Alireza Delavari

Publications of Alireza Delavari

• Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study.

  Authors: Farshad Farzadfar, Christopher J L Murray, Emmanuela Gakidou, Thomas Bossert, Hengameh Namdaritabar, Siamak Alikhani, Ghobad Moradi, Alireza Delavari, Hamidreza Jamshidi, Majid Ezzati

  Lancet. 12/2011; 379(9810):47-54.

  Non-communicable diseases and their risk factors are leading causes of disease burden in Iran and other middle-income countries. Little evidence exists for whether the primary health-care system canNon-communicable diseases and their risk factors are leading causes of disease burden in Iran and other middle-income countries. Little evidence exists for whether the primary health-care system can effectively manage non-communicable diseases and risk factors at the population level. Our aim was to examine the effectiveness of the Iranian rural primary health-care system (the Behvarz system) in the management of diabetes and hypertension, and to assess whether the effects depend on the number of health-care workers in the community. We used individual-level data from the 2005 Non-Communicable Disease Surveillance Survey (NCDSS) for fasting plasma glucose (FPG) and systolic blood pressure (SBP), body-mass index, medication use, and sociodemographic variables. Data for Behvarz-worker and physician densities were from the 2006 Population and Housing Census and the 2005 Outpatient Care Centre Mapping Survey. We assessed the effectiveness of treatment on FPG and SBP, and associations between FPG or SBP and Behvarz-worker density with two statistical approaches: a mixed-effects regression analysis of the full NCDSS sample adjusting for individual-level and community-level covariates and an analysis that estimated average treatment effect on data balanced with propensity score matching. NCDSS had data for 65,619 individuals aged 25 years or older (11,686 of whom in rural areas); of these, 64,694 (11,521 in rural areas) had data for SBP and 50,202 (9337 in rural areas) had data for FPG. Nationally, 39·2% (95% CI 37·7 to 40·7) of individuals with diabetes and 35·7% (34·9 to 36·5) of those with hypertension received treatment, with higher treatment coverage in women than in men and in urban areas than in rural areas. Treatment lowered mean FPG by an estimated 1·34 mmol/L (0·58 to 2·10) in rural areas and 0·21 mmol/L (-0·15 to 0·56) in urban areas. Individuals in urban areas with hypertension who received treatment had 3·8 mm Hg (3·1 to 4·5) lower SBP than they would have had if they had not received treatment; the treatment effect was 2·5 mm Hg (1·1 to 3·9) lower FPG in rural areas. Each additional Behvarz worker per 1000 adults was associated with a 0·09 mmol/L (0·01 to 0·18) lower district-level average FPG (p=0·02); for SBP this effect was 0·53 mm Hg (-0·44 to 1·50; p=0·28). Our findings were not sensitive to the choice of statistical method. Primary care systems with trained community health-care workers and well established guidelines can be effective in non-communicable disease prevention and management. Iran's primary care system should expand the number and scope of its primary health-care worker programmes to also address blood pressure and to improve performance in areas with few primary care personnel. None.

• Appropriate definition of metabolic syndrome among Iranian adults: report of the Iranian National Committee of Obesity.

  Authors: Fereidoun Azizi, Farzad Hadaegh, Davood Khalili, Alireza Esteghamati, Farhad Hosseinpanah, Alireza Delavari, Bagher Larijani, Parvin Mirmiran, Azadeh Zabetian, Yadollah Mehrabi, Roya Kelishadi, Hassan Aghajani

  Archives of Iranian medicine. 09/2010; 13(5):426-8.

• Appropriate waist circumference cut-off points among Iranian adults: the first report of the Iranian National Committee of Obesity.

  Authors: Fereidoun Azizi, Davood Khalili, Hassan Aghajani, Alireza Esteghamati, Farhad Hosseinpanah, Alireza Delavari, Bagher Larijani, Parvin Mirmiran, Yadollah Mehrabi, Roya Kelishadi, Farzad Hadaegh

  Archives of Iranian medicine. 05/2010; 13(3):243-4.

• Quality of care of diabetes mellitus type II patients in Iran.

  Authors: Alireza Delavari, Siamak Alikhani, Siran Nili, Rosa H Birjandi, Fariba Birjandi

  Archives of Iranian medicine. 10/2009; 12(5):492-5.

