Iranian Journal of Diabetes and Lipid Disorders

POPULATION RESEARCH CENTER: APPLICATION OF RESEARCH FOR COMMUNITY HEALTH PROMOTION

SR Majdzadeh

The current challenge in health services research is disability to present comprehensive and effective intervention plans for community health promotion. There are numerous reasons in this regard, some of which can be overcome through performance-based participatory research methods. The Population Research Center (PRC) in Tehran University of Medical Sciences (TUMS) provides the necessary ground: 1) to innovate original methods in participatory research that are compatible with our native culture, and 2) to make the results of the population research applicable to the whole society through target-based executive steps. The steps to implement health promotion (known as Planned Approach To Community Health) include: acquirement of people’s participation, health needs assessment, priority setting for health problems, designing health interventions, and evaluation of the activities. Those parts of this approach, which are mainly concerned with needs assessment in the area of endocrinology and the causal factors of related diseases, have been accomplished. The next step in this field is to plan appropriate intervention projects and to put them into practice through the principles of community participation and community empowerment.

ANALYSIS OF DEMOGRAPHIC AND SOCIOECONOMIC DETERMINANTS OF 17th ZONE TEHRAN: TEHRAN POPULATION LAB REGION

KH Shahandeh

Introduction: The human being is part of its surrounding socio-economic framework. He is affected by the environment and actively affects it. Ignoring the socio-economic dimensions of health leads to the failure of health promotion programs and widens the inequity in the health status of different groups in the society. The aim of this study is to identify the socio-economic and demographic status of the inhabitants in 17th zone of Tehran Methods: A combination of qualitative and quantitative approaches was used in this study. A crosssectional descriptive study was carried out in population research Center of Tehran University of Medical Sciences (TUMS) with a sample containing 1121 households. They were chosen by random cluster sampling. Data was gathered using the World Health Survey questionnaire of WHO. Construct validity, and test-retest reliability and internal consistency of the questionnaires were already approved. The SEAGA tools, which are classified as Rapid Appraisal (RA) methods were used to complete the community profile .Techniques such as direct observation, Semi-structured interview with key informants, field notes, social map, and trend line were devised to identify community profile. The method of triangulation was used to validate the data. Results: Data analysis showed means of age was 27/9 years. The average size of the household was 4.23. 47.5% of the respondents were unmarried. The Majority of participants (30/7%) have been qualified at high school level. The dominant ethnic group was Azari (57/8%). All of them were Moslems. The majority are self-employed (11/9%). The qualitative studies showed that district one is the economic core of the area. Economical heterogeneity in three districts of 17th zone was evident. Social problems were reported as unemployment, drug abuse, violence and aggressive behavior and so on. Conclusion: The variety of socio-economic problems among inhabitants in 17th zone of Tehran represents this area as a problematic community. Capacity building and providing proper background for community participation in solving its own health problems can be an effective approach towards sustainable development. Total reliance on the health sector to solve the numerous problems of this area will not be successful as inter-sectoral collaboration and community participation are mandatory requirements of this process

EVALUATION OF THE HOUSEHOLD EXPENSES PER CAPITA AND THE INEQUITY IN PEOPLE’S ECONOMIC STATUS AND HEALTHCARE SERVICES

S Ghajarieh Sepanlou

Introduction: The success of a health system depends on the accessibility and the quality of health services it provides. One major indicator of service quality is peoples satisfaction from the service. In this article, healthcare availability and satisfaction of people in 17th zone of Tehran is investigated.
Methods: Population Research Center has performed a survey in 17th zone of Tehran to investigate people s access to health services and healthcare costs. This face- to-face survey is based on the standard questionnaire of World Health Survey. 1121 households were chosen through cluster sampling. The validity and reliability of the questionnaire are confirmed in previous studies.
Results: The average size of the households is 4.23 and its ratio to the number of rooms in the households is 1.98. Expenses per capita and the insurance coverage and quality have no significant difference in large and small households. The share of health expenditures is significantly smaller in households with a female guardian than those with male guardians. People s overall satisfaction from health services is mediocre, little or very little in 62% of the cases.
Conclusion: Although the level of inequity in coverage and quality of health services is small over the area, the overall health care quality is not enough for customer s satisfaction. Initiatives to improve the quality of health services seem mandatory.

