Clinico-epidemiological evaluation of pharmaceutical/non-pharmaceutical poisoning in a referral poisoning emergency in the Central part of Iran.

The pattern of poisoning varies in different societies. In this study, we investigated the clinical-epidemiological features and outcomes of poisoned patients based on the substances involved, whether pharmaceutical or non- pharmaceutical toxins. This cross-sectional study involved a retrospective chart review of all poisoned patients who presented to the poisoning emergency hospital in the center of Iran between January 2015 and December 2019. We collected data on socio-demographics, the nature of the poisoning, and the outcomes. Backward stepwise binary regression analysis was conducted to predict the mortality. Throughout the study period, 5777 patients with acute poisoning met the inclusion criteria. Of these, 3524 cases (61%) were attributed to pharmaceutical, and 2253 cases (39%) were due to non-pharmaceutical poisoning. The majority of pharmaceutical poisonings (82.9%) were intentional, whereas non-pharmaceutical poisonings accounted for 46.2% of intentional exposures (P < 0.001). Patients with non-pharmaceutical poisoning were predominantly men, older in age, and had a history of addiction compared to those with pharmaceutical poisoning (P < 0.001). In binary logistic regression analysis, patients poisoned by non-pharmaceutical substances had a significantly higher risk of mortality [Odds ratio, 3.14; (95% CI 1.39-7.10); P = 0.006] compared to those poisoned by pharmaceutical substances (P < 0.001). The pattern of poisoning differs in terms of age and gender when comparing pharmaceutical to non-pharmaceutical poisoning. Patients poisoned by non-pharmaceutical may have a worse outcome compared to those poisoned by pharmaceutical substances.

Toxico-clinical study of patients poisoned with household products; a two-year cross-sectional study.

BACKGROUND: Several studies worldwide have investigated household product poisoning. We conducted a toxico-clinical study on the two-year prevalence of poisoning with household products. METHODS: This cross-sectional study was performed in Khorshid Hospital, the main referral center for poisoning cases in Isfahan, affiliated to Isfahan University of Medical Sciences, Isfahan, central Iran. All patients with intentional or unintentional household substance poisoning, referring to the poisoning emergency center of the hospital, were evaluated with respect to epidemiological and toxico-clinical features and outcomes. RESULTS: During the study period, 5946 patients were hospitalized, of which 83 (1.39%) had been poisoned with household products including 48 (57.8%) men and 35 (42.2%) women with a mean ± SD age of 34.40 ± 17.71 years. Most patients (54.2%) were in the 20-40-year-old age group. Accidental poisoning (63.9%) was the most common type of exposure (P = 0.02) predominantly in men (57.8%, P = 0.51). The most common household products were sodium hypochlorite (32.53%) followed by petroleum hydrocarbon (21.68%). Most of the accidental poisonings (77.8%) were due to petroleum hydrocarbon. 59% of cases were poisoned at home (P < 0.0001). No patient died. CONCLUSION: Household products were not common means of poisoning in our referral center. Sodium hypochlorite and petroleum hydrocarbon were the most common substances. Most of the patients were men with accidental exposure at home. Because of the availability of the household product, the frequency and outcomes may be varied in different societies.

Gluten-free products in celiac disease: Nutritional and technological challenges and solutions.

In celiac patient exposure to even only a small amount of gluten can lead to malabsorption of some important nutrients including calcium, iron, folic acid, and fat-soluble vitamins because of small-intestine inflammation. A strictly followed gluten-free (GF) diet throughout the patient's lifetime is the only effective treatment for celiac disease; however, elimination of gluten from cereal-based product leads to many technological and nutritional problems. This report discusses different substitutes to replace gluten functionality and examines the economic and social impacts of adherence to a GF diet. Better knowledge about the molecular basis of this disorder has encouraged the search for new methods of patient treatment. The new and common GF sources and different challenges encountered in production and consumption of these products and different solutions for improving their properties are discussed in this review.

Determinants of life satisfaction in Iranian children and adolescents: the CASPIAN-IV study.

