Age at natural menopause and development of chronic diseases in the female population of Kharameh, Iran: A historical cohort study.

Background and Aims: Declines in estradiol levels after menopause have been reported to be associated with several health outcomes. This study aimed to determine the effect of age at natural menopause (ANM) on some of the most common chronic diseases. Methods: This historical cohort study was performed on 2636 postmenopausal women aged 40-70 years participating in phase one of the PERSIAN cohort study in Kharameh, Iran, during 2015-2017. The effect of early (<45 years), intermediate (45-53 years), and late menopause (>53 years) on chronic diseases such as hypertension, diabetes, ischemic heart diseases, stroke, thyroid diseases, and depression was assessed using classic logistic regression for diseases with an incidence rate of more than 10% and Firth's logistic regression for diseases with an incidence of less than this amount. Results: The mean age of women was 53.48 ± 8.59. Respectively, early and intermediate menopause was associated with ischemic heart disease (odds ratio [OR = 1.61, 95% confidence interval [CI]: 1.08-2.42; p = 0.020), (OR = 1.57, 95% CI: 1.13-2.21; p = 0.008) and thyroid diseases (OR = 3.10, 95% CI: 1.64-6.24; p < 0.001), (OR = 1.83, 95% CI: 1.02-3.57; p = 0.042). furthermore, early menopause was a risk factor for diabetes (OR = 1.46, 95% CI: 1.07-2.00; p = 0.018), depression (OR = 4.79, 95% CI: 2.20-11.79; p = <0.001) and stroke (OR = 3.00, 95% CI: 1.08-9.32; p = 0.034). Conclusions: In this study, women with diabetes, ischemic heart diseases, stroke, thyroid disorders, and depression had a younger ANM compared to their healthy counterparts. Therefore, applying appropriate strategies to postpone the age of menopause, can reduce the incidence of these types of chronic diseases.

Digital Screen Time and the Risk of Female Breast Cancer: A Retrospective Matched Case-Control Study.

Background: As the use of electronic devices such as mobile phones, tablets, and computers continues to rise globally, concerns have been raised about their potential impact on human health. Exposure to high energy visible (HEV) blue light, emitted from digital screens, particularly the so-called artificial light at night (ALAN), has been associated with adverse health effects, ranging from disruption of circadian rhythms to cancer. Breast cancer incidence rates are also increasing worldwide. Objective: This study aimed at finding a correlation between breast cancer and exposure to blue light from mobile phone. Material and Methods: In this retrospective matched case-control study, we aimed to investigate whether exposure to blue light from mobile phone screens is associated with an increased risk of female breast cancer. We interviewed 301 breast cancer patients (cases) and 294 controls using a standard questionnaire and performed multivariate analysis, chi-square, and Fisher's exact tests for data analysis. Results: Although heavy users in the case group of our study had a statistically significant higher mean 10-year cumulative exposure to digital screens compared to the control group (7089±14985 vs 4052±12515 hours, respectively, P=0.038), our study did not find a strong relationship between exposure to HEV and development of breast cancer. Conclusion: Our findings suggest that heavy exposure to HEV blue light emitted from mobile phone screens at night might constitute a risk factor for promoting the development of breast cancer, but further large-scale cohort studies are warranted.

Age at natural menopause and its determinants in female population of Kharameh cohort study: Comparison of regression, conditional tree and forests.

BACKGROUND: Natural menopause is defined as the permanent cessation of menstruation that occurs after 12 consecutive months of amenorrhea without any obvious pathological or physiological cause. The age of this phenomenon has been reported to be associated with several health outcomes. OBJECTIVES: This study aimed to estimate the Age at Natural Menopause (ANM) and to identify reproductive and demographic factors affecting ANM. METHODS: This cross-sectional, population-based study was conducted on 2517 post-menopausal women aged 40-70 years participating in the first phase of the PERSIAN cohort study of Kharameh, Iran, during 2014-2017. To more accurately detect the determinants of ANM, we applied multiple linear regression beside some machine learning algorithms including conditional tree, conditional forest, and random forest. Then, the fitness of these methods was compared using Mean Squared Error (MSE) and Pearson correlation coefficient. RESULTS: The mean±SD of ANM was 48.95±6.13. Both applied forests provided more accurate results and identified more predictors. However, according to the final comparison, the conditional forest was the most accurate method which recognized that more pregnancies, longer breastfeeding, Fars ethnicity, and urbanization have the greatest impact on later ANM. CONCLUSIONS: This study found a wide range of reproductive and demographic factors affecting ANM. Considering our findings in decision-making can reduce the complications related to this phenomenon and, consequently, improve the quality of life of post-menopausal women.

