Association Between Obesity and Blood Pressure Among Iranian Children and Adolescents: A Sub-analysis from the SHED LIGHT Study.

Childhood obesity has become a major non-communicable disease worldwide. It is associated with an increased risk of cardiometabolic factors, including diabetes and hypertension (HTN). The purpose of this study was to evaluate the association between obesity and HTN among Iranian children and adolescents. Cross-sectional data from the SHED LIGHT study performed in Tehran urban area were used in this report. The anthropometric values and blood pressure were analyzed. The obesity status was identified based on body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). The blood pressure status was defined using percentiles for height, age, and sex. A total of 14,641 children with a mean age of 12.28 ± 3.1 years (6-18) were assessed, and 52.8% of them were boys. The prevalence of HTN was higher among obese compared to healthy weight subjects (p < 0.001). HTN had the strongest association with the central obesity by WC (odds ratio [OR] 4.098, 95% confidence interval [CI] 3.549-4.732), generalized obesity by BMI (OR 3.000, 95% CI 2.749-3.274), and central obesity by WHtR (OR 2.683, 95% CI 2.451-2.936). Moreover, parental university education, having studied in private schools, and the smaller number of household children increased the risk of obesity. The rate of HTN was high among children and adolescents with generalized and central obesities. HTN, elevated blood pressure, boy gender, and socioeconomic status were associated with obesity, emphasizing on the importance of screening and implementing lifestyle changes to decrease future risk of cardiovascular diseases.

Association between Dental Caries and Body Mass Index-for-Age among 10-12-Year-Old Female Students in Tehran.

INTRODUCTION: Dental caries and obesity are multifactorial diseases with diet being a common contributory factor. Many studies have reported varied outcomes about the association between dental caries and body mass index. But, there is no published study that investigates this association among female students in Tehran. The main aim of this study was to examine the relationship between dental caries and body mass index (BMI) in a sample of female students in Tehran. METHODS: In this cross-sectional study, 416 students aged between 10 to 12 years was examined for dental caries using WHO standard diagnostic criteria. The Decayed, missing and filled of permanent teeth (DMFT) were recorded. The student's weight and height were measured by two trained examiner and their BMI were calculated. BMI-for-age and dental caries categories were analyzed with Pearson correlation coefficient, Chi-square, and t-tests using SPSS computer software. RESULTS: The mean DMFT score and BMI of the study population was 1.03 ± 1.41 and 18.11 ± 3.33 respectively. The findings showed that 58.9% of the children had a normal weight, 27.9% were overweight, 10.3% were obese, and only 2.9% of the students were thin when they were compared with WHO standard of BMI for children with the same age. The respective mean DMFT values for BMI groups (thin, normal, overweight and obese) were 1.25, 0.73, 1.42, and 1.65, respectively. There was a significant association (P < 0.05) between dental caries and high BMI. CONCLUSIONS: This study demonstrated a significant association between caries frequency with high body mass index. For these reasons, the evaluation of nutritional status in students should be implemented in control programs for dental caries both on the community, schools, and individual levels.

Predicting oral health behaviors among Iranian students by using health belief model.

INTRODUCTION: The aim of this study is assessing predictors to oral health behavior in Iranian students based on the health belief model. MATERIALS AND METHODS: This cross-sectional study was conducted on 416 (applying the statistical estimation) of fifth-grade female students of Tehran in 2016. Random cluster sampling method was used to recruit students. The inclusion criteria were being grade five female student (aged 10-12 years), and studying in governmental schools, and having a signed consent from the child's parent or legal guardian. Logistic regression analysis was used to identify the variables that predict oral health behaviors. RESULTS: Overall, 416 female students were entered into the study. Of these, only 55.3% of the students reported that they were brushing at least twice a day, 22.4% were using dental floss at least once a day, and 23.1% reported checking their teeth every 6 months. The results obtained from the logistic regression analysis indicated that perceived self-efficacy, was the significant predicting factor for brushing at least twice a day (odds ratio [OR] = 1.34, 95% confidence interval [CI] =1.06-1.69, P = 0.012) and use of dental floss at least once a day (OR = 1.61, 95% CI = 1.14-2.27, P = 0.007). Furthermore, mother's job predicted use of dental floss at least once a day by (OR = 1.83, 95% CI 1.07-3.10). Perceived benefits were the significant predicting factor for 6 months check (OR = 1.78, 95% CI = 1.14-2.77). CONCLUSION: The current study provides evidence oral health can be promoted by increasing perceived self-efficacy and enhancing perceived benefits in female students.

Prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents: the CASPIAN-V Study.