CARDIOVASCULAR RISK FACTORS STUDY IN THE INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB: STATISTICAL DESIGN AND SAMPLING

Cardiovascular disorders are responsible of nearly fifty percent of deaths in industrial and developing countries. However numerous studies have revealed considerable differences in distribution of cardiovascular risk factors at the national, regional and ethnic levels. There is a necessity to elucidate the status of all recognized risk factors in any population to attribute these differences in the incidence of cardiovascular events to the changes in some risk factors or natural history of the disease in that society. The study of cardiovascular risk factors in the 17th zone of Tehran is performed according to the model of MONICA project of WHO. In this project the trend of cardiovascular events and their association with changes in risk factors is monitored in more than twenty countries and 35 centers. In this article we describe some aspects of the statistical design and sampling procedure of our aformentioned study such as sampling framework, sampling methods and its rationale, best size of clusters, sample size and sample selection in each cluster.

CARDIOVASCULAR RISK FACTORS IN AN URBAN POPULATION (17TH ZONE OF TEHRAN): TEHRAN UNIVERSITY POPULATION LABORATORY STUDY

H Fakhrazadeh

Introduction: Urbanization, establishment of sedentary life style and unhealthy diet in association with environmental stress has led the cardiovascular risk factors to prevail in the metropolitan city of Tehran. Survey of lifestyle related cardiovascular risk factors is one of the priorities of Tehran university population laboratory in the 17th zone of Tehran.
Methods:1573 inhabitants of 17th zone of Tehran were recruited by one stage cluster random sampling according to the model of WHO MONICA project.
Results: 58.6% of men and 64% of women had BMI ≥ 25 kg/m2. 41.7% of men and 37.6% of women had hypertension. 8.9% of men and 12.2% of women had diabetes. 34.4% of men and 44.6% of women had total cholesterol ≥ 200 mg/dl. 34.1% of men and 32.6% of women had triglyceride ≥ 200 mg/dl. 34.7% of men and 4.2% of women were regular smokers. 21% of participants had positive family history of cardiovascular disorders.
Conclusion: The prevalence of hypertension in this region is high, that of dyslipidemia relatively lower than the other studies performed in Iran. The prevalence of Diabetes and overweight /obesity is high and comparable to other Iranian studies. It seems that the population of this zone is at high risk for stroke and then coronary heart disease. This fact must be considered in the future interventional programs to control cardiovascular risk factors in the region.

PREVALENCE OF HYPERTENSION AND CORRELATED RISK FACTORS AMONG 25-64 AGED INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB REGION

R Pour-Ebrahim

Introduction: Hypertension is the most important modifiable cardiovascular risk factor. Hypertension is the leading global risk factor for mortality and as the third leading risk factor for cardiovascular disease burden. This survey has been conducted to determine the prevalence of hypertension among the inhabitants of 25-64 aged in 17th zone of Tehran, selected as Population Lab Region.
Methods: In a population-based cross-sectional survey conducted based on MONICA/WHO project, blood pressure measured with standard sphygmomanometer in sitting position after 10 minutes of resting in 1573 people. Blood samples collected in Venoject tubes for laboratory evaluation. Analysis was performed using the more conservative threshold of SBP ≥ 160 mm Hg and/or DBP≥ 95 mm Hg according to the criteria of the World Health Organization (WHO).
Results: A total of 1573 persons (615 men and 958 women) were evaluated. Hypertension prevalence (SBP≥160 or DBP≥95 or using antihypertensive drugs) was 29% in men and 34.8 in women. There was a significant correlation between systolic and diastolic blood pressure and BMI (p<0/0001). 58% of men and 55.8% of women with hypertension were obese (35>BMI>27).The mean of systolic and diastolic blood pressure had meaningful correlation with cholesterol, LDL, HDL, TG and homocysteine.
Conclusion: These results revealed that the prevalence of hypertension among this population was greater than supposed. The hypertension trend from 1992 is rising. Obesity is one of the most important associated risk factors of hypertension. High prevalence of other cardiovascular risk factors is a matter of concern to this population.

