The association between metabolic syndrome and its components with systemic lupus erythematosus: a comprehensive systematic review and meta-analysis of observational studies

Objectives: Based upon inflammatory-related factors in chronic systemic lupus erythematosus (SLE), as well as the long-term prescription of corticosteroids, metabolic syndrome (MetS) prevalence is expected to be higher in SLE patients than among those without SLE. The aim of this study was to systematically analyze: (1) the worldwide prevalence of MetS in patients with SLE using different criteria, (2) the risk of MetS in patients with SLE compared with those without SLE, and (3) the risk of MetS component in patients with SLE compared with healthy controls. Methods: We searched international databases, such as: Web of Science, Medline, PubMed, Scopus, Embase, CABI, CINAHL, DOAJ and Google Scholar. The articles which reported the prevalence of MetS in SLE patients, between 2006 and 2017, were included in the study if they had a: clear study design, study time and location, sound sampling approach and appropriate statistical analyses. Studies without sufficient data to determine the prevalence of MetS were excluded. Also, studies in patients suffering from other clinical diseases were not included. Results: The meta-analyses of the prevalence (40 studies (n = 6085)) and risk (20 studies (n = 2348)) of MetS in SLE patients were conducted separately. The pooled prevalence of MetS among SLE patients was found to be 26 (95 confidence interval (CI): 22-30), but varied from 18 (95 CI: 11-25) to 34 (95 CI: 25-42), depending upon the diagnostic criteria used. The overall pooled odds ratio (OR) of MetS in SLE patients, compared with healthy controls, was (OR = 2.50; 95 CI: 1.86-3.35), but this ranged from (OR = 1.23; 95 CI: 0.61-2.49) to (OR = 10.71; 95 CI: 1.33-86.48), depending upon the criteria used. Also, the risk of high fasting blood sugar (FBS; OR = 1.59; 95 CI: 1.05-2.40), low high-density lipoprotein cholesterol (HDL-C; OR = 1.43; 95 CI: 1.02-2.01), high blood pressure (BP; OR = 2.76; 95 CI: 2.19-3.47), high triglycerides (TG; OR = 2.85; 95 CI: 2.05-3.95) and high waist circumference (WC; OR = 1.37; 95 CI: 0.97-1.94) were all found to be higher in SLE patients compared with healthy controls. Conclusions: The risk of MetS was significantly higher in SLE patients, compared with healthy controls, even after adjusting for publication bias. Among MetS components, high TG and high BP were most strongly associated with SLE. Considering that high TG and high BP are preventable, there is an international need to implement effective interventions to reduce MetS components in SLE patients in order to prevent serious outcomes such as cardiovascular diseases and mortality

Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis

Background Estimating the current global prevalence of metabolic syndrome (MetS), and its components, among rheumatoid arthritis (RA) patients is necessary in order to formulate preventative strategies and to ensure there are adequate community resources available for these patients. Furthermore, the association between RA and MetS is controversial and has not previously been comprehensively assessed. Therefore, the present study aimed to: 1) determine the prevalence of MetS, and its components, among RA patients across the world 2) update the odds ratio of MetS in RA patients, compared to healthy controls, using a comprehensive systematic review and meta-analysis. Methods International databases, including: the Web of Science, PubMed, Scopus, Embase, CINAHL and other relevant databases were searched to identify English language articles which reported the prevalence and risk of MetS in RA patients between January 2000 and August 2016. The meta-analysis only included studies which clearly described the time and location of the study, utilised adequate sampling strategies, and appropriate statistical analyses Results The meta-analyses of prevalence (70 studies [n = 12612]) and risk (43 studies [n = 35220]) of MetS in RA patients were undertaken separately. The overall pooled prevalence of MetS was 30.65% (95% CI: 27.87–33.43), but this varied from 14.32% (95% CI: 10.59–18.05) to 37.83% (95% CI: 31.05–44.61), based upon the diagnostic criteria used. The prevalence of MetS also varied slightly between males (31.94%, 95% CI: 24.37–39.51) and females (33.03%, 95% CI: 28.09–37.97), but this was not statistically significant. The overall pooled odds ratio (OR) of MetS in RA patients, compared to healthy controls, was 1.44 (95% CI: 1.20–1.74), but this ranged from 0.70 (95% CI: 0.27–1.76) to 4.09 (95% CI: 2.03–8.25), depending on the criteria used. The mean age and diagnostic criteria of MetS were identified as sources of heterogeneity in the estimated odds ratios between studies (P<0.05) Conclusions According to the high prevalence of MetS in RA patients, and high risk of MetS, measuring metabolic syndrome in RA patients is strongly recommended. Furthermore, as high waist circumference (WC) is the most common metabolic syndrome component, more attention must be paid to nutrition and weight loss among those with R

The global, regional, and national burden of stomach cancer in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease study 2017

