The relationship between ultraprocessed food consumption and obesity indicators in Iranian adults.

BACKGROUND AND AIMS: Food processing changes the nature of foods, and it is growing globally due to its availability and affordability and its effects on the palatability of foods. Consumption of ultraprocessed foods (UPFs) may adversely affect weight gain. The purpose of the current study is to examine the association between UPFs consumption and adiposity among Iranian adults. METHODS AND RESULTS: A cross-sectional study was conducted on 1459 Iranian adults (≥19 years). Dietary intakes were assessed using a validated 136-item food frequency questionnaire (FFQ), and foods were classified based on the NOVA system. Overweight, obesity, and abdominal obesity were defined as body mass index (BMI) ≥25 and < 30, ≥30, respectively, and waist circumference (WC) ≥91 for women and WC ≥ 89 for men. The odds of general and abdominal obesity across the quartiles of UPFs were assessed by binary logistic regression. UPFs consumption contributed to 20.17% of daily energy intake. After adjustment for potential confounders, UPFs consumption was not associated with general or abdominal obesity. However, in the fully adjusted model, men in the top quartile of UPFs were twice as likely to be overweight compared with those in the bottom quartile (OR = 2.06, 95% CI: 1.03, 4.10; P = 0.047). No association was found in women or stratified analysis by age. CONCLUSION: The present findings suggest a sex-specific association between UPFs consumption and overweight. UPFs consumption might be associated with an increased risk of overweight in men, but no such association was found in women. Future cohort studies are required to confirm these results.

Community-based cardiovascular disease prevention programmes and cardiovascular risk factors: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to summarise the effect of community-based intervention programmes on the prevention of cardiovascular disease (CVD) by reducing cardiometabolic risk factors. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A systematic search in the PubMed database and screening of reference lists aimed to identify community-based CVD prevention programmes from inception up to April 2020. The mean differences and standard deviations for CVD risk factors, including blood pressure, lipid profile, blood glucose and body weight indices, were extracted and pooled using a random effects model. RESULTS: Screening of 11,889 titles/abstracts and full texts resulted in 48 studies being included in this review. The meta-analysis showed that community-based programmes have led to considerable decreases in systolic blood pressure (weighted mean difference [WMD] = -2.90 mm Hg, 95% confidence interval [95% CI]: -3.63, -2.16), diastolic blood pressure (WMD = -2.21 mm Hg, 95% CI: -3.12, -1.29), serum levels of low-density lipoprotein cholesterol (LDL-C; WMD = -8.88 mg/dl, 95% CI: -12.84, -4.92), triglycerides (WMD = -8.40 mg/dl, 95% CI: -12.10, -4.70), total cholesterol (WMD = -2.96 mg/dl, 95% CI: -3.10, -2.81) and fasting blood glucose (WMD = -2.06 mg/dl, 95% CI: -3.02, -1.10). A moderate decrease in body weight was also found with community-based CVD prevention programmes. However, community-based CVD prevention programmes were not associated with any significant changes in serum levels of high-density lipoprotein. CONCLUSIONS: The present study indicates that community-based strategies have successfully led to an improvement in CVD risk factors, particularly by reducing blood pressure, serum levels of LDL-C and triglycerides, obesity indices and blood glucose. The impact of these programmes on CVD is modified by the type of intervention and by different cultural and physical environments.

Longitudinal association of metabolic syndrome and dietary patterns: A 13-year prospective population-based cohort study.

BACKGROUND AND AIMS: Diet is a potential factor contributing to the development of the Metabolic Syndrome (MetS). This longitudinal study with repeated measurements of dietary intake was thus conducted to examine the longitudinal association between major dietary patterns and risk of MetS. METHODS AND RESULTS: The study was conducted within the framework of the Isfahan Cohort Study (ICS), in which 1387 participants were followed from 2001 to 2013. Validated food frequency questionnaire, anthropometric measurements, blood pressure, fasting serum lipids and blood sugars were evaluated in three phases of the study. Mixed effect Logistic and Cumulative Logit regressions were applied to evaluate the longitudinal associations between dietary patterns change and MetS and number of MetS components. Three dietary patterns were identified: Healthy, Iranian and Western dietary patterns. After adjustment for potential confounders, the higher scores of Healthy diet were inversely associated with the risk of MetS and number of MetS components (OR: 0.50, 95% CI: 0.36-0.70, OR: 0.52, 95% CI: 0.39-0.70, respectively). The greater adherence to the Iranian diet was positively associated with the risk of MetS and number of MetS components (OR: 1.28, 95% CI: 1.01-1.65, OR: 1.45, 95% CI: 1.16-1.81, respectively). The Western dietary pattern did not show any significant associations. CONCLUSION: Adherence to a Healthy diet was associated with lower risk of MetS even in a developing country setting. However, the Iranian diet was positively associated with the risk of MetS. These results may guide the development of improved preventive nutrition interventions in this adult population.

Dietary patterns and mortality from cardiovascular disease: Isfahan Cohort Study.

