A proposed simplified definition of metabolic syndrome in children and adolescents: a global perspective.

Metabolic syndrome (MetS) is becoming prevalent in the pediatric population. The existing pediatric MetS definitions (e.g., the International Diabetes Federation (IDF) definition and the modified National Cholesterol Education Program (NCEP) definition) involve complex cut-offs, precluding fast risk assessment in clinical practice.We proposed a simplified definition for assessing MetS risk in youths aged 6-17 years, and compared its performance with two existing widely used pediatric definitions (the IDF definition, and the NCEP definition) in 10 pediatric populations from 9 countries globally (n = 19,426) using the receiver operating characteristic (ROC) curve analyses. In general, the total MetS prevalence of 6.2% based on the simplified definition was roughly halfway between that of 4.2% and 7.7% estimated from the IDF and NCEP definitions, respectively. The ROC curve analyses showed a good agreement between the simplified definition and two existing definitions: the total area under the curve (95% confidence interval) of the proposed simplified definition for identifying MetS risk achieved 0.91 (0.89-0.92) and 0.79 (0.78-0.81) when using the IDF or NCEP definition as the gold standard, respectively.The proposed simplified definition may be useful for pediatricians to quickly identify MetS risk and cardiometabolic risk factors (CMRFs) clustering in clinical practice, and allow direct comparison of pediatric MetS prevalence across different populations, facilitating consistent pediatric MetS risk monitoring and the development of evidence-based pediatric MetS prevention strategies globally.

Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach.

BACKGROUND: Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress. METHODS: This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach. RESULTS: A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (ß = 0.005, SE = 0.002, p = 0.026). CONCLUSIONS: The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress. IMPACT: These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support.

The association between macronutrients intake and myopia risk: a systematic review and meta-analysis.

BACKGROUND: Dietary factors have been suggested as potential risk factors for myopia, but research findings on this relationship are inconclusive. The potential predisposing or protective role of macronutrient (carbohydrate, protein, fat) intake in the development of myopia was systematically reviewed, followed by data synthesis by meta-analysis. METHODS: A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar up to the end of June 2023 to identify all relevant studies. All observational studies that assessed the relationship between macronutrient intake with myopia, axial length (AL) of eyes and spherical equivalent refractive error (SE) on individuals younger than 18 years old were included. RESULTS: After removing duplicates and screening studies, four studies were included in the systematic review and meta-analysis. Pooled odds ratios regarding the association between myopia development and nutritional intake were 1.01 (95% CI: 0.94, 1.08), 0.97 (95% CI: 0.86, 1.08), and 0.99 (95% CI: 0.83, 1.18) for carbohydrates, proteins, and fats, respectively, indicating no significant associations. Intake of carbohydrates, proteins, and fats was not significantly associated with either SE or AL. CONCLUSIONS: Intake of carbohydrates, fats, or proteins did not influence the risk of myopia. The relationship between the intake of other macronutrients and myopia is suggested to be scrutinized in future studies. REGISTRATION: The systematic review protocol was registered on PROSPERO (registration number: CRD42024541369).

Persian version of brief infant sleep questionnaire (BISQ): a psychometric evaluation.

BACKGROUND: The high prevalence of sleep problems and their negative consequences on children and parents highlight the need to design early screening instruments to evaluate sleep problems in early childhood. We aimed to determine the validity and reliability of the Brief Infant Sleep Questionnaire (BISQ) among the Iranian population. METHODS AND MATERIALS: This study included 646 one-year-old infants by random sampling from the PERSIAN birth cohort study. Following the forward-backward translation of the BISQ, its psychometric properties, including construct validity in terms of concurrent and convergent validities as well as reliability, were evaluated. RESULTS: The CVIs and CVR ranged between 0.8 and 1.00 for all items. Therefore, we keep all the items of the original version of the BISQ in the Persian BISQ. Concurrent validity was assessed by comparing items of the Persian BISQ among different maternal views regarding their infant's sleep. All BISQ items were significantly different among the two levels of maternal view about the infant's sleep problem except daytime sleep duration. The convergent validity of the BISQ was evaluated by calculating the correlation between BISQ items and the ISQ (infant sleep questionnaire) total score as a similar tool. ISQ score was adequately correlated with nocturnal sleep latency and the number of waking at night (rs ranged from 0.59 to 0.72). In addition, the associations of mothers' and infants' demographic variables and nutritional and gestational variables with BISQ items were presented to confirm construct validity. Strong correlations were found between the repeated sleep measures for sleep arrangement, sleep position, and sleep situation (kappa ranged from 0.65 to 0.84), nocturnal sleep duration, daytime sleep duration number of wakings at night, night waking duration, nocturnal sleep latency and sleep-onset time (ICC ranged 0.91 to 0.99). CONCLUSION: The Persian version of the BISQ is a reliable and valid measure for assessing sleep problems in infants. It would be helpful to be utilized for the early diagnosis of infants' sleep problems.

