Validity and reproducibility of the PERSIAN Cohort food frequency questionnaire: assessment of major dietary patterns.

BACKGROUND: Dietary patterns, encompassing an overall view of individuals' dietary intake, are suggested as a suitable means of assessing nutrition's role in chronic disease development. The aim of this study was to evaluate the validity and reproducibility of a food frequency questionnaire (FFQ) designed for use in the Prospective Epidemiological Research Studies in IrAN (PERSIAN), by comparing major dietary patterns assessed by the FFQ with a reference method. METHODS: Study participants included men and women who enrolled in the PERSIAN Cohort Study at seven of the eighteen centers. These centers were chosen to include dietary variations observed among the different Iranian ethnic populations. Two FFQ were completed for each participant over a one-year study period (FFQ1 upon enrollment and FFQ2 at the end of the study), with 24 interviewer-administered 24-hour dietary recalls (24 h) being completed monthly in between. Spearman correlation coefficients (SCC) were used comparing FFQs 1 and 2 to the 24 h to assess validity, while FFQ1 was compared to FFQ2 to assess reproducibility of the questionnaire. RESULTS: Three major dietary patterns-Healthy, Low Protein/High Carb and Unhealthy-were identified, accounting for 70% of variance in the study population. Corrected SCC ranged from 0.31 to 0.61 in the validity and from 0.34 to 0.57 in reproducibility analyses, with the first two patterns, which accounted for over 50% of population variance, correlated at above 0.5 in both parameters, showing acceptable findings. CONCLUSIONS: The PERSIAN Cohort FFQ is suitable for identification of major dietary patterns in the populations it is used for, in order to assess diet-disease relationships.

Metabolic syndrome: a population-based study of prevalence and risk factors.

The association between personal habits and metabolic syndrome (MetS) remains controversial. This study aimed to assess the prevalence of MetS among youths and its association with cigarette, tobacco, opium, and alcohol consumption in the Rafsanjan Youth Cohort Study (RYCS). The current cross-sectional study was based on data from RYCS, as part of the Rafsanjan Cohort Study (RCS). RCS is a branch of the prospective epidemiological research studies in Iran (PERSIAN). In the present study, 2843 youths aged 15-35 were included. MetS was diagnosed using the international diabetes federation (International IDF), National Cholesterol Education Panel- Adult Treatment Panel III (NCEP-ATPIII), and Iranian criteria (IDF Iranian). Binary logistic regression models were performed to estimate odds ratios (ORs) and confidence intervals (CIs). The prevalence of MetS was 7.67%, 7.14%, and 10.13% based on NCEP-ATPIII, IDF Iranian, and International IDF criteria respectively. The odds of MetS according to international IDF and Iranian IDF in the alcohol-drinking group in the last 12 months (OR: 1.51, 95%CI 1.02-2.21, OR: 1.66, 95%CI 1.11-2.48 respectively) were greater compared with the non-drinking group. The odds of having high TG in the alcohol-drinking group in the last 12 months was 1.53 times higher than the control group (OR = 1.53, 95% CI: 1.20-1.94). Furthermore, the odds of having high waist circumference (WC) according to IDF International was significantly higher in the tobacco-smoking group in the last 12 months and in the tobacco-smoking group in the last 12 months daily (OR: 1.23, 95%CI 1.01-1.49 and OR: 1.41, 95%CI 1.01-1.98 respectively) compared to the control groups. The prevalence of MetS was 7.67%, 7.14%, and 10.13% based on NCEP-ATPIII, IDF Iranian, and International IDF criteria respectively. The odds of MetS and high TG were greater in the alcohol-drinking group in the last 12 months compared with the non-drinking group. The odds of high WC in the last 12 months, were greater in the tobacco-smoking group compared with the non-smoking group. However, more longitudinal studies are needed to verify the associations observed in the current study.

The profile of Oral Health Branch of Rafsanjan Cohort Study (OHBRCS) in Rafsanjan City, southeast of Iran.

