to provide data collection and methodology processes for estimating the trends of exposures to the selected lifestyle risk factors and their attributed burden at national and sub-national levels. METHODS: Systematic review will be performed through PubMed/MEDLINE, Scopus and ISI/Web of Science as well as Iranian databases such as IranMedex, Irandoc and Scientific Information Database (SID). In addition, hand searching of unpublished data sources will be used to identify relevant population-based studies. The searched studies will be included only if it is reasonably population-based and representative, and exposure data has been reported or could be plausibly obtained from the study. For risk factors with no surveys identified, other sources of potential data will be considered. The target population is healthy Iranian adult population living within Iran from 1990 to 2013. Other data sources include national censuses, national registration systems, and national and sub-national surveys. Spatio-temporal Bayesian hierarchical model and Bayesian multilevel autoregressive model will be used to overcome the problem of data gaps in provinces, and in some age or sex groups or in urban/rural areas. The problem of misaligned areal units will be also addressed in these models. CONCLUSION: National and sub-national assessment of major lifestyle risk factors such as unhealthy diet, physical inactivity, and smoking is necessary for priority setting and policy making in different regions of Iran.