The Effect of Human Development Index on Obesity Prevalence at the Global Level: A Spatial Analysis.

Background: Obesity is one of the major public health concerns, and its prevalence is increasing worldwide. This study aimed to investigate the effect of human development index on the prevalence of obesity across 152 countries. Methods: Country-level data on obesity prevalence and its influencing variables related to 152 countries were obtained during 2000-2019 from several sources. A Spatial Bayesian Hierarchical model was employed in this research, and the analyses were performed using R statistical software (version 3.6.1). Results: We found a positive relation between HDI and obesity prevalence, in such a way if low HDI countries advance to high HDI countries, the obesity rate is expected to increase significantly by 7.45%. Moreover, the association between obesity prevalence and the percentage of people aged 40-59 (ß=0.07), urbanization rate (ß=0.11), percentage of internet users (ß=0.01), percentage of alcohol users (ß=0.16), milk consumption per capita (ß=0.15) and Percentage of depression (ß=0.58) was significantly positive. Conversely, per capita consumption of fruits and vegetables (ß=-0.15), and smoking rate (ß=-0.02) was negatively associated with obesity prevalence. Conclusion: The prevalence of obesity is growing across all countries, especially in the countries with high and very high HDI. Therefore, policymakers must also pay attention to the negative effects of development when trying to improve the welfare of society.

The Impact of Cancer Incidence on Catastrophic Health Expenditure in Iran with a Bayesian Spatio-Temporal Analysis.

Background: We investigated the impact of cancer incidence on CHE in Iran by considering spatial variation across provinces as well as temporal trends. Methods: Data from Household Income-Expenditure Survey were merged with cancer incidence rates during 2011-2016. We developed a Bayesian hierarchical model to explore the spatial and temporal patterns of CHE and its associated factors at provincial level. We used a Besag-York-Mollie2 prior and a random walk prior for spatial and temporal random effects respectively. All statistical analysis was carried out in R software. Results: All-type cancer incidence (OR per SD (95% CrI) = 1.16 (1.02, 1.32)), unemployment rate (1.08 (1.01, 1.15)) and income equity (0.88 (0.81, 0.97)) have important association with CHE. Percentage of urbanization and percentage of poverty were not statistically significant. Conclusion: The results suggest the development of new policies to protect cancer patients against financial hardship, narrow the gap in income inequality and solve the problem of high unemployment rate to reduce the level of CHE at provincial level.

Prognostic value and optimal threshold of first thyroglobulin in low/intermediate risk DTC.

BACKGROUND: The aim of this study was to define prognostic value and optimal threshold of first thyroglobulin (fTg) measured after thyroidectomy and just before radio-iodine therapy (RIT), in low/intermediate risk patients with differentiated thyroid cancer (DTC). METHODS: This is a retrospective study in 383 patients with DTC who were treated with surgery followed by RIT. Response to treatment was assessed 1 and 2 years after RIT. Odds ratio of different risk factors like age, sex, TNM stage, fTg and Anti-Tg Ab were compared between patients with and without incomplete response 1 and 2 years after treatment. Receiver operating curve analysis was used for definition of optimal fTg cut off for detection of incomplete response. RESULTS: 218 female and 55 male with DTC had negative anti-Tg antibody (mean age: 37.5±14.5 years) and analyzed separately. fTg≥33.5 ng/mL and fTg/TSH ratio of ≥0.36 had the optimal sensitivity and specificity for detection of incomplete response 1 and 2 years after treatment. fTg<33.5 ng/mL had NPV of 98.5% for exclusion of distant metastases. Patients with fTg≥33.5 ng/mL had longer "time to excellent response" (3.6±2.3 vs. 2.0±1.8 yrs) and needed more additional treatments compared to patients with fTg<33.5 ng/mL. Multivariate analysis showed that fTg was the most potent risk factor for prediction of treatment failure 1 and 2 years after RIT. CONCLUSIONS: fTg of ≥33.5 ng/mL was the most important risk factor for prediction of treatment failure after RIT and could be included in decision algorithms regarding intensity of treatments in low/intermediate risk patients with DTC.

Association of body mass index with life expectancy with and without cardiovascular disease.

BACKGROUND: We estimated the average numbers of years lived with and without cardiovascular disease (CVD) in normal weight, overweight, and obese individuals, aged ≥30 years. METHODS: A total of 7529 participants were recruited. The multi-state Markov model was used to obtain hazard ratios (HRs) for three transitions (CVD free to nonfatal CVD, CVD free to all-cause death, and nonfatal CVD to all-cause death) stratified by body mass index (BMI) categories at baseline and adjusted for confounders including sex, age, smoking, family history of premature CVD, education and physical activity. Life expectancies (LEs) were also estimated for each transition stratifying by BMI categories and sex. RESULTS: We found 986 incident cases of nonfatal CVD and 669 overall deaths (236 CVD deaths) after more than 18 years of follow-up. Overweight and obesity were associated with an increased risk of nonfatal CVD (HR, 1.42 (95% confidence interval (CI) 1.21-1.66) and (1.64, 1.37-1.96), respectively), compared with normal weight individuals. Overweight and obesity were also associated with lower risk of mortality without CVD (0.39, 0.20-0.77) and (0.35, 0.14-0.85), respectively. Among those with CVD, overweight compared with normal weight was associated with a lower risk of mortality (0.72, 0.56-0.94). Total LEs for both men and women with overweight and obesity were not significantly different from their normal weight counterparts. Compared with normal weight individuals, men and women with obesity lived 4.1 (CI: -6.3, -1.3) and 4.3 (-6.4, -2.0) fewer years free of CVD; however, they lived 3.9 (2.1, 6.0) and 3.7 (2.1, 5.6) longer years with CVD than their normal weight counterparts, respectively. CONCLUSIONS: We demonstrated that although total LE was not influenced by higher BMI; individuals with overweight and obesity could expect longer longevity after diagnosis of nonfatal CVD. These extra years of life impose financial burden on both patients and the health care system.

Incidence and associated risk factors for premature death in the Tehran Lipid and Glucose Study cohort, Iran.

BACKGROUND: The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran. METHODS: A total of 7245 participants (3216 men), aged 30-70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated. RESULTS: After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) (n = 126), cancer (n = 51), road injuries (n = 15), sepsis and pneumonia (n = 9) and miscellaneous reasons (n = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07-1.83)], diabetes (2.53, 1.94-3.29) and current smoking (1.58, 1.16-2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25-29.9 kg/m2) (0.65, 0.49-0.87) and obesity (BMI ≥30 kg/m2) (0.67, 0.48-0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71-1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39-0.88) and obesity (0.67, 0.43-1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84-3.72). CONCLUSIONS: Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn't confirm a negative impact of overweight and obesity status on premature mortality events.