Prevalence study of clinical disorders in 6-year-old children across Iranian provinces: Findings of Iranian national health assessment survey

Objective: To assess the national prevalence of clinical disorders in 6-year-old Iranian children before school entry using a national health assessment survey. Materials and Methods: In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. Results: The study population consisted of 955388 children (48.5% girls and 76.1% urban). Of the whole children, 3.1% of the 6-year-old children had impaired vision. In addition, 1.2, 1.8, 1.4, 10, 10.9, 56.7, 0.7, 0.8 and 0.6% had color blindness, hearing impaired, speech disorder, height to age retardation, body mass index extremes, decayed teeth, having disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Conclusions: Our results confirmed that the prevalence of clinical disorders among 6-year-old children across Iranian provinces was not similar. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identify the reason for different distribution among provinces

Growth Disorders Among 6-Year-Old Iranian Children

Background: Sociodemographic factors are important determinants of weight disorders. National representative studies provide a view on this health problem at national and regional levels. Objectives: This study aimed to assess the distribution of growth disorders in terms of body mass index (BMI) and height in 6-year-old Iranian children using geographical information system (GIS). Materials and Methods: In this cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were examined in a mandatory national screening program in 2009. Descriptive analysis was used to calculate the prevalence of underweight, overweight, obesity, and short stature. Then, ArcGIS software was used to draw the figures. Results: The study population consisted of 955388 children (48.5% girls and 76.5% urban). Overall, 20% of children were underweight, and 14.3% had high BMI, consisted of 10.9% overweight and 3.4% obese. The corresponding figure for short stature was 6.6%; however, these growth disorders were not equally distributed across various provinces. Conclusions: Our results confirmed unequal distribution of BMI and height of 6-year-old children in Iran generally and in most of its provinces particularly. The differences among provinces cannot be fully explained by the socioeconomic pattern. These findings necessitate a comprehensive national policy with provincial evidence-based programs

First report on the validity of a continuous Metabolic Syndrome score as an indicator for Metabolic Syndrome in a national sample of paediatric population — the CASPIAN-III study

Wstęp: Celem pracy była ocena trafności ciągłego wskaźnika zespołu metabolicznego (cMetS) na próbie reprezentatywnej irańskich dziecioraz zidentyfikowanie zależnych od płci i wieku optymalnych wartości odcięcia wskaźnika cMetS związanych z zespołem metabolicznym.Materiał i metody: Badanie zostało przeprowadzone z udziałem 3254 uczniów w wieku od 10 do 18 lat. cMetS był ustalany poprzezzagregowanie residuów standaryzowanych względem wieku i płci następujących parametrów: obwodu w pasie (WC, waist circumference),średniego ciśnienia tętniczego (MAP, mean arterial pressure), stężenia glukozy, stężenia cholesterolu frakcji lipoprotein wysokiejgęstości (HDL-C, high density lipoprotein cholesterol) oraz stężenia triglicerydów (TG). W celu ustalenia optymalnych punktów odcięciadla przewidywania obecności zespołu metabolicznego na podstawie cMetS zastosowano analizę krzywej ROC (receiver operatingcharacteristic) z oszacowaniem czułości i swoistości zmiennych.Wyniki: Wykazano stopniowany związek między wskaźnikiem cMetS a liczbą czynników ryzyka. W przypadku obu płci zaobserwowanowyraźny wzrost średnich wartości wskaźnika cMetS wraz ze wzrostem liczby komponentów. Ogólna optymalna wartość odcięcia wskaźnikacMetS dla przewidywania obecności zespołu metabolicznego wyniosła 2,93 [czułość = 92%, swoistość = 91%, pole powierzchni podkrzywą = 0,96 (0,95–0,97)]. Wartość dla chłopców wyniosła w badaniu 2,97, a dla dziewcząt — 3,26.Wniosek: W przeprowadzonym badaniu ogólnokrajowym potwierdzono trafność wskaźnika cMetS w populacji irańskich dzieci. WskaźnikcMetS wydaje się odpowiednim wskaźnikiem do zastosowania w badaniach epidemiologicznych nad związkiem pomiędzy potencjalnymiczynnikami ryzyka a występowaniem zespołu metabolicznego w Iranie.Introduction: The aim of this study was to assess the validity of a continuous Metabolic Syndrome score (cMetS) in a nationally representativesample of Iranian children and to identify sex and age-specific optimal cut-off points of cMetS that are associated with MetS.Material and methods: This study was conducted among 3,254 schoolchildren aged 10–18 years. cMetS was derived by aggregating ageand sex-standardised residuals of waist circumference (WC), mean arterial pressure (MAP), glucose, high density lipoprotein-cholesterol(HDL-C) and triglycerides (TG). To determine the optimal cut-off points of cMetS for predicting MetS, receiver operator characteristic(ROC) curve analysis was used with an estimation of the variables’ sensitivity and specificity.Results: A graded relationship was documented between cMetS and the number of risk factors. Increasing mean values of cMetS with increasingnumbers of components were apparent for both genders. The overall optimal cMetS cut-off point for predicting the presence of MetS was 2.93 [sensitivity= 92%, specificity = 91%, area of the curve = 0.96 (0.95–0.97)]. The values for boys and girls were 2.97 and 3.26 respectively in the total study.Conclusion: This nationwide study confirmed the validity of the cMetS score in a population-based sample of Iranian children. cMetSappears to be an appropriate index for investigating the association between potential risk factors and MetS in epidemiological researchin Iran

