Ethnic differences in the lifestyle behaviors and premature coronary artery disease: a multi-center study.

BACKGROUND: Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD. METHODS: In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients' demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling. RESULTS: The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04-1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40-3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05-3.67)). CONCLUSIONS: This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.

Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses.

Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.

Healthy eating index and cardiovascular risk factors among Iranians.

OBJECTIVE: To determine the associations between Healthy Eating Index (HEI) and cardiometabolic risk factors among Iranian population. METHODS: This cross-sectional study was conducted on 9568 Iranians who participated in Isfahan Healthy Heart program (IHHP). Dietary intakes were assessed using a 48-item food frequency questionnaire (FFQ). HEI scores were calculated based on the number of food groups, different kinds of fat intakes, sodium intake, and dietary diversity score in 10 separate components. The assessment of anthropometric and biochemical variables was done using standard protocols. RESULTS: Mean ± SD of the HEI score was 39.1 ± 5.2. Those in the highest quintile of HEI consumed more fruits, vegetables, and dairy products and had lower total fat, saturated fatty acid, cholesterol, and sodium intakes. HEI scores were inversely associated with serum C-reactive protein (CRP) levels in both women and men (ß = -0.07 for both men and women; p < 0.001). Women in the highest quintile of HEI had the lowest mean values of systolic blood pressure and apolipoprotein B (mean ± SD = 112.7 ± 20.2, 112.6 ± 20.5, 110.6 ± 19.5 mmHg; p = 0.001 and mean ± SD = 99.3 ± 26.0, 100.1 ± 26.6, 97.7 ± 23.1 (mg/dL); p = 0.04, respectively). HEI weakly correlated with various cardiovascular risk factors. CONCLUSIONS: The low mean of HEI scores in this sample indicates the need to improve diet quality. Higher HEI scores were associated with healthier dietary habits and a weak inverse association was found between HEI scores and serum levels of CRP, apolipoprotein B, and systolic blood pressure.

Healthy bread initiative: methods, findings, and theories--Isfahan Healthy Heart Program.

The scientific evidences show that the content, baking methods, and types of bread can make health impacts. Bread, as a major part of Iranian diet, demonstrates a significant potential to be targeted as health promotion subject. Healthy Food for Healthy Communities (HFHC) was a project of Isfahan Healthy Heart Program (IHHP), consisting of a wide variety of strategies, like Healthy Bread (HB) Initiative. The HB Initiative was designed to improve the behaviour of both producers and consumers, mainly aiming at making high-fibre, low-salt bread, eliminating the use of baking soda, providing enough rest time for dough before baking (at least one hour), and enough baking time (at least one minute in oven). A workshop was held for volunteer bakers, and a baker-to-baker training protocol under direct supervision was designed for future volunteers. Cereal Organization was persuaded to provide less refined flour that contained more bran. Health messages in support of new breads were disseminated by media and at bakeries by health professionals. Evaluation of the HB Initiative was done using before-after assessments and population surveys. While HB was baked in 1 (0.01%) bakery at baseline, 402 (41%) bakeries in the intervention area joined the HB Initiative in 2009. Soda was completely eliminated and fibre significantly increased from 4 +/- 0.4 g% before study to 12 +/- 0.6 g% after the intervention (p < 0.001). The preparation and baking times remarkably increased. Wastage of bread decreased from 13 +/- 1.8 g% to 2 +/- 0.5 g% and was expressed as the most important advantage of this initiative by consumers. People who lived in Isfahan city consumed whole bread 6 times more than those who lived in reference area Arak (p < 0.001). The HB Initiative managed to add new breads as a healthy choice that were compatible with local dishes and made a model to solve the longstanding problems of bread. It used various health promotion approaches but was best consistent with Beattie's model.

Ethnicity based differences in statin use and hypercholesterolemia control among patients with premature coronary artery disease-results of I-PAD study.

Background: Statins use is the most important treatment for high LDL cholesterol in patients with premature coronary artery disease (CAD). Previous reports have shown racial and gender differences in statin use in the general population, but this wasn't studied in premature CAD based on different ethnicities. Methods and results: Our study includes 1917 men and women with confirmed diagnosis of premature CAD. Logistic regression model was used to evaluate the high LDL cholesterol control in the groups and the OR with 95% confidence interval (CI) was reported as the effect size. After adjustment for confounders, the odds of controlling LDL in women taking Lovastatin, Rosuvastatin, and Simvastatin were 0.27 (0.03, 0.45) lower in comparison with men. Also, in participant who took 3 types of statins, the odds of controlling LDL were significantly different between Lor and Arab compared with Fars ethnicity. After adjustment to all confounders (full model), the odds of controlling LDL were lower for Gilak in Lovastatin, Rosuvastatin, and Simvastatin by 0.64 (0.47, 0.75); 0.61 (0.43, 0.73); 0.63 (0.46, 0.74) respectively and higher for Arab in Lovastatin, Rosuvastatin, and Simvastatin by 4.63 (18.28, 0.73); 4.67 (17.47, 0.74); 4.55 (17.03, 0.71) respectively compared to Fars. Conclusions: Major differences in different gender and ethnicities may have had led to disparities in statin use and LDL control. Awareness of the statins impact on high LDL cholesterol based on different ethnicities can help health decision-makers to close the observed gaps in statin use and control LDL to prevent CAD problems.

