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BACKGROUND Obesity is the main cause or the facilitator of many physical and psychological diseases worldwide, specifically in developing countries including Iran.(1,2) It is estimated that worldwide about 3% of total health expenditure is spent annually on the treatment of obesity related disorders.(3) We wanted to compare the efficacy of two methods of education including virtual education through Telegram messages and group discussion, on anthropometric indices in health care service providers suffering from overweight or obesity in Kermanshah. METHODS This three-arm randomized control trail (RCT) was conducted on 102 overweight/obese female healthcare providers in Kermanshah. Using Excel RAND function, the eligible participants were randomly allocated into three groups; two intervention groups- Telegram message, and group discussion - and one control group. Anthropometric indices including height, weight, waist circumference (WC), and hip circumference (HC) were measured using standard instruments. Data was analysed with SPSS16 using Independent and Paired t-test, Chi-square, and ANOVA. The significance level was considered as p≤0.05. RESULTS Participants’ mean age was 41.9 ± 6.3 years. Mean of BMI was 29.8±3.8 Kg/m2. The mean of weight, BMI and HC of the three groups were not significantly different before intervention; however, the mean of the changes for all three variables in the intervention groups were significantly different (p

Objectives: Thalassemia is a public health challenge in the countries entitled belt thalassemia but there is no pooled estimated of the survival rate on thalassemia major patients. The aim of this meta-analysis was to evaluate the pooled 10-, 15-, 20-, and 30-year survival rates of the patients with beta thalassemia major around the world. Methods: A comprehensive literature search of five international databases including Medline/PubMed, Scopus, Embase, Web of knowledge and ProQuest was conducted to identify studies reporting survival rate of beta thalassemia major until March 2020. Results: From 714 retrieved studies, seven studies with 8777 subjects included in the meta-analysis. Base on random effect model, the 10-, 15-, 20-, and 30-year survival rates were 98.39, 95.07, 90.41, and 82.93 percent, respectively. Conclusions: This meta-analysis provided acceptable results for estimating survival rate of beta-thalassemia compared to other studies. Hence, these results can be effectively used to develop and implement prevention and treatment interventions for policy makers.

High serum levels of triglycerides (Tg) and low levels of high-density lipoprotein cholesterol (HDL-C) are characteristic of the Metabolic Syndrome (MetS). We assessed the ratio of Tg to HDL-C as a way to identify MetS and insulin resistance. We also evaluated its association with severity of carotid atherosclerosis. Data were analyzed from three cohorts totaling 13,908 participants. MetS was defined according to the International Diabetes Federation criteria. Optimal cut-off for Tg/HDL-C ratio was obtained using Youden's index in receiver-operating characteristic (ROC) curve analyses. The risk of MetS and IR in those with a Tg/HDL-C ratio above the optimum cutoff was evaluated by logistic regression analysis. A Tg/HDL-C ratio above the optimal cutoff level significantly increased the odds ratio for MetS in the three cohorts (OR 6.00, 4.04, and 3.50, least in the healthy population), identified insulin resistance defined by the homeostatic model of insulin resistance (HOMA-IR) (p < 0.0001), and was strongly associated with atherosclerosis severity (p = 0.0001). Tg/HDL-C ratio identifies persons with MetS, insulin resistance, and severe atherosclerosis. It should be used more widely to identify patients at high risk. This is clinically important because insulin resistance is treatable.

Background: Primary brain tumors are among the main causes of death. This study aimed to determine the epidemiological features of the brain and central nervous system cancer in the Middle East and North Africa (MENA) region. Methods: In this study, data of the Global Burden of Disease (GBD) study were used to estimate the incidence, prevalence, deaths, disability-adjusted life years (DALYs), and mortality in 21 countries in the MENA region from 1990 to 2019 based on age and sex. The percentage of the changes of epidemiologic indicators was calculated between 1990 and 2019. Results: Palestine and Turkey had the highest rate of brain and central nervous system cancer in 2019. Saudi Arabia, Oman, Iraq, and Lebanon had the highest percentage of incidence rate changes from 1990 to 2019. The prevalence of brain and central nervous system cancer in the MENA region was increased from 7.51 (95% CI: 4.95–11.01) in 1990 to 16.45 (95% CI: 10.83–19.54) in 2019 (percentage of changes = 54.35%). The standardized age mortality rate in the MENA region was increased by 2.7% in 2019 compared to that in 1990. The rate of standardized age of DALY per 100,000 individuals in the MENA region decreased from 135.09 (95% CI: 92.57–199.92) in 1990 to 128.34 (95% CI: 87.81–151.3) in 2019. Conclusion: The incidence rate, prevalence, and standardized age mortality (per 100,000) had increased significantly in the MENA region in 2019 compared to those in 1990. Focusing on the diversity of the estimates of such indices in different countries of MENA can lead to the identification of important risk factors for brain cancer in future studies.

