Adult Middle Eastern Research Articles

Impact of Nomophobia on Musculoskeletal Problems in the Upper Extremity among Adults: Implications for Occupational Therapy

Nomophobia (NO MObile PHone Phobia) is a psychological condition in which people are anxious of being cut off from their mobile phones and been associated with adverse consequences to physical and psychosocial health. The objective of this study was to measure the impact of nomophobia on musculoskeletal problems in the upper extremity among adults. The Nomophobia scale (NMP-Q) was used to measure addiction to smartphone use among 5,087 Middle Eastern adults. A snowball sampling approach was used to recruit the participants between March and June 2021. Results showed that nomophobia was evident in 1,119 participants (22%) with a mean NMP-Q score of 114.1 (SD 11.1). A total of 3,396 upper extremity symptoms were reported among our participants. The binomial logistic regression showed that NMP-Q score is a significant predictor of symptoms to the thumb only (β = 0.01, p = .026). This study has provided evidence of the negative physical consequences of addiction to smartphone use. Participants with thumb-related symptoms were more prone to sustain other concurrent upper extremity symptoms, probably due to their maladaptive habits of using the phone. Thus, it is important to increase awareness about the risks associated with the use of smartphones. Implications for occupational therapy are presented.

Socioecological Perspectives of Resilience Among Arab and Middle Eastern Migrants

This phenomenological study explored the lived experience of resilience among Arab and Middle Eastern migrants living in the United States through a socioecological framework. Nineteen first- and second-generation Arab and Middle Eastern adults were interviewed from 10 families. The study explored two research questions (a) how participants described their experience of resilience and (b) how participants experienced resilience in the microsystem, mesosystem, exosystem, and macrosystem. Data were analyzed using interpretative phenomenological analysis. Eleven subthemes emerged and included a variety of themes that described the interaction between migrants and their environment at each level of the socioecological system. Findings add to the literature by revealing the dynamic nature of resilience as well as providing a socioecological perspective of resilience, contextualizing our understanding of resilience for this community, and illuminating how socioecological factors can hinder or foster resilience.

Multiplexed LNP-mRNA vaccination against pathogenic coronavirus species.

Although COVID-19 vaccines have been developed, multiple pathogenic coronavirus species exist, urging on development of multispecies coronavirus vaccines. Here we develop prototype lipid nanoparticle (LNP)-mRNA vaccine candidates against SARS-CoV-2 Delta, SARS-CoV, and MERS-CoV, and we test how multiplexing LNP-mRNAs can induce effective immune responses in animal models. Triplex and duplex LNP-mRNA vaccinations induce antigen-specific antibody responses against SARS-CoV-2, SARS-CoV, and MERS-CoV. Single-cell RNA sequencing profiles the global systemic immune repertoires and respective transcriptome signatures of vaccinated animals, revealing a systemic increase in activated B cells and differential gene expression across major adaptive immune cells. Sequential vaccination shows potent antibody responses against all three species, significantly stronger than simultaneous vaccination in mixture. These data demonstrate the feasibility, antibody responses, and single-cell immune profiles of multispecies coronavirus vaccination. The direct comparison between simultaneous and sequential vaccination offers insights into optimization of vaccination schedules to provide broad and potent antibody immunity against three major pathogenic coronavirus species.

Dietary phytochemical consumption is inversely associated with liver alkaline phosphatase in Middle Eastern adults

Dietary phytochemical consumption is inversely associated with liver alkaline phosphatase in Middle Eastern adults

Dietary phytochemical consumption is inversely associated with liver alkaline phosphatase in Middle Eastern adults.

