Update of the clinical guideline for hypertension diagnosis and treatment in Iran.

BACKGROUND: This article introduces the updated version of the Iranian guideline for the diagnosis and treatment of hypertension in adults. The initial version of the national guideline was developed in 2011 and updated in 2014. Among the reasons necessitating the update of this guideline were the passage of time, the incompleteness of the scopes, the limitation of the target group, and more important is the request of the ministry of health in Iran. METHOD: The members of the guideline updating group, after reviewing the original version and the new evidence, prepared 10 clinical questions regarding hypertension, and based on the evidence found from the latest scientific documents, provided recommendations or suggestions to answer these questions. RESULT: According to the updated guideline, the threshold for office prehypertension diagnosis should be considered the systolic blood pressure (SBP) of 130-139 mmHg and/or the diastolic blood pressure (DBP) of 80-89 mmHg, and in adults under 75 years of age without comorbidities, the threshold for office hypertension diagnosis should be SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg. The goal of treatment in adults who lack comorbidities and risk factors is SBP < 140 mmHg and DBP < 90 mmHg. The first-line treatment recommended in people with prehypertension is lifestyle modification, while for those with hypertension, pharmacotherapy along with lifestyle modification. The threshold to start drug therapy is determined at SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg, and the first-line treatment is considered a drug or a combined pill of antihypertensive drugs, including ACEIs, ARBs, thiazide and thiazide-like agents, or CCBs. At the beginning of the pharmacotherapy, the Guideline Updating Group members suggested studying serum electrolytes, creatinine, lipid profile, fasting sugar, urinalysis, and an electrocardiogram. Regarding the visit intervals, monthly visits are suggested at the beginning of the treatment or in case of any change in the type or dosage of the drug until achieving the treatment goal, followed by every 3-to-6-month visits. Moreover, to reduce further complications, it was suggested that healthcare unit employees use telehealth strategies. CONCLUSIONS: In this guideline, specific recommendations and suggestions have been presented for adults and subgroups like older people or those with cardiovascular disease, diabetes mellitus, chronic kidney disease, and COVID-19.

The relationship between fermented and nonfermented dairy products consumption and hypertension among premature coronary artery disease patients: Iran premature coronary artery disease study.

Dairy products may affect hypertension (HTN) risk. The aim of this study was to examine the association between fermented and nonfermented dairy foods and HTN in a sample of premature coronary artery disease (PCAD) subjects. This cross-sectional study was performed on 1854 PCAD patients. A 110-item food frequency questionnaire was used to assess dietary intakes. HTN was considered if systolic blood pressure was 140 mmHg and higher and/or diastolic blood pressure was 90 mmHg and higher. The odds ratio of HTN across the quartiles of different types of dairy products was evaluated by binary logistic regression. The mean (SD) of dairy products consumption was 339.8 (223.5) g/day, of which 285.4 g/day was fermented dairy products. In the crude model, participants in the fourth quartile of fermented dairy products had lesser risk of HTN compared to the bottom quartile (OR = 0.70, 95% CI: 0.52, 0.96; p for trend = .058). However, after considering the possible confounders, the significance disappeared. Subjects in the top quartile of high-fat fermented dairy products had 34% lower risk for HTN compared to the bottom quartile (95% CI: 0.49, 0.88; p for trend < .001). Adjustment for potential risk factors weakened the association but remained significant (OR = 0.73, 95% CI: 0.53, 1.01; p for trend = .001). Nonsignificant relation was detected between low-fat fermented, low-fat nonfermented, and high-fat nonfermented dairy products and HTN. Moderate consumption of high-fat fermented dairy products, in a population with low consumption of dairy foods, might relate to reduced likelihood of HTN.

Association of obesity and the clinical course of hospitalised COVID-19 survivors.

