The trend and pattern of depression prevalence in the U.S.: Data from National Health and Nutrition Examination Survey (NHANES) 2005 to 2016.

BACKGROUND: To assess the trend and pattern of depression prevalence among adult population by demographic characteristics and severity of disease from 2005 to 2016. METHODS: We used six cycles of National Health and Nutrition Examination Survey. The Patient Health Questionnaire (PHQ-9) was used to measure of depression with the total score ranges 0-27. Socio-demographic variables including age, gender, marital status, race, education, and poverty income ratio (PIR) were used. The weighted prevalence was calculated for each cycle. Logistic regression was used for assessing time-trends in the prevalence of depression. RESULTS: A total of 31,191 participants aged>20 years were included. The intensity of prevalence trend was different among subgroups of demographic characteristics. Prevalence in females was 1.5-fold more than that in males and increased approximately 2-fold during the study period. The prevalence in "never married" and "other marital status" subgroups was almost 1.5-fold and 2-fold more than that in "married" subgroup, respectively. Prevalence in the never married subgroup increased 2-fold from the first cycle to the latest one. The prevalence of depression was more in the aged<60 years, race group other than white, low education and PIR≤1 subgroups. But, the intensity of the increasing trend was more in the subgroups of aged≥60 years, white race and PIR>1. LIMITATIONS: the possibility of age-period-cohort (APC) effect that we were unable to assess and control them. CONCLUSIONS: In sum, there was an overall increasing trend of depression which was different by demographic characteristics based on subtype of depression.

O Efeito Direto do Índice de Massa Corporal nos Resultados Cardiovasculares entre Participantes sem Obesidade Central pela Estimativa por Máxima Verossimilhança Direcionada / The Direct Effect of Body Mass Index on Cardiovascular Outcomes among Participants Without Central Obesity by Targeted Maximum Likelihood Estimation

Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P<0,05 foi considerado estatisticamente significativo. As análises foram realizadas no pacote TMLE R. Resultados: O risco de desfechos cardiovasculares atribuídos ao IMC foi significativamente revertido com a eliminação da obesidade na RCQ (p <0,001). A proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação à CC (PE = 127%; IC95% (126,128)) e RCQ (PE = 97%; IC95% (96,98)) para doença arterial coronariana (DAC), e RCQ (PE = 92%; IC95% (91,94)) para acidente vascular cerebral, respectivamente. Com relação ao sexo, a proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação a RCQ (PE = 428%; IC95% (408.439)) para DAC em homens e CC (PE = 99%; IC95% (89,111)) para acidente vascular cerebral em mulheres, respectivamente. Conclusão: Esses resultados indicam diferentes efeitos potenciais da eliminação da obesidade central na associação entre IMC e desfechos cardiovasculares em homens e mulheres. (Arq Bras Cardiol. 2021; 116(5):879-886)

Background: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. Objective: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. Methods: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. Results: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. Conclusion: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886)

The Direct Effect of Body Mass Index on Cardiovascular Outcomes among Participants Without Central Obesity by Targeted Maximum Likelihood Estimation. / O Efeito Direto do Índice de Massa Corporal nos Resultados Cardiovasculares entre Participantes sem Obesidade Central pela Estimativa por Máxima Verossimilhança Direcionada.

BACKGROUND: Body mass index (BMI) is the most commonly used index to categorize a person as obese or non-obese, which is subject to important limitations. OBJECTIVE: To evaluate the direct effect of BMI on cardiovascular outcomes among participants without central obesity. METHODS: This analysis included 14,983 males and females aged 45-75 years from the Atherosclerosis Risk in Communities Study (ARIC). BMI was measured as general obesity, and waist circumference (WC), waist-to-hip ratio (WHR) and hip circumference as central obesity. Targeted maximum likelihood estimation (TMLE) was used to estimate the total effects (TEs) and the controlled direct effects (CDEs). The proportion of TE that would be eliminated if all participants were non-obese regarding central obesity was computed using the proportion eliminated (PE) index. P <0.05 was considered statistically significant. Analyses were performed in the TMLE R package. RESULTS: The risk of cardiovascular outcomes attributed to BMI was significantly reversed by eliminating WHR obesity (p<0.001). The proportion eliminated of BMI effects was more tangible for non-obese participants regarding WC (PE=127%; 95%CI (126,128)) and WHR (PE=97%; 95%CI (96,98)) for coronary heart disease (CHD), and WHR (PE=92%; 95%CI (91,94)) for stroke, respectively. With respect to sex, the proportion eliminated of BMI effects was more tangible for non-obese participants regarding WHR (PE=428%; 95%CI (408,439)) for CHD in males, and WC (PE=99%; 95%CI (89,111)) for stroke in females, respectively. CONCLUSION: These results indicate different potential effects of eliminating central obesity on the association between BMI and cardiovascular outcomes for males and females. (Arq Bras Cardiol. 2021; 116(5):879-886).