BACKGROUNDThe hepatoprotective effects of phytochemicals are controversial. A dietary phytochemical index (DPI) has been suggested as an alternative method for quantifying the phytochemical content of foods. AIMTo assess the DPI in relation to liver function tests among a representative sample of Iranian adults.METHODSA total of 5111 participants aged 35-70 years old were included in this cross-sectional study by a multistage cluster random sampling method. Dietary intakes were collected by a validated and reliable food frequency questionnaire with 121 items. DPI was calculated by the percent of daily energy intake taken from phytochemical-rich foods. Fasting serum concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) were determined. Linear regression was used to investigate the association between DPI and levels of liver enzymes using crude and adjusted models. RESULTSThere was an inverse association between DPI score and serum ALP in the crude model (β = -0.05; P < 0.001). This association remained significant after adjustment for body mass index, age, smoking, energy intake, history of diabetes, and education (β = -0.03; P = 0.01). No significant associations were found between DPI score and serum levels of AST, ALT, and GGT. The individuals with the highest DPI scores consumed significantly higher amounts of fruits, vegetables, legumes, nuts, and cereals, yet were shown to have significantly higher serum total cholesterol and low-density lipoprotein cholesterol, as well as several other metabolic abnormalities.CONCLUSIONHigher adherence to phytochemical-rich foods was associated with lower levels of ALP, but no change in other liver enzymes. Those with higher DPI scores also consumed food items associated with a healthier overall dietary pattern; however, they also presented several unexpected metabolic derangements. Additional randomised trials are needed to better determine the effects of phytochemical-rich foods on liver function.

Risk Factors for Central Lymph Node Metastases and Benefit of Prophylactic Central Lymph Node Dissection in Middle Eastern Patients With cN0 Papillary Thyroid Carcinoma.

BackgroundProphylactic central lymph node dissection (PCLND) for adult patients with papillary thyroid carcinoma (PTC) is still a matter of debate. Data on incidence, risk and benefits of PCLND in Middle Eastern patients is lacking. Therefore, we aimed to identify the incidence and predictive clinico-pathological and molecular marker of PCLND in adult patients with clinically node negative (cN0) Middle Eastern PTC.MethodsThis retrospective study included 942 adult Middle Eastern patients with cN0 PTC who underwent total thyroidectomy (TT) or TT+PCLND. Clinico-pathological associations of central lymph node metastasis (CLNM) were assessed. Multivariate analysis was performed using logistic regression and Cox proportional hazards model.Results213 patients underwent PCLND and 38.0% (81/213) had positive CLNM. Multivariate analysis demonstrated age ≤55 years (Odds Ratio (OR) = 7.38; 95% Confidence Interval (CI) = 1.59 – 34.31; p = 0.0108), tumor bilaterality (OR = 3.01; 95% CI = 1.01 – 9.21; p = 0.0483), lymphovascular invasion (OR = 2.92; 95% CI = 1.18 – 7.23; p = 0.0206) and BRAF mutation (OR = 3.24; 95% CI = 1.41 – 7.49; p = 0.0058) were independent predictors of CLNM in adult PTC. Furthermore, patients who underwent PCLND showed significant association with improved recurrence-free survival (RFS; p = 0.0379). Multivariate analysis demonstrated that PCLND was an independent predictor of improved recurrence-free survival.ConclusionscN0 Middle Eastern PTC patients treated with PCLND showed a significantly better prognosis. PCLND was effective in improving RFS in Middle Eastern PTC patients and should be encouraged for patients with potential risk factors for CLNM.

Safety and immunogenicity of ChAdOx1 MERS vaccine candidate in healthy Middle Eastern adults (MERS002): an open-label, non-randomised, dose-escalation, phase 1b trial