Oral health status can be affected by some factors including drug abuse, systemic conditions and environmental pollutants. The present study was designed to investigate the most important and prevalent dental and oral conditions in adult population of Rafsanjan with the age of 35-70 years. Dental and oral health cohort center as part of the Rafsanjan Cohort Study (RCS) included in the prospective epidemiological research studies in IrAN was established in 2015. Of 9991 subjects enrolled in the RCS, 8682 people participated in the Oral Health Branch of Rafsanjan Cohort Study (OHBRCS). The OHBRCS included 4021 men and 4661 women with the mean age of 49.94 ± 9.51. The most prevalent of oral lesion in total population was candidiasis and the least was aphthous lesion. The prevalence of candidiasis, white and red lesions, periodontal pocket, dental calculus, CAL and the mean of DMFT were higher in the male group than that of female group (p < 0.05). Candidiasis, herpes, oral cancer, white and red lesions were more prevalent in the older age groups (p < 0.05). The mean of DMFT index in total population was 21.30 and was higher among opium users, men and older age (p < 0.05). Also, the opium users had a higher rate of CAL, periodontal pocket, red and white lesions, and candidiasis but a lower rate of BOP (p < 0.05). Younger people had more decayed and filling teeth compared to other age groups, whereas older people had more missing teeth and a higher DMFT index (p < 0.001).

The prevalence and associated factors of overweight/obesity and abdominal obesity in South-eastern of Iran: a cross-sectional study based on Rafsanjan cohort study.

BACKGROUND: Obesity has become a major health issue in both high and middle-income countries, increasing the risk of cardiovascular diseases and all-cause mortality. Risk of obesity is related to both unchangeable factors such as genetics and gender, and modifiable lifestyle factors. Most importantly, finding the major modifiable lifestyle factors which contribute to obesity may provide valuable benefits to every society. This study aimed to determine the association of demographic and lifestyle parameters with overweight/obesity and abdominal obesity in a population of Iranian adults. METHODS: In this cross-sectional study, adult participants of Rafsanjan Cohort Study (RCS) (as one of the district areas of the PERSIAN cohort (Prospective Epidemiological Research Studies in IrAN) included the study population. RCS is a population-based prospective cohort of men and women aged 35-70 years, launched in August 2015. Individuals were recruited from four urban and suburban areas of Rafsanjan, south-eastern of Iran. Trained experts interviewed each participant and completed the related questionnaires about his/her socioeconomic status, demography, anthropometric features, personal habits, physical activity and medical history. Multinomial logistic regression models were used to examine the relationships between overweight/obesity/abdominal obesity and associated factors. RESULTS: From 9980 participants, 1974 (42.42%) males and 2115 (39.70%) females were overweight, 784 (16.85%) males, 2223 (41.73%) females were obese and 1895 (40.73%) males and 989 (18.57%) females were normal weight. Also, 832 (17.9%) males and 4548 (85.4%) females had abdominal obesity and 3819 (82.1%) males and 778 (14.6%) females didn't have abdominal obesity. Based on the adjusted multiple logistic regression, overweight/obesity (BMI > 25) was associated with age > 45, female gender, education ≥ 13 years, heavy physical activity, wealth status index (WSI), alcohol consumption, current cigarette smoking and opium consumption compared to reference group. Also, odds of abdominal obesity displayed a significant association with age > 45, female gender, education > 5 years, physical activity, WSI, current cigarette smoking, alcohol and opium consumption compared to reference group. CONCLUSIONS: Our results recommend local public health strategies that promote training the society on the health benefits of avoiding alcohol, getting more physical exercise and gaining more personal education on the health-threatening lifestyle.

Total Antioxidant Capacity and Total Oxidant Status and Disease Severity in a Cohort Study of COVID-19 Patients.

BACKGROUND: Previous reports have suggested the role of oxidative stress in progression of COVID-19 infection, but there is limited information regarding the effect of antioxidant capacity and total oxidant status of patients with COVID-19 on disease severity. In the present study, we aimed to investigate the relationship between total antioxidant capacity (TAC), total oxidant status (TOS), TAC/TOS levels, and disease severity in hospitalized patients with COVID-19. METHODS: This cohort study was carried out at Masih Daneshvari Hospital in Tehran, Iran, from September 2020 to October 2020. Clinical data of 331 patients with COVID-19 admitted to the hospital were analyzed and divided into mild, moderate, and severe groups (needed oxygen, intubation, and mechanical ventilation). The patients' TAC, TOS, and TAC/TOS levels were assessed using the serum samples by colorimetric assay kit. RESULTS: We found no significant difference in serum levels of TAC, TOS, and TAC/TOS in terms of the disease severity. CONCLUSIONS: These results indicated that total antioxidant capacity and total oxidant status may not be the determining factor on the disease severity.