EVALUATION OF TYPE 2 DIABETES AND IMPAIRED FASTING GLUCOSE (IFG) AMONG 25-64 AGED INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB REGION

S Mortaz Hejri

Background: Diabetes is one of the most common chronic diseases worldwide. The number of diabetic patients in Iran is estimated 1.5 million. This survey has been conducted to evaluate diabetes and impaired fasting glucose status among 25-64 aged inhabitants of 17th zone of Tehran, selected as Population Lab region.
Methods: This study is a part of the Cardiovascular Risk Factors Survey in the Population Lab region. This survey has been designed and conducted based on MONICA/WHO project. A total of 1573 people have been recruited and assessed on age, weight, height, waist and hip circumferences. Body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were determined for comparing between groups. The known diabetic cases were found as history of taking antihyperglycemic agents or report of their family physician and new cases were diagnosed as FPG≥126mg/dl according to the ADA 2004criteria.IFG was determined by 100≤FPG≤126.Adjusted prevalences are calculated according to the 1375 census data.
Results: type 2 diabetes prevalence was 10.9% and the prevalence of IFG was 5% in this population. The age adjusted prevalences were 9.3% and 4.5% respectively. prevalences were higher in women than men in all age groups. people with diabetes had higher body mass index, waist, waist to hip ratio, mean systolic and diastolic blood pressure(p<0.05).9/8% of diabetic patients were unaware of their disease.
Conclusion: These results revealed that the prevalence of diabetes among women was higher than men. This finding may be in part because of little physical activity .Proper and effective planning to achieve the applied strategies for improving the social knowledge and awareness and also improving the life style of the people is highly necessiated.

DISTRIBUTION OF LIPID DISORDERS IN THE INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES

M Mobasseri

Introduction: Hyperlipidemia is a major cardiovascular risk factor. This survey has been performed to determine the prevalence of hyperlipidemia in the 17th zone of Tehran.
Methods: 1573 individuals 25-64 aged were recruited from the inhabitants of the 17th zone of Tehran through one stage cluster sampling. Standard questionnaires were filled out for all of the participants. Lipid profile was categorized according to the NCEP:ATP III criteria.
Results: 59% had ideal cholesterol levels, 27.1% borderline and 13.9% had high cholesterol levels. Hypercholesterolemia was more prevalent in women than men. 55% had ideal LDL-cholesterol level. Prevalence of hyper-LDL (>160mg/dl) was 2.3%. Hyper LDL was more prevalent in women than men (p<0.001). Prevalence of hypo-HDL was 13.8% and it was more common in men than women (p<0.001). 33.4% had high triglyceride levels.
Conclusion: Prevalence of dyslipidemia in this area of Tehran is not as high as that obtained from other urban studies. This fact should be considered in the future interventional programs which focus on noncommunicable disease management.

EVALUATION OF OBESITY AND OVERWEIGHT AND THEIR CHANGES PATTERN AMONG 25-64 AGED INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB REGION

