The Relationships between Social Capital, Metabolic, and Behavioral Risk Factors of Non-Communicable Diseases: A Systematic Review.

Background: Contextual risk factors such as social capital have a vital role in affecting behavioral and biological risk factors of NCDs. We aimed to systematically identify the relationship between different aspects of social capital (SC) with metabolic, and behavioral risk factors of non-communicable diseases (NCDs). Methods: This is a systematic review. The period of study was 2000-2021. We searched the English international databases, i.e. PubMed/Medline, Scopus, and Web of Science. Studies that reported NCDs' metabolic and behavioral risk factors as independent variables, were excluded. We also included studies if they analyzed the association between SC and metabolic and behavioral risk factors of NCDs. Results: After the primary and quality appraisal process, 97 studies were entered in the final phase of the analysis. Five out of 18 studies reported an inverse association between SC and the level of alcohol drinking. Twenty-seven out of 32 studies reported a significant inverse association between SC and smoking and tobacco use, while only one study reported a significant positive association. Nine studies reported a significant inverse association between SC and high blood pressure. Three studies showed a significant inverse association between SC and diabetes. Seventeen studies indicated a significant positive association between SC and physical activity. Thirteen out of 17 studies reported a significant inverse association between SC, body mass index (BMI) and overweight. Conclusion: High SC, people's participation and interaction are vital in tackling NCDs. Evidence shows positive effects of SC on prevention, control and improvement of NCDs' metabolic and behavioral risk factors.

Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021.

The study aimed to estimate the prevalence of lipid abnormalities in Iranian adults by demographic characterization, geographical distribution, and associated risk factors using national and sub-national representative samples of the STEPs 2021 survey in Iran. In this population-based household survey, a total of 18,119 individuals aged over 25 years provided blood samples for biochemical analysis. Dyslipidemia was defined by the presence of at least one of the lipid abnormalities of hypertriglyceridemia (≥ 150 mg/dL), hypercholesterolemia (≥ 200 mg/dL), high LDL-C (≥ 130 mg/dL), and low HDL-C (< 50 mg/dL in women, < 40 mg/dL in men), or self-reported use of lipid-lowering medications. Mixed dyslipidemia was characterized as the coexistence of high LDL-C with at least one of the hypertriglyceridemia and low HDL-C. The prevalence of each lipid abnormality was determined by each population strata, and the determinants of abnormal lipid levels were identified using a multiple logistic regression model. The prevalence was 39.7% for hypertriglyceridemia, 21.2% for hypercholesterolemia, 16.4% for high LDL-C, 68.4% for low HDL-C, and 81.0% for dyslipidemia. Hypercholesterolemia and low HDL-C were more prevalent in women, and hypertriglyceridemia was more prevalent in men. The prevalence of dyslipidemia was higher in women (OR = 1.8), obese (OR = 2.8) and overweight (OR = 2.3) persons, those residents in urban areas (OR = 1.1), those with inappropriate physical activity (OR = 1.2), patients with diabetes (OR = 2.7) and hypertension (OR = 1.9), and participants with a history (OR = 1.6) or familial history of CVDs (OR = 1.2). Mixed dyslipidemia prevalence was 13.6% in women and 11.4% in men (P < 0.05). The prevalence of lipid abnormalities was highly heterogeneous among provinces, and East Azarbaijan with 85.3% (81.5-89.1) and Golestan with 68.5% (64.8-72.2) had the highest and lowest prevalence of dyslipidemia, respectively. Although the prevalence of high cholesterol and LDL-C had a descending trend in the 2016-2021 period, the prevalence of dyslipidemia remained unchanged. There are modifiable risk factors associated with dyslipidemia that can be targeted by the primary healthcare system. To modify these risk factors and promote metabolic health in the country, action plans should come to action through a multi-sectoral and collaborative approach.

Evaluation of the diabetes care cascade and compliance with WHO global coverage targets in Iran based on STEPS survey 2021.

