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1.  An overview on the successes, challenges and future perspective of a national school-based surveillance program: the CASPIAN study 
The Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease (CASPIAN) study is implemented in the Islamic Republic of Iran from 2003. The aim of this national school- based surveillance program was to provide accurate data of regular surveys of this program to be reviewing methodology, protocols, data collection and questionnaires of these surveys. Information was obtained from articles and books were published from CASPIAN studies. The CASPIAN studies were repeated every two years, with blood sampling for biochemical factors every four years. Methods and questionnaires of all surveys were similar at their core level and some optional factors added in different surveys. The results of CASPIAN studies represent the public health of Iranian children and adolescents that are useful for policy makers and based on them, intervention programs can set in national and sub-national level.
doi:10.1186/s40200-014-0120-3
PMCID: PMC4302132  PMID: 25614853
Prevention; School- based survey; Non-communicable diseases; Children; Adolescents
2.  Cord blood lipoprotein profile in term, preterm, and late preterm newborns 
Background:
High concentrations of triglyceride-rich lipoproteins, and apolipoprotein B in newborns with low gestational age may increase the risk of cardiovascular diseases in the future. We investigated the lipid profile in term, late preterm and preterm Iranian infants.
Materials and Methods:
A total number of 99 term (gestational age ≥37 weeks), preterm (gestational age <34 weeks), and late preterm (34≤ gestational age <37 weeks) newborns were studied. Total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides, as well as apolipoproteins A and B were analyzed using auto analyzer.
Results:
Significant differences existed between cord blood concentrations of triglycerides, total cholesterol, and LDL-C in the term, late preterm and preterm infants (P < 0.05). The highest (61.69 mg/dl) and lowest (47.03 mg/dl) concentrations of triglycerides were documented in term and preterm newborns, respectively. Late preterm infants had the highest concentration of cord blood cholesterol. The lowest amount of cholesterol was found in term newborns (72.51 mg/dl). No significant difference existed in the mean of HDL-C and apolipoproteins in the studied groups (P > 0.05).
Conclusion:
In this study, the cord blood concentrations of cholesterol, triglycerides, and LDL-C were lower in term than in preterm and late preterm infants. This finding should be considered in infant nutrition and preventive measures.
PMCID: PMC4310075  PMID: 25657747
Cord blood; gestational age; lipoprotein; newborns
3.  Effects of synbiotics on treatment of children with failure to thrive: A triple blind placebo-controlled trial 
Background:
Failure to thrive (FTT) is a common problem of children especially in underdeveloped countries. In addition to its short-term adverse health effects, it is associated with long-term behavioral and cognitive defects. One of the recommended treatment modalities for FTT is using synbiotics. Due to high prevalence of FTT with undefined organic causes and failure of most medications on treatment of this type of FTT, we decided to search the effect of synbiotics on these patients.
Materials and Methods:
A randomized, triple-blinded, placebo-controlled trial study was done from 2011 to 2012. A number of 84 patients were randomly assigned to intervention and control groups. The synbiotics sachets were administered to study group for 6 months. The growth indices were measured at the beginning of the trial after 3 and 6 months, and compared with control.
Results:
Variance analysis of observations showed improvement of growth indices in both groups. The increase in weight was significantly higher in synbiotics group than in controls (P < 0.05). The corresponding figure was not significant for height and head circumference (P > 0.05). At the beginning of the trial, the mean weights were 10.25 ± 0.20 kg and 10.750 ± 0.160 kg in intervention and control groups, respectively, Meanwhile, after 6 months, the mean weights of two groups became 12.280 ± 0.190 and 11.760 ± 0.17 kg in intervention and control groups, respectively. This result has confirmed that the effect of synbiotics is significant on weight gain of our patients.
Conclusion:
Our findings support beneficial effects of synbiotics in weight gain of children with FTT.
PMCID: PMC4310077  PMID: 25657749
Children; failure to thrive; growth; synbiotics
4.  Effects of zinc supplementation on subscales of anorexia in children: A randomized controlled trial 
Pakistan Journal of Medical Sciences  2014;30(6):1213-1217.
Objectives: This study aims to assess the effects of zinc supplementation on improving the appetite and its subscales in children.