Kharameh cohort study (KHCS) on non-communicable diseases and preliminary findings of 3-year follow-up.

PURPOSE: The Kharameh cohort study (KHCS) is one branch of the 'Prospective Epidemiological Research Studies in Iran', located in the south of Iran. The enrolment phase of KHCS spanned from April 2015 to March 2017, during which urban and rural residents of Kharameh were enrolled in the study. KHCS aims to investigate the incidence of non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases and cancer, and its related risk factors in a 15-year follow-up. PARTICIPANTS: KHCS was designed to recruit 10 000 individuals aged 40-70 years old from both urban and rural areas of Kharameh. Thus, a total of 10 800 individuals aged 40-70 years of age were invited and, finally, 10 663 subjects were accepted to participate, with a participation rate of 98.7%. FINDINGS TO DATE: Of the 10 663 participants, 5944 (55.7%) were women, and 6801 (63.7%) were rural residents. The mean age of the participants was 51.9±8.2 years. 41.8% of the participants were aged 40-49, 35.2% were aged 50-59 and the remaining 23% were 60-70 years old. Until March 2020 (first 3 years of follow-up), the total number of patients diagnosed with NCDs was 1565. Hypertension, type 2 diabetes and acute ischaemic heart disease were the most common NCDs. Furthermore, the total number of deaths during the first 3 years of follow-up was 312, with cardiovascular diseases (38.7%) as the most common cause of death, followed by cerebrovascular diseases (11.8%) and cancer (16.2%). FUTURE PLANS: The remaining 12 years of follow-up will inevitably shed light on the genetic, lifestyle/socioeconomic status, and environmental risk and protective factors of NCDs.

Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran.

BACKGROUND: Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern. METHODS: We used the IROPICAN database in Iran and used multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer. RESULTS: We analyzed 717 cases and 3,477 controls and a subset of 215 patients and 2,145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 [95% confidence interval (CI), 0.69-1.20], we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR = 1.78; 95% CI, 1.16-2.72) compared with non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR = 2.25; 95% CI, 1.21-4.18) and for initiating waterpipe smoking at an age less than 20 (OR = 2.73; 95% CI, 1.11-6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR = 2.35; 95% CI, 1.24-4.42) than in current smokers (OR = 1.52; 95% CI, 0.72-3.15). All observed associations were consistently higher for urothelial histology. CONCLUSIONS: Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium. IMPACT: The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers. See related In the Spotlight, p. 461.

Opium use and risk of colorectal cancer: a multi-center case-referent study in Iran.

BACKGROUND: Opium use has been associated with an increased risk of cancers of the lung, oesophagus, and pancreas, and it was recently classified by the International Agency for Cancer Research as carcinogenic to humans. It is not clear whether opium also increases the risk of colorectal cancer (CRC). The aim of our study was to assess the association between various metrics of opium use and the risk of CRC. METHODS: This case-referent study from seven provinces in Iran comprised 848 CRC cases and 3215 referents. Data on opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure odds ratios (OR) adjusted for age, gender, province, marital status, family history of CRC-linked cancers, consumption of red meat, fruits and vegetables, body shape, occupational physical activity, and socioeconomic status. RESULTS: Regular opium consumption was not associated with the risk of CRC (OR 0.9, 95% confidence interval, CI: 0.7, 1.2) compared to subjects who never used opium. However, frequent opium use more than twice a day was associated with an increased risk of CRC compared to non-users of opium (OR: 2.0, 95% CI: 1.1, 3.8; p for quadratic trend 0.008). CONCLUSION: There seems to be no overall association between opium use and CRC, but the risk of CRC might be increased among persons who use opium many times a day.