Introduction: This study presents the prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents. Methods: This multi-centric study was conducted in 2015 among 4200 students aged 7-18 years. They were selected by multistage cluster sampling from 30 provinces of Iran. Anthropometric indices, biochemical and clinical parameters were measured. Results: The mean of weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FBG) was higher in boys than in girls (P < 0.05). The mean of triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) levels were higher in girls than in boys (P < 0.05). The mean of weight, height, WC, SBP, DBP, alanine transaminase (ALT) and body mass index (BMI) was higher in urban than in rural residents (P < 0.05). Overall, 16.1%, 9.4% and 11.4% were underweight, overweight and obese. Abdominal obesity was documented in 21.6% of boys and 20.5% of girls. Low HDL-C was the most prevalent abnormality of lipid profile (29.5%) followed by high serum TGs (27.7%). Low HDL-C was more prevalent in boys than in girls (32.7% vs. 26%, respectively, P < 0.05). Prevalence of obesity and overweight were higher in girls than in boys (P < 0.05). The prevalence of obesity and overweight, abdominal obesity, and low HDL-C were higher in urban than in rural residents (P < 0.05). Conclusion: We found considerably high prevalence of some cardiometabolic risk factors including overweight and obesity, low HDL-C and hypertriglyceridemia in Iranian children and adolescents. The current findings underscore the necessity of intensifying health interventions for primordial and primary prevention of non-communicable diseases from early life.

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study.

OBJECTIVE: This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents. METHODS: This nationwide study was conducted in 2015 among 4200 students aged 7-18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case-control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used. RESULTS: The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01-1.66), elevated blood pressure (OR 1.35; 95% CI 1.01-1.81) and MetS (OR 1.33; 95% CI 1.02-1.74). The two other dietary patterns were not associated with MetS and its components. CONCLUSION: Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits.

Association of parental obesity with cardiometabolic risk factors in their children: The CASPIAN-V study.

BACKGROUND: The family environment has a crucial role in the development of childhood obesity and related cardiometabolic disorders. This study aims to investigate the association of parental obesity and cardiometabolic risk factors in their children. METHODS: This multicentric cross-sectional study was performed on 14400 students (aged 7-18 years) and one of their parents. Students were recruited by multistage, stratified cluster sampling from urban and rural areas of 30 provinces of Iran. Fasting venous blood was obtained from a random sample of 4200 students. Demographic, anthropometric and clinical variables were collected. RESULTS: Data of 14002 students and results of blood samples of 3483 of them were complete and included in the current study. The prevalence of obesity in children, fathers, and mothers was 11.4%, 10.6%, and 24.2%, respectively. In students, the most commonly observed metabolic abnormality was low HDL-C (29.5%); the prevalence of metabolic syndrome and dyslipidemia was 5% and 55.7%, respectively. Significant correlations were observed between the body mass index (BMI) and waist circumference of parents and weight, height, BMI, and waist circumference, as well as systolic and diastolic blood pressure (BP) of their children (P< 0.05). In the multivariate model, the risk of excess weight (OR: 1.30, 95%CI: 1.17-1.44), obesity (OR: 1.36, 95%CI: 1.18-1.59), abdominal obesity (OR: 1.16, 95%CI: 1.05-1.29) and elevated BP (OR: 1.17, 95%CI: 1.04-1.31) were higher in those students whose parents had excess weight compared with other students. Parental obesity did not have significant association with metabolic syndrome and dyslipidemia in their children. CONCLUSIONS: Parental history of obesity could be used as a practical approach for the early preventive measures and identification of children at risk of cardiometabolic complications.

Validity of triglyceride-glucose index as an indicator for metabolic syndrome in children and adolescents: the CASPIAN-V study.

PURPOSE: The purpose of this study was to determine the cut-off values of triglycerides and glucose (TyG) index as one of the indirect indices for metabolic syndrome (MetS) in a pediatric population. METHODS: This national study was conducted in 2015 on 14400 students, aged 7-18 years. They were selected by random cluster sampling from 30 provinces of our country during the fifth survey of a national school-based surveillance program. MetS was defined based on the Adult Treatment Panel III (ATP III) criteria modified for the pediatric age group. The cut-off values of TyG index for MetS were obtained using the receiver operation characteristic (ROC) curve analysis by gender and age groups. RESULTS: Totally, 3843 students (52.3% boys) with mean (SD) age of 12.45 (3.04) years were assessed. The area under the ROC curve of TyG index for MetS was 0.83 in total participants. According to the ATP III criteria the cut-off values of the TyG index were 8.33 (8.21-8.45) in total students, 8.47 (8.36-8.58) in boys, and 8.33 (8.18-8.48) in girls. In the 7-12 and 13-18 years' age groups, these values were 8.47 (8.32-8.63) and 8.34 (8.22-8.45) in total, 8.39 (8.26-8.52) and 8.47 (8.33-8.61) in boys, 8.33 (8.11-8.55) and 8.35 (8.22-8.47) in girls, respectively. CONCLUSION: The findings of this study can be clinically helpful for screening MetS in children and adolescents but the effectiveness of these criteria needs to be evaluated by further longitudinal surveys. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study (National surveillance study).