Methods: This study was conducted in 2013 in Isfahan, Iran. It had two phases. At the first step, after validation of the Child Eating Behaviour Questionaire (CEBQ), it was completed for 300 preschool children, who were randomly selected. The second phase was conducted as a randomized controlled trial. Eighty of these children were randomly selected, and were randomly assigned to two groups of equal number receiving zinc (10 mg/day) or placebo for 12 weeks.
Results: Overall 77 children completed the trial (39 in the case and 3 in the control group).The results showed that zinc supplement can improve calorie intake in children by affecting some CEBQ subscales like Emotional over Eating and Food Responsible.
Conclusion: Zinc supplementation had positive impact in promoting the calorie intake and some subscales of anorexia.
doi:10.12669/pjms.306.6377
PMCID: PMC4320702
Anorexia; Children; Randomized controlled trial; Zinc
5.  Frequency, Causes, and Places of Unintentional Injuries in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study 
Background:
This study aims to assess the frequency, causes, and places of injuries in a nationally representative sample of Iranian children and adolescents, as well as the referral, places allocated for injured individuals.
Methods:
This nationwide study was conducted in 2011-2012 among 13486 elementary, secondary and high-school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. The Global School-based Health Survey questionnaire of the World Health Organization was used.
Results:
The study participants consisted of 50.8% boys, 75.6% urban resident with a mean age of 12.5 years. Overall, 20.25% of participants reported that they were minimally injured once in the last 12 months; this prevalence was higher in boys than in girls (25.74% vs. 14.58%, respectively, P < 0.001), without significant difference in urban (20.11%) and rural (20.69%) areas. Most of them (39.92%) were injured at homes or house yards with higher prevalence in girls than in boys (48.61% vs. 35.17%, respectively, P < 0.001) and in rural than in urban areas (27.30% vs. 20.89%, respectively, P < 0.001). Schools were reported as the second prevalent site of injury occurrence (22.50%). Emergency departments and physician offices were the most prevalent referral places for injured individuals (32.31% and 22.38%, respectively). Most of the school injuries occurred during play or sport activities (45.92%).
Conclusions:
Prevention of unintentional injuries should be considered as a health priority. Appropriate preventive strategies should be enhanced at homes and schools.
PMCID: PMC4223940  PMID: 25400879
Adolescents; children; injuries; Iran; prevention
6.  Clinical Effects of Rhus coriaria Fruits on Dyslipidemia in Adolescents: a Triple-blinded Randomized Placebo-controlled Trial 
Medical Archives  2014;68(5):308-312.
ABSTRACT
Objective:
Children and adolescents are considered as the best target groups for preventing and controlling the cardiovascular diseases risk factors and reducing mortality in adulthood. Alternative medicine and herbal drugs have been taken into account for managing dyslipidemia in this population. The beneficial effects of Sumac (Rhus coriaria L.) on lipid profile have been confirmed in some laboratory and animal studies. This study was designed to investigate the clinical effects of sumac fruits on dyslipidemia in 12-18 years-old adolescents.
Methods:
This randomized triple-blinded clinical trial was conducted on 72 obese adolescents with dyslipidemia from August 2011 to June 2012 in Isfahan Cardiovascular Research Center, Isfahan, Iran. Eligible adolescents were randomly assigned to two case and control groups. The control group received placebo capsules and the case group received capsules containing 500 mg of powdered sumac fruits, each three times a day for one month. Biochemical parameters including 12-hrs fasting serum levels of total cholesterol (Total-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured before the initiation and after the completion of the study protocol. Statistical analysis was performed using the SPSS software, version 16.0, using Independent Samples T-test, or Paired Samples T-test, for between-group and within-group analysis, respectively.
Findings:
The plasma levels of Total-C, LDL-C, and TG changed significantly over-time in the case group. Furthermore, between-group analysis showed a statistically significant difference between case and control groups with this regard (P < 0.05, for all statistical comparisons). However, HDL-C levels have not been changed significantly over-time within the case or control group, neither between the two study groups.
