Fereshteh Asgari

Third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia.

BackgroundThe burden of non-communicable diseases is rising globally. This trend seems to be faster in developing countries of the Middle East. In this study, we presented the latest prevalence rates of a number of important non-communicable diseases and their risk factors in the Iranian population.MethodsThe results of this study are extracted from the third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007), conducted in 2007. A total of 5,287 Iranian citizens, aged 15–64 years, were included in this survey. Interviewer-administered questionnaires were applied to collect the data of participants including the demographics, diet, physical activity, smoking, history of hypertension, and history of diabetes. Anthropometric characteristics were measured and serum biochemistry profiles were determined on venous blood samples. Diabetes (fasting plasma glucose ≥ 126 mg/dl), hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or use of anti-hypertensive drugs), dyslipidemia (hypertriglyceridemia: triglycerides ≥ 150 mg/dl, hypercholesterolemia: total cholesterol ≥ 200 mg/dl), obesity (body mass index ≥ 30 kg/m2), and central obesity (waist circumference ≥ 80 cm in females and ≥ 94 cm in males) were identified and the national prevalence rates were estimated.ResultsThe prevalence of diabetes, hypertension, obesity, and central obesity was 8.7% (95%CI = 7.4–10.2%), 26.6% (95%CI = 24.4–28.9%), 22.3% (95%CI = 20.2–24.5%), and 53.6% (95%CI = 50.4–56.8%), respectively. The prevalence of hypertriglyceridemia and hypercholesterolemia was 36.4% (95%CI = 34.1–38.9%) and 42.9% (95%CI = 40.4–45.4%), respectively. All of the mentioned prevalence rates were higher among females (except hypertriglyceridemia) and urban residents.ConclusionWe documented a strikingly high prevalence of a number of chronic non-communicable diseases and their risk factors among Iranian adults. Urgent preventive interventions should be implemented to combat the growing public health problems in Iran.

Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non- communicable diseases in Iran (SuRFNCD-2007)

AimWe have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR) and metabolic syndrome (MetS) in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes.MethodsData of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC) curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve.ResultsThe area under the curve (AUC) (95%CI) was 0.650 (0.631-0.670) for IDF-defined MetS and 0.683 (0.664-0.703) with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF). The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6%) and 4.325 (sensitivity: 45.4%, specificity: 69.0%) for ATPIII- and IDF-defined MetS, respectively.ConclusionWe determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.

Pattern of tobacco use among the Iranian adult population: results of the national Survey of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007)

Background Previous studies report on smoking in Iran but recent national data on tobacco use (including cigarette, water-pipe and pipe) have not been reported. Methods In 2007, 5287 Iranians aged 15–64 years were sampled from all provinces as part of a national cross-sectional survey of non-communicable disease (NCD) risk factors. Data were collected using the standardised stepwise protocol for NCD risk factor surveillance of the World Health Organization. Use of tobacco products was calculated as the sum of smoking cigarettes/cigars (smoking currently or daily any amount of factory/hand-made cigarettes or cigars), pipes (daily) and water pipes (daily). Results Total current and daily tobacco use was 14.8% (burden 7.3 million) and 13.7% (burden 6.7 million) when extrapolated to the Iranian population aged 15–64. The prevalence of current and daily cigarette smoking was 12.5% (6.1 million; 23.4% males and 1.4% females) and 11.3% (5.6 million; 21.4 males and 1.4 females); former smokers comprised 1.7 million or 3.4% of the Iranian population (6.2% males and 0.6% females; mean cessation age 34.1). The mean age of starting to smoke was 20.5 years (24.2 males and 20.4 females). The prevalence of water-pipe smoking was 2.7% (burden 1.3 million; 3.5% males and 1.9% females). Water-pipe smokers used the water-pipe on average 3.5 times a day (2.8 males and 4.5 females). Conclusion The prevalence of tobacco use has not escalated over the past two decades. Nonetheless, the burden is high and therefore warrants preventive public health policies.

Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005-2011.

AIMS To estimate the prevalence and trends of diabetes mellitus (DM) and impaired fasting glucose (IFG), 2005-2011, and to determine the contribution of obesity to DM prevalence. PATIENTS AND METHODS Data from Surveillance of Risk Factors of Non-communicable Diseases (SuRFNCD) conducted in 2005, 2007, and 2011 were gathered. DM was defined as presence of self-reported previous diagnosis or a fasting plasma glucose (FPG)≥7 mmol/L. IFG was diagnosed with FPG levels between 5.6 and 6.9 mmol/L. Prevalence rates for 2011 and trends for 2005-2011 were determined by extrapolating survey results to Irans adult population. Population attributable fraction (PAF) of obesity was also calculated. RESULTS In 2011, IFG and total DM prevalence rates were 14.60% (95%CI: 12.41-16.78) and 11.37% (95%CI: 9.86-12.89) among 25-70 years, respectively. DM was more common in older age (p < 0.0001), in women (p = 0.0216), and in urban-dwellers (p = 0.0001). In 2005-2011, trend analysis revealed a 35.1% increase in DM prevalence (OR: 1.04, 95%CI: 1.01-1.07, p = 0.011); albeit, IFG prevalence remained relatively unchanged (OR: 0.98, 95%CI: 0.95-1.00, p = 0.167). In this period, DM awareness improved; undiagnosed DM prevalence decreased from 45.7% to 24.7% (p < 0.001). PAF analysis demonstrated that 33.78%, 10.25%, and 30.56% of the prevalent DM can be attributed to overweight (BMI≥25kg/m(2)), general obesity (BMI≥30 kg/m(2)), and central obesity (waist circumference≥90 cm), respectively. Additionally, the DM increase rate in 2005-2011, was 20 times higher in morbidly obese compared with lean individuals. CONCLUSION More than four million Iranian adults have DM which has increased by 35% over the past seven years, owing in large part, to expanding obesity epidemic.