Prevalence of early and late menopause and its determinants in Rafsanjan cohort study.

Our investigation aimed to evaluate the prevalence of early and late menopause and its determinants in adult women of Rafsanjan cohort study. We used data obtained from the Rafsanjan Cohort Study, as a part of the prospective epidemiological research studies in Iran. In this cross-sectional research, 2002 postmenopausal women were included in the present study. Menopause age were divided into three groups (≤ 41 years, 42-54 years, and ≥ 55 years) based on the 10th and 90th percentile. The association between age at menopause with demographic and reproductive characteristics and some clinical risk factors of women was evaluated by logistic regressions. The mean age at menopause among the study participants was 48.63 ± 5.37 years. In this study, 11.49% and 11.39% of the women experienced early and late menopause respectively. After adjusting for all potential confounders, the results showed that taller and smoker women had higher odds of early menopause (OR 1.03, 95% CI 1.00-1.06) and OR 1.85, 95% CI 1.01-3.41) respectively) and women with history of using hormonal contraceptive more than median had lower odds of early menopause (OR 0.61, 95% CI 0.41-0.91). Also older women (OR 8.65, 95% CI 5.31-14.08) and women with a history of diabetes (OR 2.42, 95% CI 1.63-3.60), hypertension (OR 2.06, 95% CI 1.42-2.97), thyroid disease (OR 1.85, 95% CI 1.07-3.20) and depression (OR 2.00, 95% CI 1.35-2.97) had higher odds of late menopause. The results showed that the year of birth, height, smoking, history of diabetes, hypertension, thyroid disease and depression and using hormonal contraceptive were significantly associated with the menopausal age. Since age at menopause can affect subsequent health in women, understanding the determinants of menopausal age is important and should be pursued.

Serum liver enzymes and metabolic syndrome from the Rafsanjan Cohort Study.

Our investigation aimed at evaluating the relationship between metabolic syndrome, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) in the Rafsanjan cohort study (RCS). We used data obtained from the RCS, as a part of the prospective epidemiological research studies in Iran. In this cross-sectional research, 9895 participants from the baseline phase of RCS who completed medical questionnaire were included. Metabolic syndrome (MetS) defined using NCEP-ATP III criteria. The relationship between elevated serum liver enzymes levels even within the normal range and metabolic syndrome was evaluated by logistic regressions. The prevalence of MetS was 34.42% in the participants of study. The mean concentrations of AST, ALT, ALP, and GGT increased with increasing MetS components. After adjusting for all potential confounders, elevated serum concentrations of ALT, AST, GGT, and ALP even within the normal range were related with an increased odds of MetS. MetS was associated with increased levels of liver enzymes even within the normal range. These results indicated the potential for elevated liver enzymes as biomarkers for the possible presence of MetS.

Psychometric Evaluation of Chronic Patients Using the Persian Version of Patient Activation Measure (PAM).

The Patient Activation Measure (PAM) is a 13-item questionnaire that assesses patients' knowledge, skills, and confidence in self-management. The current study aimed to translate the American version of the PAM-13 into Persian and test the psychometric properties of the Persian version among chronic patients. This cross-sectional study was conducted on 438 chronically ill patients in Rafsanjan, Iran from May to November 2019. The American version of the PAM-13 was translated into Persian using a standardized forward-backward translation method. Internal consistency, test-retest reliability, face and content validity, as well as construct validity (structural and convergent validity) were all assessed. The content validity index of the Patient Activation Measure-13 Persian (PAM-13-P) was 0.91. Exploratory and confirmatory factor analyses showed that the PAM-13-P had a meaningful structural validity. The PAM-13-P scores were negatively correlated with the Partner in Health Measure (PIH) (r = -0.29, p < 0.001). In addition, the PAM13-P scores were positively correlated with the Satisfaction with Life Scale (SWLS) (r = 0.31, p < 0.001). The internal consistency was 0.88, and the repeatability was excellent [Intraclass Correlation Coefficient (ICC):0.96 and confidence interval (CI): 0.94-0.98]. This study demonstrates that the PAM-13-P is a reliable and valid measure for assessing activation among chronically ill patients. The PAM-13-P scale assesses the level of self-management of chronic patients and identifies appropriate care strategies to meet their needs.

Cross-sectional study of passive opiate smoking in relation to stroke and some of stroke attributable risk factors in women.