Potential role of serum vitamin D as a risk factor in pediatric acute lymphoblastic leukemia.

Vitamin D deficiency/insufficiency (VDD, VDI) is common in children yet limited experience exists on the association of VDD and hematologic malignancies amongst this population. Therefore, this study aimed to compare serum vitamin D levels in children with acute lymphoblastic leukemia (ALL) and controls. Moreover, vitamin D levels is compared in subjects with and without relapse and evaluated as a prognostic factor for relapse-free survival (RFS). Children with newly diagnosed ALL were recruited as case group. Data on demographic variables as well as the dietary habits were collected by interview. In addition, serum 25(OH)D3 was measured. The case group was followed up for 36 months to assess RFS. Overall, 358 subjects were included in the study (n = 169 cases, n = 189 controls). The mean levels of 25(OH)D3 were 28.05 ± 18.87 and 28.76 ± 12.99 in cases and controls, respectively (p = .68). VDD was found in 15.4% (n = 26) and 4.2% (n = 8) of the case and control groups, respectively (p < .001). Relapse was seen in 18.34% of patients and vitamin D levels of 20 ng/mL or above were associated with longer RFS (p = .044 by log-rank test). In this study, VDD and VDI amongst children with ALL were significantly higher than controls. In addition, lower levels of Vitamin D were associated with increased risk of relapse.

Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study.

BACKGROUND: There is a paucity of data on the prevalence of risk factors and their associations with incident cardiovascular disease in women compared with men, especially from low-income and middle-income countries. METHODS: In the Prospective Urban Rural Epidemiological (PURE) study, we enrolled participants from the general population from 21 high-income, middle-income, and low-income countries and followed them up for approximately 10 years. We recorded information on participants' metabolic, behavioural, and psychosocial risk factors. For this analysis, we included participants aged 35-70 years at baseline without a history of cardiovascular disease, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). We report the prevalence of each risk factor in women and men, their hazard ratios (HRs), and population-attributable fractions (PAFs) associated with major cardiovascular disease. The PURE study is registered with ClinicalTrials.gov, NCT03225586. FINDINGS: In this analysis, we included 155 724 participants enrolled and followed-up between Jan 5, 2005, and Sept 13, 2021, (90 934 [58·4%] women and 64 790 [41·6%] men), with a median follow-up of 10·1 years (IQR 8·5-12·0). At study entry, the mean age of women was 49·8 years (SD 9·7) compared with 50·8 years (9·8) in men. As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardised incidence rate of 5·0 events [95% CI 4·9-5·2] per 1000 person-years) and 4911 in men (8·2 [8·0-8·4] per 1000 person-years). Compared with men, women presented with a more favourable cardiovascular risk profile, especially at younger ages. The HRs for metabolic risk factors were similar in women and men, except for non-HDL cholesterol, for which high non-HDL cholesterol was associated with an HR for major cardiovascular disease of 1·11 (95% CI 1·01-1·21) in women and 1·28 (1·19-1·39) in men, with a consistent pattern for higher risk among men than among women with other lipid markers. Symptoms of depression had a HR of 1·09 (0·98-1·21) in women and 1·42 (1·25-1·60) in men. By contrast, consumption of a diet with a PURE score of 4 or lower (score ranges from 0 to 8), was more strongly associated with major cardiovascular disease in women (1·17 [1·08-1·26]) than in men (1·07 [0·99-1·15]). The total PAFs associated with behavioural and psychosocial risk factors were greater in men (15·7%) than in women (8·4%) predominantly due to the larger contribution of smoking to PAFs in men (ie, 1·3% [95% CI 0·5-2·1] in women vs 10·7% [8·8-12·6] in men). INTERPRETATION: Lipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women. FUNDING: Funding sources are listed at the end of the Article.

Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6-18 years.

BACKGROUND: Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide. METHODS: We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors. RESULTS: Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA). CONCLUSIONS: The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

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

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

Breast feeding, obesity, and asthma association: clinical and molecular views.

Asthma is a chronic condition that affects children worldwide. Accumulating number of studies reported that the prevalence of pediatric obesity and asthma might be altered through breastfeeding. It has been proposed that Leptin, which exists in human milk, is oppositely associated with weight increase in newborns. It may also influence peripheral immune system by promoting TH1 responses and suppressing TH2 cytokines. Leptin influences body weight and immune responses through complex signaling pathways at molecular level. Although previous studies provide explanations for the protective role of breastfeeding against both obesity and asthma, other factors such as duration of breastfeeding, parental, and prenatal factors may confound this relationship which requires further research.

The first semi-quantitative toddler's food frequency questionnaire (T-FFQ) in Iran.

Background: Only few food frequency questionnaires (FFQs) have been specifically designed and validated for toddlers. There is no valid instrument to assess usual intakes of Iranian toddlers. The present study was designed to develop a FFQ, and to examine its validity and reliability among toddlers. Material and methods: This cross-sectional study was conducted in 2019 in Iran. Mothers of 100 toddlers completed a semi-quantitative FFQ with 99 items as well as three non-consecutive dietary records. Data on maternal age, education, toddler gender, birth order, birth weight, current weight and height, and the age of beginning complementary foods were collected. By comparing the results obtained from dietary records and the FFQ, we assessed the relative validity. Reliability was evaluated by intra-class correlation coefficients between results of two FFQs administered with four weeks intervals to the same participants (n=20), as well as weighted kappa. The Bland-Altman plots were used to assess the level of agreement between two FFQs. Results: Mean and standard deviation (SD) of age was 32.71 (4.76) years and 22.42 (3.52) months, for mothers and toddlers, respectively. The FFQ showed acceptable validity and reliability. The correlation coefficients for the first FFQ were 0.82 (energy), 0.81 (fats), 0.60 (carbohydrate), 0.96 (calcium), 0.39 (iron) and 0.24 (vitamin C), all P-values were <0.001, except for vitamin C (P: 0.02). Reliability coefficients were between 0.77 (vitamin C) and 0.99 (calcium, potassium, phosphorus, zinc, riboflavin, vitamin B12, vitamin E and D). The Cronbach's Alpha was 0.91, showing high reliability. Conclusion: The present study provided a thorough assessment of both validity and reliability of T-FFQ, and indicated acceptable validity as compared with three-day dietary records and good reliability. Therefore, this FFQ could be a useful tool to evaluate usual dietary intake of toddlers.

Effects of shrimp oil on cardio-metabolic risk factors in children and adolescents.

Background: Antioxidants have beneficial effects on health. Shrimp oil has Astaxanthin and omega 3 that act as powerful antioxidants and might have anti-inflammatory effects on cardiovascular diseases. This study aims to investigate the effects of shrimp oil supplementation on cardio-metabolic risk factors in overweight and obese children and adolescents. Methods: This randomized, triple-blind, placebo-controlled clinical trial was conducted on 64 overweight and obese participants with 10-18 years of age. They were randomly assigned to receive either 500 mg shrimp oil or identical placebo that contained medium-chain triglycerides once per day for eight weeks. Dietary intake was obtained using food record questionnaire for three days at baseline and at the end of the study. Fasting blood samples were obtained at baseline and after eight weeks of intervention. Results: Overall, 53 participants completed the study; 30 subjects received shrimp oil and 23 subjects received placebo. There were no significant effects of shrimp oil on total cholesterol, triglyceride, HDL-C, LDL-C and blood pressure compared with the placebo group (p>0.05). Shrimp oil had no significant effects on body mass index, waist circumference and hip circumference compared with the placebo group (p>0.05). Conclusions: Supplementation with shrimp oil had no significant effects on improving the anthropometric measures and cardio-metabolic risk factors. Future clinical trials are needed to investigate the beneficial effects of higher doses of shrimp oil on cardio-metabolic risk factors in the pediatric age groups.

