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

Clinical cause of neonatal mortality in Iran: analysis of the national Iranian Maternal And Neonatal network

Background The neonatal mortality rate is a main indicator of the health and development of a country. Having insight into the cause of neonatal deaths may be the first step to reducing it. This paper depicts the cause of newborn deaths in Iran.Methods This cross-sectional study was performed on data from the national Iranian Maternal And Neonatal network to investigate all neonatal deaths in the country during the year 2019. The cause of death data were reported according to categories of birth weight, gestational age (GA), death time and place.Results The main causes of the 9959 neonatal deaths during the study period were respiratory distress syndrome (RDS) (37%), malformation (21%), prematurity of <26 weeks (20%), others (12%), asphyxia (7%) and infection (3%). The major causes of neonatal mortality in delivery rooms were prematurity of <26 weeks and in the inpatient wards the RDS. By increasing the GA and birth weight towards term babies, the rate of RDS gets lower, while that of malformation gets higher.Conclusions RDS was the main cause of neonatal mortality in Iran which is seen mainly in preterm babies. Prematurity of <26 weeks was another main cause. Thus, suggestions include reducing prematurity by preconception and pregnancy care and, on the other hand, improving the care of preterm infants in delivery rooms and inpatient wards

Association of Breast Feeding and Birth Weight with Anthropometric Measures and Blood Pressure in Children and Adolescents: The CASPIAN-IV Study

Noncommunicable diseases (NCDs) and their risk factors are major health threats especially for developing countries. The aim of this study was to assess the association between breast feeding (BF) and birth weight (BW) with anthropometric measures and blood pressure (BP) in a nationally–representative sample of Iranian children and adolescents. Methods: In this national survey, 14,880 children and adolescents, aged 6–18 years, were selected using a multistage, cluster sampling method from rural and urban areas of 30 provinces of Iran. BF duration and BW were assessed by validated questionnaires completed by parents. Results: The study participants were 13,486 students (participation rate of 90.6%). They consisted of 49.24% girls, 75.6% urban residents, with a mean age of 12.5 years (95% confidence interval: 12.3–12.6). The family history of obesity had a significant association with BW (p < 0.001). A substantial association was found between BF duration and the order of children in the family, both in boys (p < 0.001) and girls (p < 0.001). The mean values for height, weight, body mass index, as well as waist, wrist, and hip circumferences were higher in those with higher BW categories (p for trend < 0.001). As BW increased, there was a linear decrease in underweight (p for trend < 0.001) and a linear increase in the prevalence of generalized obesity (p for trend < 0.001) was documented. Conclusion: BW was associated with a higher prevalence in general obesity and a lower prevalence of being underweight. Duration of BF had no significant association with anthropometric measures and BP. Future longitudinal studies are necessary to determine the clinical implications of these findings

First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study

OBJECTIVE: This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents. METHOD: The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves. RESULTS: The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTNwere 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%. CONCLUSIONS: BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group

Association of sleep duration and snack consumption in children and adolescents: The CASPIAN-V study

OBJECTIVES The relationship between sleep deprivation and the risk of overweight and obesity is somewhat known in children and adolescents. This study aimed to investigate the relationship between sleep duration and eating snacks in a national sample of children and adolescents aged 6–18 years old. METHODS This cross-sectional study was carried out on the data of the fifth survey of the national school-based surveillance system entitled the “Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease” (CASPIAN-V) study. Short sleeping duration was defined 10 hr per day for children under 10 years and 9 hr per day for children ≥ 10 years. To assess food habits, the consumption frequency of some food groups including sweets, salty snacks, carbonated beverages, diet soft drinks, soft beer, fresh fruits, dried fruits, fresh juices, vegetables, packed juices, dairy products (milk, yogurt, and cheese), fast foods, tea, sugar along with tea, and coffee was asked using Likert scale ( never, rarely, weekly, and daily). RESULTS In multivariate model, short sleep versus long sleep in students was associated with increased chance of eating salty snacks (OR = 1.49 [95% CI: 1.38–1.61]; p = .001), soft drinks (OR = 1.12 [95% CI: 1.04–1.20]; p = .002), fast foods (OR = 1.66 [95% CI: 1.54–1.79]; p &lt; .001), tea (OR = 1.49 [95% CI: 1.39–1.61]; p &lt; .001), and tea with sugar (OR = 1.13 [95% CI: 1.05–1.22]; p &lt; .001). In addition, short sleep in students was associated with a decreased odds of daily intake of soft drinks without sugars (OR = 0.64 [95% CI: 0.58–0.70]; p &lt; .001), soft beer (OR = 0.92 [95% CI: 0.85–0.99]; p &lt; .001), fresh fruit (OR = 0.83 [95% CI: 0.76–0.90]; p &lt; .001), dried fruit (OR = 0.43 [95% CI: 0.39–0.46]; p &lt; .001), fresh fruit juice (OR = 0.66 [95% CI: 0.62–0.72]; p &lt; .001), packed juice (OR = 0.91 [95% CI: 0.84–0.98]; p &lt; .009), milk (OR = 0.51 [95% CI: 0.47–0.55]; p &lt; .001), yogurt (OR = 0.86 [95% CI: 0.79–0.93]; p ≤ .001), and coffee (OR = 0.82 [95% CI: 0.76–0.89]; p ≤ .001). CONCLUSIONS The findings of this study indicate a significant relationship between sleep duration and unhealthy food habits. Therefore, increasing awareness of families in this area may reduce obesity and its complications