BackgroundChAdOx1-vectored vaccine candidates against several pathogens have been developed and tested in clinical trials and ChAdOx1 nCoV-19 has now been licensed for emergency use for COVID-19. We assessed the safety and immunogenicity of the ChAdOx1 MERS vaccine in a phase 1b trial in healthy Middle Eastern adults.MethodMERS002 is an open-label, non-randomised, dose-escalation, phase 1b trial. Healthy Middle Eastern adults aged 18–50 years were included in the study. ChAdOx1 MERS was administered as a single intramuscular injection into the deltoid muscle of the non-dominant arm at three different dose groups: 5·0 × 109 viral particles in a low-dose group, 2·5 × 1010 viral particles in an intermediate-dose group, and 5·0 × 1010 viral particles in a high-dose group. The primary objective was to assess the safety and tolerability of ChAdOx1 MERS, measured by the occurrence of solicited and unsolicited adverse events after vaccination for up to 28 days and occurrence of serious adverse events up to 6 months. The study is registered with ClinicalTrials.gov, NCT04170829.FindingsBetween Dec 17, 2019, and June 1, 2020, 24 participants were enrolled (six to the low-dose, nine to the intermediate-dose, and nine to the high-dose group) and received a dose; 23 were available for follow-up at 6 months. The one dose of ChAdOx1 MERS vaccine was well tolerated with no serious adverse event reported during the 6 months of follow-up. Most adverse events were mild (67, 74%) and moderate (17, 19%). Six (7%) severe adverse events were reported by two participants in the intermediate-dose group (two feverish, two headache, one joint pain, and one muscle pain). Pain at the injection site was the most common local and overall adverse event, reported by 15 (63%) of the 24 participants. The most common systemic adverse event was headache, reported by 14 (58%), followed by muscle pain reported by 13 (54%). The vaccine induced both antibody and T cell immune responses in all volunteers; antibodies peaked at day 28 and T cell responses peaked at day 14; and continued until the end of follow-up at 6 months.InterpretationThe acceptable safety and immunogenicity data from this phase 1b trial of ChAdOx1 MERS vaccine candidate in Healthy Middle Eastern adults, combined with previous safety and immunogenicity data from a trial in the UK, support selecting the ChAdOx1 MERS vaccine for advancement into phase 2 clinical evaluation.FundingUK Department of Health and Social Care, using UK Aid funding, managed by the UK National Institute for Health Research; and King Abdullah International Medical Research Center.

Clinical Characteristics and Prognosis of Young Middle Eastern Adults with ST-Elevation Myocardial Infarction: One-Year Follow-Up.

Aims:Few studies have investigated premature ST-elevation myocardial infarction (STEMI) in the Middle East. We aimed to compare the clinical characteristics and one-year prognosis of young (<45 years) and older (≥45 years) Middle Eastern adults with STEMI.Methods and Material:A total of 706 patients with STEMI, who were prospectively enrolled in the First Jordanian Percutaneous Coronary Intervention Registry, were stratified into two groups (<45 or ≥45 years). Baseline clinical variables and one-year major adverse cardiovascular events (MACE) were evaluated.Results:Young patients (<45 years) comprised 17.4% of STEMI patients (123 of 706). Compared with older patients (≥45 years), young patients were mostly male (96% vs 82%, P<0.001), smokers (86% vs 49%, P<0.001) and less likely to have multi-vessel disease (26% vs 44%, P=0.001). Anterior STEMI was the most common diagnosis and left anterior descending artery was the most common culprit vessel in both groups. There were no significant differences between the younger and older patients in in-hospital (20% vs 19%, P=0.12) and one-year MACE (24% vs 26%, P=0.68). However, none (0%) of the young died during one-year follow-up while 21 (4%) of the older patients died (P=0.036).Conclusions:Young adult patients in the Middle East with STEMI are more likely to be smoking men with multiple risk factors and single vessel disease by angiography. Although, younger patients had similar one-year MACE to older patients, their mortality rate appears to be better. A larger study is warranted to investigate this vulnerable group of patients to prevent future events.

Religious identity and psychological well-being among middle-eastern migrants in Australia: The mediating role of perceived social support, social connectedness, and perceived discrimination.