Background Various diets and dietary compounds, through their inflammatory properties, are involved in the pathogenesis of chronic diseases including Cardiovascular Diseases (CVDs). Dietary Inflammatory Index (DII) can evaluate the inflammatory properties of diet. The purpose of this study was to determine the association between DII and CVDs in participants of the Ravansar Non-Communicable Diseases (RaNCD) cohort study, Kermanshah, Iran. Materials The present cross-sectional study was conducted using the recruitment phase data of the RaNCD cohort study on 6369 participants aged 35 to 65 years. The Food Frequency Questionnaire (FFQ) was used to assess diet. The DII scores were calculated using FFQ data. Participants with a history of myocardial infarction, stroke and coronary artery disease, and/or taking medications for the CVDs were considered as the CVDs patients. Results Of the 6369 studied participants, 9% (n = 579) had CVDs history. The mean DII score in this study was − 0.84 ± 1.6. Odds ratio (OR) of CVDs in women was 1.6 times higher than in men (CI 95% = 1.3–1.9), which this association was remained after adjusting for confounding variables (OR = 1.5, CI% = 1.2–1.9). The risk of CVDs in the fourth quartile of DII was 1.4 times higher than the first quartile of DII (OR: 1.4, CI 95% = 1.1–1.8). We found that higher adhere to DII was associated with risk of CVDs. Conclusion According to current documents, given the role of diet through inflammatory properties on the risk of CVDs, it is recommended to use DII as an appropriate index to measure the effect of diet on CVDs in Iranian population. In addition, a diet with lower DII may be healthier diet for cardiovascular health.

Aims Anthropometric indices have been proposed for the early detection of metabolic syndrome (MetS) and its risk factors. The present study aimed to determine optimal cutoff points for the Body Mass Index (BMI), Waist Circumference (WC), and Waist Hip Ratio (WHR) in the prediction of MetS. Methods This cross-sectional study was performed on 9746 adults 35–65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort. The receiver operating characteristic (ROC) curve analysis was used to compare the predictive validity and determine optimal cutoff values. Results The optimal cutoff points for BMI, WC and WHR were 27.3 kg/m2 (AUC: 78.6; 95%CI 77.1, 80.1), 97 cm (AUC: 63.8; 95%CI 60.4, 67.2) and 0.95 (AUC: 75.5; 95% CI 73.9, 77.1), respectively in men for the prediction of MetS. But in women the optimal cutoff points for BMI, WC and WHR were 28.6 kg/m2 (AUC: 65.7; 95%CI 62.1, 69.4), 98.1 cm (AUC: 65.6; 95%CI 62.4,68.8) and 0.95 (AUC:62.39; 95%CI 60.9,63.9). The risk of MetS in men and women with a BMI higher than the optimal cutoff point was respectively 2.23 and 2.30 times higher than that in those with a WC lower than the cutoff point. Conclusions BMI is a better predictor of MetS than WC and WHR in adults 35–65 years. We recommend that the optimal cut off point be set for men 27.3 kg/m2 and for women 28.6 kg/m2.

