Comparison of abdominal obesity measures in predicting of 10-year cardiovascular risk in an Iranian adult population using ACC/AHA risk model: A population based cross sectional study.

BACKGROUND: Several abdominal obesity measures have been used for prediction of 10-year cardiovascular disease (CVD) risk but the superiority of these measures remains controversial. The objective of this study was to assess the predictive ability of abdominal obesity measures for risk of CVD events in an Iranian adult population. METHODS: We analyzed the data of population based cross-section study of 567 representative samples of adult population aged 40-70 years in Babol, the north of Iran. The demographic data, the anthropometric measures, lipid profile and cardiometabolic risk factors were measured with standard methods. Waist to hip ratio (WHR), waist to height ratio (WHtR), conicity index(CI), abdominal volume index (AVI) and body mass index(BMI)were calculated. The individual 10-year CVD risk was estimated based on ACC/AHA model. ROC analysis was performed to assess the diagnostic ability of different abdominal obesity measures and body mass index (BMI) in predicting of high risk of CVD events. RESULTS: About 42.5% of men and 15% of women had at least 10% risk of 10-year cardiovascular events and 21.1% of men and 3.0% of women had ≥20% risk. Except WHR for men, all abdominal obesity measures significant predictors for ≥10% risk CVD risk in both sexes but not BMI. The greater ability of CVD risk prediction was observed by WHtR and CI in both sexes with higher AUC in females compared with men for ≥10% risk. CONCLUSION: WHtR and CI are superior indexes in predicting of high risk of CVD events in both sexes.

Clustering of cardio metabolic risk factors in Iranian adult population: A growing problem in the north of Iran.

INTRODUCTION: The clustering of components of metabolic syndrome (MetS) is a major concern in a transition population because of dramatic changing toward modern life styles. The objective of this study was to determine the prevalence of clustering of various combinations of MetS and its association with obesity. METHODS AND SUBJECTS: In a population- based cross-sectional study, a representative samples of 1000 adults were recruited in Babol, the north of Iran. The demographic data, blood pressure, body mass index and waist circumference (WC) were measured with standard method. Fasting blood sugar, serum levels of triglycerides, high density lipoprotein were measured with enzymatic method. RESULTS: A quarter of population had only one component of MetS. The prevalence of just two components was 30.7% and 26.2% in men and women respectively and about 67.1% of men and 73.3% of women had ≥2 risk factors (P=0.001). While the joint prevalence of three and four components was 22.0% and 12.0% in male and 27.3% and 16.5% in female respectively. The combination of high WC with any of other four components of MetS were significantly higher compared with any other joint combinations in particularly among women (P=0.001). The adjusted odds ratio for having clustering (≥2 risk factors) increased 5.6 times (95%CI: 2.15, 6.04) in obese subjects and remained at significant level after adjustment for age, sex, level of education. CONCLUSION: An emerging high rate of clustering of joint combination of cardio metabolic risk factors highlights an urgent intervention for life style modification in public health management.

A comparison of health-related quality of life in patients with renal failure under hemodialysis and healthy participants.

The objective of this study was to evaluate the health-related quality of life (QoL) of patients under hemodialysis (HD) and to compare this to healthy participants. We compared 154 patients on HD to 308 healthy age- and sex-matched controls recruited from Shahid Beheshti Hospital in Babol, Northern Iran in 2014. The data of health-related QoL in eight subscales were collected with interview using a standard short-form questionnaire of short form-36. The demographic data and dry weight and height were measured. The scores of each subscale were transformed from 0 (the worse state) to 100 (the best state). In univariate analysis, Wilcoxon and Kruskal-Wallis tests were used to compare the distribution of scores between cases and controls according to gender, and multiple linear regression analysis was used to adjust the regression coefficient for possible potential confounding factors. The mean overall score of health-related QoL for men was 44.7 ± 23.2 and 74.3 ± 18.1 in patients and controls, respectively, and for women was 37.1 ± 20.8 and 62.1 ± 18.7, respectively. In all subscales, the mean score of patients was significantly lower than controls (P = 0.001) in both sexes. In all eight subscales, after adjusting for demographic characteristics, the patients had significantly lower QoL than controls (P = 0.001). In addition, the independent effect of age, gender, and educational level as predictors of QoL was significant across various subscales (P = 0.001).