BACKGROUND: Life satisfaction (LS) in children and adolescents is important because of its effects on their school performance and the future adulthood life. In this multicentric study, we examined some determinants of LS in the pediatric age group. METHOD: This multicentric study was a part of the fourth national school-based surveillance program in Iran (2011-2012). It was conducted among 14,880 children and adolescents, aged 6-18 years, living in 30 provinces in Iran. We used the questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS), which was translated to Persian and validated in Iranian children and adolescents. LS was defined by a single question: 'Generally, which score between 0 (the worst) to 10 (the best) do you feel well describes your life at the moment?' The score of six and above was considered as satisfied. Multivariate logistic regression analysis was conducted to investigate the determinants of LS. RESULTS: In total, 13,486 students completed the study (response rate 90.6%). Overall, 86.7%, 78.19%, and 71.44 of students were satisfied with their life in elementary, middle, and high schools. Students in middle school (OR 0.83; 95% CI 0.73, 0.96) and high schools (OR 0.63; 95% CI 0.54, 0.72) were less satisfied with their life. Students with moderate (OR 1.36; 95% CI 1.20, 1.54) and good (OR 1.66; 95% CI 1.44, 1.91) socioeconomic status were more satisfied than those with low status. Those who consulted with one (OR 1.56; 95% CI 1.34, 1.81) or both (OR 2.22; 95% CI 1.89, 2.60) of their parents were more satisfied with their life. Students who felt being accepted by their peers were 1.34 (95% CI 1.18, 1.52) times more satisfied with their life. Other associated variables were weekly (OR 1.3; 95% CI 1.12, 1.572) or daily (OR 1.6; 95% CI 01.12, 1.57) fruit consumption, moderate (OR 1.14; 95% CI 1.01, 1.29) and high (OR 1.1; 95% CI 1.02, 1.347) physical activity, good self-rated health (OR 2.11; 95% CI 1.88, 2.37), and daily tooth brushing (OR 1.31; 95% CI 1.18, 1.46). Students with anxiety (OR 0.73; 95% CI 0.65, 0.82) and depression (OR 0.73; 95% CI 0.58, 0.74) were less satisfied with their life. CONCLUSION: Some demographic and lifestyle factors, including higher socioeconomic status, consultation with parents, healthy dietary, and physical activity habits, were associated with higher LS in children and adolescents. Then, interventions that focus on improving lifestyle factors and parents' support could increase LS among children and adolescents.

The association of socioeconomic status of family and living region with self-rated health and life satisfaction in children and adolescents: The CASPIAN-IV study.

Background: Socioeconomic status (SES) is a major determinant of health inequality in children and adolescents. The aim of this study was to evaluate the association of SES of family and living region with self-rated health (SRH) and life satisfaction (LS) among children and adolescents. Methods: This study was a part of the fourth survey of a national surveillance program, which was conducted in 30 provinces of Iran in 2011-2012. LS and SRH were assessed by a questionnaire based on the World Health Organization-Global School-based student Health Survey (WHO-GSHS). Family SES was estimated using principal component analysis (PCA) and based on family assets, parental education and occupation, and type of school. Region SES was calculated using PCA and some variables including literacy rate, family assets and employment rate. Results: Out of 14,880 invited students, 13,486 (participation rate: 90.6%) completed the survey; of whom, 49.2% were girls, and 75.6% were from urban areas with the mean ± SD age of 12.47±3.36 years. In the multivariate model, SES of family and living region was associated with LS and good SRH. In the full models, in addition to all potential confounders, family and living region SES were included simultaneously. However, only the association of family SES with LS, and good SRH remained statistically significant. Conclusion: The effect of families' SES on SRH and LS is more important than regional SES. The presented patterns of SRH and LS may be useful in developing better health policies and conducting complementary studies in this field.

Systematic review on the association of abdominal obesity in children and adolescents with cardio-metabolic risk factors.