Kamran Baveicy,1 Shayan Mostafaei,2,3 Mitra Darbandi,4 Behrooz Hamzeh,4,5 Farid Najafi,4,6 Yahya Pasdar4,5 1Student Research Committee, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Epidemiology and Biostatistics Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran; 4Research Center for Environmental Determinants of Health (RCEDH), Health Institute, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; 5Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; 6Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Yahya Pasdar Tel +98 83 38262005Fax +98 83 38263048Email yahya.pasdar@kums.ac.irBackground: The use of anthropometric indices is one of the new and low-cost diagnostic methods of metabolic syndrome (MetS). The present study aimed to determine optimal cutoff points for the visceral adiposity index (VAI), body roundness index (BRI), and a body shape index (ABSI) in the prediction of MetS.Methods: This cross-sectional study was performed on 10,000 individuals aged from 35to 65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort study, in the west region of Iran, in 2019. MetSwas defined according to International Diabetes Federation (IDF) criteria. The receiver operating characteristic (ROC) curve analysis was used to assess predictive anthropometric indices and determine optimal cutoff values.Results: The optimal cutoff points for VAI were 4.11 (AUC: 0.82; 95% CI: 0.81– 0.84) in men and 4.28 (AUC: 0.86; 95% CI: 0.85– 0.87) in women to prediction of MetS. The optimal cutoff points for BRI were 4.75 (AUC: 0.75; 95% CI: 0.74– 0.77) in men and 6.17 (AUC: 0.62; 95% CI: 0.61– 0.64) in women to prediction of MetS. The optimal cutoff points for ABSI were 0.12 (AUC: 0.49; 95% CI: 0.47– 0.51) in men and 0.13 (AUC: 0.49; 95% CI: 0.47– 0.51) in women to prediction of MetS. The risk of MetS in men and women with a VAI higher than the optimal cutoff point was, respectively, 9.82 and 11.44 times higher than that in those with a VAI lower than the cutoff point.Conclusion: Although VAI might not be very cost-beneficial compared to IDF, our study showedVAI is a better predictor of MetS than BRI in adults. ABSI was not a suitable predictor for MetS.Keywords: metabolic syndrome, body shape index, body roundness index, visceral adiposity index, ROC curve analysis

Background: Since hypertension (HTN) is responsible for more than half of all deaths from cardiovascular disease, it is important to know the nutritional factors that reduce its risk. Although little information is known about it in the Kurdish population. This study was aimed to evaluate healthy eating index (HEI) 2015 and major dietary patterns in relation to incident HTN. Methods: This case- cohort study was designed using data from Ravansar non- communicable diseases (RaNCD) cohort study (294 participants with incident HTN and 1295 participants as representative random sub-cohort). HEI 2015 and major dietary patterns were extracted using data from their dietary intake and three major dietary patterns were identified including plant- based, high protein, and unhealthy dietary patterns. To analysis of association between HEI 2015 and major dietary patterns with incident HTN Cox proportional hazards regression models were applied. Results: There was a positive significant correlation between HEI 2015 and plant- based diet (r=0.492). The participants in the highest quartile of HEI-2015 had a 39% lower risk of incident HTN, compared to participants in first quartile in both crude and adjusted model (HR: 0.61; 95% CI: 0.46-0.82) and (HR: 0.7; 95% CI: 0.51–0.97), respectively. Furthermore, participants who were the highest tertile of plant- based dietary pattern were lower risk of incident HTN in both crude and adjusted models (HR: 0.69; 95% CI: 0.54–0.9) and (HR: 0.7; 95% CI: 0.53–0.94), respectively. However, other two identified dietary patterns had no significant association with incident HTN. Conclusions: We found evidence indicating higher adherence to HEI 2015 and plant- based diet had protective effects on incident HTN. The HEI 2015 emphasizes limited sodium intake and adequate intake of vegetables and fruits.

The aim of this study was to assess the association between dietary inflammatory index (DII) and non-invasive markers of liver status in adults. This cross-sectional study was performed on 8520 adults, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort study, western Iran. The DII score was calculated based on participants’ dietary intakes obtained from Food Frequency Questionnaire (FFQ). Fatty Liver Index (FLI) score was calculated by anthropometric measurements and some non-invasive markers of liver status. Linear regression models were applied to estimate the associations and adjust the possible confounding factors. A greater DII score was significantly associated with higher energy intake, body mass index (BMI), body fat mass (BFM), blood pressure, and FLI (P

Background: Diet is one of the influential factors in developing hypertension. Moreover, the role of antioxidants in the prevention of cardiovascular diseases (CVDs) has been identified. Total antioxidant capacity (TAC) is a valid tool to assess intake antioxidants from diet. The aim of this study was to examine the association between TAC and hypertension in pre- and postmenopausal women.Methods: In this cross-sectional study was used baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study. The TAC was calculated using food items of the food frequency questionnaire. Univariable and multivariable logistic regression were applied to estimates odds ratio. Results: A total of 5,067 women were included in the study. The mean daily intake of refined grains, legumes, white meat, nuts, omega-3, and omega-6, vitamins of B1, B2, B6 and D were significantly higher among women non-hypertensive compared to hypertensive (PConclusion: A high dietary TAC was associated to a decreased risk of hypertension in pre/perimenopausal women. We suggest a diet rich in natural antioxidants as it may help prevent developing of hypertension before menopausal.