Conclusion:
In this study, the considerable effects of Rhus coriaria (sumac) on reducing serum levels of Total-C, LDL-C, and TG have been noticed during one-month trial. However, probably due to the concise period of sumac consumption, its effect on HDL-C was not statistically significant.
doi:10.5455/medarh.2014.68.308-312
PMCID: PMC4269531  PMID: 25568560
Rhus coriaria; Sumac; dyslipidemia; adolescent
7.  Controlling childhood obesity: A systematic review on strategies and challenges 
Background:
Childhood obesity is a global health problem with short- and long-term health consequences. This systematic review presents a summary of the experiences on different family-, school-, and clinic-based interventions.
Materials and Methods:
Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases. We included those studies conducted among obese individuals aged up to 18 years. Our search yielded 105 relevant papers, 70 of them were conducted as high quality clinical trials.
Results:
Our findings propose that school-based programs can have long-term effects in a large target group. This can be related to this fact that children spend a considerable part of their time in school, and adopt some parts of lifestyle there. They have remarkable consequences on health behaviors, but as there are some common limitations, their effects on anthropometric measures are not clear. Due to the crucial role of parents in development of children's behaviors, family-based interventions are reported to have successful effects in some aspects; but selection bias and high dropout rate can confound their results. Clinic-based interventions revealed favorable effects. They include dietary or other lifestyle changes like increasing physical activity or behavior therapy. It seems that a comprehensive intervention including diet and exercise are more practical. When they have different designs, results are controversial.
Conclusion:
We suggest that among different types of interventional programs, a multidisciplinary approach in schools in which children's family are involved, can be the best and most sustainable approach for management of childhood obesity.
PMCID: PMC4274579  PMID: 25538786
Adolescent; child; control; obesity; prevention
8.  A Nationwide Survey on Some Hygienic Behaviors of Iranian Children and Adolescents: The CASPIAN-IV Study 
Background:
This study aims to assess the frequency of some hygienic behaviors that is, tooth brushing and hand-washing, in Iranian school students at national level.
Methods:
This nationwide study was conducted in 2011-2012 among 14,880 elementary, secondary and high school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. We used the global school-based health survey questionnaire of the World Health Organization.
Results:
The population of this survey consisted of 13,486 children and adolescents (participation rate of 90.6%) including 49.2% girls and 75.6% urban inhabitants. The mean age of participants was 12.5 years (12.3-12.6, 95% confidence interval) According to the self-report of students, 26.9% of them (20.2% of boys and 33.9% of girls) brushed their teeth more than once a day, 37.8% of boys and 42.1% of girls brushed their teeth once a day. In general, girls brushed their teeth more than boys. The frequency of those students who never brushed their teeth was twice in rural than in urban students (11.4% vs. 6.2%, respectively). In total, 3.4% of the students stated that their school had not an appropriate place for washing hands after toilet, with three-fold higher frequency in rural than in urban schools (6.8% vs. 2.3%, respectively). 85% of students (87% of girls vs. 83% of boys) reported that they had always washed their hands after toilet, 10.1% did it occasionally and 4.1% did not.
Conclusions:
This nationwide survey revealed that Iranian students have an acceptable level of hygienic behaviors both in urban and rural areas; however, still it is necessary to improve school health facilities and hygienic habits in Iranian students.
PMCID: PMC4192768  PMID: 25317289
Children and adolescents; hygiene; Iran; school
9.  First report on the association of drinking water hardness and endothelial function in children and adolescents 
Archives of Medical Science : AMS  2014;10(4):746-751.
Introduction
This study aims to investigate the relationship of water hardness and its calcium and magnesium content with endothelial function in a population-based sample of healthy children and adolescents.
Material and methods
This case-control study was conducted in 2012 among 90 individuals living in two areas with moderate and high water hardness in Isfahan County, Iran. The flow-mediated dilatation (FMD) of the brachial artery and the serum levels of soluble adhesion molecules (sICAM-1, sVCAM-1) were measured as surrogate markers of endothelial function, and high-sensitivity C-reactive protein (hs-CRP), as a marker of inflammation.
Results
Data of 89 participants (51% boys, mean age 14.75 (2.9) years) were complete. Those participants living in the area with high water hardness had higher FMD, hs-CRP, and soluble adhesion molecules (sICAM-1, sVCAM-1) than their counterparts living in the area with moderate water hardness. Multiple linear regression analysis showed that after adjustment for confounding factors of age, gender, body mass index, healthy eating index and physical activity level, total water hardness, as well as water content of calcium and magnesium, had a significant positive relationship with FMD. The corresponding associations were inverse and significant with soluble adhesion molecules (p < 0.05).
