Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan healthy heart program

This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program [IHHP] was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area. IHHP targeted the population-at-large [n = 2,180,000] in three districts in central Iran. Data from independent sample surveys before [2000 - 2001] and after [2007] this program were used to compare differences in the intervention area and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females [P < 0.05 for all]. There were no significant changes in the prevalence of diabetes mellitus. In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area [p < 0.0001]. In males, hypercholesterolemia decreased significantly in both intervention area [18.5% to 9.6%] and reference area [14.4% to 9.8%; p = 0.005]. Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area [p < 0.0001]. A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country

Is the association between salt intake and blood pressure mediated by body mass index and central adiposity?

Objective: to assess the amount of salt intake among normotensive [NT] and prehypertensive [PHT] subjects and to determine whether the association between salt intake and blood pressure is correlated with body weight and waist circumference [WC] or is independent

Methods: a total of 806 NT and PHT subjects from Isfahan Healthy Heart Program [IHHP] were enrolled in the study. A standard questionnaire was used to assess sociodemographic characteristics. The amount of salt intake was measured by the 24-hour urine collection method. Blood pressure, height, weight, and WC were measured based on standard protocols

Results: the mean ages [+/- SD] of NT and PHT subjects were 35.9 [+/- 11.9] and 44.7 [+/- 12.5] years, respectively [P < 0.001]. The mean values of body mass index [BMI] and WC were greater among PHT than NT subjects [BMI: 27.9 +/- 3.8 vs. 25.1 +/- 4.3 kg/m2; P < 0.001 and WC: 90.2 +/- 8.6 vs. 81.2 +/- 11.2 cm; P < 0.001, respectively]. PHT subjects had higher amount of salt intake than NT ones [10.3 +/- 6.2 vs. 12.7 +/- 7.1 g/d, respectively; P = 0.003]. Odds ratio [OR] for being PHT increased significantly across the tertils of salt intake in crude model and sociodemographic- adjusted model. Further adjustment for BMI and WC values weakened the OR for being PHT and showed nonsignificant trend [OR [and 95% CI] for BMI across tertiles of salt intake: 1, 1.26 [0.59 – 2.69], 1.89 [0.93 – 3.81]; P = 0.063 and OR [and 95% CI] for WC across tertiles of salt intake: 1, 1.22 [0.58 – 2.57], 1.79[0.89 – 3.56]; P = 0.082]

Conclusion: the findings of this study suggest that the association between salt intake and blood pressure is related to body weight and WC

influence of gender and place of residence on cardiovascular diseases and their risk factors the Isfahan cohort study

To determine the impact of gender and place of residence on cardiovascular disease [CVD] events and related risk factors. In a prospective cohort study, 6323 participants free of CVD [3255 women], with age of more than 35 years from 3 cities [Isfahan, Najafabad, and Arak] and their rural districts in central Iran were followed-up from 2001 to 2007. This study was carried out at the Cardiovascular Research Institute of Isfahan University of Medical Sciences, Isfahan, Iran. Endpoints were defined as fatal- and nonfatal myocardial infarction, sudden cardiac death, unstable angina and stroke that constituted CVD events. Subjects in the rural area had significantly better risk factor profile in terms of most CVD risk factors in both genders, but it was reverse for low density lipoprotein [LDL]-cholesterol in both genders, and smoking in men. Except for smoking, men had an overall better risk factor profile compared to women. The age and risk factors adjusted hazard ratio of living in rural area was 0.71 [95% confidence interval [CI]: 0.51-0.99] for men, and 0.63 [95% CI: 0.44-0.91] for women. The age of CVD occurrence was similar in men and women, and in rural and urban areas. Hypertension was the strongest predictor of these events except for rural men showing that high LDL-cholesterol was the strongest risk factor. The findings in this study documented differences in CVD risk factors affecting the occurrence of CVD events according to gender and place of residence. Such differences should be taken into account in future preventive public health strategies for CVD prevention.

Barriers and facilitators of weight management in overweight and obese people: qualitative findings of tabassom project

Since weight management is affected by various factors, including social and behavioral ones, this study aimed to explore the peoples' experience of barriers and facilitators of weight management. This qualitative content analysis was conducted as the initial step of TABASSOM Study. Participants, who tried to reduce their weight at least once, were selected by purposeful sampling method from aerobic fitness clubs, parks, and public offices in Isfahan in 2010. Data saturation was reached after indepth unstructured interviews with 11 participants. Data analysis was done by conventional content analysis method. The participants have intermittently followed weight loss program. Barriers such as physical problems, lack of motivation, lack of work and family support and lack of time have resulted in their failures and outages. The main facilitator to start or restart after stopping such programs for a while was positive psychologic effect. Findings showed that many problems could prevent weight loss. It is important to identify obstacles that hinder weight management and regimen programs and to discuss them with people before planning for their weight management.