This study aimed to investigate the diabetes mellitus (DM) and prediabetes epidemiology, care cascade, and compliance with global coverage targets. We recruited the results of the nationally representative Iran STEPS Survey 2021. Diabetes and prediabetes were two main outcomes. Diabetes awareness, treatment coverage, and glycemic control were calculated for all population with diabetes to investigate the care cascade. Four global coverage targets for diabetes developed by the World Health Organization were adopted to assess the DM diagnosis and control status. Among 18,119 participants, the national prevalence of DM and prediabetes were 14.2% (95% confidence interval 13.4-14.9) and 24.8% (23.9-25.7), respectively. The prevalence of DM treatment coverage was 65.0% (62.4-67.7), while the prevalence of good (HbA1C < 7%) glycemic control was 28.0% (25.0-31.0) among all individuals with diabetes. DM diagnosis and statin use statics were close to global targets (73.3% vs 80%, and 50.1% vs 60%); however, good glycemic control and strict blood pressure control statistics, were much way behind the goals (36.7% vs 80%, and 28.5% vs 80%). A major proportion of the Iranian population are affected by DM and prediabetes, and glycemic control is poorly achieved, indicating a sub-optimal care for diabetes and comorbidities like hypertension.

National and sub-national trends of salt intake in Iranians from 2000 to 2016: a systematic analysis.

BACKGROUND: One fifth of the global burden of cardiovascular diseases (CVDs) in 2017 was attributable to excessive salt intake. As a member of the World Health Organization (WHO), Iran has committed itself to a 30% reduction in salt intake by 2025. Evidence on the amount and trend of salt intake among the Iranian population at national and sub-national levels is scarce. This study aimed to estimate the Iranian population's salt intake during 2000-2016 at the national and sub-national levels, by sex and age groups. METHODS: Data on national and sub-national mean salt intake was obtained through systematically searching the literature and contacting the research studies' principal investigators. Data collected through various methods were harmonized using the cross-walk method. Bayesian hierarchical and spatio-temporal-age regression models and simulation analysis were used to estimate the mean salt intake and its uncertainty interval across sex, age, year, and province. RESULTS: National age-sex standardized mean salt intake decreased from 10·53 g/day (95% uncertainty interval [UI]: 10·2 to 10·9) in 2000 to 9·41 (9·2 to 10·6) in 2016 (percent change: - 9·8% [- 21·1-3·1]). The age-standardized mean salt intake in women had decreased from 9·8 g/day (95% UI: 9·0-10·6) in 2000 to 9·1 g/day (8·6-9·7) in 2016 (percent change: - 6·6% [- 19·0-7·9]). The same measure in men was 11·1 g/day in 2000 (95% UI: 10·3-11·8) and 9·7 g/day (9·1-10·2) in 2016 (percent change: - 12·7% [- 23·0 - -0·9]). Age-sex standardized mean salt intake at the sub-national level in 2016 varied from 8·0 (95% UI: 7·0-9·0) to 10·5 (10·0-11·1). The difference between the provinces with the highest and the lowest levels of salt intake in 2016 was 31·3%. CONCLUSION: Salt intake decreased in Iran from 2000 to 2016, while persistently exceeding the recommended values. This declining trend was more pronounced between 2010 and 2016, which might be attributed to Iran's compliance to WHO's Action Plan for reducing NCDs.

Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021.

BACKGROUND: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. METHODS: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. RESULTS: By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. CONCLUSION: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

The levels of BMI and patterns of obesity and overweight during the COVID-19 pandemic: Experience from the Iran STEPs 2021 survey.