This study aims to examine the relative contribution of religious identity, social support, social connectedness, and perceived discrimination on psychological well-being (PWB) among Middle Eastern (ME) migrants in Australia. This cross-sectional study was conducted within Queensland, Australia. A total of 382 first-generation young adult ME migrants, aged 20–39 years, filled out a self-administered questionnaire. The hypothesized model was tested using a 2-step process: measurement and structural model testing. First, confirmatory factor analysis was performed to test the fitness of the measurement model, and reliability and validity indices were calculated. Structural equations modeling was then applied to test the structural model. The mediation analyses were tested using a bootstrapping method. Social support had the largest total effect on PWB through both a direct and an indirect effect via perceived discrimination and social connectedness with ethnic community (SCETH). Religious identity demonstrated both a direct and an indirect effect on PWB through social support, perceived discrimination, SCETH, and social connectedness with mainstream community (SCMN). Perceived discrimination showed a direct and an indirect effect on PWB, mediated by SCMN. The SCETH and SCMN had only direct effects on PWB. Developing interventions that assist religious institutions/networks in offering support and/or strategies to provide support to ME migrants through religious organizations could be helpful in increasing their PWB. Protecting ME migrants against discrimination based on their religious affiliation is a main area of action. Interventions that promote ME migrants’ interaction with others could result in their better mental health outcomes.

Perceived discrimination and subjective well-being among Middle Eastern migrants in Australia: The moderating role of perceived social support.

Middle Eastern (ME) migrants are vulnerable to developing mental health problems due to pre-migration and post-migration traumas and stresses. The evidence on the subjective well-being of ME migrants and its contributing factors is limited and inconclusive. The aim of this study is to examine the moderating role of perceived social support in the association between perceived discrimination and subjective well-being, after controlling for socio-demographic factors. This cross-sectional survey study was conducted in Queensland, Australia. A total of 382 first-generation young adult ME migrants, aged between 20 to 39 years, completed a self-administered questionnaire. To analyse data, a series of three hierarchical multiple regression (HMR) analyses were conducted, one for each of the subjective well-being components (i.e., positive affect, negative affect, and satisfaction with life). The interaction between perceived social support and perceived discrimination for the prediction of subjective well-being components was further explored using simple slope analysis. Gender was found to be a significant predictor of positive and negative affect. Education was found to predict satisfaction with life, but not positive and negative affect. Married migrants were found to have significantly higher life satisfaction, positive affect and lower negative affect. Perceived social support had a moderating role in the association between perceived discrimination and subjective well-being. Considering the buffering role of perceived social support against the adverse effects of perceived discrimination on subjective well-being, organizations and individuals working with ME migrants should acknowledge the significance of social support and improve their capacity to deliver effective and appropriate social support services to migrants experiencing discrimination.

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study

ABSTRACT The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18–35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

The Burden of Cardiovascular Disease Risk Factors in the Middle East: A Systematic Review and Meta-Analysis Focusing on Primary Prevention.

The increasing incidence of cardiovascular disease (CVD) threatens the Middle Eastern population. Several epidemiological studies have assessed CVD and its risk factors in terms of the primary prevention of CVD in the Middle East. Therefore, summarizing the information from these studies is essential. We conducted a systematic review to assess the prevalence of CVD and its major risk factors among Middle Eastern adults based on the literature published between January 1, 2012, and December 31, 2018, and carried out a meta-analysis. We searched electronic databases such as PubMed/Medline, ScienceDirect, Embase and Google Scholar to identify literature published from January 1, 2012, to December 31, 2018. All the original articles that investigated the prevalence of CVD and reported at least one of the following factors were included: hypertension, diabetes, dyslipidaemia, smoking and family history of CVD. To summarize CVD prevalence, we performed a random-effects meta-analysis. A total of 41 potentially relevant articles were included, and 32 were included in the metaanalysis (n=191,979). The overall prevalence of CVD was 10.1% (95% confidence interval (CI): 7.1- 14.3%, p<0.001) in the Middle East. A high prevalence of CVD risk factors, such as dyslipidaemia (43.3%; 95% CI: 21.5-68%), hypertension (26.2%; 95% CI: 19.6-34%) and diabetes (16%; 95% CI: 9.9- 24.8%), was observed. The prevalence rates of other risk factors, such as smoking (12.4%; 95% CI: 7.7- 19.4%) and family history of CVD (18.7%; 95% CI: 15.4-22.5%), were also high. The prevalence of CVD is high (10.1%) in the Middle East. The burden of dyslipidaemia (43.3%) in this region is twice as high as that of hypertension (26.2%) and diabetes mellitus (16%). Multifaceted interventions are urgently needed for the primary prevention of CVD in this region.