Opiate use is related to neuropathological disorders, stroke and stroke attributable risk factors. However, secondary exposure to opiate in relation to the above-mentioned complications is studied only in animal models and remains to be evaluated in human populations. We tested whether passive exposure to opiate is associated with stroke and the known stroke predictive factors. We carried out a cross-sectional study of 1541 never smoker women who participated in the Rafsanjan Cohort Study (RCS) with their husbands (2015-2017 recruitment phase). RCS is one of the 19 geographic districts of the Prospective Epidemiological Research Studies in Iran (PERSIAN cohort study). Unadjusted and adjusted multiple logistic regression analyses were performed to evaluate the relationship between second-hand opiate exposure (husband opiate smoking after marriage) and the odds ratio of stroke and the following stroke risk factors and predictive parameters: overweight/obesity (BMI > 25), cholesterol (chol) > 200 mg/dl, fasting blood sugar (FBS) > 125 mg/dl, low density lipoprotein (LDL) > 100 mg/dl, triglyceride (TG) > = 150 mg/dl, hypertension, diabetes, and chronic headache. We observed a significant increased adjusted odds ratio (OR) of stroke (OR = 3.43, 95% CI:1.33-8.82) and its risk factors LDL > 100 mg/dl (OR = 1.37, 95% CI:1.01-1.87) and FBS > 125 mg/dl (OR = 1.58, 95% CI:1.08-2.30) in women associated with husbands' opiate smoking. This relationship was observed after adjusting for the confounding parameters including age, education years, and first-degree family history of the relevant diseases. The increased odds ratio for stroke and high LDL displayed a dose-sensitive trend with years of husband's opiate smoking after marriage (respective p-trends: 0.02 & 0.01). We did not observe a significant association between passive opiate smoking and high TG, high Chol or the diseases diabetes, hypertension and chronic headache. However, 89% increased odds ratio of chronic headache was observed to be associated with passive opiate smoking for more than 10 years (OR = 1.89, 95% CI:1.02-3.50). We found an increased risk of stroke and high LDL and FBS in women associated with passive opiate smoking. Furthermore, a dose-sensitive connection was found between the risks of stroke, high LDL and chronic headache with the years of passive opiate exposure. Our results point to the necessity of the future analyses, which further assess whether passive opiate exposure could be considered as an independent risk factor for stroke and metabolic diseases.

Prevalence of dyslipidemia and its association with opium consumption in the Rafsanjan cohort study.

The potential effects of opium consumption on lipid profile remain unquantified. We considered the association between opium use and dyslipidemia. In this cross-sectional study, we used data obtained from the Rafsanjan cohort study, as a part of the prospective epidemiological research studies in IrAN (PERSIAN) with detailed and validated data on opium consumption and selected other exposures. A total of 9932 adults were included in the study. Logistic regression models were used to assess the relationships of opium consumption with the prevalence of dyslipidemia and lipid disorders. In this population, 73.33% had dyslipidemia and the prevalence rates of high TC, high TG, high LDL and low HDL were 54.24%, 47.45%, 34.43% and 11.91% respectively. After adjustment for all confounders, opium users compared with non-users had lower odds ratios (OR) of high TC and high LDL [0.81 (95% confidence interval, CI 0.71-0.92) and 0.80 (95% CI 0.69-0.93) respectively] and greater OR of low HDL [1.30 (95% CI 1.04-1.62)]. Longer duration of opium consumption resulted in lower ORs of high TC, 0.68 (95% CI 0.55-0.84) and high LDL, 0.82 (95% CI 0.67-0.99), and shorter duration of opium consumption resulted in increased odds of low HDL, 1.30 (95% CI 1.02-1.66). High dose of opium consumption was associated with an OR of dyslipidemia of 0.80 (95% CI 0.65-0.97), high TC of 0.80 (95% CI 0.67-0.95), and high LDL of 0.78 (95% CI 0.64-0.96) and low dose of opium consumption, with an OR of low HDL of 1.30 (95% CI 1.02-1.65). In relation to route of consumption, opium smoking was a risk factor for low HDL with an adjusted odds ratio of 1.31 (1.04-1.63). Opium use was associated with selected changes on serum lipid levels, but opium users had higher frequency of cardiovascular disease history.

The Effect of Monitoring System on Risk Assessment of Aflatoxins in Iran's Pistachio Nuts Exported to the E.U. During 2012 - 2018.