BACKGROUND: The adverse health effects of abdominal obesity are well documented in adults, but such association remains to be determined in the pediatric age group. This study aims to perform a systematic review on the association between abdominal obesity and cardio-metabolic factors such as dyslipidemia, hypertension, and hyperglycemia among children and adolescents. MATERIALS AND METHODS: A systematic literature search was conducted using PubMed, Scopus and Google Scholar databases to May 2014. Two independent reviewers identified relevant papers in several steps. After studying the titles and texts of documents, repeated and irrelevant ones were excluded. The search was refined to the English language. We did not consider any time limitation. Studies with different measuring methods of abdominal obesity were included. Studies with abdominal obese patients secondary to other disease were excluded from the study. In final, the data of association of cardio-metabolic risk factors and abdominal obesity extracted from studies. RESULTS: Overall, 3966 articles were reviewed, and 61 of them were studied according to the inclusion and exclusion criteria. Waist circumference (WC), waist-to-height ratio, and waist-to-hip ratio were the most common indexes used for defining abdominal obesity. The association of high blood pressure with increasing WC was seen in several studies. The association of other cardio-metabolic risk factors was seen in some studies. CONCLUSION: Whatever the definition used for abdominal obesity and whatever the methods used for anthropometric measurements, central body fat deposition in children and adolescents increases the risk of cardio-metabolic risk factors. Therefore, more attention should be paid to abdominal obesity of children and adolescents both in clinical practice and in epidemiological studies.

Insulin and leptin levels in overweight and normal-weight Iranian adolescents: The CASPIAN-III study.

BACKGROUND: In this study, we aim to compare insulin and leptin levels in adolescents with or without excess weight and in those with or without abdominal obesity. MATERIALS AND METHODS: This case-control study was conducted among 486 samples. We randomly selected 243 overweight and an equal number of normal-weight adolescents from among participants of the third survey of a national surveillance program entitled Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable diseases study. Serum insulin and leptin were compared between two groups and their correlation was determined with other variables. RESULTS: The mean age and body mass index (BMI) of participants were 14.10 ± 2.82 years and 22.12 ± 6.49 kg/m(2), respectively. Leptin and insulin levels were higher in overweight than in normal-weight adolescents (P < 0.05). Leptin level was higher in children with abdominal obesity than in their other counterparts (P < 0.001). Leptin level was correlated with age, fasting blood glucose, BMI, and insulin level. CONCLUSION: Insulin and leptin levels were higher among overweight and obese children, which may reflect insulin and leptin-resistance. Given the complications of excess weight from early life, prevention and controlling childhood obesity should be considered as a health priority.

Systematic review and meta-analysis on the age-specific seroprevalence of hepatitis A in Iran.

BACKGROUND: Hepatitis A virus (HAV) is a major cause of acute viral hepatitis worldwide. Annual medical and work loss costs of hepatitis A are significant even in low-endemic countries. It is recommended that each country should collect and review the information needed to estimate its national burden of hepatitis A to provide evidence for health policy makers to implement appropriate and cost-effective preventive strategy for HAV infection. The objective of this study was to estimate accurate prevalence of HAV infection in Iran for best preventive measures. MATERIALS AND METHODS: MEDLINE, Institute of Scientific Information, Scopus, Iranmedex, Irandoc, Magiran and Scientific Information Database were searched. The seroprevalence of HAV were pooled by age, sex and residence using fixed and random effect models. RESULTS: Sixteen papers representing 11857 subjects were included. The overall HAV seroprevalence was 51% (confidence interval [CI] 95%: 50-52%) in fixed and 66% (95% CI: 50-79%) in random effects models. The prevalence was 32% (CI 95%: 11-63%) in less than 20, 50% (CI 95%: 24-75%) in 20-30, and 67% (CI 95%: 17-95%) in more than 30 years of age. The difference was not significant in gender or residence subgroups. CONCLUSION: HAV infection in Iran may be considered as low or very low. Therefore, targeted vaccination of high-risk groups and more improvement in environmental sanitation would be the best preventive measure.