Conclusions
This study, which to the best of our knowledge is the first of its kind in the pediatric age group, suggests that water hardness, as well as its calcium and magnesium content, may have a protective role against early stages of atherosclerosis in children and adolescents.
doi:10.5114/aoms.2014.44866
PMCID: PMC4175776  PMID: 25276160
water hardness; endothelial function; calcium; magnesium; children and adolescents
10.  Expression of cord blood cytochrome P450 1A1 gene according to the air pollution level of the maternal residence area 
Background:
This study aimed to compare the cytochrome P450 1A1 (CYP1A1) gene expression in the cord blood of infants born from mothers living in low- and high-air polluted areas.
Materials and Methods:
The study was conducted in Spring 2012 in Isfahan, the second large and air-polluted city in Iran. The study comprised 60 neonates, consisting of 30 infants born from mothers residing in areas with high levels of air pollution and an equal number of infants born in areas with a lower air pollution level. The umbilical cord blood sample was taken immediately after birth. The relative gene expression levels of CYP1A1 were examined using real time-polymerase chain reaction method.
Results:
CYP1A1 gene expression level was 3.3-fold higher in the group living in areas with higher pollution level than in the other group (P = 0.01). No significant difference existed in the mean values of maternal age, gestational age, the newborns’ birth weight, and the gender distribution between the two groups.
Conclusion:
This study provides confirmatory evidence of prenatal health hazards of ambient air pollution and highlights the need for pollution prevention programs to protect women of childbearing age and their children. The clinical implications of this study finding should be confirmed in future longitudinal studies.
PMCID: PMC4235086  PMID: 25422651
Air pollution; CYP1A1 gene expression; fetus; prevention
11.  Reference curves of anthropometric indices in two national studies conducted among Iranian children in 2003-2004 and 2009-2010: The Caspian study 
Background:
Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010.
Materials and Methods:
Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model.
Results:
In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m2 and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m2 and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m2, 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m2, and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased.
Conclusion:
The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations.
PMCID: PMC4235089  PMID: 25422654
Anthropometric indices; children and adolescents; Iran; reference curve
12.  The Effects of Vitamin E and Omega-3 PUFAs on Endothelial Function among Adolescents with Metabolic Syndrome 
BioMed Research International  2014;2014:906019.
Aim. The present study aims to explore the effects of vitamin E and omega-3 on endothelial function indicators among adolescents with metabolic syndrome. Method. In a randomized, double blind, and placebo-controlled trial, 90 young individuals, aged 10 to 18 years, with metabolic syndrome were randomly assigned to receive either vitamin E tablets (400 IU/day) or omega-3 tablets (2.4 gr/day) or placebo. For assessing endothelial functional state, the serum level of vascular endothelial growth factor (VEGF) was measured by ELISA test. Results. The use of omega-3 supplementation for eight weeks led to significant increase in serum HDL level compared with the group treated with vitamin E or placebo group. In this regard, no significant correlations were found between the change in VEGF and baseline levels of other markers including anthropometric indices and serum lipids. Omega-3 could significantly reduce VEGF with the presence of other baseline variables (Beta = −12.55; P = 0.012). Conclusion. The administration of omega-3 can effectively improve endothelial function in adolescents with metabolic syndrome by reducing the level of serum VEGF, as a major index for atherosclerosis progression and endothelial destabilization. Omega-3 can be proposed as a VEGF antagonist for improving endothelial function in metabolic syndrome. The clinical implications of our findings should be assessed in future studies.
doi:10.1155/2014/906019
PMCID: PMC4127288  PMID: 25136638
13.  First Report on the Lipid Profile Late after Kawasaki Disease in Iranian Children 
Background:
Concerns have been raised about the possibility of a predisposition of Kawasaki disease (KD) to abnormal lipid profile after an acute phase of disease, which can predispose them to premature atherosclerosis later in life. We determined the lipid profile of children late after KD, and compared it with controls.