Evaluation of the prevalence of asthma and chronic obstructive pulmonary disease among opium users, and cigarette smokers and comparison with normal population in Kharameh: a cross-sectional study.

BACKGROUND: Recent studies have suggested that opium use may increase mortality from pulmonary diseases. However, there are limited comprehensive studies regarding the prevalence of Asthma and Chronic Obstructive Pulmonary Disease (COPD) among tobacco and opium users has been published. We aimed to determine the prevalence of respiratory disease among tobacco and opium users. METHODS: This cross-sectional study of tobacco and opium users and matched controls was conducted in the Kharameh Cohort, Fars, Iran. The prevalence of COPD and asthma, along with the participants demographical and spirometry data were examined. RESULTS: The average age of participants was 57 ± 8 years. Never smokers had a significant higher BMI (26.6 vs. 24.8), FEV1 (91% vs. 82%) and FVC (96% vs. 88%) values compared to participants with a positive smoking status. There was a statistical difference in the prevalence of COPD, asthma, and asthma COPD overlap (ACO) based on the participants smoking status, with the highest prevalence among opium and cigarette smokers, followed by opium users alone. Based on multivariate analysis, higher age, lower BMI, lower education than under diploma, cigarette smoking and opium use were significantly correlated with higher COPD prevalence; while lower age, cigarette smoking and opium use were significantly correlated with higher asthma prevalence. Illiterate participants had a significantly higher prevalence of COPD (23.6%), asthma (22%), and ACO (7.9%) among the educational groups. Regarding the prevalence of asthma, the higher socio-economic group had the lowest prevalence. CONCLUSIONS: Opium and tobacco users had a significantly higher prevalence of respiratory diseases, along with lower lung function tests based on spirometry evaluation.

Investigating the trends of incidence rates of breast cancer in Southern Iran: a population based survey.

BACKGROUND: The overall incidence of breast cancer is different all over the world and even within a nation. The present study aims to investigate the stratum-specific incidence trends of breast cancer in southern Iran. METHODS: In this retrospective cohort study, the data of Fars Population-Based Cancer Registry was used during 2001-2018. New cancer cases with ICD-O-3 codes C50.0 to C50.9 were categorized based on age group, morphology, and topography. Age-specific incidence rates of breast cancer were calculated during 2001-2018. Annual overall and truncated age-standardized incidence rates and their 95% Confidence Intervals (CIs) were also calculated. Afterward, the Annual Percentage Changes (APCs) of the age-specific and age-standardized incidence rates of breast cancer during 2001-2018 were calculated using Joinpoint regression software. RESULTS: An increasing trend was observed in the incidence of breast cancer among women during 2001-2018 (APC of age-standardized incidence rates: 9.5 (95% CI: 7.5, 11.5)).However, the trend was increasing less during the recent years. The APC of age-standardized rates decreased from 15.03 (95% CI: 10.4, 19.8) in 2007 to 6.15(95% CI: 4.0, 8.4) in 2018. The most common morphology of breast cancer was invasive ductal carcinoma (77.3% in females and 75.1% in males) and its trend was similar to the general trend of different types of breast cancer. The most common site of breast cancer was the upper outer quadrant. Most breast cancer cases were female and males accounted for 2.45% of the cases. Among females, 40-55 was the most prevalent age group. CONCLUSION: The incidence of breast cancer among women living in southern Iran showed an increasing trend from 2001 to 2018. However, the rate of increase exhibited a milder slope during the more recent years. Based on the higher prevalence of breast cancer in the 40-55 age group observed in the present study, it offers valuable insight into the potential reduction of the breast cancer screening age from 50 to 40 years for healthy Iranian women. However, before implementing such a policy change, it is crucial to conduct additional studies that specifically examine the cost-effectiveness, as well as the potential benefits and risks associated with this alteration.