Background Stomach cancer is a major health problem in many countries. Understanding the current burden of stomach cancer and the differential trends across various locations is essential for formulating effective preventive strategies. We report on the incidence, mortality, and disability-adjusted life-years (DALYs) due to stomach cancer in 195 countries and territories from 21 regions between 1990 and 2017. Methods Estimates from GBD 2017 were used to analyse the incidence, mortality, and DALYs due to stomach cancer at the global, regional, and national levels. The rates were standardised to the GBD world population and reported per 100 000 population as age-standardised incidence rates, age-standardised death rates, and age-standardised DALY rates. All estimates were generated with 95% uncertainty intervals (UIs). Findings In 2017, more than 1.22 million (95% UI 1.19-1.25) incident cases of stomach cancer occurred worldwide, and nearly 865 000 people (848 000-885 000) died of stomach cancer, contributing to 19.1 million (18.7-19.6) DALYs. The highest age-standardised incidence rates in 2017 were seen in the high-income Asia Pacific (29.5, 28.2-31.0 per 100 000 population) and east Asia (28.6, 27.3-30.0 per 100 000 population) regions, with nearly half of the global incident cases occurring in China. Compared with 1990, in 2017 more than 356 000 more incident cases of stomach cancer were estimated, leading to nearly 96 000 more deaths. Despite the increase in absolute numbers, the worldwide age-standardised rates of stomach cancer (incidence, deaths, and DALYs) have declined since 1990. The drop in the disease burden was associated with improved Socio-demographic Index. Globally, 38.2% (21.1-57.8) of the age-standardised DALYs were attributable to high-sodium diet in both sexes combined, and 24.5% (20.0-28.9) of the age-standardised DALYs were attributable to smoking in males. Interpretation Our findings provide insight into the changing burden of stomach cancer, which is useful in planning local strategies and monitoring their progress. To this end, specific local strategies should be tailored to each country's risk factor profile. Beyond the current decline in age-standardised incidence and death rates, a decrease in the absolute number of cases and deaths will be possible if the burden in east Asia, where currently almost half of the incident cases and deaths occur, is further reduced. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Keywords:GASTRIC-CANCER; HELICOBACTER-PYLORI; UNITED-STATES; STATISTICS; MORTALITY; RISK; EPIDEMIOLOGY; TERRITORIES; PREVALENCE; GUIDELINE

The causal effect and impact of reproductive factors on breast cancer using super learner and targeted maximum likelihood estimation: a case-control study in Fars Province, Iran

Objectives: The relationship between reproductive factors and breast cancer (BC) risk has been investigated in previous studies. Considering the discrepancies in the results, the aim of this study was to estimate the causal effect of reproductive factors on BC risk in a case-control study using the double robust approach of targeted maximum likelihood estimation. Methods: This is a causal reanalysis of a case-control study done between 2005 and 2008 in Shiraz, Iran, in which 787 confirmed BC cases and 928 controls were enrolled. Targeted maximum likelihood estimation along with super Learner were used to analyze the data, and risk ratio (RR), risk difference (RD), andpopulation attributable fraction (PAF) were reported. Results: Our findings did not support parity and age at the first pregnancy as risk factors for BC. The risk of BC was higher among postmenopausal women (RR = 3.3, 95 confidence interval (CI) = (2.3, 4.6)), women with the age at first marriage �20 years (RR = 1.6, 95 CI = (1.3, 2.1)), and the history of oral contraceptive (OC) use (RR = 1.6, 95 CI = (1.3, 2.1)) or breastfeeding duration �60 months (RR = 1.8, 95 CI = (1.3, 2.5)). The PAF for menopause status, breastfeeding duration, and OC use were 40.3 (95 CI = 39.5, 40.6), 27.3 (95 CI = 23.1, 30.8) and 24.4 (95 CI = 10.5, 35.5), respectively. Conclusions: Postmenopausal women, and women with a higher age at first marriage, shorter duration of breastfeeding, and history of OC use are at the higher risk of BC. © 2021, The Author(s)

Socioeconomic inequality in childhood obesity and its determinants: a Blinder�Oaxaca decomposition Desigualdade socioeconômica na obesidade infantil e seus determinantes: decomposição de Oaxaca-Blinder

Objective: Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods: This multicenter cross-sectional study was conducted in 2011�2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6�18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results: Overall, 36,529 students completed the study (response rate: 91.32); 50.79 of whom were boys and 74.23 were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51, 8.35, and 17.87, respectively. The SII for overweight, obesity and abdominal obesity was �0.1, �0.1 and �0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. Conclusion: This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels. © 2017 Sociedade Brasileira de Pediatri

Socioeconomic inequality in childhood obesity and its determinants: a Blinder�Oaxaca decomposition Desigualdade socioeconômica na obesidade infantil e seus determinantes: decomposição de Oaxaca-Blinder