FUNDAMENTO: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. OBJETIVO: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. MÉTODOS: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P<0,05 foi considerado estatisticamente significativo. As análises foram realizadas no pacote TMLE R. RESULTADOS: O risco de desfechos cardiovasculares atribuídos ao IMC foi significativamente revertido com a eliminação da obesidade na RCQ (p <0,001). A proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação à CC (PE = 127%; IC95% (126,128)) e RCQ (PE = 97%; IC95% (96,98)) para doença arterial coronariana (DAC), e RCQ (PE = 92%; IC95% (91,94)) para acidente vascular cerebral, respectivamente. Com relação ao sexo, a proporção eliminada dos efeitos do IMC foi mais tangível para participantes não obesos em relação a RCQ (PE = 428%; IC95% (408.439)) para DAC em homens e CC (PE = 99%; IC95% (89,111)) para acidente vascular cerebral em mulheres, respectivamente. CONCLUSÃO: Esses resultados indicam diferentes efeitos potenciais da eliminação da obesidade central na associação entre IMC e desfechos cardiovasculares em homens e mulheres. (Arq Bras Cardiol. 2021; 116(5):879-886).

Incidence and Risk Factors of Colorectal Cancer in the Iranian Population: a Systematic Review.

PURPOSE: Colorectal cancer (CRC) is one of the most common cancers in the world. The aim of this study was to investigate its incidence and risk factors in the Iranian population. METHODS: A literature search was conducted in PubMed, Web of Science, Scopus, SID, and Magiran from inception until 2019. Studies that reported the incidence rate and risk factors of colorectal cancer were included in this review. RESULTS: Twenty-one articles that reported the incidence rate and 13 that reported the risk factors were included. The incidence rate was different according to the population type, gender, age, and study year in different regions. The main risk factors for colorectal cancer were high consumption of red meat and fried food and low intake of fruits and vegetables, diabetes, a positive family history, and obesity. CONCLUSION: The incidence of CRC has a marked variation in different parts of Iran, and various risk factors are associated with colorectal cancer. According to incidence rate and various risk factors, precise planning is needed to control colorectal cancer in the future.

Estimation of the serial interval and basic reproduction number of COVID-19 in Qom, Iran, and three other countries: A data-driven analysis in the early phase of the outbreak.

The outbreak of COVID-19 was first reported from China, and on 19 February 2020, the first case was confirmed in Qom, Iran. The basic reproduction number (R0 ) of infection is variable in different populations and periods. This study aimed to estimate the R0 of COVID-19 in Qom, Iran, and compare it with that in other countries. For estimation of the serial interval, we used data of the 51 confirmed cases of COVID-19 and their 318 close contacts in Qom, Iran. The number of confirmed cases daily in the early phase of the outbreak and estimated serial interval were used for R0 estimation. We used the time-varying method as a method with the least bias to estimate R0 in Qom, Iran, and in China, Italy and South Korea. The serial interval was estimated with a gamma distribution, a mean of 4.55 days and a standard deviation of 3.30 days for the COVID-19 epidemic based on Qom data. The R0 in this study was estimated to be between 2 and 3 in Qom. Of the four countries studied, the lowest R0 was estimated in South Korea (1.5-2) and the highest in Iran (4-5). Sensitivity analyses demonstrated that R0 is sensitive to the applied mean generation time. To the best of the authors' knowledge, this study is the first to estimate R0 in Qom. To control the epidemic, the reproduction number should be reduced by decreasing the contact rate, decreasing the transmission probability and decreasing the duration of the infectious period.

Association between caffeine intake and cognitive function in adults; effect modification by sex: Data from National Health and Nutrition Examination Survey (NHANES) 2013-2014.

BACKGROUND & AIMS: The aim of this study was to evaluate the association between caffeine intake and cognitive function. METHODS: In this cross sectional study, we used data from the 2013-2014 National Health and Nutritional Examination Surveys (NHANES). Our research subjects were 1440 adults aged ≥60 years. The individual's cognitive functions were evaluated using the Consortium to Establish a Registry for Alzheimer's disease (CERAD) Word List Learning Test, CERAD Word List Recall Test, Animal Fluency test, and Digit Symbol Substitution Test (DSST). Participants were categorized based on the quartiles of caffeine intake. In each dimension of cognitive, we calculated and used median value as cut-off point and assessed the association between each dimension (binary) and caffeine intake using multiple logistic regression analysis in different models. RESULTS: In all of the dimensions, only the highest quartile of caffeine intakes was positively associated with the cognitive function in the crude model and also trend existed (P trend <0.05). After adjusting for potential confounders (age, sex, family income, education, marital status, history of disease, sleep disorders, thyroid problems, physical activity, social support, smoking, and some nutrients), the association was marginally significant in CERAD Word List Recall Test (P trend = 0.09), but was not significant in other dimensions of cognitive function. A statistically significant interaction was noted between caffeine intake and gender in relation to the CERAD Word List Recall Test (P = 0.02). CONCLUSIONS: Generally, there was a weak positive association between caffeine intake and cognitive performance in older adults that modified by sex. So that, the relation was stronger among male than female.