Interaction between maternal dietary fat intake, breast milk omega-3 fatty acids and infant growth during the first year of life.

BACKGROUND: Long chain fatty acids (LCFA) of human milk (HM) might be associated with different patterns of weight gain in infancy. This study aims to examine the interaction between maternal dietary fat intake, breast milk content of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) with infant growth during the first year of life. METHODS: This longitudinal study was conducted among 215 Iranian mother-infant pairs. The infants were followed up from birth to 12 months of age. Trained healthcare providers measured infant anthropometrics including weight, length and head circumference at birth, 2, 4, 6 and 12 months of age. Breast hind milk samples were collected in the morning through hand expression between 6 and 12 weeks postpartum. Maternal dietary intake was assessed using a 3-day dietary record. Linear mixed effects models were performed to determine the interaction between maternal dietary fat intake, the breast milk content of EPA and DHA with infant growth. Further adjustments were applied for potential confounders. RESULTS: Mean and standard deviation (SD) of maternal age and body mass index were 29.70 (5.24) years and 24.47 (4.42) kg/m2 , respectively. Mean (SD) of infant birth weight was 3177.50 (413.20) g, and 50% were boys. An inverse interaction existed between maternal dietary fat intake and breast milk EPA with infant 4-month weight (ß: -366.2, P-value: 0.01). We found a significant association of maternal dietary fat intake and infant 6-month weight (ß: 22.5, P-value: 0.04). An inverse interaction was documented between maternal dietary fat intake and breast milk DHA with infant weight at 12-month of age (ß: -95.3, P-value: 0.02). We found a significant association between maternal dietary fat intake and infant length at 12-month (ß: 0.06, P-value: 0.02). CONCLUSION: We found an inverse interaction between maternal dietary fat intake and breast milk omega-3 fatty acids with infant weight at 4 and 12 months of age. Although longer follow-up of growth indices is recommended, these findings suggest functional relevance of HM composition to infant growth.

Systematic review and meta-analysis of nutritional interventions to prevent of gestational hypertension or/and preeclampsia among healthy pregnant women.

Background: Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies. However, very few randomized-controlled trials have systematically summarized. Thus, we reviewed and meta-analyzed the effects of nutritional interventions on risks of gestational hypertension (GH) or/and preeclampsia (PE). Materials and Methods: A systematic search was performed using Medline, Cochrane library, Google Scholar, ISI Web of Science, Scopus, and ProQuest to find randomized clinical trials assessing the effect of nutritional interventions on incidences of GH or/and PE compared to control or placebo interventions. Results: After considering duplicates, 1066 articles were screened from the database searches. Full-text articles were retrieved for 116 records, while 87 did not have the inclusion criteria and were later omitted. Twenty-nine studies were eligible, but 8 studies were not included in the meta-analysis due to insufficient data. Finally, seven studies were included in qualitative analysis. Furthermore, 7 studies (693 in intervention vs. 721 in control) were pooled for managed nutritional interventions, three (1255 vs. 1257) for a Mediterranean-style diet, and 4 (409 vs. 312) for sodium restricted. Our results revealed that managed nutritional programs were effective in reducing the incidence of GH (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.15, 0.92); I2 = 66.9%; P = 0.010), but not for PE (OR = 0.50; 95% CI = 0.23, 1.07); I2 = 58.9%; P = 0.032. The Mediterranean-style diets in three trials (1255 vs. 1257) did not reduce the risk of PE (OR = 1.10; 95% CI = 0.71, 1.70); I2 = 2.3%; P = 0.359). Likewise, sodium-restricted interventions in four trials (409 vs. 312) did not decrease total risk of GH (OR = 0.99; 95% CI = 0.68, 1.45); I2 = 0%; P = 0.520). Meta-regression did not indicate any significant association between maternal age, body mass index, gestational weight gain, and start time of all interventions with the incidence of GH or/and PE (P > 0.05). Conclusion: The present meta-analysis showed that Mediterranean-style diets and sodium-restriction interventions did not decrease the incidence of GH or/and PE in healthy pregnancies; however, managed nutritional programs reduced the risk of GH, the total incidence of GH and PE, but not PE.