Association of sleep duration with metabolic syndrome and its components in children and adolescents; a propensity score-matched analysis: the CASPIAN-V study

Abstract Objective This study aims to evaluate the association of sleep duration with metabolic syndrome (MetS) and its components in a pediatric population. Methods This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7–18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examinations and laboratory tests were performed using standard protocols. The analysis was conducted based on the propensity score matching and conditional logistic regression was used to evaluate the association of short sleep (less than 8 h a day) and the onset of sleep with MetS and its components. Results of conditional logistic regression was reported as odds ratios (OR) and 95% confidence intervals (CI). Results Overall, 3843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.3 (3.2) years and 50.6% were boys. In the multivariate model, individuals who slept less than 8 h a day had significantly higher odds of MetS (OR 2.05, 95% CI 1.19–3.63) and high blood pressure (BP) (OR 1.46, 95% CI 1.04–2.06). Association between short sleep duration with other MetS components (including abdominal obesity, hypertriglyceridemia, hyperglycemia, and low levels of high-density lipoprotein-cholesterol was not statistically significant (P > 0.05). Moreover, association between the onset of sleep with MetS and its components was not statistically significant (P > 0.05). Conclusion Short sleep duration is associated with increased risk of MetS and high BP in children and adolescents. The clinical impact of current findings should be assessed in future longitudinal studies

Validity of a continuous metabolic syndrome score as an index for modeling metabolic syndrome in children and adolescents: the CASPIAN-V study

Abstract Background The purpose of the present study was to assess the validity of continuous metabolic syndrome score (cMetS) for predicting metabolic syndrome (MetS) and to determine the cutoff values in a representative sample of Iranian children and adolescents. Methods This national study was conducted among 3843 students, aged 7–18 years country during the fifth survey of a national school-based surveillance program. The cMetS was computed by standardizing the residuals of waist circumference, mean arterial blood pressure, high-density lipoprotein cholesterol, triglycerides, and glucose by regressing them according to age and sex and aggregating them. The optimal cut-off points of cMetS for predicting MetS were determined by the receiver operation characteristic (ROC) curve analysis in different gender and age categories. Results Totally, 3843 students (52.3% boys) with average age of 12.45 years were assessed. The mean of cMetS increased according to elevating the number of MetS components. The overall cMetS cut-off point was 1.76 (sensitivity 93% and specificity 82%) in total pediatrics. The area under the ROC curve was 94%. The values for boys and girls were 1.79 and 2.72, respectively. Conclusions cMetS performed highly accurate in predicting pediatrics with MetS in all gender and age groups and it appears to be a valid index in children and adolescents

Metabolic Syndrome And Associated Factors In Iranian Children And Adolescents: The Caspian-V Study

Introduction:Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups. , Methods: This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests. , Results: The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63). , Conclusion: High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.PubMe

Is single-child family associated with cardio-metabolic risk factors: the CASPIAN-V study

Abstract Background In the present study, the association of the cardio-metabolic risk factors and the status of single-child family were studied in a national representative sample of Iranian children and adolescents. Methods This cross sectional study was conducted as the fifth round of “Childhood and Adolescence Surveillance and PreventIon of Adult Non- communicable disease” surveys. The students’ questionnaire was derived from the World Health Organization-Global School Student Health Survey. Using survey data analysis methods, data from questionnaires’; anthropometric measures and biochemical information analyzed by logistic regression analysis. Results Overall, 14,274 students completed the survey (participation rate: 99%); the participation rate for blood sampling from students was 91.5%. Although in univariate logistic regression model, single child students had an increased risk of abdominal obesity [OR: 1.37; 95% CI: 1.19–1.58)], high SBP [OR: 1.58; 95% CI:1.17–2.14)], high BP [OR: 1.21; 95% CI:1.01–1.45)] and generalized obesity [OR: 1.27; 95% CI:1.06–1.52)], in multiple logistic regression model, only association of single child family with abdominal obesity remained statistically significant [OR: 1.28; 95% CI:1.1–1.50)]. Also in multivariate logistic regression model, for each increase of a child in the family the risk of abdominal obesity [OR: 0.95; 95% CI: 0.91–0.97), high SBP [OR: 0.88; 95% CI: 0.81–0.95)] and generalized obesity [OR: 0.95; 95% CI: 0.91–0.99)] decreased significantly. Conclusion The findings of this study serve as confirmatory evidence on the association of cardio-metabolic risk factors with single-child family in children and adolescents. The findings of study could be used for better health planning and more complementary research

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study

Abstract Objective This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents. Methods This nationwide study was conducted in 2015 among 4200 students aged 7–18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case–control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used. Results The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01–1.66), elevated blood pressure (OR 1.35; 95% CI 1.01–1.81) and MetS (OR 1.33; 95% CI 1.02–1.74). The two other dietary patterns were not associated with MetS and its components. Conclusion Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits