The worldwide trend in diabetes awareness, treatment, and control from 1985 to 2022: a systematic review and meta-analysis of 233 population-representative studies.

Background: With the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels. Methods: In this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates. Results: A total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56-63) and ranged from 41% (25-57) in low-income countries to 68% (64-72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42-48) and varied from 37% (31-43) in lower-middle-income countries to 53% (47-59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12-20), which significantly improved and reached 22% (19-25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly. Conclusion: Despite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.

Association of dietary phytochemical index with cardiometabolic risk factors.

Objective(s): Cardio-metabolic risk factors are becoming a global health concern. To address this problem, one of the proposed ways is to focus on phytochemical-rich foods consumption. Therefore, we aimed to summarize the results of observational studies (cohorts, case-control, and cross-sectional) that investigated the association between dietary phytochemical index (PI) as a new index for evaluating phytochemical-rich food intake and various risk factors of cardio-metabolic disorders. Methods: We conducted a comprehensive systematic review through PubMed, Scopus, and Web of Science databases. The literature search was performed up to August 2021 with no publication year restriction on observational studies investigating the association between PI and cardiometabolic risk factors on adults and children. A random-effect meta-analysis was used. Results: Overall, 16 articles (cross-sectional, case-control, cohort) were eligible for this systematic review and 8 studies with 99771 participants were included in the meta-analysis. Random effect meta-analysis showed that adherence to higher dietary PI decrease the odds of abdominal obesity (OR: 0.73, 95% CI: 0.58, 0.88, I2: 84.90), generalized obesity (OR: 0.84, 95% CI: 0.69, 0.98, I2: 68.10), hypertriglyceridemia (OR: 0.81, 95% CI: 0.73, 0.89, I2: 0.00), hypertension (OR: 0.86, 95% CI: 0.73, 0.99, I2: 7.02), and MetS (OR: 0.79, 95% CI: 0.69, 0.88, I2: 84.90). However, results considering the associations between dietary PI with glycemic indices, and low high-density lipoprotein cholesterol (HDL-C) were not significant (p<0.05). Conclusion: Evidence showed adverse associations between dietary PI and some cardio-metabolic risk factors such as obesity, hypertriglyceridemia, hypertension and metabolic syndrome.

Association of periodontitis with lipid profile: an updated systematic review and meta-analysis.

Purpose: The aim of this updated version of the systematic review and meta-analysis was to assess the association of PD with lipid profile. Methods: A comprehensive literature search was done in electronic databases including PubMed, Web of Science, and Scopus until August 2021. Cross-sectional, case-control, and cohort studies investigating the relationship between PD and lipid profile were included. Screening, data extraction, and quality assessment were performed independently by two investigators. A random-effect model was used to pool the effect size. Odds ratio (OR) was used as effect size for the association of PD with Hyperlipidemia, and SMD was used for the association of PD with the mean level of lipid profile. Results: Overall, 34 documents met the inclusion criteria for this systematic review, and 31 were included for the meta-analysis. Sixteen studies were cross-sectional, 16 case-control, and two cohorts. Results of the random effect model showed that PD increased the odds of dyslipidemia by 15% (OR: 1.15, 95% CI: 1.04, 1.26). The Association of PD with low HDL, high LDL, hypertriglyceridemia, and hypercholesteremia was not statistically significant (P > 0.05). The mean level of HDL in patients with PD was significantly lower than in subjects without PD (SMD: -0.69, 95% CI: -1.11, -0.26). Moreover, the mean level of LDL, TC, TG in patients with PD was significantly higher than in subjects without PD (P < 0.05). Conclusions: This meta-analysis suggests that periodontitis is associated with an increased odds of dyslipidemia. Therefore, treating periodontitis may improve dyslipidemia, particularly HDL and triglyceride levels.

Effect of exercise training on nitric oxide and nitrate/nitrite (NOx) production: A systematic review and meta-analysis.