Do lifestyle interventions affect dietary diversity score in the general population?

OBJECTIVE: The dietary diversity score (DDS) is a good indicator of diet quality as well as of diet-disease relationships; therefore, the present study was undertaken to reveal the effect of a lifestyle intervention on this index. DESIGN: A baseline and three evaluation studies were conducted in two intervention districts (Isfahan and Najaf-Abad) and a reference area (Arak), all located in central Iran. The Isfahan Healthy Hearth Programme (IHHP) targeted the entire population of nearly 2 million in urban and rural areas of the intervention communities. One of the main strategies of the lifestyle intervention phase in the IHHP was healthy nutrition. Usual dietary intake was assessed using a forty-nine-item FFQ. A diversity score for each food group was calculated and the DDS was considered the sum of the diversity scores of the food groups. RESULTS: There were significant increases in DDS in both intervention areas (P = 0.0001) after controlling for confounding factors. There was a significant interaction between area and evaluation stage with regard to DDS (P = 0.0001). The effect of the intervention on the diversity scores of all food groups was also significant (P = 0.0001 for all) after adjusting for socio-economic status. CONCLUSION: The community-based lifestyle intervention in the IHHP was successful in improving DDS which might be related to an increase of diet quality of the population that in turn might decrease the risks of chronic diseases.

Effect of a community-based intervention on nutritional behaviour in a developing country setting: the Isfahan Healthy Heart Programme.

OBJECTIVE: The present study was conducted to determine the impact of a community-based intervention on the nutritional behaviour of a representative sample of Iranian adults. DESIGN: The Isfahan Healthy Heart Programme (IHHP), a six-year, action-oriented, integrated community-based study aimed at health promotion through the reduction of CVD risk factors, targeted the whole population living in two intervention cities, and compared outcomes with the population of a non-intervention city considered as reference. Dietary interventions were performed as educational, environmental and/or legislative strategies. A global dietary index (GDI) was calculated representing the general dietary behaviour. In addition, two consumption indices were calculated for specific food groups, i.e. meat products and major sources of fat. Univariate AVOVA was conducted to evaluate the impact of the intervention on dietary behaviours. SETTING: Isfahan and Najaf-Abad (intervention cities) and Arak (reference city), central Iran. SUBJECTS: The baseline survey was conducted among 12514 randomly selected adults aged > or =19 years in both intervention and reference areas. The survey was repeated annually among about 5000 persons (2002-2005) in the intervention and reference communities. RESULTS: According to significant year x group interactions in mean fat consumption index (FCI) and meat consumption index (MCI) in the total population, a significant improvement in FCI and MCI was found in the intervention areas v. the reference area (P < 0.001). In addition, the GDI improved significantly in the intervention areas v. the reference area (P < 0.001). CONCLUSIONS: The IHHP interventions were effective in improving dietary behaviours at the population level. The highest effectiveness was documented in the change in the type of fat consumed. Such simple and integrated interventions can be adopted in other developing countries with limited financial resources.

Relationship between legumes consumption and metabolic syndrome: Findings of the Isfahan Healthy Heart Program.

BACKGROUND: Epidemiologic studies have shown an inverse association between dietary fiber and metabolic syndrome (MetS). Therefore, the purpose of this study was to investigate the association between MetS and consumption of legumes in adults in Isfahan, Iran. METHODS: This cross-sectional study was carried out on 2027 individuals who were a subsample of the 3rd phase of the Isfahan Healthy Heart Program (IHHP). Basic characteristics information such as age, sex, smoking status, and physical activity were collected using a questionnaire. A validated 48-item food frequency questionnaire was used to assess dietary behaviors. Blood pressure, waist circumference (WC), glucose, triacylglycerols, and high-density lipoprotein cholesterol were measured, and MetS was defined based on Adult Treatment Panel III guidelines. Multiple logistic regression models examined associations of frequency consumption of legumes with MetS occurrence and its components. RESULTS: All MetS components were less prevalent among subjects with regular legume intake (P < 0.01). Legume intake was inversely associated with the risk of MetS, after adjustment for confounding factors in women. Life style adjusted odds ratio of Mets between highest and lowest tertile and no consumption (as reference category) of legume intake were 0.31 (0.13, 0.70), 0.38 (0.17, 0.87), respectively, in women (P = 0.01). CONCLUSION: This study showed that age has a crucial role in MetS incidence; therefore, after further age adjustment to lifestyle adjusted model there was no significant difference in lower and higher tertile of legume intake and MetS.