We aimed to examine associations between muscle strength and obesity and serum lipid profile in Ravansar Non-Communicable Disease (RaNCD) cohort study. This study was conducted on 6,455 subjects aged 35-65 years old from baseline data of RaNCD in Iran. The associations between grip strength and adiposity measurements were explored using linear regression with adjustment for age, height, smoking status, alcohol intake, social class, and prevalent disease. The mean of body mass index (BMI) and muscle strength was 27.2 ± 4.6 kg/m2 and 33.3 ± 11.5, respectively. Muscular strength increased with increasing BMI and waist circumference (WC) in both sexes. Multivariate regression analysis revealed a 3.24 (95% confidence interval [CI], 2.29, 4.19) kg difference between BMI in top and bottom in men, and 1.71 (95% CI, 0.98, 2.34) kg/m2 in women. After multivariable adjustment, a difference of 2.04 (95% CI, 1.12, 2.97) kg was observed between the top and bottom WC quartiles in men and 1.25 (95% CI, 0.51, 1.98) kg in women. In men, with increase of low-density lipoprotein and cholesterol, the mean muscle strength was significantly increased. Muscle strength may be associated with body composition and lipid profiles. Muscle strength can be an appropriate indicator for predicting some of the problems caused by body composition disorders, which requires further longitudinal studies.

Objectives Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. Methods The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. Results Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. Conclusions The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Background The amount and type of lipids consumed greatly impact serum lipid profile and risk of cardiovascular diseases (CVDs). A novel index named atherogenic index of plasma (AIP) is a better predictor of CVD risk factors than lipids alone. This study aimed to investigate the effect of edible oils on AIP. Methods This cross-sectional study was conducted on the preliminary phase of Ravansar Non-Communicable Disease (RaNCD) cohort study. The amount of consumption of edible lipids was determined based on the validated Food Frequency Questionnaire (FFQ). AIP was calculated as log10 (TG/HDL-C). Results From 9996 participantes, 4738(47.4%), were male. The mean of AIP was 0.98 ± 0.6 (range from − 1.73 to 4.15), which in females (0.97 ± 0.6) was lower than males (1.10 ± 0.6). After controlling for confounding and affecting variables, the AIP index decreased with increasing consumption of a local oil named Kermanshahi oil [β(CI 95% ): -0.006(-0.008, -0.003)], butter[β(CI 95% ): -0.008(-0.011, -0.005)] and not statistically significant decrease with Hydrogenated or partial hydrogenated oil [β(CI 95% ): -0.008(-0.001, 0.001)] but the AIP index increased with un-hydrogenated oil [β(CI 95% ): 0.001(-0.001, 0.001)] Conclusions Kermanshahi oil and butter have a decreasing effect on AIP, the effect of margarine was neutral, and hydrogenated vegetable oil has a decreasing effect, whereas un-hydrogenated vegetable oil has an increasing effect on it. So, consumption of Kermanshahi oil may be associated with lower cardiovascular risk.

Background Although obesity contributes in increasing the risk of hypertension, it is not known the effect of obesity based on metabolic status on the incidence of hypertension. This study was aimed to determine association between obesity phenotypes including metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) and risk of hypertension incidence. Methods We conducted a case-cohort study on 6,747 adults 35–65 aged from Ravansar non- communicable diseases (RaNCD) study. Obesity was defined body mass index > 30 kg/m2 and metabolically unhealthy was considered at least two metabolic disorders based on the International Diabetes Federation criteria. Obesity phenotypes were categorized four groups including MUO, MHO, metabolically unhealthy non obesity (MUNO), and metabolically healthy non obesity (MHNO). Cox proportional hazards regression models were applied to analyze associations with hypertension incidence. Results The incidence of hypertension was one case per 1000 person-months (393/391162). The MHO (HR: 1.37; 95% CI: 1.03–1.86) and MUO phenotype (HR: 2.44; 95% CI: 1.81–3.29) was linearly associated with higher hypertension risk compared to MHNO. In addition, MUNO phenotype was significantly associated with risk of hypertension incidence (HR: 1.65; 95% CI: 1.29–2.14). Conclusions Both metabolically healthy and unhealthy obesity was elevated risk of hypertension incidence, however, this increase in metabolically unhealthy phenotypes was higher.