Investigating the relationship between liver enzymes and incidence of hypertension: A population-based cohort study in Kharameh, a city in the South of Iran.

Background and Aims: Hypertension and abnormal liver enzymes are common health issues that frequently coexist, and recent research has suggested a possible association between them, warranting further investigation. Therefore, the aim of this study is to explore the relationship between liver enzymes and hypertension. Methods: This prospective cohort study utilized data from the Kharameh cohort study, which is a branch of the Prospective Epidemiological Studies in Iran (PERSIAN) database. The study included 7710 participants aged between 40 and 70 years. Hypertension was defined in accordance with the European guidelines for hypertension management, and the association between liver enzymes and hypertension was modeled and predicted using Firth logistic regression. Results: This study investigated the association between liver enzymes and hypertension risk in a cohort of 7710 individuals aged 40-70 years. The results showed that higher levels of alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) were associated with an increased risk of hypertension, and this relationship remained significant even after adjusting for potential confounding factors. Additionally, separate analyses within age subgroups revealed a significant association between ALP concentration and high blood pressure in certain age ranges. Conclusion: The study demonstrated a significant association between high levels of ALT, GGT, and ALP and an increased risk of hypertension, regardless of other risk factors. These results suggest that monitoring liver enzymes, specifically ALT, GGT, and ALP, could serve as a useful tool to predict hypertension risk and identify individuals who could benefit from early intervention. Overall, these findings underscore the importance of monitoring liver function in preventing and managing hypertension.

Awareness, Treatment, and Control of Hypertension among 10663 Adults Based on the Baseline Data of the Kherameh Cohort Study.

Background: A comprehensive strategy to reduce the complications of hypertension (HTN) should include prevention approaches, such as increasing awareness, early diagnosis, and adequate treatment. The present study aimed to assess awareness, treatment, and control of HTN and their related factors in Kherameh, Iran. Methods: This cross-sectional study was performed on 10 663 individuals aged between 40 and 70 years using the Kherameh cohort data. HTN was defined as either systolic/diastolic blood pressure ≥140/90 mmHg or taking medications. Logistic regression was used to investigate the relationship between awareness, treatment, and control of HTN and demographic factors, comorbidities, and a family history of diseases. Results: Out of 10 663 participants, 4719 (44.3%) were men, and the average age of the participants was 51.94±8.27 years. The rates of the prevalence, awareness, treatment, and control of HTN were 27.7% (95% CI, 26.86 to 28.54), 80.3% (95% CI, 79.56 to 81.04), 78% (95% CI, 77.22 to 78.78), and 53.6% (95% CI, 52.66 to 54.54), respectively. Age, gender, body mass index, and cardiovascular disease were associated with all the dependent variables in the regression model. Additionally, occupation, diabetes, chronic diseases, a history of cardiovascular disease in first and second-degree relatives and a history of chronic diseases in second-degree relatives were related to all the dependent variables except for treatment. Conclusion: A high percentage of the patients were aware of their disease, but a smaller proportion were on medication. Consequently, about half the patients had blood pressure below 140/90 mmHg.

The association between ultra-processed foods and conventional markers of cardiovascular risk in an adult Iranian population.