Solitary and combined negative influences of diabetes, obesity and hypertension on health-related quality of life of elderly individuals: A population-based cross-sectional study.

AIMS: The health-related quality of life (HRQoL) is a matter of concern in elderly people with chronic diseases. The objective of this study was to investigate the impact of obesity, hypertension and diabetes on HRQoL among elderly. METHODS: A population based cross sectional study was conducted with 750 representative sample of elderly people aged 60-90 years in Babol, the northern Iran. The demographic data and the measurement of blood pressure and other anthropometric measures were collected. The validated short form (SF-36) questionnaire was used to assess the HRQoL. A multiple linear regression model was applied to assess the impact of obesity, abdominal obesity, hypertension and diabetes on QoL. RESULTS: The mean age (SD) of participants was 68.0±7.6 and 67.7±7.9 years for men and women respectively. Diabetes exerted the most negative effect on QoL score (adjusted coefficient=-9.2, 95% CI: -11.7, -6.5 points) followed by abdominal obesity and hypertension. Whereas a combination of three conditions was associated with a greater significant reduction in QoL scores in both sexes(adjusted coefficient=-14.5, 95% CI: -19.0, -9.9 points). However, the negative influence of obesity and hypertension on QoL was significant only in women. CONCLUSION: Most components of the QoL is affected by diabetes, obesity and hypertension particularly in women. Diabetes alone or in combination with other conditions has a negative influence in both sexes with greater effect in women. These findings justify further professional support to compensate the negative influences chronic conditions on health-related QoL especially for older obese diabetic women.

Prevalence of metabolic syndrome and the association with socio-demographic characteristics and physical activity in urban population of Iranian adults: a population-based study.

BACKGROUND: The metabolic syndrome (MetS) is the main concern of health problem in transition population. The objective was to determine the prevalence of MetS and its association with socio-demographic and physical activity in Iranian adults. METHODS: A population-based cross-sectional study of 1000 representative samples aged 20-70 years was conducted in urban area in northern Iran. The socio-demographic data were collected by interview and the physical activity was assessed by standard International Physical Activity Questionnaire (IPAQ). Weight, height, waist circumference and the systolic and diastolic blood pressures were measured by standard methods. Fasting plasma glucose, triglycerides, total cholesterol, high density lipoprotein-cholesterol level and low density lipoprotein cholesterol level were measured using enzymatic method. The ATP III criteria were used for diagnosis of MetS. RESULTS: The prevalence rate of MetS was 42.3% (36.5% men and 47.1% women, p=0.001). The higher education at university level was appeared inversely associated with MetS (age adjusted OR=0.34, p=0.001) compared with illiterate. The prevalence rates of MetS were 49.0%, 42.5% and 22.6% in low, moderate and vigorous physical activity level respectively (p=0.001). After adjusting for potential confounding factors, the vigorous physical activity was inversely associated with MetS compared with low level (adjusted OR=0.46, p=0.001). CONCLUSION: These results highlight an immediate action of preventive measures programs for modification of cardio metabolic risk factors.

Prevalence of overweight and obesity and associated risk factors in urban primary-school children in Babol, Islamic Republic of Iran.

Childhood obesity is a major public health problem globally because of changes in lifestyles. We assessed the prevalence of overweight/obesity and associated factors in urban schoolchildren in Babol in a cross-sectional study of 1000 schoolchildren aged 7-12 years. Weight and height were measured and data on sports activities and leisure time physical activities were collected by questionnaire. Overweight/obesity were assessed by comparing body mass index (BMI) values to the BMI index for age and sex percentiles set by CDC, Atlanta. The prevalence of obesity and overweight was 5-8% and 12.3% respectively. The prevalence was significantly lower in girls compared with boys (age-adjusted OR = 0.69, 95% Cl: 0.50-0.96) and higher among private-school educated children compared with public-school educated students (age adjusted OR = 2.17, 95% Cl: 1.47-3.18). For each additional score of leisure time physical activity, the age-adjusted OR decreased significantly.

Reproductive factors associated with breast cancer risk in northern Iran.