Pistachio has high nutritional value and popularity. The susceptibility of pistachio to aflatoxin contamination caused establishing a monitoring system introduced and implemented by the Ministry of Health in Iran to ensure consumers' access to safe and hygienic pistachios. In this research, aflatoxin contamination level in all consignments (7298) exporting to E.U. was examined using HPLC with fluorescence detection after immunoaffinity column clean up from Nov 2012 to Oct 2018. The average recoveries ranged 78.6% - 97.6%, with a relative standard deviation for reproducibility below 8.5% and expanded uncertainty of aflatoxin B1 (AFB1) at spiked levels 1, 4, and 8 ng/g were 0.17, 0.57, 0.89 ng/g, respectively. The results showed that aflatoxin B1 and total (AFT) were detected in 1921 (23.4%) and 1927 cases (23.5%), with the mean values ranging from 2.18 - 4.6 ng/g and 2.8 - 5.1 ng/g during six consecutive years, respectively. Implementing an effective monitoring system for pistachio nuts could determine consignments contaminated with aflatoxins. Concerning AFB1, risk assessments recorded for dietary exposure dose, margin of exposure (MOE), Hazard Index (HI), estimated liver cancer risk, and cancer incidence attributable to dietary ranged 0.0132 - 0.1180 ng/kg.bw/day, 1441 - 12843, 0.21 - 1.84, 0.00071 - 0.00633 cases/105 population/year, 0.02 - 0.2%, respectively. Identification and rejection of contaminated cargos lead to an increase in MOE (> 10000), and it also guarantees that pistachio consumption is safe from a toxicology point of view. Due to the monitoring system, the estimation of liver cancer incidence attributable to dietary AFB1 was reduced (≤ 0.02%). It indicates that the consumption of pistachio poses no health risk for Europeans and Iranians.

Serum liver enzymes and diabetes from the Rafsanjan cohort study.

BACKGROUND: We evaluated the relation between ALT, AST, GGT and ALP with diabetes in the Rafsanjan Cohort Study. MATERIALS AND METHODS: The present study is a cross-sectional research including 9991 adults participated via sampling. We used data obtained from the Rafsanjan Cohort Study (RCS), as a part of the prospective epidemiological research studies in IrAN (PERSIAN). Elevated serum levels of ALT, AST, GGT and ALP were defined according to the reference range of the laboratory in the cohort center. Serum liver enzymes levels within the normal range were categorized into quartiles, and their relationship with diabetes was evaluated by logistic regressions. FINDINGS: In present study, elevated serum levels of ALT, AST, GGT, and ALP were associated with increased odds of diabetes (adjusted ORs: 1.81, 95%CI 1.51-2.17; 1.75, 95%CI 1.32-2.32; 1.77, 95%CI 1.50-2.08; 1.60, 95%CI 1.35-1.90 respectively). Also, in subjects with normal levels of ALT, GGT and ALP, a dose-response increase was shown for diabetes. CONCLUSION: Elevated levels of ALT, AST, GGT and ALP are related to a higher odds of diabetes. Also, increased levels of ALT, GGT and ALP even within normal range were independently related with the increased odds of diabetes. These results indicated the potential of elevated liver enzymes as biomarkers for the possible presence of diabetes.

Evaluation of chest CT scan finding in the patients with acute respiratory symptoms following positive results of RT-PCR-COVID19.

BACKGROUND: Reverse transcription-polymerase chain reaction (RT-PCR) is a standard technique for diagnosing coronavirus disease 2019 (COVID-19). The parameters for the diagnosis of COVID-19 included the history of exposure to positive COVID-19 patients, clinical signs and symptoms related to the disease, inflammation factors in the blood test or positive antigen-antibody test, and chest computed tomography (CT) findings. The current study evaluated the chest CT scan findings in patients with respiratory problems following positive RT-PCR of COVID 19. MATERIALS AND METHODS: This cross-sectional study was performed on 120 patients referred to Ali Ibn-Abi Talib Hospital in Rafsanjan, Kerman Province, Iran, with respiratory symptoms between Dec-2019 to Dec-2020. Two radiologists reviewed the chest CT scans of these patients using the checklist that included parameters such as the types of involvement (consolidation/grand-glass/crazy paving, etc.) and the patterns of involvement (central/peripheral), and the pleural findings. RESULTS: The CT scan was conducted in 107 patients with a typical condition and 11 patients with an atypical form of the disease. The frequency of the typical CT image of COVID-19 in the male group was significantly higher than that in the female group (P=0.004). The frequency of reverse halo sign, septal thickening, cardiomegaly, and crazy paving was significantly higher in males than in females (P≤0.05). Also, there was a significant difference between age groups based on the number of involved lobes (P=0.04). CONCLUSION: Chest CT scan is an important diagnostic method for COVID 19 with high sensitivity. The parameters in the CT scan are beneficial for the diagnosis of COVID 19. In addition, some characters in CT scans in the male gender are more specific.

