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Cardiovascular disease (CVD), as the leading cause of death worldwide, is the collective term named for disorders afflicting the blood vessels and heart. Inflammation and enhanced oxidative stress have been shown as fundamental risk factors in the onset and progression of CVD. Chronic inflammatory conditions attenuate blood levels of antioxidants because of the continuous generation of elevated levels of reactive oxygen species (ROS). A sufficient intake of antioxidants is also suggested to beneficially interfere with CVD by quenching ROS. Antioxidant vitamins and minerals, such as vitamins A, E, and C, and zinc may slow the development and progression of CVD. This study aimed at investigating the association between daily consumption of dietary vitamins A, E, and C, and zinc and the incidence of CVD. Eligible adults (n = 5102) aged ≥ 30 years, were selected from the participants of the Tehran lipid and glucose study with an average follow-up of 5.3 years. Dietary intake was assessed using a valid and reliable semi-quantitative food frequency questionnaire. Anthropometrics and biochemical variables were evaluated at baseline and follow-up examinations. Multivariable Cox proportional hazard regression models were used to estimate the development of CVD associated with total intakes of vitamins A, E, and C, and zinc. This study was conducted on 2253 men and 2849 women aged 47.0 ± 11.6 and 45.6 ± 10.5 years, respectively. The main sources of dietary vitamins A, E, and C and zinc were fruits, vegetables, and legumes. Risk of CVD decreased from quartile 1 to quartile 4 for vitamin E intake (HR 1.00, 0.91, 0.77, and 0.57; P trend  = 0.03). The association between the risk of CVD and quartiles of vitamins A, and C and zinc intake was not statistically significant. Our study suggests an inverse association between vitamin E intake and the risk of CVD, emphasizing the potential protective role of fruit and vegetable in the prevention of CVD.

Objective: To examine the validity and reproducibility of food groups in the semi-quantitative food frequency questionnaire (FFQ) developed for the Tehran Lipid and Glucose Study (TLGS). Methods: To evaluate the reproducibility of food groups included in the FFQ, 132 subjects (61 men and 71 women) aged 20 years or older twice completed a 168-item FFQ (FFQ1, FFQ2), with a 14-month interval between FFQ1 and FFQ2. Over the 1-year interval, 12 dietary recalls (DRs) were collected (1 each month) to assess the validity of the FFQ. Seventeen food groups were derived from the FFQ based on methods described in previous studies. Age-adjusted and deattenuated Spearman correlation coefficients were used to assess the validity of the FFQ. Results: The mean (SD) age and body mass index of subjects were 35.5 (16.8) years and 25.5 (5.2) kg/m2, respectively. Validity correlation coefficients ranged from 0.03 (liquid oil) to 0.77 (simple sugars) in men (median, 0.44), and from 0.12 (snacks) to 0.79 (simple sugars) in women (median, 0.37). The energy-adjusted intraclass correlation coefficient, which reflects the reproducibility of the FFQ, was 0.51 in men and was highest for tea and coffee (0.91); in women it was 0.59 and was highest for simple sugars (0.74). The highest percentage of complete agreement and disagreement was observed for snacks and desserts (60.6%) and potatoes and dairy products (12.8%), respectively, in men, and tea and coffee (62.9%) and legumes (15.7%) in women. Conclusions: The FFQ that was designed for the TLGS was found to be reliable and valid for assessing the intake of several food groups.

Background Despite the heavy burden and impact of the polycystic ovary syndrome (PCOS) in reproduction and public health, estimates regarding its prevalence at community levels are limited. We aimed to ascertain prevalence of PCOS in a community based sample using the National Institute of Health (NIH), the Rotterdam consensus (Rott.) and the Androgen Excess Society (AES) criteria. Methods Using the stratified, multistage probability cluster sampling method, 1126 women were randomly selected from among reproductive aged women of different geographic regions of Iran. PCOS were diagnosed using universal assessment of ultrasonographic parameters, hormonal profiles and clinical histories. Results The mean +/- SD of age of study population was 34.4 +/- 7.6 years. Estimated prevalence of idiopathic hirsutism was 10.9% (95% CI: 8.9-12.9%); 8.3% of women had only oligo/anovulation and 8.0% had only polycystic ovaries. The prevalence of PCOS was 7.1% (95% CI: 5.4-8.8%) using the NIH definition, 11.7% (95% CI: 9.5-13.7%) by AES criteria and 14.6% (95% CI: 12.3-16.9%) using the Rott definition. Conclusions At community level, widespread screening of Rotterdam criteria will increase the estimated prevalence of PCOS over twofold. Establishing an explicit and contemporaneous method for definition and screening of each PCOS criteria has important investigational implications and increase the comparability of published research.

