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Background Cardiovascular diseases are a leading cause of global mortality, with diet playing a key role in their progression. The Atherogenic Index of Plasma (AIP) is a predictive marker for cardiovascular risk, but its association with dietary intake across cardiometabolic phenotypes remains underexplored. This study investigates the relationship between dietary intake and AIP, hypothesizing that energy intake and macronutrients influence AIP and, consequently, cardiovascular risk. Methods This cross-sectional study analyzed data from 9,515 participants aged 35–55 in the Azar cohort study. Based on Body Mass Index (BMI) and metabolic syndrome (MetS), participants were classified into four phenotypes: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUHO). Dietary intake was evaluated using a semi-quantitative food frequency questionnaire (FFQ), and AIP was calculated. Adjustments were made for age, gender, socioeconomic status, and physical activity. Results A notable difference was observed in demographic and clinical status between cardiometabolic groups of males and females. The AIP was highest in the MUHNW (0.42 for males; 0.28 for females) and lowest in the MHNW (0.05 for males; -0.05 for females, P  < 0.001). There was a statistically significant difference in the mean energy intake and the percentage of energy intake from protein among the cardiometabolic phenotypes ( p  < 0.001). After adjusting for confounders, only weak but meaningful correlations remained for energy, carbohydrate, and protein intake in the MUHO ( r  = 0.048, P  = 0.01; r  = 0.057, P  = 0.003; and r  = 0.050, P  = 0.01) and for carbohydrate and lipid intake in the MHO ( r  = 0.034, P  < 0.01 and r  = -0.055, P  < 0.001). Conclusion The study found weak but meaningful correlations between energy, carbohydrate, and protein intake and AIP in the MUHO phenotype and between carbohydrate and lipid intake and AIP in the MHO phenotype. This highlights the role of energy and carbohydrates in AIP within specific subgroups. Future research should focus on the effects of macronutrient combinations on AIP and long-term dietary impacts on metabolic health instead of BMI.

Background Cardiometabolic phenotypes combine metabolic health and obesity measures for a more accurate cardiovascular risk assessment than body mass index (BMI) alone. The Atherogenic Index of Plasma (AIP), based on triglycerides and high-density lipoprotein cholesterol (HDL-C), is a promising cardiovascular disease (CVD) risk marker. This study explores the relationship between cardiometabolic phenotypes and AIP to improve understanding of their combined predictive value for CVD risk. Methods This cross-sectional study analyzed data from 9,515 participants aged 35–55 in the Azar Cohort Study. Metabolic syndrome (MetS) was defined using ATP III criteria. Participants were classified into four phenotypes: metabolically healthy normal weight (MHNW, BMI < 25 kg/m 2 ), metabolically unhealthy normal weight (MUHNW, BMI < 25 kg/m 2 ), metabolically healthy obese (MHO, BMI ≥ 25 kg/m 2 ), and metabolically unhealthy obese (MUHO, BMI ≥ 25 kg/m 2 ). AIP was calculated as the logarithm of triglycerides to HDL. Multinomial regression was used to analyze the relationship between AIP tertiles and phenotypes using both unadjusted and adjusted models. Confounders were controlled for across the three groups. Results Among participants, 50.4% were classified as MHO and 28.2% as MUHO. High-risk AIP levels (> 0.21) were found in 79.6% of MUHNW and 64.6% of MUHO, compared to 18.6% of MHO and 13.5% of MHNW. After adjusting for age, physical activity (METs), the wealth score index (WSI), and smoking status, the odds ratios (ORs) for cardiometabolic phenotypes in the high-risk AIP group remained significant. At the high-risk level, MUHNW (OR = 63.49, p  < 0.001), MHO (OR = 1.96, p  < 0.001), and MUHO (OR = 32.15, p  < 0.001) showed significant associations. Conclusion In this study, significant associations were found between cardiometabolic phenotypes and AIP. Findings emphasize integrating metabolic health assessments with AIP to improve CVD risk identification. Prospective longitudinal studies are also needed to confirm these associations.