BACKGROUND AND AIMS: According to the NOVA classification system, ultra-processed foods result from extensive industrial processing and use ingredients derived from food and non-food products, which can negatively impact on cardiovascular disease risk factors. Despite this, few studies have investigated UPFs in Middle Eastern populations regardless of high consumption in this region. METHODS AND RESULTS: This cross-sectional study was conducted on data from the Prospective Epidemiological Research Studies in Iran Kharemeh cohort (n = 6611). Food frequency questionnaires were assessed and the ratio of total UPFs energy/total energy intake was calculated. Data was categorized into tertiles of UPF consumption using the NOVA classification system. Kruskal-Wallis tests were used to assess differences in nutrient and food intakes between tertiles and logistic regression analysis was applied to assess the associations between UPFs and CVD risk factors. After adjustment for potential confounders the logistic regression analysis revealed significant positive relationships between intakes of UPFs and waist circumference (WC) (T2: OR; 1.34, 95% CI; 1.13-1.60 - T3: OR; 1.41, 95% CI; 1.18-1.69, P ˂0.001), low-density lipoprotein cholesterol (LDL-C) (T2: OR; 1.20, 95% CI; 1.05-1.37 - T3: OR; 1.27, 95% CI; 1.11-1.45, P ˂0.001), non-high-density lipoprotein cholesterol (non-HDL) (T2: OR; 1.21, 95% CI; 1.07-1.37 - T3: OR; 1.24, 95% CI; 1.10-1.41, P ˂0.001) and LDL-C to HDL-C ratio (T2: OR; 1.15, 95% CI; 1.02-1.31 - T3: OR; 1.21, 95% CI; 1.07-1.38, P = 0.002). CONCLUSION: The consumption of UPFs was positively associated with WC and atherogenic blood lipids. However, increased intakes of fiber and unsaturated fats were also found in those consuming more UPFs, which was not expected. These findings offer insights into an understudied population and warrant further research.

Socioeconomic Inequalities in Chronic Disease in Kharameh Cohort Study: A Population-Based Cross- Sectional Study in Southern Iran.

BACKGROUND: The trend of chronic diseases is increasing globally. Socioeconomic status (SES) is a major factor underlying many chronic diseases. This study was conducted to investigate the socioeconomic inequalities in distribution of chronic diseases in Iran, as a middle-income country. METHODS: This cross-sectional study was conducted using the baseline data of the Kharameh cohort study, that were collected between 2014 and 2016. The number of participants in this study was 10663 people in the age range of 35 to 70 years. Principal component analysis was used for calculating the SES of the people under study. In addition, we used concentration index and concentration curve to measure socioeconomic inequality in chronic disease. RESULTS: The mean age of 10,663 participants in our study was 52.15±8.22 years and the male to female ratio was 1.26. Recurrent headache (25.8%( and hypertension (23.5%) were the most prevalent diseases. The concentration index showed that the distribution of movement disorder, recurrent headaches and gastroesophageal reflux diseases is significantly concentrated among people with low SES, and obesity among people with high SES. The results of the analysis by gender were similar to the results seen in all participants. CONCLUSION: The findings of this study show that socioeconomic inequality is the cause of the concentration of non-communicable diseases among people with low socio-economic status. Therefore, health policy makers should pay special attention to identifying vulnerable subgroups and formulate strategic plans to reduce inequalities.

Cancer incidence in Southern Iran, 2015-2018: A population based study on cancer registry profile of Fars province.

Background and Aims: Cancer registry profiles provide an insight into the trend of cancer in a specific region. The present study aimed to report the cancer incidence in Fars during 2015-2018, based on the cancer registry of Fars province. Methods: The present population-based study electronically gathered new cancer patient's data from all pathology, radiology, radiotherapy, chemotherapy departments, and mortality data of Fars province. This electronic connection was first established in 2015, in Fars Cancer Registry database. After data gathering, all duplicated patients are removed from the database. The Fars Cancer Registry database includes data such as gender, age, cancer ICD-O code, and city from March 2015 to 2018. Furthermore, the death certificate only (DCO%) and microscopic verification (MV%) were calculated using SPSS software. Results: A total of 34,451 patients with cancer were registered in the Fars Cancer Registry database during these 4 years. Among these patients, 51.9% (n = 17,866) were male, and 48.1% (n = 16,585) were female. Furthermore, the mean age of patients with cancer was about 57.3 ± 19 (60.50 ± 19 in males, 53.86 ± 18 in females). In men, prostate, skin (non-melanoma), bladder, colon and rectum, and stomach are the most common cancers. Also, in women, breast, skin (non-melanoma), thyroid gland, colon and rectum, and uterus were the most common cancers in the studied population. Conclusion: Overall, breast, prostate, skin (non-melanoma), colon and rectum, and thyroid cancers were the most common cancers among the studied population. Healthcare decision-makers could make evidence-based policies to decrease cancer incidence based on the reported data.

Physical activity and metabolic syndrome: A population base study (forest and tree model algorithms).

BACKGROUND & AIM: Lifestyle changes, prominently low mobility in recent years, have increased the prevalence of metabolic syndrome (MetS), and cardiovascular disease risk. This study aimed to determine the relationship between physical activity and MetS using modern statistical methods in a population-based study. METHODS: The target population included 10,663 people aged 40-70 years in phase 1 of the Persian Kharameh cohort study conducted in 2017. The data used in this study had questions about physical activity, demographic, anthropometrics, blood pressure, and biochemical data. RESULTS: Participants who their activity was within the fourth quarter were 36% less likely to develop MetS than the participants in the first quarter. In the decision-Tree algorithm with all variables, physical activity was significant after gender and comorbidity. With a lack of comorbidities and physical activity less than 2338 Metabolic Equivalent of Task (MET) and age greater than 53 years, the probability was 26.7% for the male population. For the female population, if associated with comorbidities, a history of diabetes in first-degree relatives, or both, the chance of developing MetS was estimated to be 70.4%. In the decision-tree algorithm, 56.0% of the predictions for MetS were due to gender. After gender, the presence of comorbidities, age, occupation, family history of diabetes, place of residence, and physical activity was discovered as the essential variables in predicting and identifying factors associated with MetS, respectively. CONCLUSION: Modern statistical methods can be used in similar research due to better presentation of results in applied clinical laws. An essential approach for treating the syndrome and preventing its complications is a lifestyle change, including educating about physical activity and promoting it.

Incidence and risk factors of cardiovascular disease among population aged 40-70 years: a population-based cohort study in the South of Iran.

BACKGROUND: Cardiovascular diseases are the main cause of mortality in the world. This study aimed to estimate the incidence and identify the risk factors of these diseases. METHODS: This prospective cohort study was performed on 9442 individuals aged 40-70 years in Kharameh, a city in the South of Iran, in 2015-2022. The subjects were followed up for 4 years. The demographic information, behavioral habits, biological parameters, and history of some diseases were examined. The density incidence of cardiovascular disease was calculated. The log-rank test was calculated to assess the cardiovascular incidence difference between men and women. Simple and multiple Cox regression with Firth's bias reduction method were used to identify the predictors of cardiovascular disease. RESULTS: The mean ± SD age of the participants was 51.4 ± 8.04 years, and the density incidence was estimated at 1.9 cases per 100,000 person-day. The log-rank test showed that men had a higher risk of cardiovascular disease than women. The Fisher's exact test showed a statistically significant difference between the incidence of cardiovascular diseases in different age groups, education levels, diabetes, and hypertension in men and women. The results of multiple Cox regression revealed that with increasing age, the risk of developing CVDs increased. In addition, the risk of cardiovascular disease is higher in people with kidney disease (HRadj = 3.4, 95% CI 1.3 to 8.7), men (HRadj = 2.3, 95% CI 1.7 to 3.2), individuals with hypertension (HRadj = 1.6, 95% CI 1.3 to 2.1), diabetics (HRadj = 2.3, 95%c CI 1.8 to 2.9), and alcohol consumption (HRadj = 1.5, 95% CI 1.09 to 2.2). CONCLUSIONS: In the present study, diabetes, hypertension, age, male gender, and alcohol consumption were identified as the risk factors for cardiovascular diseases; three variables of diabetes, hypertension and alcohol consumption were among the modifiable risk factors, so if they were removed, the incidence of cardiovascular disease could greatly reduce. Therefore, it is necessary to develop strategies for appropriate interventions to remove these risk factors.

The effect of prehypertension and hypertension on the incidence of cardiovascular disease: A population-based cohort study in Kharameh, a city in the South of Iran.