Does naloxone prevent seizure in tramadol intoxicated patients?

BACKGROUND: Tramadol poisoning has increased in recent years. Seizure is one of the side-effects of tramadol toxicity. There is a controversy about possible preventive effect of naloxone in tramadol poisoning induced seizure. Therefore, this study was performed to compare seizure incidence in tramadol poisoning patients who received and did not receive naloxone, as an opioid antagonist. METHODS: This study involved prospective data collection followed by retrospective analysis on 104 tramadol poisoning patients who were admitted in a referral poisoning center. The incidences of seizure were compared between patients received naloxone and those did not. Outcome was considered as survived without or with complications and death. Logistic Regression analysis was used to determine the effects of different variables on seizure incidence. RESULTS: 70 (67.3%) of the patients were men. The mean age of the patients was 26.3 ± 9 years old. 18.3% of the patients received naloxone in their treatment period. Seizure incidence was significantly higher among tramadol poisoning patients who did not receive naloxone compare with those received naloxone (14.1% vs. 5.1%). Among different variable studied, age had a significant effect on predicting of seizure (odds ratio = 2.09; 95% of confidence interval: 1.82-2.26; P value, 0.004). CONCLUSIONS: Although the seizure incidence was lower in patients with tramadol poisoning who received naloxone, the logistic regression did not support the preventive effect of naloxone on seizure in tramadol poisoning cases.

Tooth brushing and cardiometabolic risk factors in adolescents: Is there an association? The CASPIAN-III study.

BACKGROUND: A growing body of evidence supports an association between oral health and cardiovascular diseases and diabetes in adults. This study aimed to investigate the relationship between tooth brushing frequency and cardiometabolic risk factors in adolescents. METHODS: This nationwide population-based study was conducted among 5258 Iranian students, aged 10-18 years, living in urban and rural areas of 27 provinces in Iran. The association of tooth brushing frequency was assessed with anthropometric indexes and cardiometabolic risk factors after adjustment for potential confounders. RESULTS: Higher frequency of tooth brushing was associated with lower mean levels of low-density lipoprotein cholesterol (LDL-C) in both genders (P < 0.0001) and lower frequency of elevated LDL-C in girls (P = 0.03). The frequency of elevated blood pressure decreased with higher tooth brushing frequency in boys (P = 0.03). After adjustment for many potential cofounders such as age, gender, anthropometric indexes, screen time, socioeconomic status, and family history of non-communicable diseases, participants who washed their teeth at least once a day had lower risk of high LDL-C and low high-density lipoprotein cholesterol (HDL-C) levels in comparison to those who reported lower frequency of tooth brushing; some different associations were observed among girls and boys. CONCLUSIONS: Our findings suggest an independent and protective role of teeth brushing frequency for some cardiometabolic risk factors in adolescents. Increasing both the general health awareness and improving oral health should be considered in primordial and primary prevention of non-communicable diseases.

Knowledge of Iranian general practitioners for acetaminophen dosing in children.

OBJECTIVE: This study aims to explore the knowledge of a randomly selected cohort of Iranian general practitioners (GPs) on the topic of acetaminophen dosing for fever in children. METHODS: In this cross-sectional study, which was conducted in March 2011 in Isfahan (Iran) 515 GPs who were practicing general family medicine were sent a self-administered 10-item questionnaire about the usage of acetaminophen for fever in pediatric patients. Questions were designed to evaluate the knowledge of GPs on acetaminophen dosing amount and interval for fever in children and were formatted as multiple choice answers. The questionnaire were face and content validated and checked for reliability before the study (Croanbach's alpha = 0.75) in two separate sample sets of the same population. RESULTS: 51.5% of questionnaires were returned and analyzed. 41.9% of the physicians gave doses different from the recommended dose (10-15 mg/kg every 4 hours). Only 23.8% of the physicians suggested true maximal daily dose of acetaminophen. 65.7% of the responders usually or always gave prescriptions for antipyretics and 8.7% did not routinely give parents instructions on the dosing of antipyretics. CONCLUSIONS: We found that some GPs do not strictly adhere to the dosing guidelines of acetaminophen, so intense clinical courses of pharmacology and rational usage of drugs and other relevant educational programs for medical students and practitioners seems to be necessary for the sake of safety of pediatric patients in Iran.

Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors?

OBJECTIVES: This study was conducted to assess the effectiveness of a simple office-based program for encouraging healthy lifestyle on controlling childhood obesity and associated cardiometabolic risk factors. METHODS: This non-randomized 24-week lifestyle modification trial was conducted among 457 obese children and adolescents, aged 2-18 years, who had at least one cardiometabolic risk factor in addition to obesity. This trial included three components of exercise, diet education and behavior modification, with all recommendations provided by a pediatrician, two general physicians and a nurse. Instead of strict inhibitory recommendations, healthier lifestyle was encouraged. RESULTS: Overall 448 (98.04%) of enrolled children completed the trial with a mean age of 9.6 ± 2.9 years. After the trial, the mean of anthropometric measures and cardiometabolic risk factors decreased significantly, the mean high-density lipoprotein cholesterol (HDL-C) increased significantly, and the prevalence of the metabolic syndrome decreased from 20.8% to 1.8%. Triglycerides, LDL-C, diastolic blood pressure and WC had the highest decrease in all age groups, with the most prominent changes in the 14-18-year age group. By each -1SD decline in BMI and WC, risk factors had significant improvement. CONCLUSION: Motivational office-based counseling can be effective in treatment of childhood obesity and its associated cardio-metabolic risk factors. Such approach can be implemented in the primary health care system; and can be of special concern in low- and middle-income countries with limited human and financial resources. We suggest that expanding the roles of non-physician clinicians such as nurse practitioners can help to increase the amount of time available for such services.

National plan of establishment and maintenance of the health management system in schools and grading for awarding stars.

INTRODUCTION: Addressing school health and safetyis an important public health issue. The aim of this study was to identify the status of safety and health (HSE) in Iranian schools, and to provide a monitoring and evaluation scoring system. MATERIAL AND METHODS: A 81-item checklist was applied to obtain data regarding the performance of HSE in 60 schools in five Iranian provinces to award health stars (15-level stars). In all provinces, inadequacies and limitations were documented in safety measures such as access to emergency exits, and the risk of firing. RESULTS AND DISCUSSION: By passing this pilot phase, now an agreement is signed between the Ministry of Health & Medical Education and the Ministry of Education & Training, and this plan is implemented as a national program in Iran for improvement of the safety in schools. We suggest that establishment and maintenance of the health management system in schools and ranking and granting stars to them is one of the most appropriate plans in this regard to be implemented in the region. CONCLUSION: An innovational plan is going to be executed for the first time in Iran and may be set forth as a successful pattern of institutionalization of health systematic and dynamic system in collective environments such as schools in the region.

Effects of three types of oil dispersants on biodegradation of dispersed crude oil in water surrounding two Persian gulf provinces.

OBJECTIVE: To determine the most effective and biodegradable dispersant of spilled oil in water surrounding two Persian Gulf provinces. METHODS: This study compared the effects of three dispersants, Pars 1, Pars 2, and Gamlen OD4000 on removal of oil in two Persian Gulf provinces' water. Overall, 16 stations were selected. Using the Well method, the growth rate of isolated bacteria and fungi was identified. To specify the growth rate of microorganisms and their usage of oil in the presence of the above-mentioned dispersants, as exclusive sources of carbon, the bacteria were grown in culture medium for 28 days at 120 rpm, 30°C, and their optical density was measured by spectrophotometry. Then, we tested biological oxygen demand (BOD) and chemical oxygen demand (COD) in microorganisms. RESULTS: The highest growth rate was documented for the growth of microorganisms on either Pars 1 or Pars 2 dispersants or their mixtures with oil. However, the culture having microorganisms grown on Pars 1 had higher BOD and COD than the other two dispersants (9200 and 16800 versus 500 and 960, P < 0.05). Mixture of oil and Pars 2 as well as oil and Pars 1 dispersants showed the highest BODs and CODs, respectively. In the Bahregan province, microorganisms grown on Pars 2 had maximum amount of BOD and COD in comparison with Pars 1 and Gamlen dispersants (7100 and 15200 versus 6000 and 10560, P < 0.05). CONCLUSION: Pars 1 and Pars 2 were the most effective dispersants with highest degradability comparing Gamlen. In each region, the most suitable compound for removing oil spill from offshores with least secondary contamination should be investigated.

