Mental health problems of Iranian female adolescents and its association with pubertal development: a nationwide study.

Mental health problems including emotional and behavioral problems during puberty may be under influence of different risk factors including cultures, living in urban or rural areas and ethnic factors which may vary between different countries. The main aim of this study is to investigate the profile of emotional and behavioral problems and the role of factors such as age, stage of puberty, ethnicity, rurality and living in urban area, as risk factors in Iranian girls. As a part of a large national study we evaluated the emotional and behavioral problems in different stages of puberty in a community sample of Iranian adolescent girls from public schools that were selected by clustered random sampling method. In all subjects, demographic characteristics, and pubertal stages were measured. Emotional and behavioral problems were evaluated using Strength and Difficulties Questionnaire (SDQ). The associations of age, pubertal development indices, socioeconomic and demographic factors with the behavioral problems were assessed. A total number of 4576 students enrolled the study and responded to the questions. The mean age of participants was 13.83 ± 2.19 years. The mean total score of difficulties in participants was 14.34 ± 5.81. According to these results 813 (17.8%) adolescents had total problem scores higher than Goodman's cutoff points and the most frequent problem domain was conduct problems (20.5%). According to the results the most related variable with the total difficulty score of SDQ were ethnicity, residency in urban areas and development of menstrual cycle respectively. The results of this study showed that the most correlated factors with mental health problems in Iranian girls during puberty are ethnicity, urbanity and development of menstrual cycle.

Metabolically obese normal weight and phenotypically obese metabolically normal youths: the CASPIAN Study.

OBJECTIVES: The objectives of this study were to estimate the prevalence and distribution of cardiovascular risk factors and the metabolic syndrome in children with generalized, central, or combined types of obesity and to possibly discover if a phenotypically obese metabolically normal and a metabolically obese normal weight phenotype could be identified in children and adolescents. DESIGN: This cross-sectional study is the baseline survey of a national longitudinal study. SUBJECT/SETTING: Overall 4,811 nationally representative children, aged 6 to 18 years, were recruited from the community through randomly selected schools within six provinces in Iran. In addition to physical examination, fasting glucose and lipid profile were assessed. MAIN OUTCOME MEASURE: Obesity type was considered the independent variable, cardiovascular risk factors and the metabolic syndrome were dependent variables. Prevalence of risk factors in different types of obesity was compared by multivariate analysis of variance and post-hoc tests. Logistic regression analysis was used to examine the associations between obesity type and the metabolic syndrome. RESULTS: Varying with age and sex groups, 6% to 9% of children were categorized into the isolated central obesity group, 7.5% to 11% into the isolated generalized obesity, and 14% to 16.5% into the combined type group. The prevalence of dyslipidemia, high blood pressure, and metabolic syndrome was higher in those children with combined obesity than in those with the other two types of obesity, as well as in the central than in the generalized obesity groups. Phenotypically obese metabolically normal subjects were more prevalent in the generalized obesity group. The likelihood of metabolic syndrome was highest in those with combined obesity (odds ratio 3.7, 95% confidence interval 3.1 to 4), and lowest in generalized obesity group (odds ratio 2.1, 95% confidence interval 1.8 to 2.5). CONCLUSIONS: This study complements recent research about the adverse health hazards of abdominal obesity in children. The finding of metabolically obese normal weight children suggests that additional investigation for cardiovascular risk factors may be warranted in normal-weight children with an ethnic predisposition to chronic diseases.

Hypertriglyceridemic waist phenotype and associated lifestyle factors in a national population of youths: CASPIAN Study.