H Fakhrzadeh

Background: Obesity and overweight, as the most common metabolic disorders, are great health problem during recent decades. Obesity takes a role as independent or concordant risk factor for many diseases. So, it has a considerable share in burden of morbidities and mortalities. Urbanization and its consequences in increasing of incomes and per capita energy uptake, besides the notable reduction in physical activities are the main causes of increased rates of obesity in developing countries. This survey has been conducted to evaluate the obesity and overweight status and their pattern among the inhabitants of 25-64 aged in 17th zone of Tehran, selected as Population Lab region.
Methods: This study is a part of the Cardiovascular Risk Factors Survey in the Population Lab region. This survey has been designed and conducted based on MONICA/WHO project. A total of 1573 people have been recruited and assessed on age, weight, height, waist and hip circumferences. Body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were determined for comparing between groups.
Results: There was a significant difference in mean BMI between two sexes (26.13 kg/m2 in men vs. 28.86 kg/m2 in women). As well, WC and WHR were diverse between men and women (WC: 91.70 cm vs. 89.15 cm WHR: 0.91 vs. 0.85, respectively). Obesity prevalence was 18.6% among men and 38.3% among women. Prevalence of high WC and abnormal WHR were higher among women than men.
Conclusion: These results revealed that prevalence of obesity among adults was very high. The prevalence in women was more than two times than in men. This finding may be in part because of little physical activity and high proportions of carbohydrates intake instead of protein in daily energy uptake and also because of physiological differences among women. Proper and effective planning to achieve applied strategies for improving the social knowledge and awareness and also improving the life style and nutrition status of the people is highly necessiated.

EVALUATION OF PREVALENCE OF THE METABOLIC SYNDROME IN INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB

P Ebrahim pour

Introduction: Metabolic syndrome includes obesity, hypertriglyceridemia, glucose intolerance, hypertension and lipid profile abnormalities. The risk of cardiovascular diseases with this syndrome is higher than every components alone. In view of its burden and high mortality rate, this syndrome should be noted.
Methods: The 25-64 aged individuals in 17th zone of Tehran were studied. It was designed according to the WHO MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) project using the ATP III criteria. The parameters have been used for the risk analysis were Waist Circumference (WC), fasting serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), blood pressure (BP) and fasting plasma glucose (FPG).
Results: The crude prevalence rate of the metabolic syndrome was 29.9% and the age-adjusted prevalence was 27.5%. The prevalence increased with age. The highest prevalence among different age-groups was seen in women aged 55-64 years. In the whole population, the most metabolic abnormalities were hypertriglyceridemia and hypertension that were present in more than half of the population. The people with metabolic syndrome had higher BMI than rest.
Conclusion: Results demonstrate high metabolic syndrome rate among target population specially in women. In view. of correlation between metabolic syndrome and cardiovascular disease, it must be the priority of interventional preventive measures. Improving the diet, changing the lifestyle and increasing physical activity can be helpful.

FOOD AND NUTRIENT INTAKES AMONG 20-60 AGED INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB REGION

Sh Jazayeri

Introduction: Nutrition plays an important role in the protection and promotion of health. To plan and implement programs aiming at improving community nutritional status, a knowledge of the existing situation is essential. The aim of this cross-sectional study was to determine food and nutrient intakes of the inhabitants in Tehran University of Medical Sciences population laboratory.
Methods: In a sample of 310 women and 185 men, selected by clustered random sampling, food intake was determined using the 24-hour dietary recall (on two non-consecutive days). Weights and heights were also measured on the first visit. For analysis of data, Dorosti Food Processor, Diet Analysis plus and SPSS software were used.
Results: The average (mean ± SD) intakes of energy, protein, carbohydrate, total fat, saturated fat, cholesterol, vitamin A, B2 ,B6 ,B12, folic acid, zinc, iron, and calcium were 2902±336cal, 88±15gr, 461±69gr, 80±19gr, 27±7gr, 272±112mg, 943±319µgr RE, 1.2±.35mgr, 1.2± .37mg, 2.9±2.67µgr, 294±73.7µgr, 10.48± 2.25mg, 28.90±5.81mg, and 537±123mg in men, and 2226±234cal , 66±11gr, 344±41gr, 70±14gr, 22±6gr , 205±85mgr ,882±291µgr RE, .88±.22mg, 1.14± .24mg, 2.2±2.07µgr, 270±60.7µgr, 8.65±1.62mg, 22.66±4.27mg, and 433±113mg in women, respectively. The average (mean +SD) daily numbers of servings of the food guide pyramid main groups, namely, grains, fruits, vegetables, dairy, and meat were 12.74±3.80 ,1.52±1.44, 4.30±2.74, .97±.72 , and .9±.98 in men, and 9.8±3.3, 2.87±2.06, 2.88±2.40, .82±.60, and .86±.84 in women, respectively. Most of these intakes are under current recommendations. Thirty eight percent of the men and 23% of the women had a daily cholesterol intake of at least 300 mg. In addition, the proportions of the men and women with a daily total fat intake of at least 75 gram was 43% and 35%, respectively.
Conclusion: The findings show that while the intake of most micronutrients is lower than respective RDAs, the intake of fat and cholesterol are higher than the current recommendations. This indicates that the community is undergoing nutrition transition. It is recommended that further studies be conducted to identify more comprehensively nutritional problems of the community in question, so that appropriate programs can be prepared and implemented.