Obesity is a risk factor for chronic inflammation and severe pulmonary infections. This study aimed to assess the association between obesity and the clinical courses of hospitalised COVID-19 survivors. This cross-sectional study used the Isfahan COVID Cohort (ICC) baseline data. The ICC is an ongoing, 5-year prospective, longitudinal cohort study conducted on hospitalised COVID-19 survivors in affiliated hospitals of the Medical University of Isfahan (MUI), Iran. Patients aged 19 and over throughout Isfahan County were recruited using a consecutive sampling method 1 month after discharge. Demographic and basic characteristics, symptoms and clinical features of these patients were collected and analysed. A total of 3843 hospitalised patients with COVID-19 were included in this study. Regarding the body mass index classification in the general obesity group, the patients with overweight and obesity had more extended hospitalisation and a higher frequency of low O2 saturation compared to the normal weight patients, and the highest frequency of low O2 saturation and more extended hospitalisation was observed in patients with obesity (5.9 ± 3.8 vs. 6.8 ± 5.4 vs. 7.1 ± 5.3, respectively; p = .001 and 59% vs. 64.5% vs. 65.5%; p < .001). Furthermore, individuals with abdominal obesity had a significantly longer duration of hospitalisation compared to the non-abdominal obesity group (6.3 ± 4.6 vs. 7.0 ± 5.3; p < .001). In the fully adjusted model, a significant association was observed between abdominal obesity and an increased occurrence of low oxygen saturation compared to general obesity (odds ratio: 1.25, 95% confidence interval: 1.03-1.44). Obesity was associated with more extended hospitalisation and hypoxia in patients with COVID-19. However, no significant relationship was found between obesity and other clinical courses.

Comparing vitamin D receptor gene polymorphisms in rs11568820, rs7970314, rs4334089 between COVID-19 patients with mild and severe symptoms: a case control study.

The associations of vitamin D receptor (VDR)- single nucleotide polymorphisms (SNPs) with the symptoms of COVID-19 may vary between patients with different severities of COVID-19. Therefore, in the present study, we aim to compare VDR polymorphisms in severe and mild COVID-19 patients. In this study, a total number of 85 hospitalized patients and 91 mild/moderate patients with COVID-19 were recruited. SNPs in VDR genes were determined using ARMS and then confirmed by sanger sequencing. The mean (SD) age of participants in hospitalized and non-hospitalized group was 59.0 (12.4) and 47.8 (14.8) years, respectively. Almost 46% of participants in hospitalized and 48% of participant in non-hospitalized group were male. The frequency of TT genotype of SNP rs11568820 was significantly lower in hospitalized than non-hospitalized group (3.5% vs. 17.6%; P = 0.018). However, there was no significant differences between genotypes of SNPs rs7970314 and rs4334089 and also alleles frequencies in all SNPs of two groups. The genotype of rs11568820 SNP had an inverse association with hospitalization of patients with COVID-19 after adjustment for comorbidities [OR 0.18, 95% CI 0.04, 0.88; P = 0.034]. While, there was no relationship between genotypes of SNPs rs7970314 and rs4334089 and hospitalization. The TT genotype of rs11568820 plays protective role in sever COVID-19 and hospitalization. Further studies with a large sample size which consider various confounding factors are warranted to confirm our results.

The Relationship between Dietary Patterns and Metabolic Phenotypes: A Cross-Sectional Study in a Representative Sample of Iranian Industrial Employees.

Background and Aim: There is limited evidence to support the relationship between dietary patterns and metabolic phenotypes. Therefore, this study aimed to assess the association of dietary patterns with metabolic phenotypes among a large sample of Iranian industrial employees. Methods: This cross-sectional study was conducted among 3,063 employees of Esfahan Steel Company, Iran. Using exploratory factor analysis, major dietary patterns were obtained from a validated short form of food frequency questionnaire. The metabolic phenotypes were defined according to Adult Treatment Panel III guidelines. The independent-sample t-test, one-way analysis of variance, χ2 test, and multivariable logistic regression were applied to analyze data. Results: Three major dietary patterns were identified by factor analysis: the Western dietary pattern, the healthy dietary pattern, and the traditional dietary pattern. After controlling for potential confounders, subjects in the highest tertile of Western dietary pattern score had a higher odds ratio (OR) for metabolically healthy obese (MHO; OR 1.58, 95% confidence interval [CI]: 1.29-1.94), metabolically unhealthy normal weight (OR 1.93, 95% CI 1.08-3.45), and metabolically unhealthy obese (MUHO) phenotypes (OR 2.87, 95% CI 2.05-4.03) than those in the lowest tertile. Also, higher adherence to traditional dietary pattern was positively associated with a higher risk of MHO (OR 1.91, 95% CI 1.56-2.34) and MUHO phenotypes (OR 2.33, 95% CI 1.69-3.22) in the final model. Conclusion: There were significant associations between dietary patterns and metabolic phenotypes, suggesting the necessity of nutritional interventions in industrial employees to improve metabolic phenotype, health outcomes, and, therefore, job productivity in the workforce population.

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Ultra-processed food consumption and cardiovascular events rate: An analysis from Isfahan Cohort Study (ICS).