Background Visceral adiposity index (VAI) and atherogenic index of plasma (AIP) are relatively new indicators for predicting non-communicable diseases (NCDs). Therefore, the present study was done to assess the association of AIP and VAI with risk of cardiovascular diseases (CVDs). Methods This cross-sectional study was conducted on 7,362 individuals aged between 35 and 65 years old participated in Ravansar non-communicable diseases (RaNCD) cohort study. AIP was calculated based on levels of triglyceride and high -density lipoprotein cholesterol (HDL-C). VAI was calculated using values of body mass index (BMI), waist circumference (WC), triglyceride, and HDL-C. Logistic regression models were used to assess the association of AIP and VAI with risk of CVDs. Results Mean values of anthropometric indices, lipid profile, AIP, and VAI were significantly higher in patients with CVDs than individuals without CVDs (P P Conclusions According to the findings, AIP and VAI were positively associated with risk of CVDs. Therefore, AIP and VAI can be useful in identifying high-risk subgroups of CVDs in general population.

Background The prevalence of the metabolic syndrome (MetS) is increasing worldwide. Early detection of the MetS by valid and available indicators can help prevent, control and reduce its complications. This study aims to identify of most important anthropometric, biochemical and nutritional indices for predicting MetS. Methods This study conducted on 9,602 participants from baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study including of adults aged 35–65 years. The reference model for MetS was considered according to International Diabetes Federation (IDF) criteria. We used a wrapper algorithm and area under ROC curve (AUC) for selection and assessing most important predictors of MetS. Results The importance value (IV) for components of the models for prediction of MetS was confirmed, before implementing the models. Identified model with components of age, waist circumference (WC), body mass index (BMI), fasting blood sugar (FBS), systolic-diastolic blood pressure (SBP-DBP), triglyceride (TG), hip circumference (HC) and AUC of 0.893 (95% CI: 0.884–0.902) for men and 0.867 (95% CI: 0.853–0.881) for women was a strongest model for predictive of MetS risk. The AUC (95% CI) for non-invasive model was 0.756 (0.746–0.766) in total population has a good predictive power for MetS risk with components of age, WC, BMI, SBP, DBP. Conclusion This study demonstrated that in addition to aggressive models, models non-invasive (anthropometric indices, blood pressure and energy intake) can be also a good and convenience screening tool to predict the MetS. The models, in addition to the application of clinical diagnosis, can be widely used in researches on large populations.

Background: To provide an overview of the worldwide association between hospital beds, the burden of non-communicable diseases (NCDs), and COVID-19 mortality. Methods: We extracted data regarding COVID-19 deaths and cases from the Our World in Data as of November 21, 2020. We also obtained the following data:1) NCDs disability-adjusted life years (DALYs), health-adjusted life expectancy, and the health access and quality index from the Global Burden of Disease study; 2) the number of hospital beds, physicians, nurses and midwives per population, and out-of-pocket payments from the WHO website; 3) income levels and population density from the World Bank database. Using the principal component approach and a multilevel generalised linear model, we examined these variables’ independent associations with COVID-19 mortality rate ratio (MRR). Findings: During the study period, 17.62 COVID-19 deaths per 100,000 population were reported globally (1.20 in low-, 13.43 in lower-middle-, 14.14 in upper-middle-, and 46.72 in high-income countries). Median age increased COVID-19 mortality. Hospital beds were associated with reduced COVID-19 mortality (MRR=0.62; 95% CI: 0.59, 0.64) globally. During COVID-19 peak periods, despite a decreasing trend in COVID-19 MRR with increasing beds in high-income countries, the odds of mortality remained high even within the highest percentile of hospital beds (MRR=2.99 for 20th - 40th and 1.51 for >60 th bed percentile, respectively). On the contrary, in middle-income countries, we observed an inverse association between the number of hospital beds and COVID-19 mortality in both periods. NCD DALYs were associated with increased COVID-19 deaths, particularly during peak mortality periods in high-income countries. Death-to-case ratio increased by approximately two times during the peak vs non-peak mortality periods. Interpretations: COVID-19 is a syndemic interacting with non-communicable diseases and not only a pandemic. A comprehensive national healthcare plan against COVID-19 spread should include adequate measures to protect vulnerable patients with pre-existing chronic conditions. Funding: None. Declaration of Interests: The authors declare no conflicts of interest to disclose.

Background: Dietary factors and inflammation are associated with most non-communicable diseases (NCDs). The Dietary Inflammatory Index (DII) is a developed validated assessment tool. This study was conducted to assessed association of DII with the hypertension and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional analysis was performed on 9,811 participants of 35 to 65 years of the base-line phase data of Ravansar Non-Communicable Diseases (RaNCD) cohort study. The DII was calculated using 31 parameters food of food frequency questionnaire (FFQ). The estimates were performed using univariable and multivariable logistic regression.Results: The mean DII scores in healthy participants was -2.32± 1.60, in participant with T2DM, hypertension and both were -2.23± 1.59, -2.45± 1.60 and -2.25± 1.60, respectively (P= 0.011). Pre-inflammatory diet was significantly higher in male compared to female (PConclusions: Pro-inflammatory diet was weak associations with hypertension. Pro-inflammatory diet was significant associations with increasing T2DM and its related risk factors. Modification of diet and lifestyle is suggested to reduce inflammation.