Cohort-based analysis of maternal age at menarche in relation to young adult offspring anthropometric and metabolic parameters.

OBJECTIVES: Age of menarche is a determinant factor of cardiometabolic risk, adiposity and stature at adulthood. However, little is known about the transgenerational effects of age of menarche, especially beyond childhood of any offspring, and the studies remain limited to anthropometric outcomes in children at birth or before adolescence. In the present study, we aim to investigate the relationship of maternal age at menarche (MAM) with anthropometric and metabolic parameters in the young adult offspring (aged 15-35 years) in a Persian population. DESIGN, PATIENTS AND MEASUREMENTS: In this cohort-based cross-sectional study, we recruited 1139 mother-young adult dyads enroled in Rafsanjan Cohort Study (RCS) at adult RCS (aged 35-70 years) and youth RCS (aged 15-35 years) as part of the comprehensive PERSIAN (Prospective Epidemiological Research Studies in IrAN). In this study, MAM was categorized to early (MAM < 12 years), normal (12 ≤ MAM ≤ 14) and late menarche (MAM > 14 years). For these analyses, bivariate and multiple logistic regression models were used to investigate the relationships between late or early MAM and offspring anthropometric and metabolic parameters. RESULTS: Early MAM displayed a significant association with an increased odds ratio (OR) of tall stature adjusting for sex, age, socioeconomic status index, maternal age at birth and maternal height (as genetically determined factor). Sensitivity analysis by sex indicated this relationship to be specific to male offspring only (adjusted OR: 1.84 95% CI: 1.13-3.00, p value: .014). In addition, late MAM displayed a significant association with reduced OR of overweight/obesity and abdominal obesity in daughters only (obesity adjusted OR: 0.49, 95% CI: 0.27-0.88, p value: .018, abdominal obesity adjusted OR: 0.44, 95% CI: 0.23-0.82, p value: .010). dose-response analysis by categorization of MAM, further supported our results. On the contrary, our analyses do not support a significant relationship between MAM and youth metabolic indices, that is, metabolic syndrome, fasting blood sugar (FBS), high-density lipoprotein (HDL) and triglyceride (TG). CONCLUSIONS: The results of the present study indicate an association of maternal age of menarche with anthropometric measures of offspring in young adulthood in a sex differential manner. The data does not support a significant relationship between the metabolic indices FBS, TG and HDL in offspring with MAM. Overall, this study provides evidence for the intergenerational effects of age at menarche in the development of anthropometric measures in offspring in young adulthood (15-35), which is the first study of this kind in this age range.

Maternal opioid use is reflected on leukocyte telomere length of male newborns.

Opioid use accelerates normal aging in adults that raises a question on whether it may trans-generationally affect aging and aging biomarkers in the offspring of users as well? In the present research, we investigated the relative telomere length in umbilical cord blood of newborns born to opioid consuming mothers compared to normal controls. Telomere length shortening is a known biomarker of aging and aging related diseases. Its measure at birth or early in life is considered as a predictor of individual health in adulthood. Here, we performed a case-control study to investigate whether maternal opioid use affects newborns relative telomere length (RTL). 57 mother-newborn dyads were included in this study, 30 neonates with opioid using mothers (OM), and 27 with not-opioid using mothers (NOM)). RTL was measured in leukocyte cells genomic DNA using real-time PCR. The correlation of maternal opioid use with neonates telomer length was assessed using logistic regression analysis. The results displayed a significant association between odds ratio of long RTL and maternal opioid use when sensitivity analysis was performed by neonate sex; where the data indicates significantly increased odds ratio of long leukocyte RTL in association with maternal opioid use in male neonates only. Further work is necessary to assess this association in larger samples and test the potential underlying mechanisms for this observation.

Risk factors of kidney stone disease: a cross-sectional study in the southeast of Iran.