Methods:
This historical cohort was conducted on 32 subjects: 16 children with history of uncomplicated KD (age 11.8 ± 3.3 years, interval from the initial episode 7.1 years), and 16 healthy age-matched of their sibling or cousins. Fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) levels were compared between groups. In addition, blood pressure and body mass index (BMI) were measured and compared.
Results:
Six out of 16 KD patients and 7 out of 16 controls had abnormal lipid values. No significant difference was found in mean values of systolic blood pressures, diastolic blood pressures, BMI, TG, TC, HDL-C, and LDL-C between cases and controls.
Conclusions:
We conclude that although Iranian KD children probably had no different lipid profile compared with controls, but due to finding dyslipidemia in more than one-third of KD subjects, we suggest that periodic control of lipid values in these patients is of crucial importance.
PMCID: PMC4124558  PMID: 25104992
Atherosclerosis; children; Iran; Kawasaki disease; lipid profile
14.  Association between adolescence obesity and metabolic syndrome: Evidence from Isfahan Healthy Heart Program 
Background:
Metabolic syndrome (MetS) is more prevalent among Iranian adolescences. This study aimed to find the relationship between obesity and MetS among different education grades of Iranian adolescence.
Materials and Methods:
Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Fasting blood sugar, total cholesterol, triglyceride (TG), and high-density lipoprotein cholesterol (HDL) were measured. Trained individuals measured waist circumference and blood pressure. MetS was defined according to the De Ferranti definition.
Results:
The prevalence of overweight and obesity was 12.6% and 6.2% in junior and 11.5% and 4.3% in high school students, respectively. Obese subjects in both grades have higher waist circumference, systolic and diastolic blood pressure, and triglyceride than comparable groups. Multiple logistic regression models showed that overweight and obesity were strongly associated with MetS components analyzed. Compared to normal-weight children, overweight and obese in junior high school students were 1.47 and 2.23 times more likely to be having high TG, respectively, whereas overweight and obese in high school-students were also more likely to have elevated TG [ORs 1.94 (1.28-2.94), 4.96 (2.39-10.3) respectively].
Conclusion:
Obese children have the highest prevalence of MetS. Prevalence of MetS-related components has reached high level among Iranian adolescences that were overweight or obese.
doi:10.4103/2230-8210.137523
PMCID: PMC4138918  PMID: 25143919
Adolescence; metabolic syndrome; obesity
15.  Are obese adolescents more depressed? 
Introduction:
Obesity is a growing problem in all countries which leads to various physical, psychological, and social problems. The present study aimed to assess depression in children and adolescents aged 10-18-year old compared with the control group.
Materials and Methods:
In a case-control study, from among the 10- to 18-year-old students of the five education districts of Isfahan, 100 people (50 girls and 50 boys) were selected as obese children with the Body Mass Index (BMI) of greater than 95th percentile for their age and gender and 100 others (50 girls and 50 boys) as the control group with the BMI of 5th to 85th percentile. The case and control groups were matched for age, gender, and socio-economic status. After calculating BMI based on weight (kg)/height2 (meter), subjects were interviewed based on DSM IV criteria to diagnose clinical depression. The severity of children's depression was measured using standardized questionnaire.
Results:
The mean age of the case group was 12.2 ± 1.86-years old and that of the control group 13.06 ± 2.25. They were, respectively, diagnosed with depression of 7% and 6%. The mean depression score of the case group was 11.7 ± 5.3 and that of the control group was 10.6 ± 6.03 with no statistical significance.
Discussion:
Given our findings, the Jolly fat hypothesis applies to the case group. It seems that health policy-makers need to make intervention plans to change behavior; attitude, skill, and knowledge (BASK) of the public toward obesity and its long-term side-effects.
doi:10.4103/2277-9531.134908
PMCID: PMC4113990  PMID: 25077167
Adolescent; depression; obesity
16.  Evaluation of preventive effects of colostrum against neonatal conjunctivitis: A randomized clinical trial 
Background:
Neonatal conjunctivitis leads to several ocular consequences in the affected neonates such as blindness. Currently available therapeutic options include NaNO3, Gentamicin, Neomycin and so on, in which each of them has their own limitations. Regarding the immunologic content of colostrum and its safety and easy accessibility, we aimed to evaluate its preventive effects against neonatal conjunctivitis.
