BackgroundHealth-related quality of life (HRQoL) has frequently been compared between both healthy and obese children and healthy and chronically ill children; however, there is glaring lack of evidence regarding comparison of HRQoL in obese children with their counterparts with chronic diseases. Therefore, this study aimed to compare HRQoL among healthy, obese and chronically ill children.MethodsThis cross sectional study was conducted among 802 children (8–12 years) who were recruited via convenience sampling method. Participants were 98 healthy, 102 obese and 602 chronically ill children with six groups of chronic conditions including different types of cancer, rheumatoid arthritis, chronic gastrointestinal, kidney, neurologic and respiratory diseases. HRQoL was assessed using the Iranian version of the PedsQL questionnaire and both reports including child self-report and parent proxy-report were obtained. To compare subscales and total scores of HRQoL among healthy, obese and six groups of chronically ill children, the general linear model was used.ResultsMean self-reported HRQoL total scores were 73.7 ± 13.3 and 74.6 ± 11.8 in girls and boys respectively; based on the parents’ reports, mean HRQoL total scores were 71.6 ± 15.4 and 71.4 ± 13.0 in girls and boys respectively. From the prespectives of both children and parents, HRQoL total score was significantly lower in obese girls compared to both healthy girls and girls with chronic gastrointestinal, kidney, neurologic and respiratory diseases. Considering both children’s and parents’ reports, HRQoL total score was significantly lower in obese boys compared to both healthy boys and boys with chronic respiratory diseases. In terms of subscales of HRQoL, the impairment of HRQoL in obese children, compared to their counterparts with other chronic diseases, was more common in social functioning and physical functioning subscales, specifically in girls.ConclusionObese children reported poorer HRQoL compared to their healthy counterparts, as well as their counterparts with chronic diseases. Current findings emphasize the important impact of childhood obesity on the perceived health of these children, particularly in the social dimension, underscoring thereby the designing, planning and implementation of health promotion programs for prevention and treatment of childhood obesity.

Purpose The association between long-term BMI changes since childhood and health-related quality of life (HRQoL) in adulthood is still unclear. This study aimed to examine the association between identified BMI trajectories and HRQoL. Methods A population-based cohort of 1938 eligible children (3-18 years) and their parents have been repeatedly followed up for 18 years. Offspring BMI trajectories were identified using group-based trajectory models. HRQoL was evaluated in offspring aged 21-36 years using SF-12V2. Using quantile regression analysis, the associations of the identified BMI trajectories and HRQoL in young adulthood were examined. Results In males, persistent increasing overweight/obese group was negatively associated with 30th, 40th, 50th, and 60th percentiles of physical component summary (PCS) score distribution (β = − 2.60, p = 0.006; β = − 2.01, p = 0.005; β = − 1.86, p = 0.001; β = − 1.98, p = 0.009, respectively). A similar result was observed only in the 40th percentile of PCS distribution for the progressive overweight group (β = − 1.03, p = 0.022). In addition, the progressive overweight group in males showed a positive association with the upper tail of mental component summary (MCS) score distribution specifically for the 90th percentile (β = 1.15, p = 0.036). Regarding females, the current results indicated that the 90th percentile of MCS distributions was decreased in the persistent increasing overweight/obese group for females (β = − 1.83, p = 0.024). In addition, the progressive overweight group in females had a positive association with lower (30th and 40th) percentiles of PCS distribution (β = 1.29, p = 0.034, and β = 1.15, p = 0.030, respectively). Conclusion A sex-specific conditional association between developmental BMI trajectories from childhood and HRQoL in young adulthood was observed in physical and mental HRQoL.

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: Maternal characteristics have been known to be associated with parenting practices, which could eventually influence their child’s weight and health-related quality of life (HRQoL). Objectives: 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 the Tehran lipid and glucose study (TLGS). Participants were the children (n = 231) enrolled in TLGS during 2014 - 2016, who had complete data on maternal emotional states. The body weight and height of children were measured using the standard protocol, and BMI Z-score was determined using Anthroplus. Also, HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQLTM4.0) and the depression, anxiety, and stress scale (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 the mothers, median DASS-21 scores (interquartile ranges) in the three scales of depression, anxiety, and stress were 4 (0 - 10), 6 (2 - 12), and 14 (8 - 20), respectively. Maternal level of education was significantly associated with the DASS-21 score (β = -0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 score was significantly associated with BMI Z-score only in girls (β = 0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were the child’s age (β = -0.21, 95% CI: -0.40, -0.01) and maternal education (β = -0.24, 95%CI: -0.44, -0.02) and emotional state (β = -0.24, 95% CI: -0.44, -0.03). The 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. Conclusions: Our results indicated that the maternal emotional state was an important determinant of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and suburban populations, taking into consideration more influential factors.