Background: Visceral Adiposity index (VAI) and atherogenic index of plasma (AIP) are relatively new indicators for predicting Non-Communicable disease (NCDs). The aim of this study was to assess the association AIP and VAI with risk of developing cardiovascular diseases (CVDs) in adults.Materials: This was a cross-sectional analysis conducted on 7362 individuals aged 35 to65 years participated in Ravansar Non-Communicable Diseases (RaNCD) cohort study. AIP was calculated based on the value of TG and HDL-C. VAI was calculated using BMI (Body mass index), waist circumference (WC), serum triglyceride, and High density lipoprotein cholesterol (HDL-C).All participants were stratified into three groups based on AIP and VAI tertiles. Simple and multiple logistic regression models were applied to assess the effect of these indices on CVDs.Results: The mean of AIP and VAI was significantly higher in CVDs patients than in non-CVDs (P Conclusion: According to the findings, AIP and VAI were positively associated with CVDs in adults. Therefore, AIP and VAI can be useful in identifying high-risk subgroups of CVDs in general population.

Background The aim of this study was the assess association between of dietary inflammatory index (DII) and non-invasive markers of liver status in adults. Methods This cross-sectional study was performed on 8,520 individuals aged 35–65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort study, the west of Iran. DII score was calculated based on participants’ dietary intakes obtained from Food Frequency Questionnaire (FFQ). Fatty Liver Index (FLI) score was calculated by anthropometric measurements and some non-invasive markers of liver status. Linear regression models were used to estimate the associations and adjust for possible confounding factors. Results The mean of age was 47.24 ± 8.31 years and 4275 (%50.18) were male. A greater DII score was significantly associated with higher energy intake, BMI (body mass index), BFM (body fat mass), blood pressure and FLI (P

Background The Middle East and North Africa, is one of few regions where the number of new human immunodeficiency virus infections is increasing. The present study aimed to estimate the attributable burden of unsafe sex and drug use in Acquired immunodeficiency syndrome in the Middle East and North Africa countries. Methods We used the Global Burden of Disease data 2017 to estimate the attributable mortality and disability-adjusted life-years to unsafe sex and drug use in Acquired immunodeficiency syndrome in the Middle East and North Africa countries (21 countries) from 1990 to 2017 by region, sex and age. The percent change was calculated at three time points by country and sex. Results The rate of Disability-adjusted life years/100,000 attributed to drug use for Acquired immunodeficiency syndrome increased 1.10 (95% CI: 0.75–1.71) to 13.39 (95% CI: 9.98–18.17) in women of Middle East and North Africa countries from 1990 to 2017, and there is an increasing trend in Disability-adjusted life years attributable to drug use for Acquired immunodeficiency syndrome in men. The rate of Disability-adjusted life years/100,000 attributed to unsafe sex for Acquired immunodeficiency syndrome increased in women of Middle East and North Africa countries, 5.15 (95% CI: 3.34–8.07) to 53.44 (95% CI: 38.79–75.89); and 10.06 (95% CI: 6.61–16.18) to 46.16 (95% CI: 31.30–72.66) in men. Age-standardized mortality rate attributed to drug use and unsafe sex for Acquired immunodeficiency syndrome increased from 1990 to 2017 in both sex in Middle East and North Africa countries. Conclusion The rate of Disability-adjusted life years /100,000 and age-standardized mortality rate attributed to unsafe sex and drug use increased in Middle East and North Africa from 1990 to 2017. While most of such countries have traditional cultures with religious believes, such increase need to be addressed in more depth by all policy makers.