Secular Trends of Obesity in Iran Between 1999 and 2007: National Surveys of Risk Factors of Non-Communicable Diseases

BACKGROUND Obesity is a rapidly progressing pandemic and a central feature of the metabolic syndrome. There is no solid evidence on the recent trends of obesity in Iran. In this study we present the secular trends of overweight and obesity among Iranian adults (25-64 years old) within an 8-year period (1999-2007). METHODS The analyses were performed on the datasets of three cross-sectional national surveys: The National Health Survey-1999 (n = 21,576), National Surveys of Risk Factors for Non-Communicable Diseases (SuRFNCD)-2005 (n = 70,945), and SuRFNCD-2007 (n = 4,186). RESULTS The overall prevalence of obesity increased from 13.6% in 1999 to 19.6% in 2005 and 22.3% in 2007 [odds ratio (OR) = 1.08 per year; P < 0.001]. For overweight subjects, the rates were, respectively, 32.2%, 35.8% and 36.3% (OR = 1.02 per year; P < 0.001). During these years, the mean body mass index (BMI) (kg/m(2)) increased from 25.03 in 1999, to 26.14 in 2005, and 26.47 and 2007 (P < 0.001). The increase in prevalence of obesity was seen in both males (OR = 1.09 per year; P < 0.001) and females (OR = 1.07 per year; P < 0.001) and both urban (OR = 1.07 per year; P < 0.001) and rural (OR = 1.10 per year; P < 0.001) residents. CONCLUSIONS In conclusion, the present study highlighted the rapid growth of obesity during recent years in Iran. Our findings indicate the crucial necessity of primary prevention programs to counteract this undesired condition.

Optimal waist circumference cut-offs for the diagnosis of metabolic syndrome in Iranian adults: results of the third national survey of risk factors of non-communicable diseases (SuRFNCD-2007).

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Association between physical activity and metabolic syndrome in Iranian adults: national surveillance of risk factors of noncommunicable diseases (SuRFNCD-2007).

Metabolic syndrome (MetS) is a common health problem in developing countries. We aimed to assess the association between different aspects of physical activity and MetS in our country. A standardized international questionnaire (Global Physical Activity Questionnaire) recommended by the World Health Organization was used in the third national survey of risk factors of noncommunicable diseases (SuRFNCD-2007) to collect physical activity data from a nationally representative sample of Iranian adults. Physical activity was evaluated in 3 domains: work, commuting, and recreational activities. Both duration and intensity of activity were considered. Biochemical measurements were carried out, and MetS was defined by the International Diabetes Federation and the Adult Treatment Panel III criteria. The data collected from a total of 3296 individuals were analyzed. The national prevalence of MetS was estimated to be between 24% and 30%, depending on sex and the criteria used. The prevalence of MetS among individuals with high-, moderate-, and low-category activity was 18.7% +/- 1.5%, 25.8% +/- 2.0%, and 27.9% +/- 2.0%, respectively (P < .001). These rates were 12.6% +/- 1.6%, 26.0% +/- 1.5%, and 34.1% +/- 3.2% among individuals with vigorous activity, with nonvigorous activity, and without activity, respectively (P < .001). We demonstrated a significant linear association between the number of metabolic abnormalities and lower levels of various aspects of physical activity (total physical activity, duration of domain-specific activity, and duration of intensity-specific activity; P < .001 for all). Notably, the risk for MetS increased 1.28-fold with every 30-min/d reduction in vigorous-intensity activity (95% confidence interval = 1.15-1.42, P < .001). The results of the present study should be considered for future public health programs in Iran.

Association between physical activity and insulin resistance in Iranian adults: National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007).

BACKGROUND Insulin resistance is an underlying mechanism of metabolic syndrome. We attempted to determine the association between physical activity and insulin resistance in Iranian adults. METHODS The data of the third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran were used. We ran the Global Physical Activity Questionnaire (GPAQ) over a nationally representative sample of 3101 adults. Total physical activity (TPA) was calculated using metabolic equivalents (MET) for intensity of physical activities. Insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS When physical activity was classified into high, moderate, and low categories, HOMA-IR values significantly increased from the high category to the moderate and low categories (p<0.01). After adjustment for age, area of residence, smoking, and body mass index (BMI), TPA (r=-0.26, p<0.01 in males and r=-0.21, p<0.01 in females), duration of vigorous-intensity activity (r=-0.28, p<0.01 in males and r=-0.18, p=0.01 in females), duration of moderate-intensity activity (r=-0.16, p=0.01 in males and r=-0.17, p<0.01 in females), and the time spent on sedentary behaviors (r=0.16, p=0.01 in males and r=-0.22, p<0.01 in females) were significantly correlated to HOMA-IR. The prevalence of physical inactivity increased linearly with increasing HOMA-IR quintiles. CONCLUSIONS Our findings indicate a significant relationship between physical inactivity and insulin resistance. For communities in a transition phase of lifestyle, encouraging physical activity may help prevent insulin resistance and its adverse consequences.

Trends of diabetes according to body mass index levels in Iran: results of the national Surveys of Risk Factors of Non-Communicable Diseases (1999-2007).

Diabet. Med. 27, 1233–1240 (2010)

Prevalence of metabolic syndrome in Iran: A 2011 update.

The aim of the present study was to determine the prevalence of metabolic syndrome and its individual components among the Iranian adult population in 2011 and to investigate changes between 2007 and 2011.