Breast cancer is a common malignancy for women in most parts of the world and the incidence in Iranian women is growing. The patients are relatively younger than their western counterparts. The aim of study was to investigate the roles of reproductive factors for breast cancer in Babol. In a case-control study in Babol, we recruited a total of 100 new patients with histologically confirmed breast cancer and 200 age-matched controls selected from outpatient clinics. Demographic and reproductive factors were ascertained by in-person interview using a constructed questionnaire. Several potential confounding factors were adjusted using multiple logistic model. The adjusted odds ratio showed that having higher age at first pregnancy and abortion were associated with increased breast cancer risk (the adjusted OR = 4.1, 95% CI: 1.3-13.2 and 2.93, 95% CI: 1.64-5.24, respectively). By increasing parity, the risk had reduced significantly; among women with parity ≥ 5, the adjusted OR was 0.09 (95% CI 0.01-0.7) compared with nulliparous women, and also for each additional parity, the risk reduced by 50% (OR = 0.50, 95% CI: 0.34-0.71). The duration of breast feeding was inversely associated with breast cancer risk, while after additional adjustment for parity, no longer the protective effect of breast feeding was observed. Nulliparity, late age at first birth and abortion were the most important reproductive factors associated with breast cancer risk; therefore, it is recommended to women with these risk factors to perform breast cancer screening tests earlier.

Body mass index and waist circumference are predictor biomarkers of breast cancer risk in Iranian women.

Both obesity and breast cancer incidence increased dramatically during two recent decades in a rapidly changing society in northern Iran. In this study, we examined the ability of body mass index (BMI) and waist circumference (WC) as predictor biomarkers of breast cancer risk in Iranian women. In a case-control study of 100 new cases of histological confirmed breast cancer and 200 age-matched controls, in Babol, we measured weight, height, waist and hip circumference at time of diagnosis with standard methods. The data of demographic, characteristics, reproductive and lifestyle factors were collected by interview. We used both regression and receiver operator characteristics (ROC) analysis to estimate the predictive ability of BMI and WC for breast cancer as estimated by area under the curve (AUC). The results showed a significant difference in the mean of weight, BMI and WC between patients and controls in pre- and postmenopausal women (P<0.001). While after adjusting for BMI, no longer an association between WC and breast cancer was found. The overall accuracy of observed BMI and WC were 0.79 (95% CI: 0.74-0.84) and 0.68 (95% CI: 0.61-0.74), respectively. The accuracy of BMI and WC were 0.82 (95% CI: 0.76-0.89), 0.75(0.67-0.83) for premenopausal and 0.77(0.68-0.85), 0.60 (0.50-0.71) for postmenopausal women, respectively. BMI and WC are predictor biomarkers of breast cancer risk in both pre- and postmenopausal Iranian women while after adjusting for BMI, no longer an association between WC and breast cancer was observed. These findings imply to perform breast cancer screening program in women with a higher BMI and WC.

Prevalence of overweight and obesity and associated risk factors in urban primary-school children in Babol, Islamic Republic of Iran

Childhood obesity is a major public health problem globally because of changes in lifestyles. We assessed the prevalence of overweight/obesity and associated factors in urban schoolchildren in Babol in a cross-sectional study of 1000 schoolchildren aged 7-12 years. Weight and height were measured and data on sports activities and leisure time physical activities were collected by questionnaire. Overweight/obesity were assessed by comparing body mass index [BMI] values to the BMI index for age and sex percentiles set by CDC, Atlanta. The prevalence of obesity and overweight was 5.8% and 12.3% respectively. The prevalence was significantly lower in girls compared with boys [age-adjusted OR= 0.69, 95% Cl: 0.50-0.96] and higher among private-school educated children compared with public-school educated students [age adjusted OR = 2.17, 95% Cl: 1.47-3.18]. For each additional score of leisure time physical activity, the age-adjusted OR decreased significantly

Outcomes of total versus subtotal abdominal hysterectomy.