Background: Obesity and its increasing burden have become an urgent health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the distribution of body mass index (BMI) levels and its association with metabolic and lifestyle risk factors in an Iranian adult population by sex, age, and geographical distribution. Methods: This study involves a national survey of noncommunicable disease risk factor surveillance (STEPs) in Iran. Through systematic random sampling, in compliance with safety considerations during the COVID-19 pandemic, of the 28,520 adults who gave voluntary consent and included in the study, 27,874 participants completed the questionnaires (step 1), 27,745 individuals were anthropometrically measured (step 2), and 18,119 individuals completed laboratory evaluation (step 3). Anthropometric measurements followed based on standard protocols and by using calibrated instruments. Results: In 2021, the national prevalence of normal weight, obesity, and overweight/obesity in ≥18-year-old Iranian adults was estimated at 33.61% (95% CI: 32.99-34.23), 24.96% (24.39-25.53), and 63.02% (62.39-63.65), respectively. Compared to women, Iranian men had a lower mean BMI [25.54 (24.95-26.13 vs. 27.6 (27.07-28.12) kg/m2] (p < 0.001). There was also a significant difference in the national prevalence rate of overweight/obesity [women: 66% (61-71), men: 53% (46-60) (p < 0.001)]. The prevalence of obesity was significantly higher in participants suffering from metabolic and lifestyle risk factors. The study of the geographical extent of obesity and overweight shows that compared to national levels, the highest prevalence of being underweight was seen in the southeastern provinces. On the other hand, the highest prevalence of obesity belonged to the northeastern and central provinces. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: The study reveals a significant difference between the prevalence of obesity in male and female participants and between different regions of the country. These findings will help policymakers, clinicians, and researchers to more accurately estimate the obesity/overweight problem and to implement more effective interventional programs to promote strategies of prevention and control of weight gain.

Non-communicable diseases' risk factors in Iran; a review of the present status and action plans.

Non-communicable Diseases (NCDs) are the leading causes of death globally, imposing a heavy burden on the healthcare systems, especially in low- and middle-income countries. Iran is a country in the Middle-East region with an aging population and changing disease risk factors, and now is facing NCDs as the major health problem of the country. Investigating NCDs' risk factors and tackling preventable ones is the main intervention to control their heavy burden. In this review, we discussed the most critical risk factors in Iran and the implemented programs and action plans to control them. A better knowledge on current status of risk factors and plans to tackle them, could help policymakers effectively rule policies and allocate resources to curb heavy burden of NCDs in Iran.

The Relationship between Food Insecurity and Risk of Overweight or Obesity in under 18 Years Individuals: A Systematic Review and Meta-Analysis.

OBJECTIVE: Food insecurit (FI) has been considered as reason for childhood and adolescent overweight/obesity (OW/OB). Hence, this study was undertaken to assess these relationships. DESIGN: Related articles were found by searching the Web of Science, Scopus, PubMed and Embase databases until October 2019. Odds ratio (OR) was analized by a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias. Data were available from 32 studies. The risk ratios of 139,762 participants were pooled from these articles for the meta-analysis. RESULTS: This study domenstrated that children and adolescents in food-insecure condition are not at risk of OW/OB (OR = 1.02 95% CI: 0.99, 1.05). However, subgroup analysis indicated that FI related with inhanced risk of OW/OB in adolescents living in developed countries (OR = 1.14; 95% CI: 1.02, 1.27). Other subgroup analysis indicated that severe FI increased the risk of OW/OB among adolescents (OR = 1.24 95% CI: 1.03-1.49). In addition, we found that lower economic development significantly decreased risk of OW/OB among under 6 year children (OR = 0.88; 95% CI: 0.84, 0.93). CONCLUSIONS: Our results showed that higher FI degrees were related with more risks of OW/OB among adolescents (12-18 years). Moreover, the country economic levels had effect on the association between FI and risk of OW/OB.

Is salt intake reduction a universal intervention for both normotensive and hypertensive people: a case from Iran STEPS survey 2016.

PURPOSE: There is a direct association between salt intake and blood pressure (BP), one of the main risk factors for CVDs. However, yet there has been a debate that how strong is this association in people with and without hypertension. This study was conducted to evaluate the magnitude of the association between salt intake and BP in hypertensive and normotensive population among a nationally representative population. METHODS: The study was conducted on a nationally representative sample of 18,635 Iranian adults aged 25 years and older who participated in the STEPS survey 2016 and provided urine sample. Salt intake was estimated through spot urine sample and Tanaka equation. Multiple linear regression model in survey data analysis was used to assess the independent effect of salt intake on BP. RESULTS: After adjusting for covariates, there was a significant association between salt intake and SBP in hypertensive (p < 0.001) and normotensive people (p < 0.001). In hypertensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.37 mmHg and 0.07 mmHg, respectively. Whereas in normotensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.26 mmHg and 0.05 mmHg, respectively. Moreover, there was a significant trend toward an increase of SBP across salt intake quartiles in both hypertensive (p < 0.001) and normotensive people (p = 0.002), though the slope was steeper in hypertensive than in normotensive people. CONCLUSIONS: The present study demonstrated that salt intake significantly increased SBP in both hypertensive and normotensive people, though the magnitude of this increase was greater in hypertensive people as compared with normotensive people.