The objectives of the current study, that is the first of its kind, were to determine the prevalence of the hypertriglyceridemic waist (HW) phenotype in a nationally representative sample of children, as well as the metabolic risk factors identified by HW, and to identify lifestyle habits related to this phenotype. This national survey was conducted on 4811 representative school-students. We assessed the sensitivity and specificity of the HW phenotype for abnormal anthropometric and biochemical factors by using receiver operator characteristic curves. We determined the association of dietary patterns (obtained by factor analysis), physical activity level and some environmental factors with the HW phenotype. Overall, 8.52% of participants had the HW phenotype. Those children with the HW phenotype were more likely to have cardiovascular risk factors, notably for overweight and hypercholesterolemia. The dietary pattern characterized by junk foods increased the odds of having the HW phenotype, OR = 1.426 (95%CI, 1.109, 1.892), whereas the other dietary pattern including healthy foods decreased this odds, OR = 0.874 (95%CI, 0.765, 0.998). The risk of the HW phenotype rose with the consumption of solid hydrogenated fat as well as white-flour bread. Low education of parents and a positive family history of diabetes mellitus, obesity and or premature cardiovascular disease were the other risk factors for the HW phenotype. Low levels of physical activity significantly increased the risk of having the HW phenotype. The HW phenotype can be used as an accurate and easy tool for screening children at metabolic risk in population-based studies.

Factors associated with the metabolic syndrome in a national sample of youths: CASPIAN Study.

BACKGROUND AND AIM: To date, research on the influence of environmental factors on metabolic syndrome (MS) among youths is limited. This study was conducted to investigate for the first time the association of these factors with MS in a large national, representative sample of children from a non-Western population. METHODS AND RESULTS: The study population comprised of 4811 students (2248 boys and 2563 girls) aged 6-18 years, living in six different provinces in Iran. MS, defined based on criteria analogous to those of the Adult Treatment Panel III, was detected in 14.1% of participants. A birth weight of >4000 g in boys and <2500 g in girls increased the risk of having the MS [OR, 95% CI: 1.4 (1.007, 2.05) and 1.2 (1.1, 1.4), respectively]. Poorly educated parents and a positive parental history of chronic disease were other risks factors associated with MS. Low levels of physical activity significantly increased the risk of having MS [boys: 1.3 (1.1, 1.7); girls: 1.4 (1.2, 1.6)]. The risk of MS increased in-line with the consumption of solid hydrogenated fat [boys: 1.2 (1.07, 1.3); girls, 1.3 (1.1, 1.5)] and bread made with white flour [boys: 1.6 (1.3, 2.1); girls, 1.4 (1.1, 1.7)]. In contrast, an increased frequency of consumption of fruits and vegetable, as well as dairy products decreased the risk of having MS. CONCLUSION: Considering the effect of modifiable lifestyle habits and birth weight on MS in youths, urgent public health approaches should be directed towards primordial and primary prevention of this rapidly growing problem.

Factor analysis of cardiovascular risk clustering in pediatric metabolic syndrome: CASPIAN study.

AIMS: To assess the results of factor analysis of coronary artery disease risk factors in a large national representative sample of children, and to compare its results on the variables measured between those with or without metabolic syndrome (MetS). METHODS: This cross-sectional multicenter population survey was conducted on 4,811 nationally representative school students aged 6-18 years. MetS was defined based on criteria analogous to the Adult Treatment Panel III. Factor analysis by principle components analysis and Varimax rotation was carried out to cluster risk factors. RESULTS: MetS was present in 14.1% of subjects (n = 678). From the nine variables assessed, factor analysis of the z scores of variables show that in all age groups, three similar factors were loaded: lipids, adiposity, and blood pressure, that accounted for 87.4-90.8% of the variance. Three factors were loaded in those with MetS (cholesterol/TG, metabolic/adiposity, and blood pressure) (65.9% of variance); and four factors (cholesterol, metabolic, adiposity, and blood pressure) were loaded among those without the MetS (75.6% of variance). We did not find a central feature that underlies all three factors among children with the MetS; however, waist circumference was the only variable that was loaded for two factors. CONCLUSION: These findings support a change in the concept of MetS from that of a single entity to one that represents several distinct but intercorrelated entities. An approach to assessing risk clustering from early life, and longitudinal studies that would elucidate how these various risk domains interact over time are needed.