The modifiable noncommunicable risk factors among an Iranian population.

Noncommunicable diseases (NCDs) are a major cause of morbidity and mortality in developing countries. Risk factors, such as hypertension, dyslipidemia, obesity and smoking play an important role in the high prevalence of NCDs. In this study we assessed the type and prevalence of NCD risk factors among an Iranian adult population. We conducted a cross sectional study of 500 men and 500 women, aged 15-65 years, selected by multi-stage random cluster sampling from urban areas of Isfahan, the second largest city in Iran. The prevalences of 8 risk factors were determined in this study: sedentary lifestyle (47.2%), overweight and obestity (body mass index > or = 25 kg/m2) (60.8%), hypertension (elevated systolic and/or diastolic blood pressure) (22%), low high density lipoprotein level (27.6%), high total cholesterol level (16.9%), high triglyceride level (22.1%) and high fasting blood sugar (7.6%). Sedentary life and overweight/obesity were common at all ages, especially among women. Given the high prevalence of NCD risk factors in the studied population, there is an urgent need for age-appropriate interventions to result in lifestyle changes to decrease the prevalence of NCD risk factors.

A study on lipid content and fatty acid of breast milk and its association with mother's diet composition.

INTRODUCTION: The aim of our study was to determine the content of fat and fatty acid composition of breast milk, and its association with the mother's diet. MATERIALS AND METHODS: This cross-sectional study was conducted among pregnant mothers who came to health care centers for last prenatal care in Isfahan, Iran. Eight to 72 hours after delivery, 2 to 5 ml of colostrum was collected by hand into tubes. They were kept in an ice box and sent within half an hour to the collaborating health centre for freezing at -20°C until analysis, which was performed at the laboratory of NNFTRI in Tehran. The milk samples were homogenized by Vortex (Heidolph Vortex Shaker REAX 1. 220 V. 30 W Germany) at 2400 rpm for 30 sec. RESULTS: The data of 86 out of 91 samples were complete. The mean maternal age and gestational age was 28.37 ± 5.55 years old and 38.7 ± 1.2 weeks, respectively. The content of fat was 2.17 ± 1.22 g/100 ml breast milk. Arachidonic acid (AA, 20:4n-6) and docosohexaanoic acid DHA (22:6n-3) made 0.8 ± 0.4% and 0.3 ± 0.2% of total fatty acids. Although the AA/DHA ratio in our study is suitable, but the content of DHA is nearly low. CONCLUSION: Dietary habits of women in reproductive age group should be improved, with special emphasis on the fatty acid content of breast milk. This may have long-term impact on health promotion and disease prevention.

Emergency contraception and the knowledge of community pharmacists in isfahan, iran.

OBJECTIVES: Emergency contraception (EC) is a special contraception method that prevents pregnancy after an unsafe sexual contact. Pharmacists, as the most available member of medical team have a unique role in patient education for appropriate use of contraceptive methods. In this study, we assessed the pharmacists' knowledge about emergency contraception. METHODS: A researcher made questionnaire was developed and used according to national guide line and electronic databanks. A group of experts and pharmacists validated the questionnaire. Reliability was measured by Half-Split Test. The questionnaires were filled by pharmacists. RESULTS: Average knowledge score were 8.12 ± 0.28 for women and 7.83 ± 0.31 for men (from a maximum of 15) which showed no significant difference between men and women (P = 0.492). There was no significant difference between pharmacists who had precipitated in continuing education programs and that of those who had not (P = 0.286). Scores of pharmacists who graduated 13 years ago or more did not significantly differ from others (P = 0.287). CONCLUSIONS: Because of low scores of pharmacist's knowledge about EC and the importance of unintended pregnancy prevention, its improvement is an urgent need. Regular and frequent continuing education programs could be one of the recommended interventions.