BACKGROUND/OBJECTIVES: Evidence about the relation between dietary patterns and cardiovascular disease (CVD) is scarce in Middle Eastern countries. This study was performed to examine the association between major dietary patterns and CVD mortality in Iranian adults. SUBJECTS/METHODS: This population-based prospective cohort study was conducted among 4834 randomly selected participants aged ⩾35 years from urban and rural areas of central Iran (2001-2009) (the Isfahan Cohort Study). Dietary intakes were assessed using a food frequency questionnaire, and major dietary patterns were identified by means of exploratory factor analysis. Subjects or their next of kin were interviewed biannually looking for possible occurrence of events. Cardiovascular mortality was defined as fatal myocardial infarction, fatal stroke and sudden cardiac death. RESULTS: During the median follow-up of 9.0 years and 50 282 person-years, we found a total of 118 CVD mortalities. Four major dietary patterns were identified: 'Western', 'Mediterranean', 'Animal fat' and 'Fast food'. Adherence to the Mediterranean dietary pattern was protectively associated with CVD mortality, such that those in the highest quartile were 46% (hazard ratio (HR): 0.54; 95% confidence interval (CI): 0.32-0.91; P-value for trend=0.03) less likely to have incident CVD mortality than those in the lowest quartile. Further adjustment for potential confounders strengthened this association (HR: 0.42; 95% CI: 0.19-0.96; P-value for trend=0.02). We found no significant association between adherence to the Western, animal fat and fast food dietary patterns and CVD mortality. CONCLUSIONS: Adherence to a Mediterranean dietary pattern was associated with reduced risk for cardiovascular mortality even in a developing country setting.

Intake of legumes and the risk of cardiovascular disease: frailty modeling of a prospective cohort study in the Iranian middle-aged and older population.

BACKGROUND/OBJECTIVES: The purpose of this study was to explore the association of legume intake (beans, chickpeas, lentils and so on), as part of a low-glycemic index diet, with the risk of cardiovascular events in the Iranian middle- and old-aged people. SUBJECTS/METHODS: A total of 6504 subjects living in the three counties of Iran participated in the Isfahan Cohort Study. Totally, 6323 were free of cardiovascular disease (CVD) at their baseline examination. Of the 6323 individuals, 5398 participants remained in the study for 7 years of follow-up. They have been contacted every 2 years for possible occurrence of CVD events including fatal and non-fatal myocardial infarction, unstable angina, fatal and non-fatal stroke, and sudden cardiac death. The frequency of legume intake was estimated using a food frequency questionnaire. Cox proportional hazards models with shared gamma frailty terms were used to model time to event outcomes. RESULTS: After a median follow-up of 6.8 years, 427 cardiovascular events occurred. The intake of legumes in different tertiles of consuming measure was associated with 34% lower risk of CVD in old-aged people, after controlling for the other probable confounders (hazard ratio and 95% CI: 0.66 (0.45, 0.98), P-value=0.039). However, there was no significant association between the frequency of consuming legumes and CVD events in the middle-aged people. CONCLUSIONS: The present study indicated a strong inverse relationship between legume intake and the risk of cardiovascular events in old-aged Iranian people.

The relationship between nut consumption and blood pressure in an Iranian adult population: Isfahan Healthy Heart Program.

BACKGROUND AND AIMS: Few studies outside of Western countries have evaluated the relationship between consumption of nuts and blood pressure (BP). This study aimed to investigate the relationship between nut consumption and blood pressure in an Iranian adult population. METHODS AND RESULTS: We performed a cross-sectional investigation among 9660 randomly selected Iranian adults, sampled to represent three large Iranian regions, using data collected in the Isfahan Healthy Heart Program in 2007. The frequency of nut consumption was assessed by a food frequency questionnaire. Systolic and diastolic BPs (SBP and DBP) were measured in duplicate by trained personnel using a standard protocol. Multiple linear and logistic regressions were applied to assess the relationship between nut intake and BP levels and the presence of hypertension as SBP ≥ 140 mmHg, and/or a DBP ≥ 90 mmHg and/or current use of at least one type of anti-hypertensive medication. Those with nut consumption ≥4 times/week showed less mean of BPs and hypertension prevalence, compared to those who consumed nuts <1 times/week (p < 0.001). Compared to no consumption, consuming nuts ≥4 times/week was associated with a 34% lower prevalence of hypertension (multivariate odds ratio (OR) = 0.66; confidence interval (CI) = 0.51-0.87; p for trend = 0.009). CONCLUSIONS: More frequent nut consumption is associated with lower BP and lower risk of hypertension among Iranian adults.

The relationship between nut consumption and lipid profile among the Iranian adult population; Isfahan Healthy Heart Program.