  Diabetes is a relatively common ill-health condition in Iran with a prevalence of 7.7% in the age range of 25 - 64 years and with a rather high burden. It is not only a chronic devastating diseaseDiabetes is a relatively common ill-health condition in Iran with a prevalence of 7.7% in the age range of 25 - 64 years and with a rather high burden. It is not only a chronic devastating disease which causes high rates of death directly, but also a strong risk factor for some other common chronic conditions, e.g., cardiovascular diseases. The worst complications of diabetes develop when quality healthcare services are not provided to patients or are not used by them. This study was conducted to depict the first national picture of quality of care provided for known diabetic patients in Iran. The study was conducted alongside the "Iran's National Noncommunicable Diseases Risk Factor Surveillance survey" of 2005; a cross-sectional study with a multistage cluster sampling approach which targeted Iranians older than 15 years of age. Only 6.4% of the respondents had a HbA1c test during the year before questioning and 25.7% reported to have undertaken a lipid profile examination in the same period of time. Positive responses for eye and foot examinations in the year leading to survey were 39.8% and 20.5%, respectively. About 97.4% of the patients had poor control according to their most recent HbA1c levels. About 25% needed an improvement in diabetes control according to their blood levels of low-density lipoproteins, and 45% of them were hypertensive. All measures of quality of care of diabetes type II were poor in Iranian diabetic patients except for eye examination. Healthcare system of the country needs to focus on patients' easier and better access to laboratory facilities together with a strong training program for care providers and patients to help with better implementation of clinical guidelines and standards of care. A follow-up mechanism is needed to check the trend of quality of care of diabetes in Iran.

• The First Nationwide Study of the Prevalence of the Metabolic Syndrome and Optimal Cut-off Points of Waist Circumference in the Middle East: The National Survey of Risk Factors for Non-Communicable Diseases of Iran.

  Authors: Alireza Delavari, Mohammad Hossein Forouzanfar, Siamak Alikhani, Afsaneh Sharifian, Roya Kelishadi

  Diabetes care. 04/2009;

  Objective: To provide the first national estimate on the prevalence of the metabolic syndrome (MetS) and its components, as well as the first ethnic-specific cut-off point for waist circumferenceObjective: To provide the first national estimate on the prevalence of the metabolic syndrome (MetS) and its components, as well as the first ethnic-specific cut-off point for waist circumference (WC) in the Eastern Mediterranean Region. Research Design and Methods: This national survey was conducted in 2007 on 3024 Iranians aged 25-64 years living in urban and rural areas of all 30 provinces in Iran. The MetS was defined by different criteria, namely the definition of the National Cholesterol Education Program-Adult Treatment Panel III (ATP III), the International Diabetes Federation (IDF) criteria, and the modified definition of the NCEP/ATP III (ATPIII/AHA/NHLBI). Results: The age-standardised prevalence of the MetS was about 34.7% (95% CI 33.1, 36.2) based on the ATP III criteria, 37.4% (35.9-39.0%) based on the IDF definition, and 41.6% (40.1-43.2%) based on the ATPIII//AHA/NHLBI criteria. By all definitions, the prevalence of the MetS was higher in women, in urban areas, and in the 55-64-year age group compared to men, rural areas and other age groups, respectively. The burden of the MetS was estimated to affect more than 11 million Iranians. The optimal cut-off point of WC for predicting at least two other components of the MetS as defined by IDF was 89 cm for men and 91 cm for women. Conclusions: The high prevalence of the MetS with considerable burden on the middle-aged population mandates the implementation of national policies for its prevention, notably by tackling obesity. The obtained WC cut-off points can be used in the region.

• Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran.

  Authors: Alireza Esteghamati, Mehrshad Abbasi, Siamak Alikhani, Mohamad M Gouya, Alireza Delavari, Mehdi H Shishehbor, Mehrdad Forouzanfar, Alieh Hodjatzadeh, Rashid D Ramezani

  American journal of hypertension : journal of the American Society of Hypertension. 06/2008; 21(6):620-6.