Background It has been documented that regular physical activity is considered one of the most effective strategies for preventing diabetes; however, it is not the sole contributing factor. Therefore, we decided to evaluate the meditation effect of liver function and anthropometric indices on the relationship between incidence of diabetes and physical activity (PA) in the Azar cohort population. Materials and methods Subjects who were diabetic in the baseline phase from 15,006 participants in study of azar cohort population were excluded and to follow up, a total of 13,253 people was included in the analysis. Demographic characteristics, physical activity, 10 anthropometric indices (AI) and seven liver indices (LI) were measured. Evaluated and displayed using Pearson correlation heatmap and canonical correlation of liver and anthropometric indices. The Generalized Structural Equation Modeling (GSEM) with the Maximum Likelihood method employed to estimate the model. Results During the follow-up years, a total of 685 participants developed diabetes. The measurements of the AI were significantly higher in subjects with diabetes ( P  < .001). Patients with diabetes were older, had a higher proportion of women, and had lower values of PA ( P  < .05). Body Roundness Index (BRI) and Waist height ratio (WHtR) exhibited the largest AUCs for predicting diabetes onset risk (both AUC = 0.6989) among these anthropometric measures. The increase in AI (RR [95%CI] = 1.25 [1.22,1.29], P  < .001) and liver enzyme (LE) (RR [95%CI] = 1.14 [1.08.1.19], P  < .001) increase the risk of diabetes by 25% and 14%, respectively. Despite the mediation effects of AI and Liver Enzymes for an increase of one MET of PA, the risk of developing diabetes decreases by 5% (RR [95% CI] = .95 [.92,.99], P  = .013). Around VAF = 53% of the association between PA and diabetes onset (Total effect: RR [95% CI] = .90 [.87,.94], P  < .001) was mediated by AI and LE. Conclusions A low level of PA was found to be significantly correlated with high levels of AI and LI, all of which are associated with an increased risk of developing diabetes. These analyses provide evidence that when the relationship between PA and diabetes is mediated by AI and LI this association becomes stronger, with AI playing a more significant role than LI.

Oral health is often overlooked among the elderly due to the numerous comorbidities prevalent in this population. However, oral health significantly influences quality of life by affecting both general health and psychological well-being. The present study aimed to assess dental caries in elderly individuals using the DMFT index (decayed, missing, and filled teeth) and to explore its relationship with various factors based on data from the Azar cohort study in Iran. In this cross-sectional study, data from the initial phase of the Azar cohort study, which involved 2629 elderly individuals (aged 60 years and older), were statistically analyzed. The Azar cohort study evaluated demographic factors, the history of chronic diseases, and behavioral habits using a well-designed questionnaire administered through face- to -face interviews. The DMFT index was evaluated through oral examination. A negative binomial regression analysis with a log link function was employed to investigate the relationship between the DMFT and related variables, including gender, age, marital status, level of education, socioeconomic status, chronic diseases, smoking, alcohol consumption, and body mass index. The mean (SD) age of elderly individuals was 64.15±2.91 years. The mean (SD) DMFT was 28.42±6, and the mean (SD) number of missing teeth was 26.58±8.36. Approximately 70.8% of elderly individuals were edentulous. Women exhibited a higher mean DMFT score and a greater number of missing teeth compared to men. The mean DMFT score and its components significantly differed based on the level of education and socioeconomic status. However, no significant relationship was found between the DMFT index and the variables in the multiple regression analysis. The high prevalence of edentulism and the elevated DMFT scores in the elderly population of the Azar cohort indicate a poor oral health status among older individuals. Providing the dental services within the primary health care system for the adults, can be beneficial in improving oral health in old age.