Background: Exercise and physical activity can improve circulation through various mechanisms, such as the increment of nitric oxide (NO) production, by affecting vascular endothelial nitric oxide synthase, and reducing reactive oxygen species (ROS). Although, theoretically, this mechanism is well known, studies in living subjects have made controversial findings regarding the association of NO production and its metabolites [nitrate/nitrite (NOx)] with physical activity. Hence, this systematic review and meta-analysis was designed to gather all these studies and evaluate the effects of exercise training, and physical activity duration and length on the mean change of serum/plasma NO and NOx. Method: We searched all available bibliographic electronic databases from inception through to May 2022 to include all randomized controlled trials (RCT) and quasi-experimental trials which assessed the effect of exercise and training on NO and NOx levels. Random-effects meta-analysis was used to pool the standardized mean difference (SMD) and 95% confidence interval (CI) of included RCT studies which assessed the effect of training. Stratified meta-analysis was performed according to the type of exercise (high-intensity interval training (HIIT), aerobic training (AT), the duration of exercise (≤8 and > 8 weeks), and length of exercise in each session ≥40 and 40 < minutes). Results: Overall, 15 and 10 studies were included in the systematic review and meta-analysis, respectively. According to the random-effects meta-analysis, exercise significantly increased the mean change of NO and NOx compared to control (SMD: 1.82, 95%CI: 1.14 to 2.49. In the stratified meta-analysis, the mean change of NO and NOx in the intervention group was significantly higher than in the control group in the AT (SMD: 1.36, 95%CI: 0.55-2.18), HIIT (SMD: 2.55, 95%CI: 1.14-3.96), duration of ≤8 (SMD: 2.29, 95%CI: 1.24-3.35) and > 8 weeks (SMD: 1.19, 95%CI: 0.52-1.86), length of ≥40 (SMD: 1.61, 95%CI: 1.04-2.18), and 40 < minutes in each session (SMD: 2.07, 95%CI: 0.79-3.35). Conclusion: The findings of this study indicate that, regardless of exercise duration, length, and type (AT or HIIT), exercise can significantly increase serum NO and NOx levels.

The mental health status of offshore oil platform workers during the COVID-19 pandemic.

Background: Previous studies indicated that offshore workers have a high level of work-related stress on an everyday basis. This study aims to assess the prevalence and determinants of mental health conditions in offshore oil platform workers during the COVID-19 pandemic. Methods: Workers of three oil and gas platforms were assessed in this cross-sectional study. Their mental status was evaluated by the Posttraumatic Stress Disorder (PTSD-8) questionnaire, and Depression Anxiety, Stress Scales (DASS) questionnaires. Furthermore, we assessed satisfaction with life (SWL) with a single question. Finally, multivariate logistic regression was used to determine the association of demographic and work-related variables with mental health outcomes. Results: Overall, 278 (Males:197, Females: 81) out of 315 invited workers with a mean age of 35.6 (SD: 7.2) years were included in this study using a random sampling method (participation rate: 88.2%). PTSD symptoms and Insomnia were observed in 9 (3.2%) and 138 (49.6%) of the participants, respectively. The prevalence of stress, anxiety, and depressive symptoms were 72 (25.9%), 70 (24.6%), and 85 (30.5%), respectively. Based on multivariable (adjusted) logistic regression analysis, women had significantly higher odds of stress and anxiety than men; those with an academic education were significantly more dissatisfied with their lives than those without an academic education. Conclusion: Our findings revealed a high prevalence of anxiety, depressive symptoms, and stress among offshore oil platformers during the COVID-19 pandemic, especially in women. Indicating that women and those with a higher education level in the oil platform work settings are more susceptible to stressors.

Association of single child family with subjective health complaints in children and adolescents.

The number of single-child families has been increasing across developing countries during the last decades. We aimed to examine the association between being a single child (SC) and subjective health complaints (SHCs) in Iranian children and adolescents. This study was conducted as a part of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V). This national survey included a total of 14,400 students 7-18 years and their parents from rural and urban areas in 30 provinces of Iran. Data on demographic characteristics, lifestyle variables, and SHCs were measured using the questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS). Multivariate logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for the association of being an SC with SHCs. Data on 14,151 participants were available for this study, of whom 7.7% (1092) were SCs. The most frequent SHCs were irritability (37.1%, 95%CI: 36.3-37.9%), feeling nervous 32.5%, 95% CI: (31.7-33.3%), and headache 24.3%, 95%CI: (23.6-25.0% ). In the multivariate model, being an SC significantly increased the odds of dizziness [adjusted OR (95% CI): 1.37(1.08-1.72)] and backache complaint [1.22(1.01-1.47)]. The association of being an SC with other SHCs (feeling low, irritability, feeling nervous, difficulty in getting to sleep, headache, stomachache) was not statistically significant (p value > 0.05). Our results suggest that being an SC may be associated with higher odds of dizziness and backache complaints.

