The levels of BMI and patterns of obesity and overweight during the COVID-19 pandemic: Experience from the Iran STEPs 2021 survey.

Background: Obesity and its increasing burden have become an urgent health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the distribution of body mass index (BMI) levels and its association with metabolic and lifestyle risk factors in an Iranian adult population by sex, age, and geographical distribution. Methods: This study involves a national survey of noncommunicable disease risk factor surveillance (STEPs) in Iran. Through systematic random sampling, in compliance with safety considerations during the COVID-19 pandemic, of the 28,520 adults who gave voluntary consent and included in the study, 27,874 participants completed the questionnaires (step 1), 27,745 individuals were anthropometrically measured (step 2), and 18,119 individuals completed laboratory evaluation (step 3). Anthropometric measurements followed based on standard protocols and by using calibrated instruments. Results: In 2021, the national prevalence of normal weight, obesity, and overweight/obesity in ≥18-year-old Iranian adults was estimated at 33.61% (95% CI: 32.99-34.23), 24.96% (24.39-25.53), and 63.02% (62.39-63.65), respectively. Compared to women, Iranian men had a lower mean BMI [25.54 (24.95-26.13 vs. 27.6 (27.07-28.12) kg/m2] (p < 0.001). There was also a significant difference in the national prevalence rate of overweight/obesity [women: 66% (61-71), men: 53% (46-60) (p < 0.001)]. The prevalence of obesity was significantly higher in participants suffering from metabolic and lifestyle risk factors. The study of the geographical extent of obesity and overweight shows that compared to national levels, the highest prevalence of being underweight was seen in the southeastern provinces. On the other hand, the highest prevalence of obesity belonged to the northeastern and central provinces. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: The study reveals a significant difference between the prevalence of obesity in male and female participants and between different regions of the country. These findings will help policymakers, clinicians, and researchers to more accurately estimate the obesity/overweight problem and to implement more effective interventional programs to promote strategies of prevention and control of weight gain.

A global, regional, and national survey on burden and Quality of Care Index (QCI) of bladder cancer: The global burden of disease study 1990-2019.

INTRODUCTION: Bladder cancer (BCa) is the second most common genitourinary cancer and among the leading causes of cancer-related deaths. We aimed to assess BCa quality of care (QOC) utilizing a novel multi-variable quality of care index (QCI). MATERIALS AND METHODS: Data were retrieved from the Global Burden of Disease 1990-2019 database. QCI scores were calculated using four indices of prevalence-to-incidence ratio, Disability-Adjusted Life Years-to-prevalence ratio, mortality-to-incidence ratio, and Years of Life Lost-to-Years Lived with Disability ratio. We used principal component analysis to allocate 0-100 QCI scores based on region, age groups, year, and gender. RESULTS: Global burden of BCa is on the rise with 524,305 (95% UI 475,952-569,434) new BCa cases and 228,735 (95% UI 210743-243193) deaths in 2019, but age-standardized incidence and mortality rates did not increase. Global age-standardized QCI improved from 75.7% in 1990 to 80.9% in 2019. The European and African regions had the highest and lowest age-standardized QCI of 89.7% and 37.6%, respectively. Higher Socio-demographic index (SDI) quintiles had better QCI scores, ranging from 90.1% in high SDI to 30.2% in low SDI countries in 2019; however, 5-year QCI improvements from 2014 to 2019 were 0.0 for high and 4.7 for low SDI countries. CONCLUSION: The global QCI increased in the last 30 years, but the gender disparities remained relatively unchanged despite substantial improvements in several regions. Higher SDI quintiles had superior QOC and less gender- and age-based inequalities compared to lower SDI countries. We encourage countries to implement the learned lessons and improve their QOC shortcomings.

Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran.

INTRODUCTION: COVID-19 clinical course, effective therapeutic regimen, and poor prognosis risk factors in pediatric cases are still under investigation and no approved vaccinehas been introduced for them. METHODS: This cross-sectional study evaluated different aspect of COVID-19 infection in hospitalized COVID-19 positive children (≺18 years oldwith laboratory confirmed COVID-19 infection, using the national COVID-19 registry for all admitted COVID-19 positive cases from February 19 until November 13,2020, in Iran. RESULTS: We evaluated 6610 hospitalized children. Fifty-four percent (3268) were male and one third of them were infants younger than 1 year. Mortality rate in total hospitalized children was 5.3% and in children with underlying co-morbidities (14.4%) was significantly higher (OR: 3.6 [2.7-4.7]). Chronic kidney disease (OR: 3.42 [1.75-6.67]), Cardiovascular diseases (OR: 3.2 [2.09-5.11]), chronic pulmonary diseases (OR: 3.21 [1.59-6.47]), and diabetes mellitus (OR: 2.5 [1.38-4.55]), resulted in higher mortality rates in hospitalized COVID-19 children. Fever (41%), cough (36%), and dyspnea (27%) were the most frequent symptoms in hospitalized children and dyspnea was associated with near three times higher mortality rate among children with COVID-19 infection (OR: 2.65 [2.13-3.29]). CONCLUSION: Iran has relatively high COVID-19 mortality in hospitalized children. Pediatricians should consider children presenting with dyspnea, infants≺ 1 year and children with underlying co-morbidities, as high-risk groups for hospitalization, ICU admission, and death.