Effect of Ganoderma lucidum on serum lipid profiles: A systematic review and meta-analysis on animal studies.

Background: Ganoderma lucidum (G. lucidum) is one of the most popular edible mushrooms in the world which has various pharmacological components. Recently, some animal studies have investigated the lipid-lowering effects of G. lucidum and have shown contradictory results. This study aims to systematically review the effects of G. lucidum on lipid parameters in animal studies. Materials and Methods: A systematic search was conducted in the Medline database (PubMed), Scopus, Web of Science, Cochrane Library, and Google Scholar up to the end of January 2022. Only animal studies and all eligible randomized controlled trials (RCTs), including cluster RCTs and randomized crossover trials were included. The English language studies that assessed the effects of G. lucidum on lipid profiles including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and very low-density lipoproteins (VLDL) were selected. Results: Among 358 studies, 49 articles were included in the systematic review and meta-analysis. G. lucidum consumption was associated with decreased levels of TG (standardized mean difference [SMD] = -1.52, 95% CI: -1.79, -1.24), TC (SMD = -1.51, 95% CI: -1.75, -1.27), LDL-C (SMD = -2.03, 95% CI: -2.37, -1.69) and VLDL (SMD =-1.06, 95% CI: -1.638, -0.482). Furthermore, G. lucidum consumption was associated with increased levels of HDL-C (SMD = 1.03, 95% CI: 0.73, 1.33). Conclusion: G. lucidum has favorable effects on TG, TC, LDL-C, HDL-C, and VLDL. Different doses of G. lucidum have various degrees of effectiveness on lipid profiles.

Association between parabens concentrations in human amniotic fluid and the offspring birth size: A Sub-study of the PERSIAN birth cohort.

OBJECTIVE: Parabens are extensively used, and cause widespread exposure of the general population including pregnant women and developing fetuses to these pollutants. In this study, we aimed to investigate the association between the maternal exposure of parabens to study their transfer passed through the placental barrier to amniotic fluid; the second objective was to determine the association of paraben concentration in the amniotic fluid with the offspring birth size. METHODS: This cross-sectional study was conducted from June 2019 to March 2021 in Isfahan, Iran. Samples of amniotic fluid were collected as set from 128 pregnant women at Cesarean section. The amniotic fluid concentrations of four parabens including methylparaben (MP), ethylparaben (EP), propylparaben (PP), and butylparaben (BP) were determined using gas chromatography tandem mass spectroscopy (GC-Mass). RESULTS: The pointed parabens were extracted from yielded clear supernatant using a dispersive liquid-liquid microextraction (DLLME) method. Four paraben derivatives including MP (normal: 0.68 ± 0.7; overweight: 1.40 ± 1.76; obese: 0.30 ± 0.26; p-value: 0.275), EP (normal: 0.14 ± 0.09; overweight: 0.72 ± 0.72; obese: 0.38 ± 0.05; p-value: 0.434), PP (normal: 0.05 ± 0.05; overweight: 0.06 ± 0.06; obese: 0.20 ± 0.17; p-value: 0.770), and BP (normal: 2.89 ± 1.80; overweight: 3.89 ± 6.48; obese: 5.80 ± 7.56; p-value: 0.341) were simultaneously detected in samples of maternal amniotic fluid using GC-MS. In 92.2% (n = 118) of pregnant women, the paraben derivatives (MP, EP, PP, BP) were detected. We found that considerable levels of MP, EP, PP, and BP existed in 22.6% (n = 29), 21.9% (n = 28), 29.7% (n = 38), and 85.2% (n = 109) of samples, respectively. In addition, the correlation between paraben concentrations in amniotic fluid and birth size was investigated. The results showed that an inverse significant association between MP and head circumference, chest, hip, and arm circumference. While a positive correlation between MP and height of newborn was observed. Similar correlations were observed for EP and weight, height, head circumference, chest, hip, and arm. CONCLUSION: The current study indicated that parabens have been detected in amniotic fluid samples and a strong/possible correlation between exposure of pregnant women to parabens and the birth size of newborns.

Socioeconomic inequality in violent behaviors, life dissatisfaction, and self-rated health in pediatric population: the CASPIAN-V study.

BACKGROUND: Bullying, being a victim of violent behaviors, life satisfaction (LS) and self-rated health (SRH) in children and adolescents, all have consistently been recognized as vital factors in school performance and future individual life. METHODS: This cross-sectional data secondary study was a part of the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V) in 2015. A total of 14,400 students 7-18 years and their parents living in 30 provinces in Iran were studied. A validated questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS) was used to measure the outcomes and socioeconomic variables. Family's socioeconomic status (SES) was determined using principal component analysis (PCA). The crude and adjusted odds ratios (95% confidence interval (CI)) were estimated using multiple logistic regressions for each outcome. RESULTS: A total of 14,274 students completed the study, of whom 50.6% were boys. Overall, the prevalence of bullying, being a victim, life dissatisfaction (LDS), and poor SRH among students was 35.6, 21.4, 21.1, and 19.0%, respectively. In multiple-logistic regression analysis (Adjusted OR, (95%CI), students with an illiterate father and mother (1.60, (1.25-2.04), 1.28, (1.03-1.61), unemployed father (1.58, (1.29-1.81)), and one-parent family (1.32, (1.05 - 1.64) had a higher odd of Poor-SRH. Besides, a family size larger than four members (1.14, (1.03-1.25), and low-SES (1.35, (1.15-1.56), and illiteracy of the mother (1.64, (1.30-2.08) had a direct association with LDS. Mother illiteracy also increased the odds of bullying (1.77, (1.45-2.16) and being a victim (1.58, (1.26-1.98). CONCLUSIONS: Some socioeconomic variables can be proposed as the statistically significant attribution of bullying and being a victim, LDS, and Poor-SRH in children and adolescents.

Socioeconomic inequality in different phenotypes of childhood obesity and its determinants in Iran: a Blinder-Oaxaca decomposition method.

BACKGROUND: Childhood obesity has become a significant public health issue worldwide. Socioeconomic status is among its key determinants. This study examined the socioeconomic inequality in different phenotypes of childhood obesity at the national level in Iran. METHODS: This national, multistage school cross-sectional study was undertaken in 2015 on 14,400 students aged 7-18 years from urban and rural areas of 30 provinces of Iran. Using principal component analysis, socioeconomic status (SES) was categorized into tertiles. SES inequality in different phenotypes of obesity (i.e., generalized obesity", "abdominal obesity", and combined obesity) was estimated using the concentration index. The determinants of this inequality were assessed by the Blinder-Oaxaca decomposition method. RESULTS: Overall, 14,274 students completed the study (response rate: 99%). The mean age was 12.28 years, 50.6% were boys, and 71.42% lived in urban areas. The prevalence of generalized obesity and abdominal obesity was 20.8% and 11.3%, respectively. The concentration index for different phenotypes of obesity was positive, indicating that inequality is more common amongst the low SES groups. High SES, being male, living in a rural, and having a positive family history of obesity were associated with general obesity. Moderate physical activity and living in a rural area were associated with abdominal obesity. In addition, living in a rural area, having a high SES, being male, and having a positive family history of obesity were associated with combined obesity. CONCLUSION: According to the present study findings, all childhood obesity phenotypes were more prevalent in Iranian children with high SES. Therefore, due to obesity and other diseases, it is essential to implement environmental changes in addition to designing macro-educational programs and prevention strategies.

Trend of passive smoking and associated factors in Iranian children and adolescents: the CASPIAN studies.