BACKGROUND AND AIMS: The contribution of ultra-processed foods (UPFs) to daily energy intake and, therefore, their health effects may vary between countries. We aimed to investigate the association between UPFs and the incidence risk of cardiovascular events (CVEs) and cardiovascular mortality in the Isfahan cohort study. METHODS AND RESULTS: In 2001, 6504 participants aged ≥35 years were enrolled and followed until 2017. Dietary intake was assessed using a validated food frequency questionnaire, and the NOVA system was applied for UPF classification. Any new case of CVE, including fatal and non-fatal myocardial infarction (MI) or stroke, unstable angina (UA), and CVD death, was recorded. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through Cox proportional hazards regression models. A total number of 819 CVE, 164 MI, 348 UA, 172 strokes, and 181 cardiovascular deaths were recorded during 61352.5 person-years of follow-up. The median (IQR) of UPF consumption was 2.47 (1.00-5.23) times/week. In the fully adjusted model, individuals in the fourth quartile of UPFs had no higher risk for incident MI and UA (HR = 1.12, 95% CI: 0.87, 1.46; P for trend = 0.364), stroke (HR = 0.93, 95% CI: 0.58, 1.46; P for trend = 0.601), cardiovascular mortality (HR = 0.95, 95% CI: 0.61, 1.47; P for trend = 0.596), and CVE (HR = 1.08, 95% CI: 0.88,1.34; P for trend = 0.515) in comparison with those in the first quartile. CONCLUSION: This mid-term prospective cohort study provides no evidence for a significant association between UPF and CVE risk. Longer studies are required to confirm this association.

Association of triglyceride glucose index with cardiovascular events: insights from the Isfahan Cohort Study (ICS).

BACKGROUND: There is limited evidence regarding the evaluation of the association between the triglyceride glucose (TyG) index, an indicator of insulin resistance, and the incident risk of cardiovascular disease (CVD). Therefore, we aimed to examine the relationship between the TyG index and CVD incidence in a cohort of Iranian adults. METHODS: This study was performed in the framework of the Isfahan Cohort Study (ICS). The study population included 5,432 individuals aged ≥ 35 years. CVD events, including acute myocardial infarction (MI), stroke, and unstable angina (UA), were diagnosed by physicians. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The relationship between the TyG index and CVD events was investigated using Cox regression models. Receiver operating characteristics (ROC) curve analysis was used to determine the best cut-off for the TyG index for predicting CVD outcomes. RESULTS: During a median follow-up period of 11.2 years, a total number of 819 CVD, 164 MI, 172 stroke, and 384 UA were recorded. Following adjustment for multiple confounders, elevated TyG levels were associated with a higher risk of CVD (HR = 1.48; 95% CI 1.22-1.79; p < 0.001), MI (HR = 2.24; 95% CI 1.42-3.52; p < 0.001), stroke (HR = 1.45; 95% CI 0.96-2.19; p = 0.042), but not UA (HR = 1.28; 95% CI 0.96-1.69). The optimal TyG index cut-off was 8.91 for predicting CVD (sensitivity 58%; specificity 58%), 9.04 for predicting MI (sensitivity 57%; specificity 65%), 8.92 for predicting stroke (sensitivity 57%; specificity 57%), and 8.98 for predicting UA (sensitivity 53%; specificity 61%). CONCLUSION: We found a robust, direct association between the TyG index and the incidence of CVD events. This emphasizes the significance of observing the TyG index as an indicator of the occurrence of CVD events.

Association of the triglyceride glucose index with all-cause and cardiovascular mortality in a general population of Iranian adults.

BACKGROUND: The triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this regard specially in low and middle-income countries. PURPOSE: To examine the association between TyG index and risk of CVM and ACM in Iranians. METHODS: This prospective cohort study included 5432 adults (age ≥ 35 years) with no history of CVD events. Fasting glucose and triglyceride were measured at baseline in all participants and TyG index was calculated. Cox frailty model was used to calculate hazard ratios (HRs) for CVM and ACM across the tertiles of TyG index. RESULTS: After a median follow-up of 11.25 years, a total number of 191 cardiovascular deaths, and 487 all-cause mortality was recorded. The risk of both CVM and ACM increased across the tertiles of TyG index. In the adjusted model for lifestyle and metabolic variables, the risks of ACM and CVM increased by 41% (95% CI 1.11, 1.81; P for trend = 0.005) and 64% (95% CI 1.07, 2.50; P for trend = 0.024), respectively. However, adjustment for diabetes mellitus disappeared the significance for both ACM and CVM. These associations may vary by sex. TyG was not related to the risk of non-CVD mortality. CONCLUSION: The predicting value of TyG index for ACM and CVM might be mediated by diabetes status. Further studies are required to confirm these findings.