Background Dental caries are influenced by the interplay of tooth structure, biofilm, dietary sugars, salivary factors, and genetic predispositions. However, limited research has examined the relationship between sugar intake and dental caries in adults. This study aimed to evaluate the association between cariogenic dietary intake and dental caries among adults, utilizing data from the Azar cohort study. Methods This secondary cross-sectional study utilized baseline data from the Azar Cohort, conducted in 2014 among adults aged 35 to 70 in Shabestar, Iran. Participants who were completely edentulous or had incomplete data were excluded from the analysis. Individuals with a reported daily energy intake of less than 800 or more than 8,000 kilocalorie/day were excluded from the analysis. Based on the inclusion and exclusion criteria, a total of 8,479 participants were deemed eligible for analysis.Data for the Azar Cohort were collected through face-to-face interviews using a standardized and validated questionnaire. The DMFT (Decayed, Missing, and Filled Teeth) index was evaluated by a trained examiner in accordance with the national PERSIAN cohort protocol. The cariogenic diet was categorized into simple sugars and grains/starches. Daily meal frequency was divided into four groups. Associations were analyzed using negative binomial regression with a log link, adjusting for potential confounders. Results In this study, a total of 8,479 participants were deemed eligible for inclusion. The mean DMFT score was 15.68 ± 6.78. A significant positive association was identified between high simple sugar intake (≥ 56.68 g/day) and DMFT scores. However, no significant associations were observed regarding grain/starch intake or meal frequency. Conclusion The conclusion drawn from this study is that a high daily intake of simple sugars is strongly correlated with elevated DMFT scores among adults. Implementing sugar reduction policies could serve as a cohesive strategy for the prevention and control of various non-communicable diseases, including dental caries.

ObjectivesMost previous research on plant-based diets and hypertension primarily focused on the general population, with limited data available among adults with type 2 diabetes (T2DM). Therefore, the present study was designed to investigate the association between plant-based dietary patterns and hypertension among adults with T2DM.DesignCross-sectional study.SettingThe AZAR cohort is part of the Persian Cohort, an Iranian screening programme, and includes participants who were residing in Shabestar county, East Azerbaijan Province, Iran for a minimum of 9 monthsParticipantsA total of 1947 participants with T2DM were included in the current analysis.Outcome measuresHypertension was the outcome measure. This was defined as blood pressure ≥140/90 mm Hg, self-reported physician-diagnosed hypertension (supported by medical records) or use of antihypertensive medications.ResultsThe mean age of the participants was 54.90±8.25 years, with 61% being female. The prevalence of hypertension among the participants was 48.6% (n=946). Adherence to plant-based diet index (PDI) showed a significant inverse association with hypertension in the crude model (OR: 0.60, 95% CI: 0.46 to 0.80, P-trend<0.001), but this association became non-significant after adjusting for confounders (OR: 0.88, 95% CI: 0.63 to 1.24, P-trend: 0.54). Moreover, healthful plant-based diet index displayed a significant positive association with hypertension in unadjusted analysis (OR: 2.03, 95% CI: 1.52 to 2.70, P-trend<0.001), which also disappeared after controlling for potential confounders (OR: 0.86, 95% CI: 0.61 to 1.21, P-trend: 0.35). However, no significant relationship was found between adherence to unhealthful plant-based diet index and hypertension in crude or fully adjusted models. Findings remained consistent across different subgroups, as well as sensitivity analyses.ConclusionsThe present study did not find a significant association between adherence to PDIs and hypertension in T2DM patients. Future studies are needed to investigate this association and to explore potential mechanisms linking plant-based dietary pattern with hypertension in diverse populations.

Background Early prediabetes screening holds immense significance in decreasing the incidence of diabetes. Therefore, we aimed to evaluate the association of hepatic enzymes with prediabetes and diabetes in the Azar cohort population in Iran. Methods This cross-sectional study utilized data from the Azar cohort study, initiated in 2014, with 14,865 participants aged 35–70 years. This study defines prediabetes, according to the American Diabetes Association (ADA), as fasting blood sugar (FBS) of 100–125 mg/dl. An FBS ≥ 126 mg/dL or a history of diabetes indicates diabetes. Serum liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) were measured, and associations with prediabetes and diabetes were analyzed using binary logistic regression. Results In a study of 14,865 participants, 16% had prediabetes and 14.1% had diabetes. The serum levels of ALT, AST, GGT, and ALP were significantly higher ( P  < 0.05) in the prediabetic and diabetic patients. The adjusted logistic regression model showed a dose-response increase for all hepatic enzymes, with the highest ORs in the fourth quartile for both prediabetes and diabetes. The highest OR for prediabetes and diabetes was in the fourth GGT quartile. Conclusion Our findings suggest that serum ALT, GGT, and ALP levels are strongly associated with prediabetes and diabetes. These hepatic enzymes may be considered easy and valuable early indicators of diabetes risk, prompting timely interventions to slow disease progression.