BACKGROUND/OBJECTIVE: The study was carried out to assess the relationship between nut consumption and lipid profile among Iranian adults. SUBJECT/METHODS: The study was based on data from the Isfahan Healthy Heart Program across three counties in central Iran in 2007. A cross-sectional survey of 9660 randomly selected adults aged ≥ 19 years were chosen based on sex, age and settlement distributions in each community. Nutritional behaviors were assessed by validated qualitative 48-item food frequency questionnaires, which covered regular intakes of four types of nuts: walnuts, almonds, pistachios and hazelnuts. Analysis of covariance and logistic regression tests were utilized to determine odds ratio (OR) 95% confidence interval of hyperlipidemia according to nut consumption patterns in unadjusted and three-adjusted models. RESULTS: The results showed a significant link between high nut consumption and lower total cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) levels and apo B/apo A ratio (P<0.05) in female subjects and lower TG, LDL-C and apoB/apoA ratio in male subjects (P<0.05). The frequency of nut consumption was inversely associated with dyslipidemia, especially for those who had consumed nuts ≥ 4 times weekly (0.67 (0.57-0.79)). After adjusting for sex, age and other potential confounders, ORs increased enormously. Except for low apo A and high LDL-C, more frequent nut consumption (4 ≤ times per week) had a significant inverse effect on other dyslipidemia risk factors in all four models. CONCLUSIONS: We concluded that frequent consumption of nuts, particularly ≥ 4 times a week, may result in lower dyslipidemia occurrences and may exert cardioprotective effects.

The Isfahan cohort study: rationale, methods and main findings.

A 10-year longitudinal population-based study, entitled the Isfahan Cohort Study (ICS) is being conducted. The ICS commenced in 2001, recruiting individuals aged 35+ living in urban and rural areas of three counties in central Iran, to determine the individual and combined impact of various risk factors on the incidence of cardiovascular events. After 24379 person-years of follow-up with a median follow-up of 4.8 years, we documented 219 incident cases of ischemic heart disease (IHD) (125 in men and 94 in women) and 57 incident cases of stroke (28 in men and 29 in women). The absolute risk of IHD was 8.9 (7.8-10.2) per 1000 person-years for all participants, 10.6 (8.8-12.5) per 1000 person-years for men and 7.4 (6.0-9.0) per 1000 person-years for women. The respective risk of ischemic stroke was 2.3 (1.7-3.0), 2.3 (1.6-3.3) and 2.3 (1.5-3.2) per 1000 person-years. The risk of IHD was approximately 3.5-fold higher in the presence of hypertension, followed by diabetes mellitus and hypercholesterolemia with near 2.5- and twofold higher risk, respectively. This cohort provides confirmatory evidence of the ethnic differences in the magnitude of the impact of various risk factors on cardiovascular events. The differences may be due to varying absolute risk levels among populations and the existing ethnic disparities for using western risk equations to local requirements.

Clustering of coronary artery disease risk factors in patients with type 2 diabetes and impaired glucose tolerance.

A cross-sectional study in Isfahan city, Islamic Republic of Iran, compared the frequency of coronary artery disease risk factors in known and newly diagnosed diabetic patients and individuals with impaired glucose tolerance (IGT) with normal individuals. The prevalence of known cases of diabetes, new cases of diabetes and cases with IGT in the general population sample of 3940 were 4.3%, 1.1%, and 6.2% respectively. The frequency of dyslipidaemia was significantly different comparing diabetics and normal individuals. There was a significantly higher prevalence of risk factors (i.e. increased body mass index or waist circumference accompanied by dyslipidaemia) in the female population. The study highlights the importance of defining strategies for prevention and early diagnosis of diabetes in the community.

Clustering of coronary artery disease risk factors in patients with type 2 diabetes and impaired glucose tolerance

A cross-sectional study in Isfahan city, Islamic Republic of Iran, compared the frequency of coronary artery disease risk factors in known and newly diagnosed diabetic patients and individuals with impaired glucose tolerance [IGT] with normal individuals. The prevalence of known cases of diabetes, new cases of diabetes and cases with IGT in the general population sample of 3940 were 4.3%, 1.1%, and 6.2% respectively. The frequency of dyslipidaemia was significantly different comparing diabetics and normal individuals. There was a significantly higher prevalence of risk factors [i.e. increased body mass index or waist circumference accompanied by dyslipidaemia] in the female population. The study highlights the importance of defining strategies for prevention and early diagnosis of diabetes in the community

Antihypertensive and antihyperlipidemic effects of Achillea wilhelmsii.

Achillea wilhelmsii C. Koch (Asteraceae) is widely found in different parts of Iran. This plant is full of flavonoids and sesquiterpene lactones, which have been shown to be effective in lowering blood lipids and hypertension. We conducted a double-blind placebo controlled clinical trial to study the antihyperlipidemic and antihypertensive effects of Achillea drops. We randomly selected 120 men and women, aged 40-60 years, and divided them in two distinct groups of moderate hyperlipidemic and primary hypertensive subjects. They were treated either with hydroalcoholic extract or with placebo in the form of 15-20 drops twice daily for more than 6 months. Blood pressure and serum lipids (total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol) were measured in the groups for 3 periods of 2 months each. The mean and standard deviation of alternations in these variables between the group taking placebo and that taking drugs was calculated by Student's t-test. The results showed a significant decrease in triglycerides after of 2 months while decreases in triglycerides, total cholesterol and LDL-cholesterol were significant after 4 months. Levels of HDL-cholesterol were significantly increased after 6 months' treatment. A significant decrease was observed in diastolic and systolic blood pressure after 2 and 6 months, respectively (p < 0.05).