Which risk factor best predicts coronary artery disease using artificial neural network method?

BACKGROUND: Coronary artery disease (CAD) is recognized as the leading cause of death worldwide. This study analyses CAD risk factors using an artificial neural network (ANN) to predict CAD. METHODS: The research data were obtained from a multi-center study, namely the Iran-premature coronary artery disease (I-PAD). The current study used the medical records of 415 patients with CAD hospitalized in Razi Hospital, Birjand, Iran, between May 2016 and June 2019. A total of 43 variables that affect CAD were selected, and the relevant data was extracted. Once the data were cleaned and normalized, they were imported into SPSS (V26) for analysis. The present study used the ANN technique. RESULTS: The study revealed that 48% of the study population had a history of CAD, including 9.4% with premature CAD and 38.8% with CAD. The variables of age, sex, occupation, smoking, opium use, pesticide exposure, anxiety, sexual activity, and high fasting blood sugar were found to be significantly different among the three groups of CAD, premature CAD, and non-CAD individuals. The neural network achieved success with five hidden fitted layers and an accuracy of 81% in non-CAD diagnosis, 79% in premature diagnosis, and 78% in CAD diagnosis. Anxiety, acceptance, eduction and gender were the four most important factors in the ANN model. CONCLUSIONS: The current study shows that anxiety is a high-prevalence risk factor for CAD in the hospitalized population. There is a need to implement measures to increase awareness about the psychological factors that can be managed in individuals at high risk for future CAD.

The association between glycemic index, glycemic load and total carbohydrate intake and risk of premature coronary artery disease: Iran Premature Coronary Artery Disease Study (IPAD) - A Case-Control Study.

BACKGROUND AND AIMS: The association between glycemic index (GI), glycemic load (GL), total carbohydrate intake, and risk of cardiovascular diseases has been controversial. Premature coronary artery disease (PCAD) is characterized by the age of onset lower than 55 and 65 respectively in men and women. The aim of the current study is to investigate the relationship between GI, GL and carbohydrate levels and the risk of PCAD in Iran. METHODS AND RESULTS: In total, 419 healthy people and 553 patients struggling with PCAD have participated in this case-control study. Dietary GI and GL were calculated using a validated food frequency questionnaire at the baseline. Crude and multivariable logistic regression were used to assess the relationship between GI, GL, and total carbohydrate intake and risk of PCAD. The mean age of participants was 51.13 ± 6.90 and 46 % of them were women. A significant direct relationship was observed between higher carbohydrate intake (OR: 1.74, 95%CI: 1.27-2.38) and GL levels (OR: 1.56, 95 % CI:1.14-2.14) and risk of PCAD. These associations were not significant after adjusting for potential variables. No significant association has been observed between GI and odds of PCAD even after controlling for all covariates. CONCLUSION: We found no significant association between GI, GL, and total carbohydrate intake and risk of premature coronary heart disease. Further observational and clinical trials are required to assess this relationship.

National burden of rheumatoid arthritis in Canada, 1990-2019: findings from the Global Burden of Disease Study 2019 - a GBD collaborator-led study.

OBJECTIVE: The objectives of this study were: (1) to describe burden of rheumatoid arthritis (RA) and trends from 1990 to 2019 using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) data, (2) to describe age and sex differences in RA and (3) to compare Canada's RA burden to that of other countries. METHODS: Disease burden indicators included prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life-years (DALYs). GBD estimated fatal and non-fatal outcomes using published literature, survey data and health insurance claims. Data were analysed by Bayesian meta-regression, cause of death ensemble model and other statistical methods. DALYs for Canada were compared with DALYs of countries with similarly high Socio-Demographic Index values. RESULTS: In Canada, the RA prevalence rate increased by 27% between 1990 and 2019, mortality rate decreased by 27%, YLL rate decreased by 30%, YLD increased by 27% and DALY rate increased by 13%, all age standardised. The decline in RA mortality and YLL rates was especially pronounced after 2002. The disease burden was higher in females for all indicators, and DALY rates were higher among older age groups, peaking at age 75-79 years. Prevalence and DALYs were higher in Canada compared with global rates. CONCLUSION: Trends in RA burden indicators over time and differences by age and sex have important implications for Canadian policy-makers, researchers and care providers. Early identification and management of RA in women may help reduce the overall burden of RA in Canada.

Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double-blind placebo-controlled trial (EMPT-ANGINA Trial).

INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT-ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA). METHOD: In this 8-week, double-blind, randomized, placebo-controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components. RESULTS: The mean age of individuals in the empagliflozin and placebo groups was 67.46 ± 9.4 and 65.47 ± 7.0 years, respectively (p = .304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 ± 20.70 vs. 224 ± 25.36, p < .001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1 mm ST-segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p = .125). CONCLUSION: Empagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.

Methotrexate & rheumatoid arthritis associated atherosclerosis: A narrative review of multidisciplinary approach for risk modification by the international board of experts.

Rheumatoid arthritis (RA) is an idiopathic, autoimmune connective tissue disorder that primarily affects the synovial joints, causing symmetric, erosive-deforming polyarthritis. It is also associated with extra-articular manifestations, particularly cardiovascular (CV) diseases (CVD). CV risk modification in RA remains unsolved despite recent advances in the management of RA. RA is an independent risk factor for atherosclerosis. RA and atherosclerosis share similar pathophysiological features (such as the pro-inflammatory cascade activation including interleukin-6) and risk factors (such as microflora dysbacteriosis and smoking). Patients with RA experience an exacerbation of atherogenesis, with atheromas destabilization, endothelial dysfunction, vasculitis, and hypercytokinemia. Consequently, the inflammatory response associated with RA is the basis for CVD development. The treat-to-target strategy not only improved RA control but also had a favorable effect on the morpho-functional state of the CV system in patients living with RA. Thus, disease-modifying antirheumatic drugs (DMARDs) - in particular methotrexate - may have a beneficial effect on the prevention of CV events in RA. It must be mentioned that RA is a serious multi-system disease, not only because of a window period during which the course of RA can be reversed, but also due to early damage to the heart and blood vessels. For this reason, a thorough cardiological assessment must be performed for all patients with RA, regardless of sex, age, disease stage, and disease activity score.

Diabetic Cardiomyopathy: 2023 Update by the International Multidisciplinary Board of Experts.

Diabetes mellitus (DM) is considered by many the pandemic of the 21st century and is associated with multiple organ damages. Among these, cardiovascular complications are responsible for an incredible burden of mortality and morbidity in Western Countries. The study of the pathological mechanisms responsible for the cardiovascular complications in DM patients is key for the development of new therapeutic strategies. The metabolic disorders caused by hyperglycemia, insulin resistance, and dyslipidemia, results in a cascade of pathomorphological changes favoring the atherosclerotic process and leading to myocardial remodeling. Parallel to this, oxidative stress, calcium overload, mitochondrial dysfunction, activation of protein kinase C signaling pathways, myocardial lipomatosis, and low-grade inflammation of the myocardium - are the main pathways responsible for the diabetic cardiomyopathy development. This review aims to appraise and discuss the pathogenetic mechanisms behind the diabetic cardiomyopathy development.

Body weight changes and diabetes mellitus incident: A cohort study from the Middle East.

Objective: Obesity is a known risk factor for diabetes, but the effect of weight changes on the incidence of diabetes is not yet determined. This study aims to evaluate the long-term effects of weight change [based on body mass index (BMI)] on the incidence of diabetes mellitus (DM) in a middle eastern population. Method: In the Isfahan Cohort Study (ICS) 6504 adults equal or greater than 35 years of age were recruited at 2001 and were followed until 2013. Absolute BMI changes (ΔBMI) were calculated by subtracting the baseline BMI from the BMI measured at follow-ups. To compare participants with different baseline BMI easier, relative changes in BMI were quantified as the percentage of changes from baseline. DM was assessed based on standard definitions. Multivariable Cox regression was used to determine the association between ΔBMI and the incidence of diabetes. Results: During follow-ups, 261 new cases of diabetes were recorded, with an IR of 3401.29 per 100,000 P-Y. The highest number of new cases of type 2 DM belongs to participants with overweight and obesity who had minimal BMI changes (less than 5% of their baseline BMI limits; 42 and 38 new cases, respectively). Participants who were obese at baseline and had lost more than 10% or gained 5-10% of baseline BMI were in the groups with the highest IR [360.05-95% CI (239.3-541.8) and 322.39-95% CI (178.5-582.1) respectively]. There was no significant association between BMI changes and the incidence of DM in the participants with normal BMI, overweight, and obesity at baseline in cure and adjusted models. Conclusions: This study showed there was no significant association between diabetes mellitus incidence and BMI changes.