  BACKGROUND: The prevalence of hypertension in the Middle East is not well defined. We examined the prevalence, awareness, treatment, and control of hypertension in Iran. METHODS: The Survey of RiskBACKGROUND: The prevalence of hypertension in the Middle East is not well defined. We examined the prevalence, awareness, treatment, and control of hypertension in Iran. METHODS: The Survey of Risk Factors of Noncommunicable Diseases was conducted in 2005 and contains a representative sample of the Iranian adult population. Of 70,981 participants, the data of 68,250 adults aged 25-64 years who had two valid blood pressure (BP) readings were analyzed to estimate the total prevalence of hypertension (systolic BP >or= 140 mm Hg, diastolic BP >or= 90 mm Hg, or the concurrent use of antihypertensive agents) in the Iranian adult population. RESULTS: Approximately 25% or 6.6 million Iranians aged 25-64 years had hypertension; additionally 46% or 12 million Iranians aged 25-64 years had prehypertension. Among hypertensive patients, 34% were aware of their elevated BP; 25% were taking antihypertensive medications; and of these treated subjects, only 24% had BP values <140/90 mm Hg. Hypertension and prehypertension were associated with age, male gender, obesity, central obesity, hypercholesterolemia, and diabetes. CONCLUSIONS: The prevalence of hypertension and prehypertension is high, and the rates of awareness, treatment, and control are unacceptably low. These results underscore the urgent need to develop national strategies to improve prevention, detection, and treatment of hypertension in Iran.

• Association of body mass index and abdominal obesitywith marital status in adults.

  Authors: Mohsen Janghorbani, Masoud Amini, Hasan Rezvanian, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Archives of Iranian medicine. 05/2008; 11(3):274-81.

  BACKGROUND: Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with currentBACKGROUND: Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with current marital status among the adult population of Iran. METHODS: A nation-wide cross-sectional survey was conducted from December 2004 through February 2005.The subjects were selected by stratified probability cluster sampling through household family members in Iran. Weight, height, waist circumference, and marital status of 89,404 men and women aged 15 - 65 (mean: 39.2) years were recorded. Four classes of body mass index, i.e., <18.5, 18.5 - 24.9, 25 - 29.9, and >/=30 kg/cm2, and three marital status, i.e., currently-, formerly-, and never-married were used. Abdominal obesity was defined as waist circumference >/=102 cm in men and >/=88 cm in women. RESULTS: The prevalence of overweight was twofold higher in married men (OR: 2.24; 95% CI: 2.08 - 2.41) and women (OR: 2.36; 95% CI: 2.20 - 2.53) than never-married men and women, even when age, educational level, leisure time physical activity, smoking habits, and place of residence were controlled. The multivariate OR of obesity was increased about threefold in married men (2.82; 95% CI: 2.51 - 3.18) and women (3.64; 95% CI: 3.31 - 3.99). The prevalence of abdominal obesity was twofold higher among married men (2.02; 95% CI: 1.79 - 2.29) and about threefold higher among married women (2.87; 95% CI: 2.69 - 3.06). CONCLUSION: The marital status appears to influence the likelihood of developing overweight, obesity, and abdominal obesity in both men and women in Iran.

• Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults.

  Authors: Mohsen Janghorbani, Masoud Amini, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Journal of hypertension. 04/2008; 26(3):419-26.

  OBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwideOBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Blood pressure (BP) and associated risk factors of 35 048 men and 34 674 women aged 25-65 years (mean 44.1 years) were measured. RESULTS: The prevalence of Pre-HTN was 59.6% in men and 44.5% in women; and 19.8% of men and 26.9% of women were hypertensive, according to Joint National Committee 7 criteria. Pre-HTN was more common among men whereas HTN was more common among women. Multivariate analysis revealed that age, overweight, obesity, abdominal obesity and high cholesterol were strongly associated with Pre-HTN in both genders. In women, low educational attainment, residence in an urban area and high blood glucose were also associated with Pre-HTN. Age, low educational attainment, overweight, obesity, abdominal obesity and high cholesterol and blood glucose were strongly associated with HTN in both genders. CONCLUSION: Pre-HTN and HTN appear to be quiet common in Iran and were associated with obesity. More men than women present with Pre-HTN, whereas more women than men present with HTN. Prevention and treatment strategies are urgently needed to address the health burden of Pre-HTN and HTN and to prevent prehypertensive people from developing HTN and cardiovascular disease.

• Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey.

  Authors: Roya Kelishadi, Siamak Alikhani, Alireza Delavari, Farshid Alaedini, Afshin Safaie, Eliyeh Hojatzadeh

  Public health nutrition. 04/2008; 11(3):246-51.