BACKGROUND: It is well documented that, similar to active smokers, passive smokers are also at an increased risk of developing non-communicable diseases, and it could impose high financial costs on the healthcare system. This study aimed to evaluate the trend of passive smoking and related determinants during the three phases of a school-based surveillance program. METHODS: This is a secondary study using the national data obtained from three phases of the surveillance program entitled The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease (CASPIAN) study, conducted from 2008 to 2014 on Iranian children and adolescents living in urban and rural areas of 30 provinces in Iran. Participants were selected by cluster multistage sampling method. RESULTS: Overall, the study participants consisted of 33,288 students (50.5% boys) with a mean (± SD) age of 12.8 ± 3.2 years. The passive smoking rate was significantly increased from 35.6% in 2008 to 43.2% in 2015 among children and adolescents. According to the multivariate logistic regression, father's university education, mother's employment, life satisfaction, and socioeconomic status had a protective role regarding second-hand smoke exposure. In contrast, the father's self-employment had a positive role in increasing the rate of passive smoking. CONCLUSION: Considering the increasing trend of passive smoking and its considerable adverse health effects, it is necessary to implement large-scale public interventions to reduce the rate and hazards of exposure to tobacco smoke.

Association between dietary fat quality indices with anthropometric measurements in children and adolescents.

BACKGROUND: The association between anthropometric measures and dietary fat quality indices is unclear in pediatric age groups. The present study aimed to assess the association between dietary lipophilic index (LI) and thrombogenic index (TI) as dietary fat quality indices with anthropometric measurements in children and adolescents. METHOD: This nationwide cross-sectional study was conducted on 4323 students aged 6-18 years that were selected by multistage cluster sampling from 31 provinces of Iran. Dietary intake was collected using a validated food frequency questionnaire and dietary LI and TI were calculated by formula. Data on anthropometric measures were collected by standard protocols. RESULTS: The multivariate regression analysis revealed that TI and LI had inverse association with neck circumference Z-score (ß = 0.11, p = 0.013 and ß = 0.12 p = 0.006, respectively). There was a positive correlation between LI with height Z-score (ß = 0.12, 95% CI: 0.01, p = 0.009). However, there was no significant association between LI and TI with other anthropometric indices (P > 0.05). CONCLUSION: The quality of dietary fats was associated with some anthropometric indices. Further large-scale studies are required to highlight the importance of dietary fat quality indices in relation to cardio-metabolic risk factors in pediatric age groups. Reducing intake of saturated fatty acids, increasing consumption of monounsaturated fatty acids and a balanced intake of omega-3 and omega-6 to reduce the risk of cardiovascular diseases risk factors are recommended.

Determinants of life satisfaction and self-rated health in Iranian children and adolescents: a structure equation model.

BACKGROUND: Life satisfaction (LS) and self-rated health (SRH) are related with health outcomes. It is expected that these items are also related to healthy behaviors. Therefore, this study was conducted in order to find out the main determinants of LS and SRH in nationwide representative sample of Iranian children and adolescents. METHODS: This study was performed on 13,834 students aged 7-18 years who were selected by multistage, stratified cluster sampling method from 30 provinces of Iran. Life satisfaction and SRH were assessed through a questionnaire based on World Health Organization-Global School-based Student Health Survey protocols. Path analysis was applied to evaluate the relationships among the study variables using the structural modeling. RESULTS: Life satisfaction was directly affected by age (- 0.037 in boys & -0.028 in girls); sedentary time (0.055 in boys & 0.048 in girls); school satisfaction (0.249 in boys & 0.250 in girls); and well-being (0.186 in boys & 0.176 in girls). Self-rated health was directly affected by LS (0.28 in boys & girls) and school satisfaction (0.21 in boys & 0.22 in girls); and indirectly affected by age (- 0.046 in boys & -0.017 in girls); sedentary time (- 1.99 in boys & -0.145 in girls); family size (- 0.005 in boys & -0.014 in girls); and socio-economic status (0.015 in boys & 0.058 in girls). CONCLUSIONS: This study indicated that school satisfaction had the greatest positive direct effect on both LS and SRH.