Background The aim of the present study was to validate the Lifestyle Behavior Checklist (LBC) questionnaire, to measure Iranian parents' perceptions of their children's weight-related behaviors and their self-efficacy in dealing with those behaviors. Methods The LBC was translated into Farsi. Face and content validity of the questionnaire was evaluated by an expert panel. A total of 213 mothers of 3–12-year-old children responded to the questionnaire. Criterion validity of the questionnaire was evaluated through comparing its result with a parenting style questionnaire. Principal component analysis (PCA) and confirmatory factor analyses (CFA) were used to evaluate construct validity of the questionnaire. Reproducibility was measured by twice administration of LBC, one month apart and using Spearman's rho correlation test. The questionnaire's internal consistency was assessed by calculating Cronbach's α. Results LBC Problem scale was significantly correlated with authoritarian parenting style score, while the Confidence scale was significantly correlated with authoritative and negatively with permissive and authoritarian parenting styles. PCA suggested a six-factor construct, including, fussy eating, food-related problem behaviors, overeating behaviors, low interest in physical activity, poor self-image and sedentary behaviors. The results of CFA indicated acceptable fit indices for the proposed models. Both, Problem scale (Cronbach's α = 0.8) and Confidence scale (Cronbach's α = 0.95) had high internal consistency. Spearman correlation coefficients indicated acceptable reproducibility for both the Problem scale (r = 0.74) and the Confidence scale (r = 0.70). Conclusions The Farsi version of LBC questionnaire is reliable and reasonably valid to measure Iranian mothers' perception of their children's weight-related problem behavior.

Background Preventing overweight in childhood and subsequent stages of life is still a global challenge. Despite numerous relevant lifestyle interventions, data on their impact on different BMI change pathways over time is rare. The present study aimed to investigate the effect of a multi-setting lifestyle intervention on BMI trajectories from childhood to young adulthood. Methods A multi-setting lifestyle intervention at the school, family, and community levels have been conducted in the Tehran Lipid and Glucose Study framework. A total of 2145 children (4–18 years, 49% boys, and 18% intervention) were recruited for the baseline assessment and were followed through five follow-up examinations during a median of 16.1 years. Using a group-based trajectory model, BMI trajectories from childhood to young adulthood were identified, and their association with the implemented intervention was assessed. Results Four trajectory groups of BMI from childhood to young adulthood were identified, including Normal weight (41%), Young adulthood overweight (36%), Early childhood increasing overweight and adulthood obesity (19%), and Early childhood increasing obesity (4%). Only Young adulthood overweight and Early childhood increasing obesity were affected by the intervention and were concomitant with lower BMI levels than the control group, with the highest estimated effect in the latter (β=-0.52 and p = 0.018; β=-1.48 and p < 0.001, respectively). Conclusion The current findings indicate the highest effectiveness of a practical, healthy lifestyle intervention on those whose obesity started in the early years of life or youth. Our results could help policymakers and planners design more targeted lifestyle modification and weight control interventions. Trial registration This study is registered at Iran Registry for Clinical Trials, a WHO primary registry (http://irct.ir). The Iran Registry for Clinical Trials ID and date are IRCTID:IRCT138705301058N1, 29/10/2008.

Background The effect of thyroid dysfunctions on the female reproductive system is well recognized. Although many studies pointed out the possible effect of female reproductive status alteration on thyroid function, there are too many contradictions to come up with an exact conclusion. This study aimed to investigate the associations of parity, abortion, and menopause status with the prevalence and incidence of thyroid dysfunctions. Methods From the Tehran Thyroid Study (TTS) population, 2191 euthyroid female participants at baseline were selected and followed up in three-year intervals. Multivariable Cox proportional hazard model was used to determine associations between the incidence of thyroid dysfunctions with parity, abortion, and menopause status; age, smoking, body mass index, and thyroid peroxidase antibodies positivity were adjusted. Results At the baseline, multiple parities were significantly associated with overt hypothyroidism (OR, 95% CI: 1.12, 1.0-1.26) and subclinical hyperthyroidism (OR, 95% CI: 1.11, 1.03–1.21). Likewise, multiple abortions were associated with overt hyperthyroidism (OR, 95% CI: 2.09, 1.02–4.26). Multiple parities (≥ 4) significantly increased the risk of incident subclinical and clinical hypothyroidism. Moreover, the incidence of overt hypothyroidism significantly decreased in mothers with a history of abortion. No significant associations between menopause status with the prevalence and incidence of hypothyroidism or hyperthyroidism were observed. Conclusions There are relationships between parity and abortion with thyroid function. Understanding the exact mechanism requires more information at the cellular and molecular level on signaling cascades alterations during pregnancy.

Background The present study aimed to investigate the relationship of obesity phenotypes with depression, anxiety, and stress of the adult participants in Tehran Lipid and Glucose Study (TLGS). Methods Depression, anxiety, and stress levels of 2469 adult participants aged > 19 (1158 men and 1311 women) from Tehran Lipid and Glucose Study were examined among different obesity phenotypes in the current study. Weight, height, and waist circumferences of participants were measured by trained personnel. Obesity was defined as BMI ≥ 30 kg/m², and metabolically unhealthy status based on having metabolic syndrome (MetS) or diabetes type 2. Finally, four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Ordinal logistic regression analysis was used to compare sex-specific odds ratios. Results The mean age of 2469 men and women was 46.2 ± 15.9 and 45.6 ± 14.7, respectively. In total, women were more likely to experience different levels of depression (30.5%), anxiety (44.2%), and stress (43.5%). After adjusting for potential confounders, the odds of experiencing higher levels of anxiety were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25–2.54; P = < 0.001) or non-obese (OR: 1.61, 95% CI: 1.17–2.21; P = < 0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28–2.34; P = < 0.001) comparing to their MHNO counterparts. Moreover, the odds of experiencing higher levels of stress were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02–1.90; P = 0.04), and in MUO women (OR: 1.45, 95% CI: 1.07–1.96; P = 0.02) comparing to their MHNO counterparts. No difference in having higher levels of depression was observed in both genders. Conclusions Compared to MHNO individuals, MUO women and all metabolically unhealthy men reported higher levels of anxiety and stress. The obesity phenotypes were by no means associated with depression in men and women.