Introduction Obesity is one of the main risk factors for cardiovascular disease (CVD) and cardiometabolic disease (CMD). Many studies have developed cutoff points of anthropometric indices for predicting these diseases. The aim of this systematic review was to differentiate the screening potential of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) for adult CVD risk. Methods We used relevant key words to search electronic databases to identify studies published up to 2019 that used receiver operating characteristic (ROC) curves for assessing the cut-off points of anthropometric indices. We used a random-effects model to pool study results and assessed between-study heterogeneity by using the I2 statistic and Cochran's Q test. Results This meta-analysis included 38 cross-sectional and 2 cohort studies with 105 to 137,256 participants aged 18 or older. The pooled area under the ROC curve (AUC) value for BMI was 0.66 (95% CI, 0.63-0.69) in both men and women. The pooled AUC values for WC were 0.69 (95% CI, 0.67-0.70) in men and 0.69 (95% CI, 0.64-0.74) in women, and the pooled AUC values for WHR were 0.69 (95% CI, 0.66-0.73) in men and 0.71 (95% CI, 0.68-0.73) in women. Conclusion Our findings indicated a slight difference between AUC values of these anthropometric indices. However, indices of abdominal obesity, especially WHR, can better predict CVD occurrence.

Metabolic syndrome (MetS) is a prevalent disorder associated with diabetes and cardiovascular diseases. Lifestyle and occupation can increase the risk of developing MetS. Since dietary pattern is a major component of lifestyle, this study aimed to determine the relationship between consumption of animal source foods (ASFs) and MetS among food suppliers. This cross-sectional study was conducted on 112 male food suppliers. We measured anthropometric indices, body composition, and blood pressure of the participants. Blood biochemistry was determined using 5 mL fasting blood samples. MetS was defined based on the guidelines described by the International Diabetes Federation (IDF). ASF intake, including dairy products, eggs, red meat, poultry, and fish, was assessed using food frequency questionnaires. Overall, 46.4% of participants had MetS. Participants who consumed dairy 3∼5 times/d and more than 5 times/d had lower risk of MetS [odds ratios (OR): 0.18 (confidence interval (CI) 95%: 0.05∼0.62) and OR: 0.20 (CI 95%: 0.06∼0.67), respectively] compared with participants in the lowest tertile. The risk of hypertension was significantly decreased in participants who consumed dairy products >5 times/d [OR: 0.22 (CI 95%: 0.07∼0.67)]. Other ASFs were not associated against the risk of MetS in crude and adjusted models. Our findings indicated that adhering to dairy products can decrease the risk of MetS. Higher adherence to dairy products was also protective against hypertension in these participants.

This study aimed to determine the indirect effect of risk factors associated with overweight and obesity through physical activity (PA) and dietary pattern (DP), using structural equation model in the adults' population.This cross-sectional study was conducted on 10,000 adults from baseline data of Ravansar Non Communicable Disease cohort study, in the west region of Iran in 2018. Structural equation modeling was used to assess the causal effects of associated factors on obesity and overweight as the outcome.In general, the population at higher economic level was significantly more dependent on the healthy DP. The direct effect of socioeconomic status (SES) on overweight and obesity was - 0.070, the indirect effect was 0.127, and the total effect was 0.057. When stratified by gender, in women, SES had a weak direct effect (β = 0.024) and indirectly, through the variables of PA and DP, had a significant effect (β = 0.088) on the outcome. The same situation has been observed in men. That is a weak direct effect of SES (β = 0.070) and a significantly indirect effect, through three variables such as PA, DP, and smoking status, on the outcome.Factors associated with overweight and obesity not only by direct effect, but also can indirectly and through mediators (such as DP and PA as two important mediation variables) cause this outcome. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Depression is the most common mental disorder among subjects with HIV. The present study was conducted to determine the relationship between dietary intake and depression among male and female with HIV/AIDS. 335 HIV/AIDS subjects were evaluated who referred to Behavioral Disorders Counseling Center in Kermanshah, province in Iran. Depression was assessed using Beck questionnaire. Food frequency questionnaire was used to assess dietary intake. Our findings indicated that 76.1% of the studied subjects had varying degrees of depression. The rate of depression in the men was significantly higher than in the women (P = 0.007). The mean of weight in the men with depression was significantly lower than of the men without depression (P = 0.01). Higher adhere to legume and vegetables in the men (OR 0.049, CI 95% 0.003–0.713 and OR 0.534, CI 95% 0.334–0.855, respectively) and dairy products in the women (OR 0.493, CI 95% 0.265–0.917) were associated with decrease risk of depression. The results of this study were shown that the high prevalence of depression among these subjects. Higher intake of legume and vegetables and dairy products had a protective effect on the risk of depression. Level V, descriptive cross-sectional study.