There is still controversy about the best technique for hysterectomy to reduce postoperative adverse effects. This randomized clinical study in Babol, Islamic Republic of Iran, compared some clinical complications and sexual functioning following subtotal (SAH) and total abdominal hysterectomy (TAH). A total of 150 women (50 allocated to SAH and 100 to TAH) were followed up at 6 months postoperatively. Length of hospitalization was 4.40 (SD 1.90) days after SAH and 4.48 (SD 1.67) days after TAH. Haemoglobin level, postoperative fever, symptoms of dyspareunia and frequency of sexual intercourse were not significantly different between the 2 groups of women. SAH did not show any significant benefits over TAH.

Association of educational level with risk of obesity and abdominal obesity in Iranian adults.

BACKGROUND: The impact of education on obesity may vary according to population and geographic region. The objective of the present study was to determine the association between education and obesity. METHODS: A cross-sectional study of 3600 subjects aged 20-70 years was conducted by using a cluster sampling technique in an adult population residing in the north of Iran, in 2004. Weight, height, waist and hip circumference were measured and data concerning education level, demographic characteristics and physical activities were collected by interview. Logistic regression analysis was used to estimate the association between education and general obesity (body mass index >or=30) as well as abdominal obesity (waist circumference >88 cm in women and 102 cm in men). RESULTS: The adjusted odds ratio (OR) for general obesity at education level of high school and college compared with illiterate and primary level was 0.55 [95% confidence interval (CI): 0.43-0.71]. A greater negative association was observed for education at university level (OR = 0.32, 95% CI: 0.22-0.47) irrespective to sex. However, with regard to abdominal obesity, after controlling for confounding factors, the adjusted OR for education at university level remained significant only in women but not in men. CONCLUSION: The findings of this study indicate that education level is inversely associated with general obesity in both sexes but with abdominal obesity only in women.

Outcomes of total versus subtotal abdominal hysterectomy

There is still controversy about the best technique for hysterectomy to reduce postoperative adverse effects. This randomized clinical study in Babol, Islamic Republic of Iran, compared some clinical complications and sexual functioning following subtotal [SAH] and total abdominal hysterectomy [TAH]. A total of 150 women [50 allocated to SAH and 100 to TAH] were followed up at 6 months postoperatively. Length of hospitalization was 4.40 [SD 1.90] days after SAH and 4.48 [SD 1.67] days after TAH. Haemoglobin level, postoperative fever, symptoms of dyspareunia and frequency of sexual intercourse were not significantly different between the 2 groups of women. SAH did not show any significant benefits over TAH

The patterns and determinants of birth intervals in multiparous women in Babol, northern Iran.

The present study aimed to determine the patterns and factors associated with birth intervals in multiparous women in Babol, northern Iran. We conducted a cross-sectional study of 500 multiparous women at health centers and referred to the hospital for delivery in Babol, northern Iran in 2007. Data were collected using a questionnaire, including birth intervals, demographics, fertility variables, such as maternal education, maternal age at birth, gender of index child, history of still births, child status (infant mortality or still birth) of index child, parity, duration of breast feeding, residence area, contraception method used, and attendance at a family planning clinic. The data were analyzed using a logistic regression model. The mean (+/- SD) birth interval was 61 +/- 25.7 months. In 3.8% of women the birth interval was < 2 years, in 41.7% it was 4-5 years and in 28% it was > or = 6 years. The majority of women (76.8%) were age 20-34 years old at the time of pregnancy. About one-fourth (22.4%) of women were > or = 35 years old at the time of pregnancy and 0.8% of women were < 20 years old at pregnancy. Maternal age, duration of breast feeding, sex of index child, history of still births, history of infant mortality of the index child, type of contraception used, regular attendance at a family planning clinics and parity showed a significant correlation with birth interval (p < 0.05).

Age at menarche in girls born from 1985 to 1989 in Mazandaran, Islamic Republic of Iran.

This cross-sectional study was carried out on 2246 girls born between 1985 and 1989 to determine the age of menarche in Mazandaran province, northern Islamic Republic of Iran. Six cities were selected randomly and cluster sampling used to select high-school students in urban and rural areas. Students with malnutrition, anaemia and chronic infections such as tuberculosis were excluded. The mean (standard deviation) age of menarche was 12.5 (1.1) years, 95% CI: 12.45-12.55 years. The most frequent occurrence of menarche was in summer and least frequent in winter. Menarche age was significantly higher in girls living in rural areas and with fathers with lower education.