Materials and Methods:
In this clinical trial, conducted from November 2011 to July 2012, 300 preterm neonates, with culture negative eye swab, were enrolled and randomly assigned into three groups. The intervention group received two drops of colostrum. Control group received no treatment and other neonates were treated with topical Erythromycin ointment (0.5%). All neonates were followed for occurrence of clinical conjunctivitis for 28 days. Data analysis were performed by Chi-square test.
Results:
Our data demonstrate the beneficial preventive effects of Colostrum against neonatal conjunctivitis (P = 0.036).
Conclusion:
Colostrum is suggested as an alternative prophylactic option for antibiotics against neonatal conjunctivitis. As colostrum is easily accessible without cost, potential hazards and side effects, public education about its topical favorable effects is worthwhile.
doi:10.4103/2277-9531.134776
PMCID: PMC4114003  PMID: 25077156
Antibiotic prophylaxis; colostrum; neonatal conjunctivitis; ophthalmia neonatorum
17.  Growth Disorders Among 6-Year-Old Iranian Children 
Background:
Sociodemographic factors are important determinants of weight disorders. National representative studies provide a view on this health problem at national and regional levels.
Objectives:
This study aimed to assess the distribution of growth disorders in terms of body mass index (BMI) and height in 6-year-old Iranian children using geographical information system (GIS).
Materials and Methods:
In this cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were examined in a mandatory national screening program in 2009. Descriptive analysis was used to calculate the prevalence of underweight, overweight, obesity, and short stature. Then, ArcGIS software was used to draw the figures.
Results:
The study population consisted of 955388 children (48.5% girls and 76.5% urban). Overall, 20% of children were underweight, and 14.3% had high BMI, consisted of 10.9% overweight and 3.4% obese. The corresponding figure for short stature was 6.6%; however, these growth disorders were not equally distributed across various provinces.
Conclusions:
Our results confirmed unequal distribution of BMI and height of 6-year-old children in Iran generally and in most of its provinces particularly. The differences among provinces cannot be fully explained by the socioeconomic pattern. These findings necessitate a comprehensive national policy with provincial evidence-based programs.
doi:10.5812/ircmj.6761
PMCID: PMC4102995  PMID: 25068062
Body Mass Index; Child; Socioeconomic Factors
18.  Clinical Effects of Portulaca Oleracea Seeds on Dyslipidemia in Obese Adolescents: a Triple-blinded Randomized Controlled Trial 
Medical Archives  2014;68(3):195-199.
Objective:
Childhood obesity is a major public health concern worldwide while the current epidemic may be secondary to over consumption of high-fat, energy-rich foods. Purslane (Portulaca oleracea L.) has been traditionally used in medicine for several antioxidant and anti-atherogenic activities. In this study the anti-dyslipidemic effects of P.oleracea was evaluated in obese adolescents.
Methods:
In this triple-blinded randomized placebo-controlled clinical trial which was done from July 2011 to June 2012, obese adolescent patients whom were referred to the Isfahan Cardiovascular Research Institute (Iran) were randomly allocated to the two arms of cases and controls. The cases group was asked to take one capsule containing powdered P. oleracea seeds (500 milligrams) two times a day for one month, and the controls group were asked to take identical but placebo (lactose) capsules in the same way. Biochemical parameters including 12-hours fasting serum levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured before the initiation and after the completion of the study protocol.
Findings:
Total cholesterol, LDL-C, and TG showed statistically significant changes over time (one month) in the P. oleracea group (p < 0.05). However, between-group analysis using general linear model (multivariate) test revealed that the differences in the mentioned parameters between two study groups were statistically significant just for LDL-C and TG, while others did not differ significantly.
Conclusion:
P. oleracea L. may have positive effects on serum lipids profile which may be attributed to its polyphenolic and antioxidant compounds. This herbal drug seems to be well-tolerated in adolescent population as well. Further studies are recommended.
doi:10.5455/medarh.2014.68.195-199
PMCID: PMC4240324  PMID: 25568533
Portulaca oleracea; dyslipidemia; adolescent; obesity; clinical trial
19.  Absence of Association between -1131T>C Polymorphism in the Apolipoprotein APOA5 Gene and Pediatric Metabolic Syndrome 
Iranian Journal of Pediatrics  2014;24(3):319-322.