Background: Maternal characteristics have been known to be associated with parenting practices that could eventually influence their child’s weight and health-related quality of life (HRQoL). This study aimed to assess the direct and indirect associations of maternal emotional states (depression, anxiety and stress) with body mass index (BMI) and HRQoL in their children. Methods: This study was conducted within the framework of Tehran Lipid and Glucose Study (TLGS). Participants were children (n=231) who participated in the TLGS during 2014-2016 with complete data on maternal emotional states. Body weight and height of children were measured using standard protocol and BMI-Z scores were determined using Anthroplus. HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQL TM 4.0) and the depression, anxiety and stress scales (DASS-21) respectively. Structural equations modeling (SEM) was used to assess the direct and indirect relations of maternal emotional states with children’s BMI Z score and HRQoL. Results: Mean age, BMI Z-score and HRQoL total score in children were 13.8±3.1 years, 0.74±1.5 and 84.7±11.3 respectively. In mothers, median scores (Interquartile ranges) of DASS-21 in three scales including depression, anxiety and stress were 4(0-10), 6(2-12) and 14(8-20) respectively. Maternal level of education was significantly associated with DASS-21 scores (β=-0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 scores were significantly associated with BMI Z scores only in girls (β=0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were child’s age (β=-0.21, 95% CI: -0.40, -0.01), maternal education (β=-0.24, 95%CI: -0.44, -0.02) and emotional state (β=-0.24, 95% CI: -0.44, -0.03). Child’s age (β=-0.33, 95%-CI: -0.53, -0.10) and maternal emotional state (β=-0.31, 95% CI: -0.54, -0.08) were significantly associated with HRQoL in girls. Conclusion: Our results indicate maternal emotional states to be the important determinants of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and sub-urban populations taking ino consideration more influential factors.

Background: The present study aimed to investigate the associations of obesity phenotypes with depression, anxiety, and stress symptoms among adults in the Tehran Lipid and Glucose Study (TLGS).Methods: Depression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study. Obesity was defined as body mass index (BMI) ≥30 kg/m², and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes. Results: The mean age of 2469 men and women was 46.2±15.9 and 45.6±14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25-2.54; P=<0.001) or non-obese (OR: 1.61, 95% CI: 1.17-2.21; P= <0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28-2.34; P=<0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02-1.90; P=0.04) compared to MHNO men and in MUO women (OR: 1.45, 95% CI: 1.07-1.96; P=0.02) compared to MHNO women. No difference in depression levels was observed in either sex. Conclusions: Our results showed that men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity in both sexes and utilizing future health promotion planning.

Background: The present study aimed to investigate the relationship of obesity phenotypes with depression, anxiety, and stress among adults in the Tehran Lipid and Glucose Study (TLGS)."Methods: Depression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study. Weight, height, and waist circumferences of participants were measured. Obesity was defined as body mass index (BMI) ≥30 kg/m², and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes. Results: The mean age of 2469 men and women was 46.2±15.9 and 45.6±14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25-2.54; P=<0.001) or non-obese (OR: 1.61, 95% CI: 1.17-2.21; P= <0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28-2.34; P=<0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02-1.90; P=0.04) compared to MHNO men, and in MUO women (OR: 1.45, 95% CI: 1.07-1.96; P=0.02) compared to MHNO women. No difference in having higher levels of depression was observed in either sex. Conclusions: Our results showed that men and women with various obesity phenotypes experience different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity.

Introduction: The current longitudinal study aimed to investigate the association of three stable obesity phenotypes (persistent metabolically healthy normal weight (P MHNW), persistent metabolically healthy obese (P MHO), persistent metabolically unhealthy obese (P MUO)), and one transient (MHO to MUO) obesity phenotype with health-related quality of life (HRQoL) throughout an 18-year period. Methods: 1932 participants (649 men and 1283 women) who completed the HRQoL questionnaire during 2016-2019 were recruited in the current investigation. Based on the body mass index (BMI) and metabolic status, participants were classified into four obesity phenotypes, including 1) P MHNW, 2) P MHO, 3) P MUO, and 4) Transient from MHO to MUO. The HRQoL was compared between groups using analysis of covariance. Participants' age, marital status, occupation status, education level, physical activity, and smoking were adjusted. Results: After adjustment for confounder variables, a significant difference among obesity phenotypes was indicated in PCS scores of both sexes and MCS scores just in women (P value=<0.001). The P MUO had the lowest scores in PCS and MCS, and P MHO had the highest MCS scores compared to other obesity phenotypes in either sex. Conclusion: The results of the present study indicate the negative effect of long-term concurrence of obesity and metabolic disorders on the HRQoL of adults. However, long-term obesity alone or loss of metabolic health in the short term did not affect individuals' assessment of their physical and mental health. These findings highlight the importance of preventive interventions in people with obesity; also indicate the need for awareness-raising strategies about healthy lifestyles to improve the quality of life in society.