Background:The rising prevalence of childhood obesity is a major health problem worldwide. Hence, there is a growing need for health professionals to become capable of assessing the factors that determine lifestyle in a culturally relevant manner.Objectives:This study aimed to develop and assess a questionnaire for measuring determinants of obesity-related behaviors in Tehranian adolescents.Patients and Methods:Based on the results of a qualitative study and an extensive literature review, the 44-item “Inventory of determinants of obesity-related behaviors in adolescents (IDOBA)” with eight subscales was developed: 1) unhealthy nutrition and physical inactivity; 2) stress-related eating; 3) perceived inability; 4) perceived lack of threat; 5) perceived priority of educational achievement; 6) perceived acceptability; 7) motivation loss; and 8) lack of support. Validity of IDOBA was assessed, utilizing face, content, and construct validity methods. To confirm face validity, ten overweight/obese adolescents completed the questionnaire. To calculate content validity ratio (CVR) and content validity index (CVI), a different panel of ten experts commented independently on the necessity, relevance, clarity, and simplicity of each item. To assess construct validity using exploratory factor analysis (EFA), a total of 478 adolescents (57.7% male) aged 13 to 18 years, who were recruited from schools, participated in the study. Confirmatory factor analysis (CFA) was used to test whether the data fit the hypothesized measurement model that was derived from EFA. Test-retest and internal consistency methods were used to assess reliability of the IDOBA scale.Results:All items were perceived as relevant and comprehendible by adolescents. Content validity was confirmed by the panel of experts. The internal consistency, as measured by Cronbach’s alpha coefficients, exceeded the minimum reliability standard of 0.60 for eight subscales. No ceiling effects were observed. Detected floor effects ranged from 0.2% for perceived acceptability subscale score to 18.8% for lack of threat subscale score. The EFA suggested an eight-factor construct and the results of the CFA indicated acceptable fit indices for the proposed model. All subscales demonstrated satisfactory test-retest reliability (intra-class correlation coefficient, 0.42 - 0.91) over one month.Conclusions:Results provided initial evidence that the IDOBA is a valid and reliable instrument for measuring determinants of obesity-related behaviors in Iranian adolescents, indicating that the questionnaire can be used in future weight management programs for Tehranian adolescents.

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 long-term effectiveness of healthy lifestyle interventions on improving leisure-time physical activity (LTPA) in adolescents and its factors in low- and middle-income communities is unclear. This study is the first to investigate LTPA trends in a population of Iranian adolescents who underwent a multi-setting lifestyle intervention, considering sex and the time of intervention onset. Methods Participants were 2374 adolescents (57.2% girls), aged 12–18 years, who participated in the Tehran Lipid and Glucose Study (TLGS) during 1999–2001 and followed for a median follow-up of 15.9 over five data points every 3 years. Adolescent participants were assigned to the intervention or control groups based on their residential areas. Boys and girls were categorized into 12–15 or 16–18 years old to minimize participants’ bio-psychological differences, facilitate environmental interventions by more compliance with the Iranian educational system and identify the best time to start the intervention. All adolescents in the intervention area received healthy lifestyle interventions via the school-, family-, and community-based programs. LTPA was assessed using the reliable and validated Iranian Modifiable Activity Questionnaire (MAQ) version over the five data points. The Generalized Estimating Equations method was used to evaluate educational intervention’s effect on LTPA in adolescents during the follow-up. Results In boys who experienced the early onset of intervention (12–15 years), the interaction effect of follow-up examinations and the intervention was significant where the impact of the intervention differed over time. In this group, LTPA was higher in the control group than in the intervention group at the first follow-up examination (β = − 1088.54). However, an increasing trend of LTPA was observed in the intervention group until the third follow-up examination (β = 1278.21, p = 0.08, and β = 1962.81, p = 0.02, respectively), with borderline significance levels at the 2nd (P = 0.08) and the 4th (P = 0.08) measurements. The interaction terms and main effects of intervention and follow-up examinations were not significant in boys with late intervention onset. Although older boys in the intervention group had higher LTPA than the control group, there were no significant differences among study groups in all follow-up examinations. Regarding girls, LTPA did not differ significantly between intervention and control groups in all follow-up examinations (P > 0.05). Conclusion Our results showed that a multi-setting practical lifestyle intervention could improve long-term energy expenditure in LTPA in adolescent boys who have experienced an early onset intervention. Findings emphasized the vital role of gender and the onset of these interventions. The current results would be valuable to plan tailored interventions to improve LTPA and community health. Trial registration This study is registered at Iran Registry for Clinical Trials (IRCT), a WHO primary registry (http://irct.ir). The TLGS clinical trial was the very first registration in the IRCT (Iran Registry of Clinical Trials). it was registered on 2008-10-29 by the registration number IRCT138705301058N1. Based on the international committee of medical journal Editors (ICMJE), “retrospective registration” is acceptable for trials that began before July 1, 2005.

Background: Previous studies have shown that spiritual experience may reduce cardiovascular disease (CVDs). However, little is known about the relationship between spiritual health and the gender-specific risk of CVDs in communities with different cultures.Methods: A total of 3249 individuals (53.7% female, 75.0% middle-aged) participated in the Tehran Lipid and Glucose Study (TLGS) from 2015 to 2017 were included. Based on the ACC/AHA pooled cohort equation, CVD risk over ten years was examined. Spiritual health was measured using a developed tool for measuring spiritual health in Muslim populations (SHIMA-48). Linear regression models were used to assess the association between spiritual health and ACC/AHA risk scores. The natural logarithm scale was calculated to consider the normal distribution hypothesis of the regression model. Results:The current results suggest a slight but significant increase in the mean of spiritual health in women compared to men in both cognitive/emotional and behavioral dimensions (P < 0.001). In both sexes, a higher prevalence of smoking was observed in participants with lower levels of spiritual health (P < 0.004). In men, compared to those with a low level of spiritual health (the first tertile), the logarithm of the ACC-AHA risk score was reduced by 0.11 (P = 0.004) and 0.18 (P < 0.001) for those in the second and third tertiles of spiritual health, respectively. This result may be attributed to higher cigarette smoking among the latter group. Similar results were not observed in women. Conclusions:Current results indicate a gender-specific association between spiritual health and cardiovascular disease risk. Our findings imply that promoting spiritual health can be considered an effective strategy in future preventive interventions, primarily by controlling the desire to smoke in men.