BACKGROUND: The prevalence of kidney stones in the world is increasing and environmental factors seem to play a major role in this issue. The aim of the present study was to investigate the prevalence of risk factors of kidney stones in the adult population of Rafsanjan city based on the data of the Rafsanjan Cohort Study (RCS). METHODS: In the baseline phase of this study, 10,000 people aged 35 to 70 years are enrolled in the RCS, as one of the prospective epidemiological research studies in Iran. From this population, 9932 participants completed related demographic questionnaires as well as reported a history of diabetes mellitus, kidney stone, and hypertension diseases. The obtained data were analyzed using univariable and multivariable logistics regression. RESULTS: According to the obtained results, 46.54% of the studied population were male and 53.46% were female. The mean age of the participants was 49.94 ± 9.56 years. 2392 people accounting for 24.08% of the population had kidney stones. After adjustment of the variables, six variables of gender, WSI, no consumption of purified water, BMI, and history of hypertension and diabetes were found to be significant related factors of kidney stone disease. CONCLUSIONS: Gender, hypertension, obesity, diabetes, and personal habits like alcohol consumption, opium use and, cigarette smoking are effective in the development of kidney stones. So, by identifying the susceptible patients and teaching them, the burden of the disease on society and the individual can be reduced. The results of this study are helpful to health care providers for preventive planning for kidney stone disease.

Cohort-based analysis of paternal opioid use in relation to offspring's BMI and plasma lipid profile.

A growing body of evidence suggests that opioid use may affect consumer's offspring by second-hand passive smoke exposure, as well as by transgenerational impacts mediated by genetic and epigenetic alterations of paternal gametes. In human studies, these effects are limited to investigating the neural, behavioral and cognitive characteristics of offspring. Only animal studies have investigated the metabolic parameters influenced by passive opium smoke exposure. Here, we conducted population-based analyses aimed to estimate the association of paternal opioid consumption, started before or after child birth, with BMI status and plasma lipid profile of young adult offspring. The present study includes 840 parents-offspring trios (offspring aged 15-35, parents aged 35-70) who participated in the prospective Rafsanjan Cohort Study (RCS)-a city in the south-east of Iran-as one of the district areas of the PERSIAN cohort (Prospective Epidemiological Research Studies in IrAN). All procedures for interviews, anthropometric measurements and physical examinations, biological sample collection and laboratory tests for blood biochemical parameters were conducted according to the PERSIAN cohort protocol, and in the well-established RCS setting. Crude and adjusted multiple logistic regression analysis were conducted to assess the relationship of paternal regular opioid use with offspring's BMI status, and plasma lipid factors. The prevalence of fathers who use opioids regularly among the studied trios was 42.8% (360/840). Our regression analyses demonstrated that paternal opioid use started pre-fatherhood is associated with 76% higher adjusted odds ratio (OR) of overweight/obesity in young offspring (adjusted OR 1.76 (95% CI 1.15-2.71)), adjusting for sex, age, parental BMIs, paternal smoking status and socioeconomic status index (WSI). This relationship persisted when fathers who used opioid by routes other than inhaling (oral) were excluded from logistic analysis (adjusted OR 1.73 (95% CI 1.12-2.68)). Interestingly, sex stratified analysis displayed a 201% increased odds ratio of overweight/obesity in sons of fathers who use opioid regularly, started after child birth (Adjusted OR 3.01 (95% CI 1.68-5.39), while no significant association was found in daughters (adjusted OR 0.74 (95% CI 0.35-1.54)). Additionally, increasing exposure-response relationships were observed between odds ratios of overweight/obesity and the number of years of paternal opioid use after birth (p-trend = 0.0008). Paternal regular opioid use started pre-fatherhood was associated with 54% lowered risk of underweight [adjusted OR 0.46 (95% CI 0.24-0.86)]. Finally, paternal opioid consumption started either before or after child birth did not show a significant association with the high level of the three parameters of plasma lipid factors (triglyceride, cholesterol and HDL-cholesterol) in offspring. Our results suggest that the environmental impacts of paternal regular opioid use may be sufficient to make an effect on male offspring metabolism independent of genetic and epigenetic impact on gametes.

Smoking, alcohol and opioids effect on coronary microcirculation: an update overview.