  OBJECTIVE: To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran. DESIGN AND SETTINGS: This population-based studyOBJECTIVE: To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran. DESIGN AND SETTINGS: This population-based study was performed in early 2005 as part of the World Health Organization (WHO) STEPwise approach to non-communicable diseases' risk factor surveillance. Dietary and physical activity habits were assessed by WHO questionnaires. SUBJECTS: The study population comprised 89,532 subjects aged over 15 years living in the 28 provinces of Iran. RESULTS: Overall, 50.4% (n = 45,113) of the participants were male and 64.6% (n = 57 866) were from the urban areas. The national estimates of overweight, obesity and morbid obesity were 28.6%, 10.8% and 3.4%, respectively. Body mass index (BMI) > or = 25 kg m-2 in men, women, urban residents and rural residents were found in 37%, 48%, 46.7% and 35.5%, respectively. Abdominal obesity was present in 43.4% of women, 9.7% of men, 28.5% of the urban residents and 23% of the rural residents. Overweight as well as generalised and abdominal obesity were more prevalent in the 45-64-year age group. Although there was no significant difference in frequency of consumption of the food groups in subjects with different BMI categories, various kinds of physical activities showed a steady decline with increasing BMI. CONCLUSIONS: The findings of the present study provide alarming evidence for health professionals and policy makers about the very high prevalence of generalised and abdominal obesity in Iran. The unhealthy lifestyle habits, notably sedentary lifestyles in our community, are the major contributing factors for this emerging public health problem.

• Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-Communicable Diseases of Iran.

  Authors: Alireza Esteghamati, Mohamad M Gouya, Mehrshad Abbasi, Alireza Delavari, Siamak Alikhani, Farishid Alaedini, Afshin Safaie, Mehrdad Forouzanfar, Edward W Gregg

  Diabetes care. 02/2008; 31(1):96-8.

  OBJECTIVE: Despite concerns regarding a diabetes epidemic in the Middle East, internationally published data on national estimates of prevalent type 2 diabetes in Iran do not exist. With thisOBJECTIVE: Despite concerns regarding a diabetes epidemic in the Middle East, internationally published data on national estimates of prevalent type 2 diabetes in Iran do not exist. With this article, we document a dramatically high prevalence of diabetes in Iran. RESEARCH DESIGN AND METHODS: Our data are based on the results of the first Survey of Risk Factors of Non-Communicable Diseases of Iran, 2005. In this national cross-sectional survey, 70,981 Iranian citizens aged 25-64 years were recruited. RESULTS: We found that 7.7% of adults aged 25-64 years, or 2 million adults, have diabetes, among whom one-half are undiagnosed. An additional 16.8%, or 4.4 million, of Iranian adults have impaired fasting glucose. CONCLUSIONS: The high prevalence of diabetes in working-age adults is an ominous sign for this developing nation. As the relatively young Iranian population ages in the future and urbanization continues or accelerates, the prevalence of diabetes will likely escalate.

• First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults.

  Authors: Mohsen Janghorbani, Masoud Amini, Walter C Willett, Mohammad Mehdi Gouya, Alireza Delavari, Siamak Alikhani, Alireza Mahdavi

  Obesity (Silver Spring, Md.). 11/2007; 15(11):2797-808.

  OBJECTIVE: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. RESEARCH METHODS AND PROCEDURES: A nationwideOBJECTIVE: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. RESEARCH METHODS AND PROCEDURES: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal-weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and >or=40 (kg/m(2)), respectively. Abdominal obesity was defined as WC >or=102 cm in men and >or=88 cm in women. RESULTS: The age-adjusted means for BMI and WC were 24.6 kg/m(2) in men and 26.5 kg/m(2) in women and 86.6 cm in men and 89.6 cm in women, respectively. The age-adjusted prevalence of overweight or obesity (BMI >or=25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI >or=30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. DISCUSSION: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.

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

  Authors: Roya Kelishadi, Mohammad Mehdi Gouya, Khosrow Adeli, Gelayol Ardalan, Riaz Gheiratmand, Reza Majdzadeh, Minou Sadat Mahmoud-Arabi, Alireza Delavari, Mohammad Mehdi Riazi, Hamed Barekati, Molouk Motaghian, Keivan Shariatinejad, Ramin Heshmat

  Nutrition, metabolism, and cardiovascular diseases : NMCD. 10/2007;

  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 theBACKGROUND 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 6-18years, 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 >4000g in boys and <2500g 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.

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

  Authors: Roya Kelishadi, Mohammad Mehdi Gouya, Gelayol Ardalan, Mohsen Hosseini, Molouk Motaghian, Alireza Delavari, Reza Majdzadeh, Abtin Heidarzadeh, Minou Sadat Mahmoud-Arabi, Mohammad Mehdi Riazi

  Journal of tropical pediatrics. 07/2007; 53(3):158-64.

