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

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

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

Inequality in School Readiness and Autism among 6-Year-Old Children across Iranian Provinces: National Health Assessment Survey Results

Objective: To assess the national inequality of school readiness and autism among 6-year-old Iranian children before school entry using a national health assessment survey. 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. Findings: The study population consisted of 955388 children (48.5% girls and 76.1% urban residents). Of the whole children, 3.1% of the 6-year-old children had impaired vision. In addition, 1.2, 1.8, 1.4, 7.6, 0.08, 10, 10.9, 56.7, 0.7, 0.8 and 0.6 percent had color blindness, hearing impaired, speech disorder, school readiness, autism, height to age retardation, body mass index extremes, decayed teeth, disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Conclusion: Our results confirmed that there is an inequality in distribution of school readiness and autism in 6-year-old children across Iranian provinces. 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 inequality among provinces

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

First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study

Abstract Background The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10–19 years, and to explore how well these anthropometric data match with international growth references. Methods In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10–19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines. Results The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10–14 years , and 3118 (58%) with 15–19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P  Conclusions The current growth curves generated from a national dataset may be included for establishing WHO global database on children’s growth. Similar to most low-and middle income populations, Iranian children aged 10–19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in public health policy-making.</p

Priority strategic directions in adolescent health in Iran based on the WHO's Global Accelerated Action for the Health of Adolescents

OBJECTIVES: In line with the World Health Organization's Global Accelerated Action for the Health of Adolescents (AA-HA!) guidance, the goal of the current research was to identify critical strategies for adolescents' health and to determine the role and distribution of responsibilities among the leading players in the field of adolescent health in Iran. METHODS: The current qualitative and applied study is part of the Ministry of Health and Medical Education's "Adolescent, Youth and School Health" plan to develop the "National Adolescent Health Plan Document" in 2020. First, stakeholder analysis was done, then a pool of nationally appropriate strategies was selected from the list of priority strategies recommended by the WHO in the AA-HA! through several group sessions. After that, the experts selected priority strategies based on the criteria of feasibility, acceptability, effectiveness, guaranteed resources, coordination with other plans and temporal priority, scoring, and executive priorities. Eventually, the priority strategies were assigned to different players/stakeholders in the field over several sessions bearing in mind the methods of implementation and the target groups. RESULTS: The experts identified 58 priority strategies/actions for adolescent health under the seven priority areas of positive development, sexual protection, reproductive health, mental health, substance abuse, self-harm, violence, unintentional injury, communicable and non-communicable diseases, nutrition, and physical activity. CONCLUSIONS: The highest identified priority areas were in the areas of vaccination; special health care package for service providers; training and education to promote health literacy and self-care, life skills, sexual awareness, and prevention/protection against violence; community-based mental health services, planning for adolescents' spare time, substance use prevention

Methodology and early findings of the third survey of CASPIAN study: A national school-based surveillance of students′ high risk behaviors

Background: A school-based surveillance system entitled the childhood and adolescence surveillance and prevention of Adult Noncommunicable disease (CASPIAN) Study is implemented at national level in Iran. This paper presents the methods and primary findings of the third survey of this surveillance system. Methods: This national survey was performed in 2009-2010 in 27 provinces of Iran among 5570 students and one of their parents. In addition to physical examination, fasting serum was obtained. Body mass index was categorized based on the World Health Organization growth charts. Findings: Data of 5528 students (2726 girls, 69.37% urban, mean age 14.7 ± 2.4 years) were complete and are reported. Overall, 17.3% (17.3% of girls and 17.5% of boys) were underweight, and 17.7% (15.5% of girls and 19.9% of boys) were overweight or obese. Abdominal obesity was documented in 16.3% of students (17.8% of girls and 15% of boys). 57.6% of families consumed breads, the staple food for Iranians, prepared with white flour. Most families (43.8% in urban areas and 58.6% in rural areas) used solid hydrogenated fats. 22.7% of students did not add salt to the table food. 14.2% of students reported to have a regular daily physical activity for at least 30 min a day. Overall, 10.4% of students (11.7% in urban areas and 7.3% in rural areas) reported that they used tobacco products, often waterpipe. 32.8% of students experienced at least three times of bullying in the previous 3 months. During the year prior to the survey, 14.46% of students had an injury needing the interference by school health providers. Conclusion: This survey is confirmatory evidence on the importance of establishing surveillance systems for risk behaviors to implement action-oriented interventions

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

Association of alanine aminotransferase concentration with cardiometabolic risk factors in children and adolescents: the CASPIAN-V cross-sectional study

ABSTRACT BACKGROUND: It has been suggested that the levels of some liver enzymes, and especially alanine aminotransferase (ALT), might be correlatable with cardiometabolic risk factors. We investigated the relationship between ALT concentration and cardiometabolic risk factors among children and adolescents. DESIGN AND SETTING: This nationwide study in Iran was conducted within the framework of the fifth survey of a national surveillance program known as the Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease study (CASPIAN-V). METHODS: The participants comprised 4200 students aged 7-18 years, who were recruited through multi-stage random cluster sampling in 30 provinces in Iran. Physical examinations and laboratory tests were conducted in accordance with standard protocols. RESULTS: Overall, 3843 students (participation rate: 91.5%) completed the survey. Mean ALT levels were significantly higher in individuals with dyslipidemia, in terms of elevated total cholesterol (TC) or LDL-cholesterol or triglycerides (TG), excess weight and dyslipidemia. Some cardiometabolic risk factors were associated with higher levels of ALT, with the following odds ratio (OR) and 95% confidence interval (CI):metabolic syndrome (OR: 1.013; 95% CI: 1.001-1.025); elevated TC (OR: 1.060; 95% CI: 1.039-1.081), elevated LDL (OR: 1.031; 95% CI: 1.016-1.046), elevated TG (OR: 1.056; 95% CI: 1.040-1.072) and dyslipidemia (OR: 1.051; 95% CI: 1.034-1.068). CONCLUSION: This large population-based study revealed that some cardiometabolic risk factors were significantly associated with ALT levels. These findings suggest that an association with fatty liver is an underlying mechanism for development of cardiometabolic risk factors