Background and Aim: Prehypertension and hypertension are important risk factors for cardiovascular diseases. This study was carried out to evaluate the effect of prehypertension and hypertension on the development of cardiovascular diseases. Methods: This prospective cohort study was performed on 9442 people aged 40-70 in Kharameh, southern Iran. Individuals were divided into three groups: normal blood pressure (N = 5009), prehypertension (N = 2166), and hypertension (N = 2267). In this study, demographic data, disease histories, behavioral habits, and biological parameters were studied. At first, the incidence density was calculated. Then Firth's Cox regression models were used to investigate the association between prehypertension and hypertension with the incidence of cardiovascular diseases. Results: The incidence density in the three groups of individuals with normal blood pressure, prehypertension, and hypertension was 1.33, 2.02, and 3.29 cases per 100,000 person-days, respectively. The results of multiple Firth's Cox regression by controlling all factors showed that the risk of occurrence of cardiovascular disease in people with prehypertension was 1.33 times (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.01-1.73, p = 0.03) and those with hypertension were 1.85 times higher (HR = 1.77, 95% CI: 1.38-2.29, p < 0.0001) than the individuals with normal blood. Conclusion: Prehypertension and hypertension have played an independent role in the risk for developing cardiovascular diseases. Therefore, early detection of individuals with these factors and control of other risk factors in them can contribute to reducing the occurrence of cardiovascular diseases.

Plant-based diets could ameliorate the risk factors of cardiovascular diseases in adults with chronic diseases.

Adherence to plant-based diets is recommended to prevent and control chronic diseases. However, not all plant-based foods are healthy for this purpose. This study investigated the relationship between plant-based diets and risk factors for cardiovascular diseases (CVDs) in adults with chronic diseases. This cross-sectional study was performed on 3678 males and females (age range: 40-70 years) with chronic diseases who participated in the Kharameh cohort study. A validated semiquantitative food-frequency questionnaire was used to calculate the plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Lipid profile, fasting blood sugar (FBS), blood pressure, and anthropometric indices were measured. Multivariable-adjusted logistic regression analysis was performed to determine the association between plant-based diets and CVDs risk factors. Higher adherence to the PDI was inversely associated with the level of FBS (odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.33-0.53; p < .001). A significant decrease was observed for total cholesterol in those with higher adherence to hPDI (OR = 0.80; 95% CI: 0.65-0.98; p = .035). Additionally, the score of uPDI was positively related to FBS (OR = 1.23; 95% CI: 1.00-1.53; p = .01), total cholesterol (OR = 1.23; 95% CI: 1.01-1.49; p = .061), and low-density lipoprotein (OR = 1.39; 95% CI: 1.13-1.71; p = .009). It was concluded that adherence to PDI and hPDI was related to a lower level of FBS and total cholesterol, respectively. Moreover, the findings suggested that regular intake of the uPDI was correlated with some risk factors for CVDs in adults with chronic diseases.

A population-based study of obesity and its complications in southern Islamic Republic of Iran.

Background: General and central obesity are important risk factors for chronic diseases and health-related outcomes. Aims: We determined the prevalence of obesity and related complications among individuals aged 40-70 years in Kherameh, southern Islamic Republic of Iran. Methods: This cross-sectional study included 10 663 people aged 40-70 years who participated in the first phase of the Kherameh cohort study. Data were collected on demographic characteristics, history of chronic diseases, family history of diseases, and various clinical measures. We used multiple logistic regression analysis to establish the relationships between general and central obesity, and related complications. Results: Of the 10 663 participants, 17.9% had general obesity and 73.5% had central obesity. In people with general obesity, the odds of having the non-alcoholic fatty liver disease and cardiovascular disease were 3.10 times and 1.27 times higher than in individuals with normal weight, respectively. People with central obesity had higher odds of having other components of metabolic syndrome such as hypertension (OR: 2.87; 95% CI: 2.53-3.26), high triglyceride levels (OR: 1.71; 95% CI: 1.54-1.89), and low high-density lipoprotein cholesterol levels (OR: 1.53; 95% CI: 1.37-1.71) than those without central obesity. Conclusions: The study showed a high prevalence of general and central obesity and health-related effects, and its association with several comorbidities. Given the level of obesity-related complications found, primary and secondary prevention interventions are needed. The results may help health policymakers establish effective interventions to control obesity and related complications.

Opium use and risk of lung cancer: A multicenter case-control study in Iran.

Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.