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

  Authors: Roya Kelishadi, Riaz Gheiratmand, Gelayol Ardalan, Khosrow Adeli, Mohammad Mehdi Gouya, Emran Mohammad Razaghi, Reza Majdzadeh, Alireza Delavari, Keyvan Shariatinejad, Molouk Motaghian, Ramin Heshmat, Abtin Heidarzadeh, Hamed Barekati, Minoo Sadat Mahmoud Arabi, Mohammad Mehdi Riazi

  International journal of cardiology. 06/2007; 117(3):340-8.

  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 aBACKGROUND: 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.

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

  Authors: Roya Kelishadi, Gelayol Ardalan, Khosrow Adeli, Molouk Motaghian, Reza Majdzadeh, Minoo Sadat Mahmood-Arabi, Alireza Delavari, Mohammad Mehdi Riazi, Roshanak Namazi, Mohammad Arash Ramezani

  Annals of nutrition & metabolism. 02/2007; 51(3):208-15.

  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 measuredAIMS: 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.

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

  Authors: Roya Kelishadi, Emran Mohammad Razaghi, Mohammad Mehdí Gouya, Gelayol Ardalan, Riaz Gheiratmand, Alireza Delavari, Molouk Motaghian, Vahid Ziaee, Zahra Dana Siadat, Reza Majdzadeh, Ramin Heshmat, Hamed Barekati, Minoo Sadat Mahmoud Arabi, Abtin Heidarzadeh, Keivan Shariatinejad

  Hormone research. 02/2007; 67(1):46-52.

  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 onBACKGROUND/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.

• 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.

  Authors: Roya Kelishadi, Gelayol Ardalan, Riaz Gheiratmand, Mohammad Mehdi Gouya, Emran Mohammad Razaghi, Alireza Delavari, Reza Majdzadeh, Ramin Heshmat, Molouk Motaghian, Hamed Barekati, Minou Sadat Mahmoud-Arabi, Mohammad Mehdi Riazi

  Bulletin of the World Health Organization. 02/2007; 85(1):19-26.

  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 representativeOBJECTIVE: 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.

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

  Authors: Roya Kelishadi, Gelayol Ardalan, Riaz Gheiratmand, Reza Majdzadeh, Alireza Delavari, Ramin Heshmat, Mohammad Mehdi Gouya, Emran Mohammad Razaghi, Molouk Motaghian, Mohammad Reza Mokhtari, Hamed Barekati, Minoo Sadat Mahmoud Arabi

  European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 01/2007; 13(6):956-63.

  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 theBACKGROUND: 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.

• Paediatric metabolic syndrome and associated anthropometric indices: the CASPIAN Study.

  Authors: Roya Kelishadi, Gelayol Ardalan, Riaz Gheiratmand, Khosrow Adeli, Alireza Delavari, Reza Majdzadeh, For The Caspian Study Group

  Acta paediatrica (Oslo, Norway : 1992). 01/2007; 95(12):1625-34.

  AIM: To determine the prevalence of paediatric metabolic syndrome (MetS) and its best predictive anthropometric index. METHODS: This national study was conducted among 4811 students (2248 boys andAIM: To determine the prevalence of paediatric metabolic syndrome (MetS) and its best predictive anthropometric index. METHODS: This national study was conducted among 4811 students (2248 boys and 2563 girls) aged 6-18 y. This is the first study of its kind in Iran and, to our knowledge, in Asia as well. Two definitions were used for the MetS: type A was defined based on criteria analogous to ATP III, and type B was defined according to the cut-offs obtained from NHANES III. Both types A and B define high fasting blood sugar as > 100 mg/dl and systolic/diastolic blood pressure as > 90th percentile. RESULTS: The mean (SD) age of students studied was 12.07+/-3.2 y. MetS type A was seven times more prevalent than type B (14% vs 2%, respectively, p<0.0001), and had no significant gender difference. The most frequent components of both definitions of the MetS were low high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG). Waist circumference (WC) and waist-to-hip ratio (WHR) had the strongest and weakest associations, respectively, with the MetS. CONCLUSION: Establishment of a uniform set of criteria for the MetS in children is needed. Routine WC measurement in the paediatric population may be clinically useful.

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

  Authors: Roya Kelishadi, Gelayol Ardalan, Riaz Gheiratmand, Reza Majdzadeh, Alireza Delavari, Ramin Heshmat, Mohammad Reza Mokhtari, Emran Mohammad Razaghi, Molouk Motaghian, Idin Ahangar-Nazari, Minoo Sadat Mahmood-Arabi, Hamed Barekati

  Preventive medicine. 07/2006; 42(6):423-6.

  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 schoolOBJECTIVES: 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.