First reference curves of waist and hip circumferences in an Asian population of youths: CASPIAN study.

The Objective of the present study is to develop the first age- and gender-specific reference curves for waist and hip circumferences in an Asian population of youths. This cross-sectional population survey was conducted in 2003-04 on a nationally representative sample of 21111 school-students living in urban (84.6%) and rural (15.4%) areas of 23 provinces in Iran. After anthropometric measurements, smoothed reference curves for waist and hip circumference (WC, HiC) and waist-to-hip ratio (WHR) were developed by the LMS method. In both genders, WC and HiC percentile values increased with age. For girls, the 50th to 95th percentile curves for WC had a sharp increase between 8 and 13 years and 11-15 years, respectively, and began to plateau after this age, whereas for boys, these curves had a persistent and less sharp increase with age, until the age of 18 years. The WHR curves of girls decreased with age until 15 years and began to plateau thereafter, whereas for boys the 25th to 95th curves had a plateau pattern. Comparison of the current reference curves with the British ones showed that in boys, the 5th and 50th percentile curves were similar in both studies, but the 95th percentile curve of our study was higher than the British curves. For girls, the 5th percentile curves of both studies were similar, but the 50th and 95th percentile curves of our study were higher than the British ones. These curves represent the first childhood WC, HiC and WHR reference curves obtained in Asia. These curves can provide baseline data for analysis of time trends, as well as for international comparisons.

Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study.

OBJECTIVE: To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children. METHODS: A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires. FINDINGS: Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins (R(2) = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI (R(2) = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups. CONCLUSION: Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered.

Association of anthropometric indices with cardiovascular disease risk factors among children and adolescents: CASPIAN Study.

BACKGROUND: For the first time in Iran, and to the best of our knowledge in Asia, we assessed the anthropometric indices most closely correlated to cardiovascular disease (CVD) risk factors in a large nationally representative sample of children and adolescents to be used as a simple tool for identifying those at risk. METHODS: This multi-center study was performed among a representative sample of 4811 school students (2248 boys and 2563 girls) aged 6-18 years, as part of the baseline survey of a national surveillance system. Anthropometric indices and CVD risk factors were measured using standard protocols, and their correlation was analyzed by using Receiver Operator Characteristic (ROC) curves and partial correlation. RESULTS: The most prevalent CVD risk factors were low HDL-C (28%), followed by hypertriglyceridemia (20.1%), and overweight (17%). The ROC analyses showed that among boys, all anthropometric indices had the same association with CVD risk factors in 6-9.9-year-age group, while in the 10-13.9 and 14-18-year-age groups, respectively waist circumference (WC) and body mass index (BMI) were the best in distinguishing CVD risk factors. Among girls, these indices were respectively BMI and waist to stature ratio (WSR); WC and WSR; and WC. In the partial correlation analysis, in boys, the highest coefficient was found for BMI; BMI and WC; and for WC and WSR; in girls, these indices were BMI; WC and WSR; and BMI respectively. CONCLUSIONS: In the present study, BMI, WC and WSR were the most appropriate in predicting CVD risk factors. It may be clinically useful in the pediatric population to routinely measure WC and WSR in addition to BMI as a screening tool to identify high-risk youth.

Association of physical activity and the metabolic syndrome in children and adolescents: CASPIAN Study.