Age at menarche in girls born from 1985 to 1989 in Mazandaran, Islamic Republic of Iran

This cross-sectional study was carried out on 2246 girls born between 1985 and 1989 to determine the age of menarche in Mazandaran province, northern Islamic Republic of Iran. Six cities were selected randomly and cluster sampling used to select high-school students in urban and rural areas. Students with malnutrition, anaemia and chronic infections such as tuberculosis were excluded. The mean [standard deviation] age of menarche was 12.5 [1.1] years, 95% CI: 12.45-12.55 years. The most frequent occurrence of menarche was in summer and least frequent in winter. Menarche age was significantly higher in girls living in rural areas and with fathers with lower education

Prevalence of obesity, central obesity and the associated factors in urban population aged 20-70 years, in the north of Iran: a population-based study and regression approach.

Obesity is an undesirable outcome of changing of lifestyle and behaviours. It is also reversible predisposing factor for the development of several debilitating diseases. This study was aimed to determine the prevalence rate of obesity, overweight, central obesity and their associated factors in the north of Iran. We conducted a population-based cross-sectional study with a sample of 1800 women and 1800 men with respective mean ages of 37.5 +/- 13.0 and 38.5 +/- 14.2 years of urban population aged 20-70 years living in the north of Iran. The demographic and lifestyle data, in particular, age, gender, marital status, marriage age, family history of obesity, educational level, occupation, occupational and leisure time physical activity, duration of exercise per week, parity and the number of children were collected with a designed questionnaire. Diagnosis of obesity and central obesity were confirmed by the WHO standard recommended method by determining of body mass index (BMI) and waist circumference (WC). Logistic regression model was used to estimate the adjusted odds ratio (OR) and its 95% confidence interval. Over half of the study subjects were at educational levels of high school or higher; 79.4% of population was married and 35.3% had a family history of parental obesity. The majority of subjects in particular women had none or low levels of physical activity. The overall prevalence rates of obesity and overweight were 18.8% and 34.8% respectively. The overall prevalence rate of central obesity was 28.3%. The rate of obesity in women was higher than men (P < 0.0001). In both genders, particularly in the women, the rate of obesity was raised by increasing age. There was an inverse relation between the risk of obesity and marriage age, the high level of education (OR = 0.19, P < 0.0001), severe occupational activity (OR = 0.44, P < 0.0001), the level of exercise (in subjects with 3-4 h exercise per week, OR = 0.58, P < 0.001) and leisure time activity. Marriage, history of parental obesity and parity > or =5 were associated with increased risk of obesity (OR = 2.2, P < 0.001 and OR = 2.43, P < 0.0001 and OR = 3.73, P < 0.0001 respectively). The results of this study indicate an increased rate of obesity and overweigh in the north population of Iran. With respect to these findings, low level of activity and education, parity, family history of obesity, marriage at earlier age and ageing are responsible for both obesity and central obesity in the north of Iran. Therefore, a community-based multiple strategies are required to combat with increasing rate of obesity and its subsequent complications such as diabetes, coronary artery disease, hypertension and osteoarthritis.

Factors associated with the pattern of breastfeeding in the north of Iran.

BACKGROUND: The health benefits of breastfeeding to infants and mothers have been well established. Its pattern varies between populations and the differences may originate from varying social and cultural factors. AIMS: The aims of this study were to determine the pattern of breastfeeding and to assess its determinants in a population-based study in Babol, in the north of Iran. SUBJECTS AND METHODS: A cross-sectional study of 600 randomly selected mothers with infants 12-24 months old was conducted in the north of Iran in 1998. Data concerning breastfeeding status, breastfeeding duration and social and demographic factors were collected through interviews with the mothers. The probability of continuation of breastfeeding (i.e. survival probability) was estimated by using the non-parametric Kaplan-Meier method of survival analysis. The Cox regression analysis was applied to determine the factors associated with duration of breastfeeding. RESULTS: The results showed that the incidence of breastfeeding was 87 and 89% at 12 months in urban and rural areas and 18 and 53% at 24 months, respectively. The difference in the pattern of breastfeeding between urban and rural areas was significant after 12 months (p=0.04). The Cox regression model analysis showed that living in a rural area, increment of birth order, higher education level of mothers, and being housewife mothers were associated with longer duration of breastfeeding. Although, in the univariate analysis, women with high education appeared to have shorter duration of breastfeeding in comparison with illiterate mothers, after controlling the effect of mother's working status and other variables using the Cox regression model, high level of education had a positive association with longer duration of breastfeeding, i.e. the risk of weaning was decreased in comparison with illiterate women. Also, the risk of shorter duration of breastfeeding was increased significantly among mothers with a high level of stress. The results did not show a significant difference in pattern of breastfeeding in relation to age of mothers and sex of infants. CONCLUSION: Although the rate of breastfeeding among mothers in Babol was increasing, greater health education efforts are needed to support and promote the healthy practice of breastfeeding, especially among the young, less educated, nullipara, in urban areas and among women who are employees.