Objective: Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods: This multicenter cross-sectional study was conducted in 2011�2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6�18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results: Overall, 36,529 students completed the study (response rate: 91.32); 50.79 of whom were boys and 74.23 were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51, 8.35, and 17.87, respectively. The SII for overweight, obesity and abdominal obesity was �0.1, �0.1 and �0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. Conclusion: This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels. © 2017 Sociedade Brasileira de Pediatri

Socioeconomic inequality in oral health behavior in Iranian children and adolescents by the Oaxaca-Blinder decomposition method: The CASPIAN- IV study

Background: The present study set to describe the socioeconomic inequality associated with oral hygiene behavior among Iranian pediatric population. Methods: A representative sample of 13486 school students aged 6-18 years was selected through multistage random cluster sampling method from urban and rural areas of 30 provinces in Iran. Principle Component Analyses (PCA) correlated variables summarized as socioeconomic status (SES). Association of independent variables with tooth brushing was assessed through logistic regression analysis. Decomposition of the gap in tooth brushing between the first and fifth SES quintiles was assessed using the counterfactual decomposition technique. To assess the relation between tooth brushing and each socioeconomic category, Concentration Index (C) and the slope index of inequality (SII) were used, representing the linear regression coefficient. Results: The participation rate was 90.6 (50.7 boys and 75.6 urban inhabitants). The mean age of participants was 12.47 ± 3.36 years. The frequency of tooth brushing increased across SES quintiles, prevalence of tooth brushing between the first and fifth quintile, under 20 difference, increased from 58.22 (95 CI: 56.24,60.20) to 78.61 (95 CI: 77.00,80.24). Only 3 of the difference is explained by the factors considered in the study, and 17 remained unknown. Residence area, family size, and smoking status made a significant contribution to the gap between the first and last SE groups. Residence area -2.01 (95 % CI: -3.46, -0.55) was along the maximum levels of gaps between SE categories. Conclusions: The findings revealed a socio-economic inequality in oral health behavior in Iranian children and adolescents. Also, factors influencing oral health are addressed to develop and implement complementary public health actions. © 2016 The Author(s)

Health-related quality of life according to the socioeconomic status of living areas in Iranian children and adolescents: Weight disorders survey

Background: Health-related quality of life (HRQoL) has become a major concern in the field of children�s health research. We assessed HRQoL among Iranian children and adolescents according to the socioeconomic status (SES) of their living region. Methods: Via multistage cluster sampling from rural and urban school students aged 6 to 18 years, this nationwide study was conducted from 2011 to 2012. HRQoL was assessed using the adolescent core version of the Pediatric Quality of Life questionnaire. Through survey data analysis methods, the data were compared according to the SES of the living region, sex, and the living area. Results: Overall, 23043 students participated in the survey (participation rate=92.2). The mean age of the participants was 12.55±3.31 years. Boys accounted for 50.8 of the study population, and 73.4 were from urban areas. At national level, the mean of the HRQoL total score was 81.7 (95 CI: 81.3 to 82.1) with a mean of 83.5 (95 CI: 83.0 to 84.1) for the boys and 79.8 (95 CI: 79.1 to 80.5) for the girls. The highest and the lowest scores, respectively, belonged to social functioning (90.0 95% CI: 89.7 to 90.3) and emotional functioning (78.2 95% CI: 77.7 to 78.7). The highest total HRQoL score belonged to the second highest SES region of the country (mean=83.1; 95% CI: 82.5 to 83.7). The association between total HRQoL and the score of all the subscales and SES in the living area was statistically significant (P<0.001). Conclusion: The results of the present study showed that in the children and adolescents, SES was associated with HRQoL. Accordingly, HRQoL and the related SES differences should be considered one of the priorities in health research and health policy. © 2019, Shiraz University of Medical Sciences. All rights reserved

Association of neck circumference with general and abdominal obesity in children and adolescents: The weight disorders survey of the CASPIAN-IV study

Objectives: This study aimed to evaluate the association of neck circumference (NC) with obesity to determine the sex-specific and age-specific optimal cut-off points of this measure in association with obesity in a national sample of the Iranian paediatric population. Methods: This survey on weight disorders was conducted among a national sample of Iranian children and adolescents, aged 6-18 years. Using the area under the curve (AUC) of the receiver operator characteristic curves, we evaluated the association of NC with general and abdominal obesity. Results: This national survey was conducted among 23 043 school students (50.8 boys) with a mean age (SD) of 12.55 (3.31) years. A significant association was documented between NC and other anthropometric measures in both sexes and in the whole population. In all age groups and genders, NC performed relatively well in classifying participants to overweight (AUC: 0.67 to 0.75, p<0.001), general obesity (AUC: 0.81 to 0.85, p<0.001) and abdominal obesity (AUC: 0.73 to 0.78, p<0.001). Conclusions: NC can be considered as a simple timesaving clinical tool for obesity detection in large population-based studies in children and adolescents. It is significantly correlated with indices of adiposity and can reliably identify children with general and abdominal obesity in the Iranian paediatric population