Objective: In the present study, we evaluated the association of rs662799 variant of the APOA5 gene with Metabolic syndrome (MetS) in a sample of children and adolescents from Isfahan.
Methods: This case control study comprised 50 cases of MetS and 50 controls. Mismatched polymerase chain reaction–restriction fragment length polymorphism (mPCR-RFLP) was used to genotype -1131T>C polymorphism.
Findings : No significant association was documented for APOA5 genotypes with the measured laboratory parameters for CC, CT, and TT genotypes in the two groups studied. By logistic regression using a dominant model, the odds ratio (95% confidence interval0 for the MetS was 0.38 (0.139–1.0350 and 0.29 (0.08–1.071 for the unadjusted and adjusted models, respectively.
Conclusion: This study suggests that among studied children and adolescents, -1131T>C polymorphism in the APOA5 gene may not be a major contributor to the MetS risk.
PMCID: PMC4276588  PMID: 25562027
Apolipoprotein A5 Gene; Metabolic Syndrome; Children; Adolescents; Triglyceride; Cholesterol
20.  Do Iranian tobacco growers support the World Health Organization framework convention on tobacco control? 
Context:
Studies on the World Health Organization Frame-work Convention on Tobacco Control (FCTC) are scarce in Iran and the Eastern Mediterranean region (EMR).
Aim:
This study was conducted in 2007-2008 in Iran to design a practical evaluation model of the implementation of FCTC with the potential to be adopted in the EMR. Given that, the findings of this evaluation can be useful in increasing political and public support for enforcing the implementation of legislations, testing their feasibility, and maintaining sustainability. The viewpoints of tobacco growers as part of stakeholders in this regardwould have an influential role.
Settings and Design:
This study was a qualitative one to investigate the tobacco growers viewpoints about thestrengths/weaknesses of FCTC implementation in Iran.
Materials and Methods:
In this study, we conducted semi-structured in-depth individual interviews with 5 tobacco growers. All interviews were carried out with their permissionwere recorded and were assured that their interviews will be kept confidential. All questions were related to different FCTC articles, then written transcripts were prepared and the basic concepts were extrapolated.
Statistical Analysis:
After transcribing the recorded interviews, we extracted first level codes and main concepts from them.
Results:
The findings suggested that although tobacco growers agreed with FCTC implementation, however, subjects like the necessity to support tobacco growers and obtaining insurance from the government, the necessity of the enforcement of national tobacco control law and planning to decrease access to tobacco by policy makers were the most key points that tobacco growers pointed to them.
Conclusion:
Our results showed that tobacco growers agreed with the implementation of FCTC but they worried about their job and the expenses of their daily life. Therefore, it seems that policy makers have to design a plan to support tobacco growers for changing tobacco with a safe cultivate.
doi:10.4103/2277-9531.131904
PMCID: PMC4089143  PMID: 25013825
Frame-work convention on tobacco control; policy makers; tobacco growers
21.  Insulin and leptin levels in overweight and normal-weight Iranian adolescents: The CASPIAN-III study 
Background:
In this study, we aim to compare insulin and leptin levels in adolescents with or without excess weight and in those with or without abdominal obesity.
Materials and Methods:
This case-control study was conducted among 486 samples. We randomly selected 243 overweight and an equal number of normal-weight adolescents from among participants of the third survey of a national surveillance program entitled Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable diseases study. Serum insulin and leptin were compared between two groups and their correlation was determined with other variables.
Results:
The mean age and body mass index (BMI) of participants were 14.10 ± 2.82 years and 22.12 ± 6.49 kg/m2, respectively. Leptin and insulin levels were higher in overweight than in normal-weight adolescents (P < 0.05). Leptin level was higher in children with abdominal obesity than in their other counterparts (P < 0.001). Leptin level was correlated with age, fasting blood glucose, BMI, and insulin level.
Conclusion:
Insulin and leptin levels were higher among overweight and obese children, which may reflect insulin and leptin-resistance. Given the complications of excess weight from early life, prevention and controlling childhood obesity should be considered as a health priority.
