Factors associated with the metabolic syndrome in a national sample of youths: CASPIAN Study.

BACKGROUND AND AIM: To date, research on the influence of environmental factors on metabolic syndrome (MS) among youths is limited. This study was conducted to investigate for the first time the association of these factors with MS in a large national, representative sample of children from a non-Western population. METHODS AND RESULTS: The study population comprised of 4811 students (2248 boys and 2563 girls) aged 6-18 years, living in six different provinces in Iran. MS, defined based on criteria analogous to those of the Adult Treatment Panel III, was detected in 14.1% of participants. A birth weight of >4000 g in boys and <2500 g in girls increased the risk of having the MS [OR, 95% CI: 1.4 (1.007, 2.05) and 1.2 (1.1, 1.4), respectively]. Poorly educated parents and a positive parental history of chronic disease were other risks factors associated with MS. Low levels of physical activity significantly increased the risk of having MS [boys: 1.3 (1.1, 1.7); girls: 1.4 (1.2, 1.6)]. The risk of MS increased in-line with the consumption of solid hydrogenated fat [boys: 1.2 (1.07, 1.3); girls, 1.3 (1.1, 1.5)] and bread made with white flour [boys: 1.6 (1.3, 2.1); girls, 1.4 (1.1, 1.7)]. In contrast, an increased frequency of consumption of fruits and vegetable, as well as dairy products decreased the risk of having MS. CONCLUSION: Considering the effect of modifiable lifestyle habits and birth weight on MS in youths, urgent public health approaches should be directed towards primordial and primary prevention of this rapidly growing problem.

Optimal method for early detection of cardiac disorders in thalassemia major patients: magnetic resonance imaging or echocardiography?

BACKGROUND: Heart failure resulting from myocardial iron deposition is the most important cause of death in ß-thalassemia major (TM) patients. Cardiac T2*magnetic resonance imaging (MRI), echocardiography, and serum ferritin level serve as diagnostic methods for detecting myocardial iron overload. In this study, we aimed to evaluate the relationship between the above-mentioned methods. METHODS: T2*MRI and echocardiographic measurement of left ventricular (LV) systolic and diastolic function were performed in 63 patients. Serum ferritin level was measured. The relationships between all assessments were evaluated. RESULTS: There were 40 women and 23 men with a mean age of 23.7±5.1 years (range, 15-35 years). There was no statistically significant correlation between serum ferritin level and LV systolic and diastolic function (P=0.994 and P=0.475, respectively). T2*MRI results had a significant correlation with ferritin level; 63.6% of patients with serum ferritin level >2,000 ng/mL had abnormal cardiac MRI, while none of the patients with ferritin level <1,000 ng/mL had abnormal cardiac MRI (P=0.001). There was no significant correlation between MRI findings and LV systolic function (P=1.00). However, we detected a significant difference between LV diastolic function and cardiac siderosis (P=0.03). CONCLUSION: MRI findings are a good predictor of future cardiac dysfunction, even in asymptomatic TM patients; however, diastolic dysfunction may happen prior to cardiac siderosis in some patients, and echocardiography is able to diagnose this diastolic dysfunction while T2*MRI shows normal findings.

Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study.

OBJECTIVE: To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children. METHODS: A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires. FINDINGS: Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins (R(2) = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R(2) = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups. CONCLUSION: Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered.

Association of anthropometric indices with cardiovascular disease risk factors among children and adolescents: CASPIAN Study.