Smoking, heavy alcohol drinking and drug abuse are detrimental lifestyle factors leading to loss of million years of healthy life annually. One of the major health complications caused by these substances is the development of cardiovascular diseases (CVD), which accounts for a significant proportion of substance-induced death. Smoking and excessive alcohol consumption are related to the higher risk of acute myocardial infarction. Similarly, opioid addiction, as one of the most commonly used substances worldwide, is associated with cardiac events such as ischemia and myocardial infarction (MI). As supported by many studies, coronary artery disease (CAD) is considered as a major cause for substance-induced cardiac events. Nonetheless, over the last three decades, a growing body of evidence indicates that a significant proportion of substance-induced cardiac ischemia or MI cases, do not manifest any signs of CAD. In the absence of CAD, the coronary microvascular dysfunction is believed to be the main underlying reason for CVD. To date, comprehensive literature reviews have been published on the clinicopathology of CAD caused by smoking and opioids, as well as macrovascular pathological features of the alcoholic cardiomyopathy. However, to the best of our knowledge there is no review article about the impact of these substances on the coronary microvascular network. Therefore, the present review will focus on the current understanding of the pathophysiological alterations in the coronary microcirculation triggered by smoking, alcohol and opioids.

Effect of opium consumption on cardiovascular diseases - a cross- sectional study based on data of Rafsanjan cohort study.

BACKGROUND: There are differences of opinion about the beneficial or detrimental effects of opium consumption on cardiovascular diseases (CVDs). So, we aimed to study the association between opium use and CVDs. METHODS: We used data obtained from the Rafsanjan Cohort Study (RCS), as a part of the prospective epidemiological research studies in IrAN (PERSIAN), with detailed, validated data on opium consumption and some other exposures. A total of 10,000 adults were enrolled in the study. Logistic regression models were used to assess the possible relationships of opium consumption with the prevalence of ischemic heart diseases (IHD) and myocardial infarction (MI). RESULTS: In this study, 9990 participants in the baseline phase of the Rafsanjan adult cohort study were included according to their completed questionnaire. Among all participants, 870 and 296 individuals were found to suffer from IHD and MI, respectively. Opium consumption was found to be relatively high in the RCS participants, especially in men (men = 2150 and women = 228). Opium use was associated with a higher odds of IHD and MI, with the adjusted odds ratios (95% CI) of 1.51 (1.22-1.86) and 1.79 (1.31-2.45), respectively. Also, dose-response increases were observed with the highest odds ratios in the 4th quartile for MI and IHD (p-values for trend < 0.001). Increased odds were observed for the two main methods of opium consumption, i.e. oral and smoking, but oral administration had higher odds ratio. CONCLUSIONS: Opium consumption is associated with the increased odds of both IHD and MI diseases.

The profile of Rafsanjan Cohort Study.

Owning the largest human-made jungle of pistachio, the second largest copper mine, and being located on the trade route of opium transit, distinguish Rafsanjan from many other cities in Iran. The environmental exposures and lifestyle factors associated with these characteristics of Rafsanjan, have raised concern about possible health outcomes for individuals living in and around this city. Thus, local health authorities initiated the Rafsanjan Cohort Study (RCS), as part of the prospective epidemiological research studies in IrAN (PERSIAN). RCS is a population-based prospective cohort of men and women aged 35-70 years, launched in August 2015. Individuals from diverse socioeconomic levels and lifestyles were recruited from four urban and suburban areas of Rafsanjan (participation rate 67.42%). Questionnaire-based interviews regarding demographics, dietary and environmental exposures, medical and occupational history, as well as anthropometric measurements were completed for all participants. Additionally, bio-specimens (blood, urine, hair, and nail) were collected, and dental and eye examinations were performed. The enrollment phase ended in December 2017, and a 15-year follow-up is planned. A total of 9990 individuals were enrolled in RCS (53.41% females). About 26% of men are pistachio farmers. The baseline prevalence of major non-communicable disease (NCD) risk factors such as cigarette smoking, alcohol consumption and opium use were 25.45%, 10.02%, and 23.81%, respectively. The mean ± SD of other common risk factors are as follows: body mass index (27.83 ± 4.89 mm Hg), systolic blood pressure (107.18 ± 17.56 mm Hg) diastolic blood pressure (71.13 ± 10.83), fasting blood sugar (113.27 ± 39.11 mg/dL) and plasma cholesterol (198.78 ± 41.89 mg/dL). These results indicate a concerning prevalence of NCD risk factors in Rafsanjan city, warranting further detailed investigations, particularly regarding the association of NDC with agricultural/industrial pollutants and drug abuse.