PMCID: PMC4116567  PMID: 25097618
Children; insulin; leptin; obesity; overweight
22.  Association between psychosocial distress with cardio metabolic risk factors and liver enzymes in a nationally-representative sample of Iranian children and adolescents: the CASPIAN-III study 
Background
The present study was designed to evaluate association of psychosocial distress with cardio metabolic risk factors and liver enzymes in Iranian children and adolescents.
Method
This nationwide study was conducted as the third survey of the school-based surveillance system that was conducted among 5593 school students, 10–18 years in Iran. High triglyceride (TG), high fasting blood sugar (FBS), high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), hypertension (HTN), generalized obesity and abdominal obesity were considered as cardio metabolic risk factors and alanine transaminase (ALT) and aspartate aminotransferase (AST) were considered as liver enzymes. Data were analyzed using multiple logistic regression (MLR) analysis.
Result
Psychosocial distress was detected in2027 (71.2%) of boys and 1759 (63.3%) of girls. Among boys, the mean of LDL, AST and DBP were higher and the mean FBS and HDL were lowering those with psychiatric distress than their other counterparts. Girls with psychosocial distress had significantly higher mean of HDL and FBS than those without psychiatric distress. Psychosocial distress significantly increased the odds of high LDL (OR = 2.36, 95%CI 1.53, 3.64), high FBS (OR = 1.23, 95%CI 1.02, 1.49) and low HDL (OR = 1.65, 95%CI 1.41, 1.95).
Conclusion
Psychosocial distress in adolescents is associated with increased risk of some cardio metabolic risk factors.
doi:10.1186/2251-6581-13-44
PMCID: PMC3975638  PMID: 24602504
Psychosocial distress; Cardio metabolic risk factor; Adolescents
23.  The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries 
Background:
Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.
Methods:
We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.
Results:
Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55; diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33–4.25; diabetes: OR 1.97, 95% CI 1.53–2.53) and decreased through country income levels such that we did not detect an association in high income countries.
Interpretation:
The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
doi:10.1503/cmaj.131090
PMCID: PMC3940572  PMID: 24516093
24.  Indicators Developed to Evaluate the International Framework Convention on Tobacco Control in Iran; A Grounded Theory Study 
Iranian Journal of Medical Sciences  2014;39(2 Suppl):213-217.
This study aimed to develop indicators for evaluating the implementation of The Framework Convention on Tobacco Control (FCTC) in Iran. We used the “grounded theory” framework. Totally, 265 policy-makers, stakeholders, and community members were recruited by purposeful sampling in 2008. After analyzing the gathered data, 251 indicators, including 82 indicators as “applied indicators”, were derived from second-level codes for three groups. A suitable evaluation questionnaire can be designed based on the extracted indicators for policy makers, stakeholders, and the community to follow the implementation of the FCTC in Iran.
PMCID: PMC3993040  PMID: 24753645
Program evaluation; Tobacco; Iran
25.  Prevalence of Prehypertension and Hypertension in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study 
Background:
The global health burden has faced toward non-communicable diseases (NCDs). It is suggested that adulthood blood pressure (BP) is tracked from childhood. This study aims to evaluate the mean BP and the prevalence of prehypertension and hypertension in the Iranian pediatric population.
Methods:
In a national survey as the 4th phase of Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable diseases study and through random multistage cluster sampling, a national sample of Iranian school students, aged 6-18 years, were recruited. Data gathered by means of modified World Health Organization Global school-based student health survey questionnaire, a weight disorders determinants questionnaire and anthropometric and BP measurements. Prehypertension (HTN) was defined as BP equal or greater than 90th age and sex specific percentile or ≥120/80 mmHg and HTN was defined as BP ≥95th percentile.
Results:
A total of 13486 students entered the study (49.2% girls, 75.6% urban). Mean age of participants was 11.47 ± 3.36 years. A total rate of 4.17% (3.84-4.52 95% CI) for high systolic BP (SBP), 4.33% (3.99-4.68) for high diastolic BP (DBP) and 6.88% (6.45-7.32) for high SBP and/or DBP was depicted.
Conclusions:
The prevalence rate of high BP (pre-HTN together with HTN) is substantially high in this population. It is needed to study the causative situations and implement relevant interventions.
PMCID: PMC3990919  PMID: 24791193
Adolescent; blood pressure; child; hypertension; Iran; pre-hypertension

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