Validating the Suinn-Lew Asian Self-Identity Acculturation Scale Among Middle Eastern Migrants: Linear Versus Orthogonal Approaches

: The current study aimed at validating the 26-item Suinn-Lew Asian Self-Identity Acculturation scale (SL-ASIA) using confirmatory factor analysis (CFA) in first-generation young adult Middle Eastern (ME) migrants, and also exploring the agreement between the outcomes of linear and orthogonal approaches of acculturation using SL-ASIA. The CFA and convergent and discriminant validity measures were employed to validate the original linear SL-ASIA and the subsequently designed orthogonal SL-ASIA for first-generation young adult ME migrants in Australia (n = 382). Cohen’s Kappa coefficient was used to measure the agreement between classifications obtained by the linear and orthogonal methods of measuring acculturation. The CFAs of the initial six-factor 21-item linear scale and the two-factor five-item orthogonal scale indicated poor fits. However, after model specification and validation, satisfactory fit and validity indices were achieved for the modified scales. The validated linear SL-ASIA comprised five factors and 15 items, and the validated orthogonal SL-ASIA comprised two factors and four items. The Kappa coefficient showed a high level of consistency between the linear and orthogonal models of acculturation, confirming that the use of either scale can lead to similar research outcomes. The study also supports the use of the validated linear and/or orthogonal scales to measure acculturation. This finding responds to the existing gap in the literature that until now, no acculturation scale is validated for ME migrants, and also no study is conducted to validate the orthogonal SL-ASIA.

Incidence and risk factors for recurrent cardiovascular disease in middle-eastern adults: a retrospective study

BackgroundIndividuals with established cardiovascular disease (CVD) and risk factors such as age, smoking, hypertension, and diabetes mellitus are at an increased risk of recurrent cardiovascular events and death. The incidence rate of recurrent CVD events varies between countries and populations. The United Arab Emirates (UAE) has one of the highest age-standardized death rates for CVD worldwide. The aim of our study was to estimate the incidence rates and determine the predictors of recurrent CVD events among UAE nationals.MethodsWe investigated an outpatient-based cohort of patients with a history of CVD visiting Tawam Hospital between April 1, 2008 and December 31, 2008. They were followed-up until July 31, 2018. Univariable and multivariable Cox proportional hazards regression models were used to determine the association between major CVD risk factors and the risk of CVD recurrence.ResultsA total of 216 patients (167 males, 49 females) with a history of CVD were included. They were followed for a median (interquartile range) of 8.1 (5.5–9.3) years, with a total of 1184 patient-years of follow-up. The overall incidence rate of recurrent CVD events was 92.1 per 1000 patient-years. The 8-year cumulative incidence was 73.7%. Age, female sex, and diabetes mellitus were significant predictors of recurrent CVD events, where females had a 1.96 times higher risk of recurrent CVD events than males.ConclusionSignificant predictors of recurrent CVD events are older age, female sex, and diabetes mellitus. The incidence rate of recurrent CVD events was 92.1 per 1000 patient-years. Preventive measures, based on international guidelines for CVD management, may improve CVD morbidity and mortality in the UAE population.

Stereophotogrammetric analysis of labial morphology in a young adult Middle-Eastern population

IntroductionThe majority of previous research delineating the morphological characteristics of the orolabial region has been on Caucasian populations, with very minor research on Mediterranean populations, and none on the Lebanese population. AimThe primary aim was to collect information on the gender-specific 3D morphology of the mouth and lips in young Middle Eastern adults. The secondary aim was to explore the presence of associations between orolabial morphology and age and body mass index (BMI), and to assess correlations between linear orolabial dimensions and area/volume measures. MethodsThe study used non-invasive stereophotogrammetry to collect information on gender-specific 3D labial morphology (linear distances, areas, and volumes) for 122 adult Lebanese subjects, aged 18–30 years (47 males, 75 females). Associations between labial morphology and age and body mass index were assessed, in addition to correlations between linear orolabial dimensions and area/volume measures. ResultsAll linear, angular, area, and volume lip measurements displayed significant variability. Both lip area and volume were smaller in the upper than in the lower lip. Eighteen out of the 20 linear measurements were significantly larger in males. The ratio, area, and volume measurements mostly displayed no statistically significant gender dimorphism. ConclusionsAlongside presenting the first documented report on anthropometric labial measurements of a young Lebanese adult population, this research highlights the presence of gender dimorphism in linear and angular measurements, but not in area and volume measurements, and a strong association between certain linear labial measurements and lip area and volume. In addition, it presents pilot data on the association between labial anthropometry and body mass index.