Is non-high-density lipoprotein associated with metabolic syndrome? A systematic review and meta-analysis.

Introduction: Novel atherogenic lipid indices, including non-high-density lipoprotein cholesterol (non-HDL-C) which is calculated by subtracting the HDL-C value from the total cholesterol level, atherogenic index (ratio between triglycerides (TG) and HDL-C concentrations (TG/HDL-C)), and Diff-C (calculated by subtracting low-density lipoprotein (LDL-C) from non-HDL-C), have been known as valuable predictors of dyslipidemia and subsequent cardiovascular diseases. Previous studies have reported the potential association of novel atherogenic lipid indices with metabolic syndrome (MetS). This meta-analysis aimed to assess the pooled association of novel atherogenic lipid indices with MetS or its components. Methods: A systematic search was conducted through PubMed, Scopus, and Web of Science (WoS) databases from January 2000 until March 2021 to evaluate the association of novel atherogenic lipid indices, including non-HDL-C, atherogenic index, and the difference between non-HDL-C and LDL-C (Diff-C) with MetS. Observational studies were included without any language restriction. As exclusive studies evaluating the association of non-HDL-C with metabolic syndrome (MetS) were eligible to be included in quantitative analyses, a random-effect meta-analysis was performed to pool the odds ratios (ORs). A stratified meta-analysis was performed based on the definition of MetS [Adult Treatment Panel (ATP) and International Diabetes Federation (IDF)] and the studied population. Results: Overall, 318 studies were retrieved from an initial systematic search. After screening, 18 and five studies were included in the qualitative and quantitative syntheses, respectively. Qualitative synthesis revealed an association between non-HDL-C, Diff-C, and atherogenic index with MetS and its components. Stratified meta-analysis showed that an increased non-HDL-C level was associated with an increased odds of MetS based on ATP criteria (OR: 3.77, 95% CI: 2.14-5.39) and IDF criteria (OR: 2.71, 95% CI: 1.98-3.44) in adults (OR: 3.53, 95% CI: 2.29-4.78) and in children (OR: 2.27, 95% CI: 1.65-2.90). Conclusion: Novel atherogenic lipid indices, including atherogenic index, Diff-c, and non-HDL-C, are strongly associated with increased odds of MetS and its components. The indices could be considered as potential predictors of MetS and its components in clinical practice.

Association of Serum Retinol Concentrations With Metabolic Syndrome Components in Iranian Children and Adolescents: The CASPIAN-V Study.

Background: As a fat-soluble vitamin, vitamin A plays a crucial role in adipogenesis, lipolysis, insulin resistance, and obesity. However, it is still unclear whether they are associated with cardiometabolic risk factors in children and adolescents. The current study aimed to determine the association between serum retinol concentration and the cluster of metabolic syndrome components among children and adolescents. Methods: This nationwide cross-sectional study was performed on 2,518 students aged 7-18 years from the Childhood and Adolescence Surveillance and Prevention of Adult Non- communicable disease (CASPIAN-V) study. Students were selected via multistage cluster sampling method from 30 provinces of Iran in 2015. Multivariable logistic regression was used to assess the association of serum retinol concentration with metabolic syndrome (MetS) components. Results: Overall, the mean (SD) age of study participants was 12.16 (3.04) years, and 44.9% (n = 1,166) of them were girls. The mean serum retinol concentration was 1.48 ± 1.55 µmol/L and vitamin A deficiency was observed among 19.7% (95% CI: 18.2-21.3) of study subjects. The results of the logistic regression analysis showed that increasing serum retinol concentrations were associated with an increased likelihood of developing obesity (OR: 1.12, 95% CI: 1.04, 1.20), abdominal obesity (OR: 1.07, 95% CI: 1.01, 1.14), low high-density lipoprotein cholesterol (HDL-C) (OR: 1.10, 95% CI: 1.04, 1.16) and high fasting blood glucose (FBG) (OR: 1.21, 95% CI: 1.10, 1.35), whereas it was associated with a decreased odds of developing high blood pressure (OR: 0.82, 95% CI: 0.73, 0.93). Nevertheless, there was no statistically significant association between metabolic syndrome itself and retinol concentration (OR: 1.02, 95% CI: 0.88, 1.18). Conclusion: We found that serum retinol concentration was positively associated with metabolic syndrome components such as obesity, low HDL-C, and high FBG, but not with metabolic syndrome itself.