Metabolically healthy status and BMI in relation to depression: A systematic review of observational studies.

AIM: Findings of association between metabolically healthy status and BMI and risk of depression are controversial. This study aimed to assess the relation between metabolically healthy status and BMI and depression. METHODS: All published studies up to 25 June 2018 were searched by using the databases of PubMed, ISI Web of Science, SCOPUS and Google Scholar and following key words were used: metabolically AND (healthy OR unhealthy OR benign) AND (overweight OR obes* OR "over weight") AND phenotype AND (depression OR depress* OR "depressive disorder"). RESULTS: After screening title and abstract and considering inclusion criteria, 5 studies were found to be included in our study. Metabolically unhealthy obesity was associated with 30%-83% increased risk of depression and metabolically unhealthy non-obesity was associated with 19%-60% increased risk of depression. Metabolically healthy obesity was not associated with the risk of depression in all studies. CONCLUSIONS: In conclusion, metabolically health status and BMI are associated with risk of depression. Metabolically unhealthy situation increased risk of depression greater than metabolically healthy status.

Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: A systematic review and meta-analysis.

OBJECTIVES: Classical ketogenic diet (KD) and modified Atkins diet (MAD) are two types of KD commonly used for the treatment of intractable epilepsy throughout the world. Studies have shown the efficacy of these diets. However, no systematic review and meta-analysis study has to date compared the efficacy of KD and MAD in a time trend. Therefore, the objectives of the present study were to compare the short-term and long-term efficacy of classical KD and MAD in children and adolescents with epilepsy and to determine the efficacy of classical KD and MAD at multiple time points and in a time trend. METHODS: Main electronic literature databases, including MEDLINE/PubMed, Web of Science, Scopus, and EMBASE, were searched in November 2016. Rate difference and random effects model were used to compare the efficacy of the classical KD and MAD. RESULTS: Overall, 70 studies were eligible for inclusion. Meta-analysis revealed a non-significant trend toward a higher efficacy of MAD at month-3 and month-6 (P > 0.05). In the classical KD group, the percentage of responder patients achieving ≥50% seizure reduction was 62, 60, 52, 42, and 46% at month-1, 3, 6, 12 and 24 and for the MAD group was 55, 47, 42, and 29% at month-1, 3, 6, and 12, respectively. DISCUSSION: Classical KD does not differ substantially from MAD in ≥50% and ≥90% reduction of seizure frequency at month-3 and month-6. Overall, the number of patients achieving seizure freedom increases over time.

Food insecurity and adult weight abnormality risk: a systematic review and meta-analysis.

PURPOSE: Research into the relationship between food insecurity and weight abnormality has yielded varied and contradictory results. Therefore, a systematic review and meta-analysis were carried out to examine the association between food insecurity and weight abnormality in adults. METHODS: Pertinent studies were identified by searching PubMed and Scopus databases, up to February 2018. Data were available from 31 studies. These studies were conducted in 14 different countries. The odds ratio of 115,993 individuals in these studies was pooled for the meta-analysis. RESULTS: The present meta-analysis showed that adults in food-insecure households are more at risk of obesity (OR 1.15, 95% CI 1.06-1.23). Subgroup analysis by gender also revealed that women had a higher risk of obesity compared to men in food-insecure households (OR 1.26, 95% CI 1.05-1.46). Furthermore, subgroup analysis by food insecurity level implied that a severe level of household food insecurity may be associated with a higher risk of underweight (49%) than overweight (37%) or obesity (29%) among adults. In addition, subgroup analysis revealed that with lower levels of national economic development, the risk of weight abnormality shifted from obesity to underweight. CONCLUSION: It seems that adults in food-insecure households, especially women, are at higher risk of obesity. The weight abnormality risk may increase with the intensification of the level of food insecurity. Also, the level of economic development is an important factor in the effects of food insecurity on weight status. However, due to the high heterogeneity among studies, the results should be interpreted with caution.