SMOKING STATUS AND TRENDS IN RISK FACTORS FOR CARDIOVASCULAR DISEASE IN INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB REGION

F Adili

Introduction: Cigarette smoking is a major modifiable risk factor for cardiovascular disease and it has been identified as the single most important cause of cardiovascular accident related deaths in most countries.
Methods: 1573 people who lives in 17th zone of Tehran (Population Research Center of Tehran University of Medical Sciences) were investigated by a cross- sectional study. A group of trained persons collected data by the standard questionnaire that contained demographic and smoking status characteristics. Furthermore the fasting blood samples were taken for more evaluation. Data were analyzed with SPSS software.
Results: According to this study 37/4% of men and 4/2% of women were smoker. There were relationship between cigarette smoking and serum level of homocysteine, Folic Acid, cholesterol, LDL, HDL, Uric Acid, hypertension and BMI (P<0/05). But it was no significant with vitamin B12 and TG statistically.
Conclusion: There were relationship between cigarette smoking and male gender, age, unmarried status and the level of education. So public education should be accomplished in society specially among families for prevention of cardiovascular risk factors.

EVALUATION OF TOTAL PLASMA HOMOCYSTEINE, FOLIC ACID AND VITAMIN B12 IN 25-64 AGED INHABITANTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES POPULATION LAB REGION

H Fakhrzadeh

Introduction: Elevated plasma total homocysteine is an independent risk factor for cardiovascular disease and a sensitive marker of vitamin B12 and folate insufficiency. Folate and vitamin B12 have a protective effect on cardiovascular disease. This effect may be partly explained by mechanisms independent of homocysteine. This survey is the first population based study to evaluate the plasma total homocysteine, folic acid and vitamin B12 in 1214 healthy Iranian persons.
Methods: This study which was a part of the Cardiovascular Risk Factors Survey in the Population Lab region, has been designed and conducted based on MONICA/WHO project. A total of 1214 people have been recruited and assessed on serum homocysteine, folic acid and vitamin B12 with interview, questionnaires, examination and blood sampling. Blood samples were gathered in Venoject tubes and analyzed according to standard methods.
Results: The variables were assessed in 1214 participants include 428 men (35.3%) and 786 women (64.7%). Prevalence of hyperhomocysteinemia was 96.4% in men and 83.3% in women (p<0.0001). Geometric mean of serum homocysteine was 19.02 ± 1.46 µmol/l in men and 14.05± 1.45 µmol/l in women (p<0.004) and increased with age. Folic acid deficiency was seen in 527 (98.9% )men and 833 women (98.0%). 161 (30.1%)men and 232(27.2%) women had vitamin B12 deficiency.
Conclusion: These results revealed that the prevalence of hyperhomocysteinemia, folic acid and vitamin B12 deficiency was higher than other communities considerably. Preventive interventions as food fortification with folic acid is necessary.