Factors affecting the survival of patients with oesophageal carcinoma under radiotherapy in the north of Iran.

Factors relevant to the survival of patients with oesophageal cancer under radiotherapy have been studied in northern Iran where its incidence is high. We conducted an analytical study using a historical cohort and information from the medical charts of patients with oesophageal cancer. Out of 523 patients referred to the Shahid Rajaii radiotherapy centre in Babolsar from 1992 to 1996, we followed 230 patients for whom an address was available in 1998. The frequency of prognostic factors among those not contacted was very similar to those included in the study. The data were analysed using survival analysis by the nonparametric method of Kaplan Meier and the Cox regression model to determine risk ratios (RR) of prognostic factors. Survival rates were 42% at 1 year, 21% at 2 years, and 8% at 5 years after diagnosis. Patients aged 50-64 were found to have poorer survival compared with those less than 50 (RR = 1.73, P = 0.03); the risk ratio for ages f = 65 was 1.88 (P = 0.03). Females had significantly better survival than males (RR = 0.71, P = 0.02). For each 100 rads dose of radiotherapy, the risk ratio was significantly decreased by 1% (RR = 0.99, P = 0.05); for each session of radiotherapy, the risk ratio was significantly decreased by 4% (RR = 0.96, P = 0.0001); for each square centimetre size of surface under radiotherapy, the risk ratio significantly increased (RR = 1.002, P = 0.04). We did not observe a significant difference on survival by histology, anatomical location of tumours, or type of treatment (P > 0.05). Prognosis is extremely poor.

Extension of receiver operating characteristic analysis to data concerning multiple signal detection tasks.

RATIONALE AND OBJECTIVES: When receiver operating characteristic (ROC) studies involve multiple detection tasks in the same patient, the correlations among the within-patient interpretations and the shortage of patients raise several analytic challenges. The authors propose methods for both parametric and nonparametric analysis of this type of data. METHODS: First, they computed one accuracy statistic for each task. Then one jackknife "pseudovalue" was calculated for each task and each patient. Then, they formed a summary index from the accuracy statistics and calculated the standard error of this summary index on the basis of the observed correlations among the jackknife pseudovalues. The method was extended to comparisons of two diagnostic systems and illustrated by using data from a clinical study. RESULTS AND CONCLUSION: This approach can be used with rating or quantitative data and with any index of accuracy, whether calculated parametrically or nonparametrically.

Sampling variability of nonparametric estimates of the areas under receiver operating characteristic curves: an update.

RATIONALE AND OBJECTIVES: Several methods have been proposed for calculating the variances and covariances of nonparametric estimates of the area under receiver operating characteristic curves (AUC). The authors provide an explanation of the relationships between them and illustrate the factors that determine sampling variability. METHODS: The authors investigated the algebraic links between two methods, that of "placements" and that of "pseudovalues" based on jackknifing. They also performed a numerical investigation of the comparative performance of the two methods. RESULTS: The "placement" method has a simple structure that illustrates the determinants of the sampling variability and does not require specialized software. The authors show that the pseudovalues used in the jackknife method are directly linked to the placement values. CONCLUSION: Because of the close link, borne out in a numeric investigation of the sampling variation, and because of the ease of computation, the choice between the two methods can be based on users' preferences. For indexes other than the AUC, however, the use of pseudovalues holds greater promise.