Association of short stature and obesity with cardio-metabolic risk factors in Iranian children and adolescents: the CASPIAN-V study.

PURPOSE: The object of the present study was to examine the relationship of short stature and obesity with cardio-metabolic risk factors in children and adolescents from Iran. METHODS: Present nationwide cross-sectional study was conducted as a part of the fifth survey of CASPIAN study on 7 to 18 years old children and adolescents from 30 provinces of Iran in 2015. Short stature and excess weight were defined as age and sex-specific height lower than 5th percentile and BMI higher than 85th percentile respectively. The multivariate logistic regression model was applied to assess the aim of the study. RESULTS: A total of 3844 children and adolescents (52.4%: boys, 72.2%: urban areas) with an average age of 12.45 ± 3.04 years were enrolled in this study. The prevalence of short stature, excess weight and combined-short stature and excess weight was estimated as 15.8%, 17.6% and 2.2%. Odds of abdominal obesity in children with only short stature (OR: 2.11, 95%CI: 1.59-2.80), only excess weight (OR: 17.38, 95%CI: 13.89-21.75) and combined-short stature and excess weight (OR: 22.83, 95%CI: 13.93-37.39) were higher than children with normal-height and weight. Moreover, odds of high BP and metabolic syndrome were further in the students with combined excess weight and short stature compared to the normal-height and weight group. CONCLUSION: We found that abdominal obesity, hypertension, and metabolic syndrome in short stature and obese children and adolescents were greater than those with normal-height and weight. Further prospective evaluations are required to clarify the association between short stature and cardio-metabolic risk factors.

Prevalence and determinants of vitamin D deficiency in Iranian children and adolescents: the CASPIAN-V study.

PURPOSE: To examine the prevalence and determinants of vitamin D deficiency in Iranian children and adolescents. METHODS: We used data from a national school-based surveillance program conducted among 7-18-year-old children and adolescents living in rural and urban areas in 30 provinces of Iran. Data on student's lifestyle, health behaviors, and health status was obtained through a validated questionnaire. Serum 25-hydroxy vitamin D (25-OH-D) level was measured by chemiluminescent immunoassay. Vitamin D deficiency was defined as serum 25-OH-D concentrations < 30 ng/ml. Determinants of vitamin D deficiency were identified using logistic regression analysis. RESULTS: Data of 2,596 participants were available for this study. Prevalence of vitamin D deficiency was 71.1 % (95 % Confidence interval (CI): 69.3-72.8 %), without significant difference between boys and girls (72.0 % vs. 70.1 %, respectively, p = 0.29). In the multivariate regression model, in both genders, those who reported having sun exposure for at least 30 min/day and those taking vitamin D supplementation had lower odds for vitamin D deficiency (all p values < 0.05). In boys, obesity increased the odds of vitamin D deficiency (adjusted OR, 95 % CI: 1.57, 1.08-2.27). The association of vitamin D deficiency with other demographic characteristics and food items was not statistically significant. CONCLUSIONS: This large population-based study revealed a high frequency of hypovitaminosis D in Iranian children and adolescents. Sun exposure for at least 30 min/day and taking vitamin D supplementation may reduce the risk of vitamin D deficiency.

Association of serum 25-hydroxyvitamin D concentration with anthropometric measures in children and adolescents: the CASPIAN-V study.

BACKGROUND: Serum 25-hydroxyvitamin D (25(OH)D) concentrations reflect vitamin D status, with deficiency implicated as an underlying factor for many adverse health effects. This study aims to analyze the association between vitamin D status and different anthropometric measures in a large pediatric population. METHODS: This nationwide cross-sectional study was conducted in 2019 in blood samples obtained from school students of 30 provinces in Iran. Participants were 2596 children and adolescents aged 7-18 years. Weight, height, waist circumference (WC), hip circumference (HC), neck circumference (NC), and wrist circumference (WrC) were measured. Body mass index (BMI) and waist-to-height ratio (W/HtR) were calculated. Serum 25(OH)D concentrations were measured using chemiluminescent immunoassay. RESULTS: Participants consisted of 55% boys, 71.3% urban inhabitants, with a mean (SD) age of 12.1 (3.0) years. Overall, vitamin D deficiency was documented in 10.6% of participants, insufficiency in 60.4%, and sufficiency in 29% of the population studied. The mean of BMI and WC was higher in the vitamin D deficient than in the vitamin D sufficient group (19.31 kg/m2 and 69.24 cm vs. 18.34 kg/m2 and 65.73 cm, respectively, P < 0.01). Multivariate linear regression models revealed a significant association of vitamin D insufficiency with WC and W/HtR (P < 0.05). Likewise, in the multivariate regression models, vitamin D deficiency was associated with BMI, WC, and W/HtR (P < 0.05). CONCLUSION: Our findings on the inverse association between vitamin D status and some anthropometric measures underscore the importance of providing vitamin D by fortification and supplementation programs of vitamin D for the pediatric population. LEVEL OF EVIDENCE: V.