Introduction/Objective. As a risk factor for chronic diseases, metabolic syndrome (MS) is increasing at an alarming rate. The prevalence of MS varies according to lifestyle and occupation in different populations. The present study aimed to determine the prevalence of MS and its components in food suppliers. Methods. A total of 112 food suppliers were randomly selected from all around the city. Data collection tools included demographic, physical activity, and food frequency questionnaires. Body composition was measured using Bio-Electrical Body Analyzer. A sample of 5 ml of fasting blood was taken from participants to assess lipid profile, blood sugar, insulin, and liver enzymes. The data were analyzed using ?2, Kolmogorov?Smirnov and ANOVA tests. Results. Participants? mean BMI was 27.1 ? 3.9 kg/m2, 43.6% were overweight, and 26.4% were obese. Consumption of vegetables was less and of meats more than recommended amounts. The prevalence of MS was 45.5% (51 people), which increased with aging (p = 0.02). Among factors causing MS, the most common one was waist-to-hip ratio (WHR) > 0.09 (72.7%), followed by high triglyceride and low HDL. Conclusion. In this study, the prevalence of MS among food suppliers was higher than the world average and than prevalence in other countries. WHR (or obesity) was found to be the most important risk factor for MS. To reduce the risk of MS, changing dietary consumption habits and increased physical activity are recommended to persons with high risk and sedentary occupations.

Changes in food consumption patterns during Ramadan may cause metabolic changes, but these have not been well studied. We aimed to determine food intake, glucose homeostasis, lipid profiles, and body composition before, during, and after Ramadan fasting. 160 healthy men were enrolled and investigated at three times (before, at the end of, and 1 month after Ramadan). Body composition was estimated by bio-impedance. Fasting blood samples were obtained for measuring fasting blood sugar (FBS), lipid profiles and insulin level. Insulin resistance (IR) was identified by the homeostatic model assessment (HOMA) of peripheral IR. Food intake was measured using a validated food frequency questionnaire before and during Ramadan. Statistical analysis was performed by SPSS 16 and P

Background: Lifestyle and food pattern play a key role in the creation and control of metabolic syndrome (MS). Objective: The present study was conducted to determine the role of nutritional and anthropometric factors as the predictors of MS in food production and distribution business owners. Materials and Methods: The present cross-sectional study was conducted on 112 food retailers selected in a random fashion. The study questionnaires included the demographic information questionnaire and food frequency questionnaire. The body composition was measured using the body analyzer. To examine lipid profiles and blood sugar, 5 ml fasting blood samples were taken from the participants. The data were analyzed using the logistic regression test. Results: The present study found high waist–hip ratio and body fat mass to be the strongest anthropometric predictors of MS. High lean body mass and total body water were negatively correlated with and played a protective role in MS. Consumption of dairy products as a food group was negatively correlated with MS, i.e., the higher the consumption, the lower the emergence rate of MS. The prevalence of MS was found to be 30.4% in the over 40 age group, 51.4% in 40–49 years old and 61.3% in those aged 50 and above, suggesting a positive correlation between the prevalence of MS and increasing age (P = 0.02). Conclusion: The present study found increased waist circumference and reduced dairy consumption to increase the risk of MS. Furthermore, weight reduction changes in lifestyle by increasing physical activities and observing proper diets were found to significantly decrease the risk of MS.

Background: Inadequate food intake is one of the causes of malnutrition, which is an important complication of HIV and accelerates the progress of HIV toward acquired immunodeficiency syndrome (AIDS). Objective: The present study aimed to assess nutritional status of people with HIV/AIDS. Materials and Methods: The present cross-sectional study recruited 340 people with HIV/AIDS visiting Behavioral Diseases Counseling Center in Kermanshah Province. Malnutrition was measured by body mass index (BMI). Food Frequency Scale was used to assess food intake, and the amounts of food intake were compared to recommended daily allowance (RDA). The data were analyzed in Stata-11 using Chi-square, Kruskal–Wallis, and ANOVA tests. Results: Mean BMI among men and women was 22.12 ± 3.75 kg/m2 and 25.54 ± 4.66 kg/m2. The prevalence of BMI-based malnutrition was 42.21% (141 people). Of participating patients, 11.08% were underweight, 22.75% overweight, and 8.38% obese. Underweight was reported more prevalent in men than in women and also in singles than in married patients (P = 0.001). Intake of protein, folate, Vitamins A and E, and fiber was less than RDA in a significantly large number of patients. Vitamin A deficiency was more evident in men and folate and calcium deficiencies in women. Conclusion: The present study showed inadequate intake of micro- and macro-nutrients in patients with HIV/AIDS. Malnutrition was observed as varying degrees of underweight and overweight, which requires greater attention to and care for these patients.