The genetic variations among individuals are one of the notable factors determining disease severity and drug response. Nowadays, COVID-19 pandemic has been adversely affecting many aspects of human life. We used the Tehran Cardio-Metabolic Genetic Study (TCGS) data that is an ongoing genetic study including the whole-genome sequencing of 1200 individuals and chip genotyping of more than 15,000 participants. Here, the effect of ACE2 variations by focusing on the receptor-binding site of SARS-CoV-2 and ACE2 cleavage by TMPRSS2 protease were investigated through simulations study. After analyzing TCGS data, 570 genetic variations on the ACE2 gene, including single nucleotide polymorphisms (SNP) and insertion/deletion (INDEL) were detected. Interestingly, two observed missense variants, K26R and S331F, which only the first one was previously reported, can reduce the receptor affinity for the viral Spike protein. Moreover, our bioinformatics simulation of 3D structures and docking of proteins explains important details of ACE2-Spike and ACE2-TMPRSS2 interactions, especially the critical role of Arg652 of ACE2 for protease function of TMPRSS2 was uncovered. As our results show that the genetic variation of ACE2 can at least influence the affinity of this receptor to its partners, we need to consider the genetic variations on ACE2 as well as other genes in the pathways that contribute to the pathogenesis of COVID-19 for designing efficient drugs and vaccines.

BackgroundAlthough the association between obesity and health-related quality of life (HRQoL) is well-documented, studies on the association between weight trajectories and HRQoL among spouses are limited. This longitudinal study aimed to characterise distinct body mass index (BMI) trajectories and their association with HRQoL at individual and spousal levels.MethodsThe total sample of 773 couples was followed for an average of 15 years. Univariate group–based trajectory models and multi-trajectory group–based models were used to identify latent classes of individual and couple BMI trajectories, respectively. Linear regression analyses were applied to investigate the associations between identified BMI trajectories and HRQoL at the individual level and at the spousal level, where spousal HRQoL refers to the association between both partners’ BMI trajectories and each individual’s HRQoL.ResultsBased on BMI changes over the life course, four trajectories were identified in wives and husbands at both individual and couple levels, ranging from stable healthy weight to progressively increasing overweight and obesity, with all trajectories showing an overall rise in BMI with age. In the fully adjusted model, compared with wives in the mild progressive overweight group, the mean score of physical HRQoL in women in the progressive obesity group (β=−2.14, p=0.02) and severe progressive obesity group (β=−2.55, p=0.03) was significantly lower. Moreover, compared with husbands with stable healthy weight status, those in the progressive obesity group had lower physical HRQoL (β=−2.67, p=0.02). At the spousal level, lower physical HRQoL was observed in individuals whose BMI trajectories, together with their partner’s trajectory, indicated higher risk (eg, wives with severe progressive obesity and husbands with stable overweight) compared with couples with both partners in lower-risk BMI trajectories (β=−3.61, p=0.01). A similar effect was observed only in severe progressive obese women whose husbands were of stable healthy weight during their lifespan. None of the BMI trajectories at either individual or spousal levels affected mental HRQoL.ConclusionOur findings indicate a significant effect of individuals’ BMI patterns on the physical domain of HRQoL. Spousal HRQoL associations reflect how both partners’ BMI trajectories are jointly associated with individual HRQoL. Clinically, these results highlight the potential importance of early weight management, particularly in women, in relation to long-term physical HRQoL and possible benefits for both partners. Further investigation is required to assess the role of potential confounders in BMI–HRQoL associations.

It is well documented that physical inactivity is related to weight gain and a whole host of chronic diseases. This study investigated trends of low physical activity among Iranian adolescents in urban and rural areas between 2006–2011. A total of 12,178 adolescents, aged between 15 and 19 years, participated in National Surveys of Risk Factors for Non-Communicable Diseases. Data on physical activity was obtained using the global physical activity questionnaire. A complex sample survey and multinomial logistic regression were used to model physical activity levels. The percentage of adolescents who had low levels of physical activity increased from 2006 to 2011 in both urban and rural areas. Low and moderate levels of physical activity were lower in rural girls as compared with urban girls, with a prevalence ratio of 0.59 (95% CI 0.47–0.74) and 0.59 (95% CI 0.47–0.74), respectively. The corresponding values for boys residing in rural areas compared with boys in urban areas were 0.56 (95% CI 0.43–0.75) and 0.60 (95% CI 0.48–0.74), respectively. The adolescents' lifestyles showed an increasing trend for physical inactivity in both genders; however, in rural areas, only girls had a rising affinity for a sedentary lifestyle throughout the 2006–2011 years.