Timing of puberty in Iranian girls according to their living area: a national study.

BACKGROUND: This study aimed to compare the timing of puberty between various geographic locations and different ethnicities. METHODS: This national survey was conducted in 20 provinces in Iran. Healthy Iranian girls were selected from public schools using cluster random sampling. A total number of 30 clusters including 7493 girls, aged 6.0-20 years, were selected. In order to compare different areas, the national classification of the provinces based on climate, ethnicity, geographic locations, and socioeconomic variables were used. Accordingly, there are 11 regions in Iran. Analysis of variance was used to compare the mean ages of menarche, pubarche, and thelarche in different regions. RESULTS: Tehranian girls, with 11.99 ± 1.35 years (mean ± SD), had the lowest age of menarche which was statistically significantly. The second region with lowest age at menarche was Fars (12.40 ± 1.27 years). The mean age at breast bud stage (B2) was significantly lower in Ghazvin-Zanjan region (8.97 ± 1.45 years). In Fars region, the mean age at B2 stage of breast development (11.01 ± 1.88 years) was higher than other regions except for Mazendran-Guilan and Tehran-related cities. The mean age at public hair development at Tanner stage 2 (PH2) in Kordestan-Lorestan-Ilam region (10.70 ± 1.23 years) was significantly higher than other regions. CONCLUSIONS: We found significant differences in the age of pubertal stages of girls living in various regions with different ethnicity and geographic characteristics. Considering the impact of pubertal age on general health, more studies should be done about the lifestyle and environmental factors affecting the onset of puberty.

Double burden of nutritional disorders in young Iranian children: findings of a nationwide screening survey.

OBJECTIVE: To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry. DESIGN: Cross-sectional nationwide survey. SETTING: Mandatory national screening programme before entrance to elementary school in 2008 in Iran. SUBJECTS: All Iranian children entering public and private elementary schools. RESULTS: The study population comprised 862,433 children (48.4% girls, 77.2% urban resident). Overall, 6.5% of children had short stature, 19.1% were underweight, 12.8% were overweight and 3.4% were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces. CONCLUSIONS: The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children's growth.

Secular trends in the national prevalence of overweight and obesity during 2007-2009 in 6-year-old Iranian children.

BACKGROUND: This study aimed to determine the secular trends in the national prevalence of overweight and obesity among 6-year-old Iranian children, and to compare the results in Northern, Central and Southern parts of the country. METHODS: The data were collected as part of a routine and mandatory national screening program on children entering elementary schools in 2007, 2008 and 2009. RESULTS: The study population comprised 2,600,065 children including 862,433 in 2007, 782,244 in 2008 and 955,388 in 2009. Of total children 12.8%, 13.5% and 10.9% were overweight in 2007, 2008 and 2009, respectively (P > 0.05). The corresponding figures for obesity were 3.4%, 3.5% and 3.4%, respectively (P > 0.05). In all surveys, the prevalence of overweight was higher in Southern region than in the other two regions. P for trend was not significant for prevalence rates of overweight and obesity in any of the regions. CONCLUSIONS: To the best of our knowledge, this study was the first of its kind in presenting the nationwide trend of overweight and obesity in young children living in a developing country. It showed a considerably high prevalence of overweight and obesity, but with a constant rate in three years. The higher prevalence of overweight in Southern region than in Central and Northern regions might be related to the lower socioeconomic position of this population. At a very young age, children's lifestyle is more under control of parents. Primordial and primary prevention efforts against the overweight epidemic can be effective and shall be further strengthened.