Using factor analysis to identify dietary patterns in Iranian adults: Isfahan Healthy Heart Program.

OBJECTIVE: To identify dietary patterns of a representative sample of Iranian adults using factor analysis. METHODS: This study was conducted in 2000-2001 as the baseline survey of Isfahan Healthy Heart Program (IHHP). We studied 12,514 participants aged ≥19 years who were randomly selected in three counties of Central Iran. A validated 48-item food frequency questionnaire was completed and factor analysis was used to identify dietary patterns. RESULTS: Four major dietary patterns were identified, namely "Western", "animal fat", "traditional" and "Mediterranean". In both men and women, we found a significant positive relationship between age and Mediterranean diet, and a negative relationship between age and the other three dietary patterns (P < 0.001). The Western and traditional dietary patterns showed a significant negative relationship with education in both genders (P < 0.01). The Western dietary pattern correlated positively with being single, widowed, or a divorced man (P < 0.001). CONCLUSIONS: We identified four major dietary patterns. As dietary pattern analysis is useful to identify dietary behaviors in relation to health risks, the results can be practical.

Consumption of sugar-sweetened beverages in relation to the metabolic syndrome among Iranian adults.

BACKGROUND: Few data are available linking intake of sugar-sweetened beverages (SSBs) with the metabolic syndrome. Furthermore, findings from these studies are inconsistent and most are from Western societies; no information is available in this regard from Middle Eastern populations. OBJECTIVE: This study was conducted to assess the relationship between SSB consumption and metabolic syndrome in an Iranian adult population. METHODS: In this cross-sectional study, data from 1,752 people (782 men and 970 women) that were selected with the multistage cluster random sampling method from three counties of Isfahan, Najafabad and Arak were used. A validated food frequency questionnaire was used to assess participants' usual dietary intakes. Consumption of SSBs was calculated by summing up the consumption of 'soft drinks' and 'artificially sweetened fruit juices'. To categorize participants, we used three levels of SSB consumption: <1 time/week, 1-3 times/week, and >3 times/week. Biochemical assessments were done after an overnight fasting. Metabolic syndrome was defined according to the guidelines of Adult Treatment Panel III. RESULTS: Subjects with high consumption of SSBs (>3 times/week) were younger than those with low consumption (<1 time/week). Mean BMI was not significantly different across SSB categories. High consumption of SSBs was associated with greater intakes of energy and almost all food groups. We found a significant difference in serum triglyceride levels between men consuming SSBs 1-3 times/week and those consuming <1 time/week. However, after controlling for potential confounders, this association disappeared. In crude models, no significant associations were found between SSB intake and prevalence of the metabolic syndrome in either gender. After adjustment for potential confounders including BMI, we found that men in the top category of SSB intake were 17% more likely to have the metabolic syndrome (odds ratio (OR) 1.17; 95% confidence interval (95% CI) 0.56-2.46), while women in the highest category were 20% less likely to have the syndrome (OR 0.80; 95% CI 0.46-1.42) as compared with those in the bottom category. However, these associations were not significant in either men or women. CONCLUSION: Our results do not support the previous findings on the association between SSB consumption and metabolic syndrome. Prospective studies are needed to further explore for this association.

Effect of hydrogenated, liquid and ghee oils on serum lipids profile.

BACKGROUND: Trans fatty acids are known as the most harmful type of dietary fats, so this study was done to compare the effects of hydrogenated, liquid and ghee oils on serum lipids profile of healthy adults. METHODS: This study was a randomized clinical trial conducted on 129 healthy participants aged from 20 to 60 years old who were beneficiaries of Imam-e-Zaman charitable organization. Subjects were randomly divided into 3 groups and each group was treated with a diet containing cooking and frying liquid, ghee, or hydrogenated for 40 days. Fasting serum lipids, including total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), apoprotein A (Apo A), and apoprotein B (Apo B) were measured before and after the study. RESULTS: TC, TG and Apo B had a significant reduction in the liquid oil group compared to the hydrogenated oil group. In the ghee group TG declined and Apo A increased significantly (P < 0.01). Liquid oil group had a significant reduction in HDL-C, compared to the ghee oil group (P < 0.05). CONCLUSION: It was concluded that consuming liquid oil along with frying oil caused to reduce all serum lipid levels. However, ghee oil only reduced TG and increased HDL-C levels.