To examine the trends of 7 cardiovascular health metrics (CVH metrics) incorporate of smoking, physical activity, diet, body mass index (BMI), fasting plasma glucose (FPG), total cholesterol (TC), and blood pressure (BP) level during three cross-sectional STEPwise approaches to surveillance (STEPS), 2007–2016, among Iranian adults. The study population consisted of 19,841 women and 17,243 men, aged 20–65 years. The CVH metrics were categorized as ‘ideal’, ‘intermediate’, and ‘poor’. The sex-stratified weighted prevalence rate of each CVH metrics was reported. The conditional probability of each poor versus combined intermediate and ideal metric was analyzed using logistic regression. In 2016 compared to 2007, the prevalence of poor BP level (20.4% vs. 23.7%), smoking (13.7% vs. 23.8%), TC ≥ 240 mg/dl (2.4% vs. 11.2%) and FPG < 100 mg/dl (75.6% vs. 82.3%) declined, whereas poor physical activity level (49.7% vs. 30%), poor healthy diet score (38.1% vs. 4.1%), BMI levels ≥ 25 kg/m 2 (62.8% vs. 57.8%) increased. Despite a high prevalence of obesity among women, it remained constant in women but showed an increasing trend in men; moreover, the trends of low physical activity and current smoking were better for women. Despite some improvement in CVH metrics, < 4% of Iranian adults meet ≥ 6 CVH metrics in 2016; this issue needs intervention at the public health level using a multi-component strategy.

To investigate the associations of marital status with major clinical outcomes including type 2 diabetes (T2D), hypertension, cardiovascular disease (CVD) and all-cause mortality. The study cohort (1999-2014) included 9,737 (45% male) Iranian adults with a mean age of 47.6 years. Marital status was defined as married versus never married, divorced and widowed. The relationship between marital status and the four above mentioned outcomes were investigated using Cox regression models adjusted for the main confounders, specific to each outcome. After more than 12 years of follow-up, 1,889 (883 men) individuals developed hypertension, 1,038 (468 men) T2D, 1015 (597 men) CVD and 668 (409 men) all-cause mortality. Compared with married, being never married in men was associated with higher risk of hypertension [hazard ratio (HR): 1.55; 95% confidence interval (CI), 1.11-2.16] and all-cause mortality (2.17; 0.95-5.00; p-value = 0.066) after adjusting for confounders. Among women, compared with married status, widowed status was associated with a lower risk of T2D (0.74; 0.56-0.97) in the confounders adjusted model. Moreover, never married women had a lower risk of hypertension (0.58; 0.37-0.90) compared to married ones in the age adjusted model, a finding that did not achieve significance, after further adjustment for confounders. We found that the relationship between marital status and health outcomes varied by gender. Being never married was an important risk factor for hypertension and tended to be a significant risk factor for mortality in men. However, among women, being widowed was associated with a lower risk of T2D.

Sudden cardiac death (SCD) is described as death within one hour, if observed, from the onset of symptoms, and within 24 h of being alive and well if not observe. Study population includes 3705 men and 4446 women, aged ≥ 30 years. Multivariable Cox proportional hazard models were used to determine the risk factors associated with SCD. After a median follow-up of 17.9 years, 244 SCD (165 in males) occurred. The age-standardized incidence rate (95% confidence intervals (CI)) of SCD was 2.3 (2.1–2.7) per 1000 person-year. Current smoking [Hazard ratio (HR): 2.43, 95% CI: 1.73–3.42], high waist circumference [1.49: 1.04–2.12], hypertension [1.39: 1.05–1.84], type 2 diabetes mellitus [2.78: 2.09–3.69], pulse rate ≥ 90 beats per/minute [1.72: 1.22–2.42] and prevalent cardiovascular disease [1.75: 1.26–2.45] were significant risk factors. The corresponding population attributed fractions (PAF) were 14.30, 16.58, 14.03, 19.60, 7.62, and 8.30, respectively. Being overweight [0.58: 0.40–0.83] and obese [0.61: 0.38–0.98] decreased the risk of SCD. After excluding known diabetes cases from our data analysis, the newly diagnosed diabetes still showed an HR of 2.0 (1.32–3.00) with a PAF of 7.15% in the full adjustment model. To deal with sudden death as a catastrophic outcome, multi-component strategies by policy health makers are suggested.

In recent decades, ongoing GWAS findings discovered novel therapeutic modifications such as whole-genome risk prediction in particular. Here, we proposed a method based on integrating the traditional genomic best linear unbiased prediction (gBLUP) approach with GWAS information to boost genetic prediction accuracy and gene-based heritability estimation. This study was conducted in the framework of the Tehran Cardio-metabolic Genetic study (TCGS) containing 14,827 individuals and 649,932 SNP markers. Five SNP subsets were selected based on GWAS results: top 1%, 5%, 10%, 50% significant SNPs, and reported associated SNPs in previous studies. Furthermore, we randomly selected subsets as large as every five subsets. Prediction accuracy has been investigated on lipid profile traits with a tenfold and 10-repeat cross-validation algorithm by the gBLUP method. Our results revealed that genetic prediction based on selected subsets of SNPs obtained from the dataset outperformed the subsets from previously reported SNPs. Selected SNPs’ subsets acquired a more precise prediction than whole SNPs and much higher than randomly selected SNPs. Also, common SNPs with the most captured prediction accuracy in the selected sets caught the highest gene-based heritability. However, it is better to be mindful of the fact that a small number of SNPs obtained from GWAS results could capture a highly notable proportion of variance and prediction accuracy.