Evaluation of decayed, missing and filled teeth (DMFT) index in the 12 years old students of Tehran City, Iran

Aim: The main aim of this study was to Evaluate of Decayed, Missing and Filled Teeth (DMFT) Index in 12 Year Old Students of Tehran City, and to identify related factors that affect dental caries within this group. Methods: A cross-sectional survey was conducted among students of 12 years old in Tehran, Iran. Dental caries status was assessed in terms of decayed teeth (DT), filled teeth (FT) and decayed, missing and filled teeth (DMFT). "Data were analysed using SPSS version 22; a multivariate regression analysis was used to determine statistically significant associations between DMFT and other variables (p < 0.05). Results: A total of 416 respondents participated in the study. The mean age of the students was10.94 (SD=0.628) years, and the mean DMFT was 1.03 (SD=1.41). So that, in this study DT (0.53 ± 0.95) had the highest and MT (0.14 ± 0.47) had the lowest mean. A multivariate regression analysis model results showed a significant relation between high DMFT scores and such variables as increasing age, lower levels of mother's education, higher family income, lower frequency of tooth brushing and dental flossing, having a history of no visits to the dentist (P<0.05). Conclusion: The current study shows that Iranian female students have a poor oral health behavior, as very few subjects use dental floss on a regular basis. Although there appeared to be a significant relationship between caries scores and demographic factors such as age and socio-behavioral variables include family income, the level of mothers' education, the frequency of dental brushing and flossing, and both the frequency and type of visit to a dentist

Methodology and Early Findings of the Fifth Survey of Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease: The CASPIAN-V Study.

BACKGROUND: This paper presents the methodology and early findings of the fifth survey of a school-based surveillance program in Iran. METHODS: This nationwide study was conducted in 2015 as the fifth survey of a surveillance program entitled "Childhood and Adolescence Surveillance and PreventIon of Adult Non- communicable disease" (CASPIAN-V) study. The protocol was mainly based on the World Health Organization-Global School student Health Survey. We studied 14400 students, aged 7-18 years, and their parents living in 30 provinces in Iran. Fasting blood was obtained from a sub-sample of 4200 randomly selected students. RESULTS: The participation rate for the whole study and for blood sampling were 99% and 91.5%, respectively. The mean (SD) age of participants was 12.3 (3.2) years, consisting of 49.4% girls and 71.4% urban residents. Overall, 16.1% were underweight (17.4% of boys and 14.8% of girls), and 20.8% had excess weight consisting of 9.4% (8.7% of boys and 10.2% of girls) of overweight and 11.4% (12.5% of boys and 10.3% of girls) of obesity. Abdominal obesity was documented in 21.1% of students (21.6% of boys and 20.5% of girls). Low HDL-C was the most prevalent abnormality of the lipid profile (29.5%) followed by high serum triglycerides (27.7%). Of students, 59.9% consumed whole wheat bread; and 57% reported that they never or rarely added salt to table. The reported daily consumption of fresh fruits, vegetables, and milk was about 60%, 32% and 40%, respectively. 13.7% of participants had at least 30-min daily leisure-time physical activity. CONCLUSIONS: The current findings provide an overview of the current health status and lifestyle habits of children and adolescents. This surveillance program would help planning preventive programs at individual and community levels.

Methodology of the Comprehensive Program on Prevention and Control of Overweight and Obesity in Iranian Children and Adolescents: The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program.

BACKGROUND: The World Health Organization program on Ending Childhood Obesity (WHO-ECHO) has developed a comprehensive and integrated package of recommendations to address childhood obesity. The present study, entitled IRAN-ECHO, was designed and implemented in the framework of the WHO-ECHO program. METHODS: The IRAN-ECHO program is implementing multicomponent interventions by considering life course dimensions. The program has two parts: a population approach and an individual approach. The population approach considers different periods in life, including prenatal, infancy, childhood, and adolescence, as well as family and society. The individual approach targets those children or adolescents with overweight or obesity; this part is conducted as a referral system that is now integrated in the current national health system. As part of the population approach, a quasi-experimental study was conducted in six provinces to compare the status before and after implementing parts of the interventions. By intersectoral collaboration with different organizations, multicomponent interventions are conducted for different age groups. RESULTS: The IRAN-ECHO program is being conducted in six provinces, and will be considered in all provinces in the near future. Its main effects could be assessed in future years. Part of this program that was conducted as a quasi-experimental survey comprised 7149 students and showed that a high percentage of students had acceptable knowledge about adverse health effects of overweight and obesity. However, the knowledge about the low nutritional value of unhealthy snacks such as potato chips, puffs, industrial juices, and carbonated drinks was not appropriate. Many participants had the undesirable attitude of skipping one of the main meals when attempting to lose weight. CONCLUSIONS: The IRAN-ECHO program is presenting the feasibility of conducting the WHO-ECHO recommendations in Iran. The scope of potential policy recommendations to decrease childhood obesity is extensive and includes various elements. This program considers multisectoral interventions through population and individual approaches. The multicomponent interventions of this program address the obesogenic environment by considering the life course dimensions. It is expected that, by its life course interventions, it could help in primordial and primary prevention of noncommunicable diseases.