Are different perceived stressors associated with metabolic syndrome: a longitudinal cohort study of adults in central Iran.

Purpose: The link between metabolic syndrome (MetS) and various stressors has not been thoroughly investigated. We aimed to examine the relationship between MetS and different perceived stressors. Methods: In this study, we included participants of the Isfahan Cohort study from three counties in central Iran, with data in the 2007 (n = 3178) and 2013 (n = 1693) follow-up stages. We examined the association between distress and perceived stress domains (including job security, job conflicts, personal conflicts, loss and separation, social relations, and health concerns) and MetS. Results: MetS was identified in 35.8% of participants in the 2007 cohort and 46.2% in the 2013 cohort. In the fully adjusted analysis, the odds ratio (OR) (95%CI) for MetS according to psychological status was 1.65 (1.64-1.65) for psychological distress level, 1.09 (1.01-1.20) for psychological distress score, and 1.21 (1.09-1.42) for total perceived stress score. There was also evidence of association for social relations, personal conflicts, job conflicts, job security, health concern, loss and separation, educational concerns, and sexual life subscales. Conclusion: Perceived stressors and some of their subscales were associated with MetS.

The relationship between nut consumption and premature coronary artery disease in a representative sample of Iranians: Iran-premature coronary artery disease (IPAD) study.

OBJECTIVE: The cardioprotective effects of nuts are well established. However, the positive impacts of nuts in preventing CVD at a younger age, a condition known as premature coronary artery disease (PCAD), is still debated. Therefore, we aim to determine the association between nuts and PCAD occurrence and its severity in different Iranian ethnicities. DESIGN: This case-control study was conducted within the framework of the Iran-premature coronary artery disease (I-PAD) study, an ongoing multi-centric study on Iranian patients of different ethnicities. SETTING: This multi-centric case-control study was conducted in among 3253 persons under the age of 70 years in women and 60 years in men from different ethnicities in Iran. PARTICIPANTS: Information on nut consumption was collected using a validated FFQ. Subjects were selected from among the candidates for angiography. Cases were those whose coronary angiography showed stenosis of more than 75 % in at least one vessel or more than 50 % of the left main artery, while the control group participants had normal angiography results. RESULTS: In the crude model, compared to the first quartile, the highest quartile of nut consumption was significantly associated with a lower risk of PCAD (OR = 0·26, 95 % CI (0·21, 0·32); Pfor trend = 0·001). In the top quartile of nut intake, a substantial decrease in PCAD was observed after controlling for putative confounders (OR = 0·32; 95 % CI (0·24, 0·43); Pfor trend = 0·001). Additionally, a 75 % decrease in the risk of severe PCAD was observed in the participants in the highest quartile of nut intake. CONCLUSION: A significant inverse association was observed between nut intake and the risk and severity of PCAD in the Iranian population. Large-scale clinical trials are required to confirm these findings.

The association between dietary patterns and quality of life: a cross-sectional study among a large sample of industrial employees.

BACKGROUND: considering the diet, as a whole (dietary patterns), can provide more information regarding dietary guidelines to decrease health problems and improve quality of life (QoL) of industrial workers.Therefore, the aims of this study were to identify major dietary patterns and to evaluate their association with quality of life among Iranian industrial employees. METHODS: This cross-sectional study was conducted on 3,063 employees of Isfahan Steel Company, Isfahan, Iran, in 2015. Dietary data were evaluated through a validated form of a food frequency questionnaire. Exploratory factor analysis was used to extract major dietary patterns,. To assess the QoL, Euro-QoL five- dimension questionnaire was used. Latent class analysis was used to classify participants based on QoL. Multivariable logistic regression was employed to evaluate the association between dietary patterns and QoL. RESULTS: Three dietary patterns, i.e. western, healthy and traditional, and two classes, i.e. high and low quality of life. were identified from study participants. Lower adherence to the healthy dietary pattern increased the risk of being in low QoL class in which subjects in the lowest tertile of healthy dietary intake had higher odds of being in low QoL class (adjusted OR (AOR): 1.51, 95% CI: 1.19-1.91). However, subjects in the lowest tertile of traditional diet, low adherence, had 30% lower risk of belonging to the low QoL class (AOR:0.70, 95% CI: 0.55-0.88). Higher adherence to western dietary pattern increased the risk of low quality of life, but it was not statistically significant. CONCLUSION: Higher adherence to a healthy diet and lower adherence to traditional dietary pattern were associated with better QoL in manufacturing employees.