The prevalence, awareness, and treatment of lipid abnormalities in Iranian adults: Surveillance of risk factors of noncommunicable diseases in Iran 2016.

BACKGROUND: Hypercholesterolemia is one of the modifiable risk factors for atherosclerosis and cardiovascular diseases. Prevention and treatment of hypercholesterolemia and other lipid abnormalities require reliable data regarding the current prevalence of these abnormalities in the country. OBJECTIVE: This study aims to determine the current prevalence, awareness, and treatment of lipid abnormalities in Iran. METHODS: We planned to recruit 31,050 individuals who are 18 years old and above and take blood samples from individuals who are 25 years and above as representative sample at national and provincial levels in 2016. In practice, we recruited 21,293 Iranian adult aged more than 25 years through a systematic random sampling from 30 provinces of Iran. Sociodemographic, anthropometric, and lifestyle data and history of cardiometabolic diseases were gathered. Serum total cholesterol, high-density lipoprotein-cholesterol (HDL-C), triglyceride, low-density lipoprotein-cholesterol (LDL-C), and non-HDL-C were investigated. The prevalence of lipid abnormalities, awareness, treatment, and achievement to non-HDL-C and LDL-C goals were determined based on National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: In this representative Iranian adult population, 80.0% had at least one lipid abnormality, 69.2% had low HDL-C, 39.5% had high non-HDL-C, 28.0% had hypertriglyceridemia, and 26.7% hypercholesterolemia. Of those with hypercholesterolemia, 74.2% were aware of their lipid abnormality. Only 22.0% and 36.5% of the study population met the desired level of non-HDL-C and LDL-C, respectively. CONCLUSION: Low HDL-C is the main lipid abnormality in adult Iranian population. The majority of the population did not meet the desired level of non-HDL-C and LDL-C. Public health preventive policies should be made and implemented to better manage dyslipidemia.

Salt intake among Iranian population: the first national report on salt intake in Iran.

OBJECTIVE: In Iran, there has been no national report on salt intake based on laboratory measurements so far. Therefore, this study was conducted to measure salt intake among Iranian population at the national level. METHODS: In stepwise approach to conduct a surveillance survey 2016, 18 624 Iranian adults (25 years old and above), as a representative sample of Iranian adult population at national and subnational levels, underwent urine sodium measurement and were included in this study. The participants were recruited through a systematic random sampling from 30 provinces of Iran. For each individual, through a computer-assisted interview, a questionnaire on lifestyle risk factors was completed, all anthropometric indices were measured, and data on sodium of spot urine sample for all individuals and 24-h urine sample for a subsample were collected. To estimate the 24-h salt intake, common equations were used. RESULTS: In total, 97.66% of the population consumed at least 5 g of salt per day. In addition, in 41.20% of the population, the level of salt intake was at least two times higher than the level recommended by the WHO for adults. The mean of salt intake among Iranian population was 9.52 g/day (95% confidence interval: 9.48-9.56). CONCLUSION: The study showed that the consumption of salt among the Iranian population is higher than the level recommended by WHO. To reduce salt intake, it is necessary to adopt a combination of nationwide policies such as food reformulation and food labelling.

Efficacy of low glycemic index treatment in epileptic patients: a systematic review.

Low glycemic index treatment (LGIT) is one of the new kinds of ketogenic diet (KD), designed to simplify the implementation of the KD. To date, several studies have attempted to determine the efficacy of LGIT in patients with epilepsy; however, their results are debatable. This study aims to retrieve all the LGIT studies to shed light on LGIT efficacy in epileptic patients. Electronic literature databases including MEDLINE/PubMed, Web of Science, Scopus, EMBASE were searched in July 2017. Interventional or observational studies exploring the efficacy of LGIT were included in the study. The National Heart, Lung, and Blood Institute quality assessment tool was used for the quality assessment of included studies. Two hundred and eighteen records were retrieved through a literature search. Following the screening process, eight studies were included. According to the ratings of the quality assessment tool, four studies were classified as good and four were categorized as fair. The result of the current study reveals that LGIT has a beneficial effect in patients with intractable epilepsy. However, more high-quality studies are required to determine the efficacy of LGIT in patients with intractable epilepsy.