Evaluation of Serum Levels of Inflammation, Fibrinolysis and Oxidative Stress Markers in Coronary Artery Disease Prediction: A Cross-Sectional Study.

BACKGROUND: Coronary Artery Disease (CAD) has long been recognized as a global health issue. Inflammation, Fibrinolysis and Oxidative Stress play an important role in the disruption of plaques leading to CAD. Markers that reflect this pathophysiologic mechanism may have prognostic value. OBJECTIVE: To estimate the serum concentrations of high-sensitivity C-reactive protein (hs-CRP), sialic acid (SA), vitronectin (VN), plasminogen activator inhibitor-1 (PAI-1), oxidized low density lipoprotein (OX-LDL) and malondialdehyde (MDA) with significant prognostic value in patients with CAD. METHODS: The markers included, hs-CRP, SA, VN, PAI-1, OX-LDL and MDA, were compared between 160 angiographically diagnosed CAD patients and 20 age- and sex-matched healthy individuals. The subjects were divided into 4 groups according to angiography results, and association between all risk factors of CAD was studied. Serum levels of SA, VN, PAI-1, and OX-LDL were measured by enzyme-linked immunosorbent assay (ELISA); MDA was measured based on reaction with thiobarbituric acid (TBA); and hs-CRP level was estimated by immunoturbidimetry using a commercial kit. The diagnostic value of these variables was further assessed by ROC curve analysis. Multiple logistic regression was used to evaluate the diagnostic power of the combination. Furthermore, p < 0.05 was considered as significant. RESULTS: Serum levels of hs-CRP, SA, VN, PAI-1, and OX-LDL were significantly higher in patient groups compared to control group (p < 0.001). Using both normal and CAD patients as subjects, ROC analysis was performed. The cutoff for OX-LDL, MDA, PAI-1, VN, hs-CRP and SA was 2.67 (ug/mL), 5.49 (mmol/mL), 67 (ng/mL), 254 (ng/mL), 3.4 (mg/dL), 7/89 (mg/dL), respectively. Eventually, the complete diagnostic efficacy was classified as: SA, hs-CRP, PAI-1, OX-LDL, MDA and VN. CONCLUSION: Serum levels SA, hs-CRP, VN, PAI-1, OX-LDL and MDA may be predictive of adverse cardiovascular outcomes. Interestingly, these analyses can help as diagnostic and monitoring markers in CAD patients.

Prevalence and determinant factors of anemia in children aged 6-12 months after starting an iron supplement in the east of Iran.

OBJECTIVE: Anemia in infants is a common problem, with regular iron supplementation the suggested policy for prevention and control of anemia. The aim of this study was to determine the prevalence and the determining factors of anemia as well as the benefits of regular iron supplementation in 6- to 12-month-old children. DESIGN/SETTING/SUBJECTS: In this cross-sectional study, 897 children aged from 6 to 12 months cared for at the Tabas Health Centers, affiliated with Birjand University of Medical Sciences, South Khorasan, Iran, were enrolled in the study. Demographic and anthropometric data as well as the level of hemoglobin were collected through interviews and laboratory tests, respectively. Data analysis was performed using SPSS-22 and stata-13. Chi2, polychromic PCA, and logistic regression were used. The statistical significance level was 0.05. RESULT: The prevalence of anemia, according to the WHO criterion for hemoglobin, was 36.8% (95% CI, 33.6-40.0). Its prevalence showed a decreasing trend as age and duration of iron supplement increased. Each 1-month increase in infant age was associated with a decreased risk of anemia [OR=0.88 (95% CI, 0.80-0.98)]. Anemia was not significantly different between genders. Individuals in the highest category for parity (≥3) were at a 2.3-fold greater risk of anemia compared with the lowest category [OR=2.35 (95% CI, 1.43-3.84)]. In contrast, individuals in the highest category for maternal age (>35 years) had a 62% lower risk of anemia compared with the reference category (<25 years) [OR=0.38 (95% CI, 0.20-0.72)]. CONCLUSION: Implementation of an iron supplementation plan in Iran has decreased anemia among 6- to 12-month-old children.