BACKGROUND: For the first time in Iran, and to the best of our knowledge in Asia, we assessed the anthropometric indices most closely correlated to cardiovascular disease (CVD) risk factors in a large nationally representative sample of children and adolescents to be used as a simple tool for identifying those at risk. METHODS: This multi-center study was performed among a representative sample of 4811 school students (2248 boys and 2563 girls) aged 6-18 years, as part of the baseline survey of a national surveillance system. Anthropometric indices and CVD risk factors were measured using standard protocols, and their correlation was analyzed by using Receiver Operator Characteristic (ROC) curves and partial correlation. RESULTS: The most prevalent CVD risk factors were low HDL-C (28%), followed by hypertriglyceridemia (20.1%), and overweight (17%). The ROC analyses showed that among boys, all anthropometric indices had the same association with CVD risk factors in 6-9.9-year-age group, while in the 10-13.9 and 14-18-year-age groups, respectively waist circumference (WC) and body mass index (BMI) were the best in distinguishing CVD risk factors. Among girls, these indices were respectively BMI and waist to stature ratio (WSR); WC and WSR; and WC. In the partial correlation analysis, in boys, the highest coefficient was found for BMI; BMI and WC; and for WC and WSR; in girls, these indices were BMI; WC and WSR; and BMI respectively. CONCLUSIONS: In the present study, BMI, WC and WSR were the most appropriate in predicting CVD risk factors. It may be clinically useful in the pediatric population to routinely measure WC and WSR in addition to BMI as a screening tool to identify high-risk youth.

Association of physical activity and the metabolic syndrome in children and adolescents: CASPIAN Study.

BACKGROUND/AIM: To determine the association of physical activity and the metabolic syndrome in a large national-representative sample of children. METHODS: This study was performed in 2003-2004 on 4,811 school students aged 6-18 years, selected by multi-stage random cluster sampling from six provinces in Iran. We assessed the level of physical activity using a standardized questionnaire, and categorized it to the tertiles. The metabolic syndrome was defined based on criteria analogous to those of the Adult Treatment Panel III. RESULTS: The participants comprised 2,248 boys and 2,563 girls with a mean age of 12.07 +/- 3.2 years. In all age groups, boys were more physically active than girls. The metabolic syndrome was detected in 14.1% of participants, and its prevalence was higher in those subjects in the 1st, 2nd and 3rd tertiles of physical activity, respectively (15.1 vs.14.2 and 13.1%, respectively, p <0.05). This difference was seen in boys, while no difference was found between girls in the 2nd and 3rd tertiles of physical activity. Physical activity was linked to a cluster of factors consisting of high-density lipoprotein-cholesterol and waist circumference, followed by triglycerides in boys, and of triglycerides, waist circumference and blood pressure in girls. In both genders, before and after adjustment for age and body mass index, low levels of physical activity significantly increased the risk of having the metabolic syndrome [in boys: OR: 1.8, 95% CI: 1.1, 2.1; and in girls, OR: 1.6 (1.1, 1.9)]. CONCLUSION: We found an association between physical activity and the metabolic syndrome, which was independent of body mass index and age. Children should be encouraged to have greater physical activity.

Is family history of premature cardiovascular diseases appropriate for detection of dyslipidemic children in population-based preventive medicine programs? CASPIAN study.

The objectives of this study were to determine the prevalence of dyslipidemia and the usefulness of self-report family history (FH) of premature cardiovascular disease (CVD) for identifying children with lipid disorders. This study was conducted on a representative, population-based sample of 4811 Iranian children and adolescents (2248 boys and 2563 girls) aged 6-18 years. We compared the obtained serum lipid profile with that of the Lipid Research Clinic (LRC) and calculated the predictive value of FH for detecting those children with dyslipidemia.Overall, for both genders and for age groups, the mean serum triglycerides (TG) and its percentiles were significantly higher, and the mean and percentiles of total, low-density, and high-density cholesterol (TC, LDL-C, and HDL-C respectively) were significantly lower than the LRC values. In total, 45.7% of participants had dyslipidemia; the most frequent ones were low HDL-C (24.8%) and hypertriglyceridemia (24.5%), followed by hypercholesterolemia (6.4%) and high LDL-C (6.3%), respectively. The mean serum lipid levels and the anthropometric measures were not significantly different among those with or without positive FH. The sensitivity, and specificity, positive and negative predictive values for FH in detecting those children with dyslipidemia were 28.4, 70.3. 44.7, and 53.8%, respectively. The usefulness of FH in identifying dyslipidemic children was relatively low. The common lipid disorders in our community were the components of the metabolic syndrome. We suggest that the current guidelines for screening lipid disorders in youths, which are based on cholesterol, should consider such ethnic differences.