BACKGROUND/AIM: To determine the association of physical activity and the metabolic syndrome in a large national-representative sample of children. METHODS: This study was performed in 2003-2004 on 4,811 school students aged 6-18 years, selected by multi-stage random cluster sampling from six provinces in Iran. We assessed the level of physical activity using a standardized questionnaire, and categorized it to the tertiles. The metabolic syndrome was defined based on criteria analogous to those of the Adult Treatment Panel III. RESULTS: The participants comprised 2,248 boys and 2,563 girls with a mean age of 12.07 +/- 3.2 years. In all age groups, boys were more physically active than girls. The metabolic syndrome was detected in 14.1% of participants, and its prevalence was higher in those subjects in the 1st, 2nd and 3rd tertiles of physical activity, respectively (15.1 vs.14.2 and 13.1%, respectively, p <0.05). This difference was seen in boys, while no difference was found between girls in the 2nd and 3rd tertiles of physical activity. Physical activity was linked to a cluster of factors consisting of high-density lipoprotein-cholesterol and waist circumference, followed by triglycerides in boys, and of triglycerides, waist circumference and blood pressure in girls. In both genders, before and after adjustment for age and body mass index, low levels of physical activity significantly increased the risk of having the metabolic syndrome [in boys: OR: 1.8, 95% CI: 1.1, 2.1; and in girls, OR: 1.6 (1.1, 1.9)]. CONCLUSION: We found an association between physical activity and the metabolic syndrome, which was independent of body mass index and age. Children should be encouraged to have greater physical activity.

Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.

BACKGROUND: This study was performed to determine the blood pressure (BP) percentile curves by height, as well as to assess the prevalence of high BP and its influencing factors among children in the first national survey in this field in Iran. DESIGN: A multicentre national cross-sectional survey. METHODS: This study was performed in 23 provinces among a representative sample of 21,111 students aged 6-18 years. RESULTS: Age and sex-specific percentile curves of systolic and diastolic BP were obtained by height. A comparison of the values obtained corresponding to the 90th percentiles with the Second Task Force cut-offs showed that the BP values and trends were relatively similar in both studies. The overall prevalence of systolic, diastolic as well as systolic or diastolic hypertension according to the Second Task Force study 95th percentile cut-off points were 4.2, 5.4 and 7.7%, respectively, without a significant sex difference. A history of low birthweight, overweight, taller height, the consumption of solid hydrogenated fat, as well as the frequency of fast food consumption increased the risk of both systolic and diastolic hypertension. Male sex, large waist, and low education of the mother were the risks for systolic hypertension, whereas the risk of diastolic hypertension rose with living in an urban area, attending public school, low physical activity level, having a housewife mother, and a positive family history of obesity, especially in the parents. CONCLUSION: Considering the effect of modifiable environmental factors on the childrens' BP, encouraging breast feeding and a healthy lifestyle may have an important effect on public health.

Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study.

OBJECTIVES: To determine the national prevalence of smoking among Iranian youths and its environmental influencing factors. METHODS: This study was performed in 2003-2004 among 11,966 school students, ages 11-18 years, selected by multi-stage random cluster sampling from 20 provinces in Iran. The participants filled out self-administered anonymous questionnaires. RESULTS: The prevalence of self-reported cigarette smoking was 14.3%, with a higher prevalence in boys than in girls (18.5% vs. 10.1%, respectively, P < 0.001), and in high school than in middle school students (17.4% vs. 10.6%, respectively, P < 0.001). Overall, 42.2% of smokers were daily smoker, and the rest were occasional smoker. The mean age of the first attempt to smoke was 13.2 +/- 2.5 years with no significant gender difference but was significantly lower in daily than in occasional smokers. The place of the first attempt to smoke was mostly in friend parties (41.6%) and traditional teahouses (23.2%) for boys and the family parties (37.1%) and the traditional teahouses (27.4%) for girls. The higher school level and having a tobacco user at home significantly increased the likelihood of smoking in adolescents, with the highest odds ratio (OR) found for having a smoker sister in girls (OR = 4.5, 95%CI, 2.5, 8.2), and having a smoker brother in boys (OR = 2.4, 95%CI, 2.03, 3.05). CONCLUSION: Smoking is becoming as a major public health threat among Iranian youths. Control measures should be considered not only for cigarette smoking, but also for the socially accepted habit of water pipe use that is revived in traditional teahouses.