Metabolic Syndrome and Cardiovascular Risk Factors in a National Sample of Adolescent Population in the Middle East and North Africa: The CASPIAN III Study

Objective. The present study was designed to investigate the prevalence of different combinations of the metabolic syndrome (MetS) risk factors among a nationally representative sample of adolescents in the Middle East and North Africa (MENA). Methods. The study sample, obtained as part of the third study of the school-based surveillance system entitled CASPIAN III, was representative of the Iranian adolescent population aged from 10 to 18 years. The prevalence of different components of MetS was studied and their discriminative value was assessed by receiver operating characteristic (ROC) curve analysis. Results. The study participants consisted of 5738 students (2875 girls) with mean age of 14.7±2.4 years) living in 23 provinces in Iran; 17.4% of participants were underweight and 17.7% were overweight or obese. Based on the criteria of the International Diabetes Federation for the adolescent age group, 24.2% of participants had one risk factor, 8.0% had two, 2.1% had three, and 0.3% had all the four components of MetS. Low HDL-C was the most common component (43.2% among the overweight/obese versus 34.9% of the normal-weight participants), whereas high blood pressure was the least common component. The prevalence of MetS was 15.4% in the overweight/obese participants, the corresponding figure was 1.8% for the normal-weight students, and 2.5% in the whole population studied. Overweight/obese subjects had a 9.68 increased odds of (95% CI: 6.65–14.09) the MetS compared to their normal-weight counterparts. For all the three risk factors, AUC ranged between 0.84 and 0.88, 0.83 and 0.87, and 0.86 and 0.89 in waist circumference, abdominal obesity, and BMI for boys and between 0.78 and 0.97, 0.67 and 0.93, and 0.82 and 0.96 for girls, respectively. Conclusion. The findings from this study provide alarming evidence-based data on the considerable prevalence of obesity, MetS, and CVD risk factors in the adolescent age group. These results are confirmatory evidence for the necessity of primordial/primary prevention of noncommunicable disease should be considered as a health priority in communities facing a double burden of nutritional disorders

Economic Inequality in Healthy and Junk Foods Consumption and its determinants in Children and Adolescents: the CASPIAN- IV Study