The Cognitive Functions in Adults with Chronic Pain: A Comparative Study.

Background. Several studies have reported an association between chronic pain and reduction of cognitive abilities of adults living in Western cultures. No literature could be found on the relationship between chronic pain and cognition among Middle Eastern adults. Objective. To compare four of the most commonly reported cognitive domains [memory, attention, processing speed, and executive functioning] among Middle Eastern adults with and without chronic pain. Methods. This matched group comparative study included 69 community residing and functionally independent Middle Eastern adults. Forty participants had chronic pain and 29 were pain-free. We administered five standardized cognitive assessments that are independent of culture and language to measure variable tasks of memory, attention, processing speed, and executive functioning. The study was conducted in a rehabilitation research setting with a controlled environment. Results. Evidence of decreased cognitive processing was found in patients with chronic pain. The chronic pain participants performed significantly worse than the pain-free participants on the cognitive measures of long-term memory, selective attention, processing speed, and executive functioning. Conclusion. The effect of Middle Eastern culture on the cognitive abilities of patients with chronic pain was negligible. Despite the wide variations between Eastern and Western cultures, the performance of our Middle Eastern participants in this study was consistent with performance of Western adults reported in previous studies.

Nasalance Scores in Lebanese English-Speaking Adults Using Nasometric Analysis

To obtain normative data for nasalance scores in Middle Eastern English-speaking adult population. Cross-sectional study. A total of 102 subjects were recruited in the study, 26 were excluded, thus, 77 Middle Eastern English-speaking adults (mean age = 23.77 ± 4.295; 39 males, 38 females) with normal speech and no hearing problems participated in the study. Using Nasometer II 6450, nasalance scores were obtained for each participant's readings of 3 passages: Zoo and Rainbow passages and nasal sentences. Mean nasalance score, standard deviation and range. Mean nasalance scores for Zoo passage, Rainbow passage and nasal sentences were 25.21 ± 11.07, 34.04 ± 9.30 and 41.29 ± 9.87 respectively. Mean scores didn't differ significantly between males and females, though scores for the Zoo passage were slightly higher among males (26.51 ± 11.66) than females (23.87 ± 10.42). In within-session reliability testing, 86% of retests for all three passages fell within 5 nasalance points of the previous test. In across-session reliability testing, 93% of retests for all 3 passages were within 5 points of initial test. This study provides normative data for nasalance scores among Middle-Eastern adults, which can help make nasometer and determination of nasalance more clinically useful in this population.

Dietary Factors and Type 2 Diabetes in the Middle East: What Is the Evidence for an Association?––A Systematic Review

This review aims to search and summarise the available evidence on the association between dietary factors and type 2 diabetes mellitus (T2DM) in Middle Eastern populations, where diabetes prevalence is among the highest in the world. Electronic databases were searched; authors, libraries, and research centres in the Middle East were contacted for further studies and unpublished literature. Included studies assessed potential dietary factors for T2DM in Middle Eastern adults. Two reviewers assessed studies independently. Extensive searching yielded 17 studies which met the inclusion criteria for this review. The findings showed that whole-grain intake reduces the risk of T2DM, and potato consumption was positively correlated with T2DM. Vegetables and vegetable oil may play a protective role against T2DM. Dietary patterns that are associated with diabetes were identified, such as Fast Food and Refined Grains patterns. Two studies demonstrated that lifestyle interventions decreased the risk of T2DM. In summary, the identified studies support an association between some dietary factors and T2DM; however, many of the included studies were of poor methodological quality so the findings should be interpreted with caution. The review draws attention to major gaps in current evidence and the need for well-designed studies in this area.