Paediatric metabolic syndrome and associated anthropometric indices: the CASPIAN Study.

AIM: To determine the prevalence of paediatric metabolic syndrome (MetS) and its best predictive anthropometric index. METHODS: This national study was conducted among 4811 students (2248 boys and 2563 girls) aged 6-18 y. This is the first study of its kind in Iran and, to our knowledge, in Asia as well. Two definitions were used for the MetS: type A was defined based on criteria analogous to ATP III, and type B was defined according to the cut-offs obtained from NHANES III. Both types A and B define high fasting blood sugar as > 100 mg/dl and systolic/diastolic blood pressure as > 90th percentile. RESULTS: The mean (SD) age of students studied was 12.07+/-3.2 y. MetS type A was seven times more prevalent than type B (14% vs 2%, respectively, p<0.0001), and had no significant gender difference. The most frequent components of both definitions of the MetS were low high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG). Waist circumference (WC) and waist-to-hip ratio (WHR) had the strongest and weakest associations, respectively, with the MetS. CONCLUSION: Establishment of a uniform set of criteria for the MetS in children is needed. Routine WC measurement in the paediatric population may be clinically useful.

Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.

BACKGROUND: This study was performed to determine the blood pressure (BP) percentile curves by height, as well as to assess the prevalence of high BP and its influencing factors among children in the first national survey in this field in Iran. DESIGN: A multicentre national cross-sectional survey. METHODS: This study was performed in 23 provinces among a representative sample of 21,111 students aged 6-18 years. RESULTS: Age and sex-specific percentile curves of systolic and diastolic BP were obtained by height. A comparison of the values obtained corresponding to the 90th percentiles with the Second Task Force cut-offs showed that the BP values and trends were relatively similar in both studies. The overall prevalence of systolic, diastolic as well as systolic or diastolic hypertension according to the Second Task Force study 95th percentile cut-off points were 4.2, 5.4 and 7.7%, respectively, without a significant sex difference. A history of low birthweight, overweight, taller height, the consumption of solid hydrogenated fat, as well as the frequency of fast food consumption increased the risk of both systolic and diastolic hypertension. Male sex, large waist, and low education of the mother were the risks for systolic hypertension, whereas the risk of diastolic hypertension rose with living in an urban area, attending public school, low physical activity level, having a housewife mother, and a positive family history of obesity, especially in the parents. CONCLUSION: Considering the effect of modifiable environmental factors on the childrens' BP, encouraging breast feeding and a healthy lifestyle may have an important effect on public health.

Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study.

OBJECTIVES: To determine the national prevalence of smoking among Iranian youths and its environmental influencing factors. METHODS: This study was performed in 2003-2004 among 11,966 school students, ages 11-18 years, selected by multi-stage random cluster sampling from 20 provinces in Iran. The participants filled out self-administered anonymous questionnaires. RESULTS: The prevalence of self-reported cigarette smoking was 14.3%, with a higher prevalence in boys than in girls (18.5% vs. 10.1%, respectively, P < 0.001), and in high school than in middle school students (17.4% vs. 10.6%, respectively, P < 0.001). Overall, 42.2% of smokers were daily smoker, and the rest were occasional smoker. The mean age of the first attempt to smoke was 13.2 +/- 2.5 years with no significant gender difference but was significantly lower in daily than in occasional smokers. The place of the first attempt to smoke was mostly in friend parties (41.6%) and traditional teahouses (23.2%) for boys and the family parties (37.1%) and the traditional teahouses (27.4%) for girls. The higher school level and having a tobacco user at home significantly increased the likelihood of smoking in adolescents, with the highest odds ratio (OR) found for having a smoker sister in girls (OR = 4.5, 95%CI, 2.5, 8.2), and having a smoker brother in boys (OR = 2.4, 95%CI, 2.03, 3.05). CONCLUSION: Smoking is becoming as a major public health threat among Iranian youths. Control measures should be considered not only for cigarette smoking, but also for the socially accepted habit of water pipe use that is revived in traditional teahouses.