Background: Nutritional habits and its determinants, especially in children and adolescents have recently turned into the one of the major concerns of health researches. We examine the diet contribution inequality in according to socio-demographic factors, age, gender, physical activity and body image to alleviate this gap in Iranian children and adolescents. Materials and Methods: Study sample was comprised of 14,880 students aged 6-18 years who selected from urban and rural districts of 30 provinces of Iran via stratified multi-stage sampling method. A short food frequency questionnaire was used for estimating the food group consumption. The Blinder-Oaxaca method was applied to investigate the inequality in the prevalence of healthy and junk foods consumption between the first and fifth socio-economic status (SES) quintiles. Results: The frequency of healthy and junk foods consumption showed considerable differences between the SES quintiles. The highest differences were found in the frequency of fresh fruit (25.38%), vegetable (12.92%), and milk (10.74%) consumption, respectively. The daily consumption of vegetables, and fresh and dried fruits increased linearly by increasing the SES quintiles. The highest absolute difference was seen in the frequency of fresh fruit consumption between the bottom and top of the socioeconomic groups (SII value=-32%).  The estimated SII was statistically significant for the consumption of all healthy and junk foods except for fast foods and milk consumption. The estimated C index for consumption of healthy and junk foods was positive and negative, respectively. Conclusion: This study provides the considerable information on the consumption of healthy and junk foods and its determinants among Iranian children and adolescents for better programming, developing health policies, and future complementary analyses

Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study

Abstract Objectives: This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. Methods: This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6&#8211;18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. Results: Eating more frequently (&#8805;6 vs. &#8804;3) was found among students who were at younger age (11.91 vs. 13.29 years) (p < 0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57&#8211;0.79), 5 (OR: 0.74, CI: 0.62&#8211;0.87), and 6 (OR: 0.54, CI: 0.44&#8211;0.65) had lower odds of being obese compared to those who had EF &#8804; 3. Having EF of 4 (OR: 0.82, CI: 0.71&#8211;0.94), 5 (OR: 0.86, CI: 0.74&#8211;0.99), and &#8805;6 (OR: 0.73, CI: 0.63&#8211;0.85) was related to lower prevalence of abdominal adiposity. Conclusion: Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group

Prevalence of prehypertension and hypertension in a nationally representative sample of iranian children and adolescents: The CASPIAN-IV study

Background: The global health burden has faced toward non-communicable diseases (NCDs). It is suggested that adulthood blood pressure (BP) is tracked from childhood. This study aims to evaluate the mean BP and the prevalence of prehypertension and hypertension in the Iranian pediatric population. Methods: In a national survey as the 4 th phase of Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable diseases study and through random multistage cluster sampling, a national sample of Iranian school students, aged 6-18 years, were recruited. Data gathered by means of modified World Health Organization Global school-based student health survey questionnaire, a weight disorders determinants questionnaire and anthropometric and BP measurements. Prehypertension (HTN) was defined as BP equal or greater than 90 th age and sex specific percentile or ≥120/80 mmHg and HTN was defined as BP ≥95 th percentile. Results: A total of 13486 students entered the study (49.2% girls, 75.6% urban). Mean age of participants was 11.47 ΁ 3.36 years. A total rate of 4.17% (3.84-4.52 95% CI) for high systolic BP (SBP), 4.33% (3.99-4.68) for high diastolic BP (DBP) and 6.88% (6.45-7.32) for high SBP and/or DBP was depicted. Conclusions: The prevalence rate of high BP (pre-HTN together with HTN) is substantially high in this population. It is needed to study the causative situations and implement relevant interventions

Prevalence of Growth Disorders in a Nationally Representative Sample of Iranian Adolescents According to Socioeconomic Status: The CASPIAN-III Study

This study aims to assess the prevalence of growth disorders among a nationally representative sample of Iranian adolescents according to the socioeconomic status (SES) of their living area. Methods: This nationwide cross-sectional survey was conducted among a representative sample of 5624 adolescents aged 10–18 years. They were selected by multistage cluster sampling from 27 provinces of Iran. Subnational classification of the country was based on geography and social class of each region. Analysis of variance and Chi-square tests were used to compare the prevalence of growth disorders according to sex and SES of the living regions. Results: The mean and standard deviation for body mass index was 19.42 (4.09) kg/m2, with a significant trend from the Southeast region with lowest SES to the Central part with highest SES (ptrend < 0.001). The prevalence of obesity, combined overweight and obesity, as well as abdominal adiposity increased with a significant trend from low to high SES (all ptrend < 0.001, except for girls' height, ptrend = 0.003). The opposite direction was documented for the prevalence of underweight and short stature, with the highest frequencies in the Southeast (lowest SES) and the lowest in Central part (highest SES). Conclusion: Excess weight was more prevalent in high SES regions, whereas underweight and short stature were more prevalent in low SES regions. These findings underscore the necessity of implementing evidence-based health promotion programs and preventive strategies according to SES