Predictive accuracy of the ‘Framingham’s general CVD algorithm’ in a Middle Eastern population: Tehran Lipid and Glucose Study

To examine the performance of 'the Framingham's general CVD algorithm' in estimating 5-year risk of cardiovascular disease (CVD) and coronary heart disease (CHD) in an adult Middle Eastern community. In a population-based prospective cohort, the Tehran Lipid and Glucose Study (TLGS), CVD risk estimates were calculated for 3838 individuals (2183 women) free of CVD at baseline. Over 8.6 years, there were 119 CVD (106 CHD) events among women, and 164 (137) among men aged ≥ 30 years. Standard risk factors [age, systolic blood pressure (SBP), antihypertensive treatment, total and high-density lipoprotein cholesterol, smoking and diabetes mellitus], measured at baseline, were significantly related to the incidence of CVD. The only exception, lack of significance for coefficients of SBP among women, was attributable to collinearity between age and SBP. For most risk factors, hazard ratios (HRs) for CVD were similar for the TLGS and the Framingham cohorts' participants. Few exceptions were lower HR for SBP among TLGS' women and lower HR for age among TLGS' men. The Framingham equations quite correctly discriminated participants [C statistic: CVD, 0.818 (women) and 0.774 (men); CHD: 0.822 (women) and 0.751 (men)] with good calibration (all calibration χ(2) values < 15, ps > 0.1). The Framingham's CVD algorithm was effective at ranking individuals and could be used to quantify risk and to guide preventive care in Iranian adults. For regions without established cohort, recalibration using risk factors and CVD (CHD) rates may be an effective method to develop CVD (CHD) risk prediction algorithms for local practice.

Metabolic syndrome in normal-weight Iranian adults

Background: The risk of metabolic risk factors increases in Middle-Eastern adults within the normal limits of BMI. There is a report that 30.1% of the Iranian population had metabolic syndrome but no reports on the prevalence of this syndrome among individuals within the various BMI categories are available. The present study estimates the prevalence of metabolic syndrome in adult population with normal levels of BMI (18.5-24.9 kg/m 2 ). Methods: In this population-based cross-sectional study, a representative sample of 3444 subjects (1737 males and 1707 females) aged≥20 years with normal body mass index (BMI= 18.5-24.9 kg/m 2 for both genders) were included. Demographic data were collected; anthropometric indices and blood pressure were measured according to standard protocol. Biochemical analysis was conducted on fasting blood samples. The metabolic syndrome was defined according to the ATP Ш guidelines as the presence of three or more of the metabolic factors. Means and proportions, and multivariate odds ratios that quantify the association between metabolic syndrome and normal BMI quartiles, controlling for age, physical activity, smoking and education were presented. Results: The overall prevalence of the metabolic syndrome in normal weight men and women were 9.9% (CI 95%: 8.49-11.30) and 11.0% (CI 95%: 9.5-12.4, P=0.2), respectively. Men had slightly lower BMI than women (22.4±1.8 vs. 22.5±1.7 kg/m 2 , P<0.001), while their WC was higher (79.8±6.6 vs.79.3±7.7 cm, P<0.001). The prevalence of high WC and low HDL was higher in women, while high blood pressure, high triglyceride levels and having at least two metabolic risk factors were more prevalent in men. Individuals at the highest category of normal BMI had significantly higher odds for being at risk for metabolic syndrome compared to those at first category (OR; 5.21 for men and 2.15 for women). There was a significant increasing trend in odds for having all the metabolic syndrome components except for high FBS and high WC in men. Women revealed a similar increasing trend except for high FBS across normal BMI quartiles. Conclusion: Normal weights Iranians have excess cardiovascular risk. Therefore interventions for prevention of diabetes and cardiovascular disease could be considered in normal weight population. On the other hand, the cut-points of BMI, suggested by WHO, may be inappropriate for the Iranian adult population.