Association of dietary behaviors, biochemical, and lifestyle factors with metabolic phenotypes of obesity in children and adolescents.

BACKGROUND AND AIMS: To examine the association of dietary behaviors, lifestyle, and biochemical factors with metabolic phenotypes of obesity among obese Iranian children and adolescents. METHODS: This cross-sectional study was conducted within the framework of the fifth phase of CASPIAN study. Of 3840 students aged 7-18 years of 30 Iranian provinces, 408 subjects were diagnosed as obese; they were divided into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) groups. Biochemical factors, anthropometric measures, dietary, and lifestyle habits were compared between groups. RESULTS: Of the 408 obese subjects, 68 (16.7%) were the MUO; the remaining 340 (84.3%) fall in the MHO group. The MUO group had significantly higher systolic and diastolic BPs, FBS, TG, ALT, anthropometric measures, and lower HDL levels than MHO groups (all p-value < 0.05). The frequency of high birth weight (> 4000 gr) was significantly higher in the MUO group than the MHO group (p-value: 0.04). A higher percentage of individuals with breastfeeding duration ≥ 6 month was found in the MUO group (95.5% (95% CI 86.1-98.6%)) compared to MHO group (85.7% (95% CI 80.4-89.7%)) (p-value = 0.04). Among dietary and lifestyle-related behaviors, only the frequency of salty snack consumption and eating food according to the parents' request was significantly higher in the MUO group than the MHO group (p-value < 0.05). CONCLUSION: Dietary habits and lifestyle factors may determine the obesity phenotypes in children and adolescents.

Association of Serum 25-Hydroxyvitamin D Level With Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study.

Background and Objective: Different metabolic phenotypes of obesity are related to cardiometabolic risk factors in children and adolescents. Vitamin D, as one important factor, could be related to different subgroups of metabolic obesity and might affect metabolic disorders. The purpose of this study was to evaluate the relationship between serum 25-hydroxyvitamin D concentration and subsets of metabolic phenotypes of obesity in children and adolescents. Methods: This nationwide cross-sectional study was conducted in the framework of the fifth survey of a national surveillance program, the CASPIAN study. Overall, 2,594 students aged 7-18 years were assessed for 25-hydroxyvitamin D status. Metabolic syndrome (MetS) was defined according to the ATP III criteria modified for the pediatric age group. Participants were classified into four metabolic phenotypes of obesity according to categories of the BMI and metabolic status: "metabolically healthy obese" (MHO), "metabolically non-healthy non-obese" (MNHNO), "metabolically non-healthy obese" (MNHO), and "metabolically healthy non-obese" (MHNO). Multinomial logistic regression analysis was performed for evaluating the association of 25-hydroxyvitamin D status with different metabolic phenotypes of obesity. Results: In this study, 85.2% of participants were classified as MHNO, 11.0 % as MHO, 2.5% as MNHNO, and 1.3% as MNHO. The frequency of hypovitaminosis D was more prevalent in MNHO (85.3%) than in other phenotypes (MHNO: 70%; MHO: 76.5%; MNHNO: 78.1%, respectively; p < 0.05). In the multivariate model, hypovitaminosis D significantly increased the odds of being MHO (OR: 1.46; 95% CI: 1.07-1.77) and MNHO (OR: 2.89; 1.05-8.31) compared to the healthy group. Likewise, in multivariate model, per each unit (ng/mL) increment in 25-hydroxyvitamin D concentration, the odds of MNHNO and MNHO decreased significantly by 7% (OR: 0.93; 0.91-0.96) and 6% (OR: 0.94; 0.91-0.98) respectively. Conclusion: Our results support the hypothesis that 25-hydroxyvitamin D concentration is associated with metabolic obesity phenotypes. Longitudinal studies are necessary to assess the clinical impacts of this finding.