RISK SCORING SYSTEM FOR PREDICTION OF ABDOMINAL OBESITY IN A NATIONAL SAMPLE OF YOUTHS: CASPIAN STUDY

Abstract &nbsp;&nbsp; BACKGROUND: Abdominal obesity is a predictor for many cardio-metabolic disorders in different age groups. The use of available information on factors associated with abdominal obesity has been proposed as an effective way of identifying at-risk individuals. To assess the effectiveness of a risk scoring system for abdominal obesity in a large and representative population of youths. &nbsp;&nbsp; METHODS: Waist-to-height ratio (WHtR) is an effective surrogate measure of abdominal obesity in children. This analysis was performed to find out the normal cut off value for WHtR by calculating the risk score. To develop a risk score to identify high-risk individuals for abdominal obesity, we analyzed data from a national survey, entitled CASPIAN Study, that was conducted on a nationally - representative sample of Iranian students aged 6-18 years. The risk equation was determined by a multiple logistic regression analysis, and Receiver Operator Characteristics (ROC) analysis was used to determine the cut-off value for the risk equation. &nbsp;&nbsp; RESULTS: The independent risk factors associated with abdominal obesity were living in rural area, attending public school, positive family history of diabetes and obesity in first and second degree relatives, lower mother&rsquo;s education level, number of household members; whereas physical activity decreased this risk. The area under curve (AUC) for the ROC was 63% (95% CI: 0.612, 0.643).A CASPIAN study population value&gt;=39 had optimum sensitivity (64%) and specificity (54%) for determining abdominal obesity score. &nbsp;&nbsp; CONCLUSION: This method can be helpful in screening and prevention of abdominal obesity by identifying those at-risk individuals in a timely manner. &nbsp; &nbsp;&nbsp; Keywords: Risk Score; abdominal obesity; prediction; children. &nbsp;</p

Association of hypertriglyceridemic-waist phenotype with liver enzymes and cardiometabolic risk factors in adolescents: the CASPIAN-III study

Abstract Objective This study aims to investigate the role of metabolic syndrome (MetS) and the hypertriglyceridemic-waist (HW) phenotype in determining cardiometabolic risk factors and elevated liver enzymes in a national sample of Iranian pediatric population. Method This nationwide study was conducted in the framework of the third survey of a surveillance program. Students, aged 10-18 years, were recruited from 27 provinces in Iran. The prevalence of cardiometabolic risk factors was compared in students with and without HW and MetS. The association of HW with different cardiometabolic risk factors was determined. Results The mean age of studied population was 14.73 ± 2.41 years. Prevalence of HW and MetS was 3.3% and 4%, respectively. Sixty-nine (71.1%) participants with HW had MetS. The prevalence of obesity, elevated systolic blood pressure, hypercholesterolemia, and elevated alanine aminotransaminase (ALT) was significantly higher in subjects with HW phenotype and MetS than in their peers (p < 0.05). A significant association was observed between HW and elevated levels of cholesterol and ALT, as well as between obesity and low HDL-C (p < 0.05). Conclusions The current findings serve as complementary evidence to previous studies, which have been mainly conducted among adults, suggesting that the HW phenotype is associated with cardiometabolic risk factors, especially with elevated cholesterol and ALT. The authors propose that, in primary care settings and in large epidemiological studies, the measurement of all MetS components can be replaced by studying HW as a screening tool for identifying children at high risk for cardiometabolic disorders