Background The role of age at first marriage in chronic disease risk remains understudied, and evidence on its association with chronic health outcomes in men and women is limited. We therefore examined the relationship between age at first marriage and the risk of chronic diseases among adult men and women in the Azar cohort. Methods This cross-sectional study used data from 13,326 participants in the Azar Cohort, which evaluates risk factors for chronic non-communicable diseases (NCDs) in northwest Iran. A structured questionnaire captured demographic variables, age at first marriage, medical history, and personal habits. Based on age at first marriage, participants were classified into two groups: under 18 years (child marriage) and 18 years or older (adult marriage). Results Among 13,326 participants, the prevalence of child marriage was 26.36%. Women constituted a larger share of the child marriage group than men (46.6% vs. 3.6%; P  < 0.001). In men, child marriage showed no association with NCDs except for obesity (Odds ratio [OR]: 1.43) and multimorbidity (MM) (OR: 1.41). In women, marriage before 18 years was associated with higher odds of diabetes (OR: 1.25), hypertension (OR: 1.37), cardiovascular disease (OR: 1.67), stroke (OR: 1.84), depression (OR: 1.35), obesity (OR: 1.50), and MM (OR: 1.53). Notably, the highest odds occurred for stroke. Conclusion Child marriage was associated with obesity and MM in men, and with diabetes, hypertension, cardiovascular disease, stroke, depression, obesity, and depression in women. These results indicate a need for tailored health interventions for people affected by child marriage, particularly women. Longitudinal follow-up is recommended to assess causality.

Introduction Due to the high prevalence of asthma worldwide, paying attention to oral health is important. This study explores the relationship between DMFT (decayed, missing, and filled teeth) and asthma, disease duration, and related medications in the Azar cohort population. Methods and materials In this cross-sectional analytical study, the part of the data related to asthma, disease duration, type of medications, and DMFT were extracted from the Azar cohort study. Azar cohort started among 15,006 adults (35–70 years old) in 2014 in the northwest of Iran. In the present study, all 538 asthmatic people in Azar cohort population included in asthma group and 1076 of non-asthmatic people included in the control group. The outcome variable was DMFT, D, M and F. A negative binomial with loglink was used to adjust the effect of confounding variables in regression models. Results Among the asthmatics, 28.3% were using anti-asthmatic medications. In 38.3% of the asthmatic group, the disease duration was ten years or more. In the asthmatic group, the mean DMFT was 23.15 ± 8.67, and the greatest section of the DMFT was related to M component. The relationship of DMFT and M component with asthma, disease duration, and medication were insignificant but D component showed significant relationship with asthma. Conclusion It can be assumed that the history of asthma does not have an effective role in DMFT index and M component in adults but decayed teeth were higher in asthmatics.

Introduction Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions, characterized by painful ulcers that develop on non-keratinized oral mucosa, significantly affecting the quality of life. This study aimed to evaluate the prevalence of RAS and its associated risk factors within the Azar cohort population. Methods This cross-sectional study utilized data from the Azar cohort, which has been ongoing since 2014 in Shabestar City, East Azarbaijan, Iran, involving 15,006 adults aged 35 to 70 years. To assess the prevalence of RAS, participants were provided with a description of these lesions and asked whether they had ever experienced RAS in the oral cavity. Data collection was based on self-reports and examinations conducted by the physicians involved in the Azar cohort. Participants with RAS were classified into the RAS group, while the remaining participants were categorized into the non-RAS group. We assessed the association between RAS and various factors using binary logistic regression. Results In the study population, there were 3,503 individuals in the RAS group and 11,503 individuals in the non-RAS group. The prevalence of RAS in the Azar cohort was 23.34%. Individuals over 50 years of age ( p  < 0.001), those with a poor ( p  < 0.001) or very poor ( p  = 0.02) socio-economic status, a low educational level ( p  = 0.01), smokers ( p  < 0.001) and individuals with a history of smoking who have since quit ( p  = 0.01) were significantly less affected by RAS. Conversely, individuals with genital aphthous lesions ( p  < 0.001), depression ( p  < 0.001), rheumatoid disease ( p  = 0.01), and food allergies ( p  < 0.001) were significantly more affected by RAS. Conclusions Factors such as being under 50 years of age, possessing a high socioeconomic status, having a higher level of education, experiencing genital aphthous disease, suffering from depression, having rheumatoid disease, and having food allergies may be associated with a higher prevalence of RAS.