Publications by authors named "Akram Pourshams"

116 Publications

Long-term opiate use and risk of cardiovascular mortality: results from the Golestan Cohort Study.

Eur J Prev Cardiol 2020 Sep 10. Epub 2020 Sep 10.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran.

Aims: Tens of millions of people worldwide use opiates but little is known about their potential role in causing cardiovascular diseases. We aimed to study the association of long-term opiate use with cardiovascular mortality and whether this association is independent of the known risk factors.

Methods And Results: In the population-based Golestan Cohort Study-50 045 Iranian participants, 40-75 years, 58% women-we used Cox regression to estimate hazard ratios and 95% confidence intervals (HRs, 95% CIs) for the association of opiate use (at least once a week for a period of 6 months) with cardiovascular mortality, adjusting for potential confounders-i.e. age, sex, education, wealth, residential place, marital status, ethnicity, and tobacco and alcohol use. To show independent association, the models were further adjusted for hypertension, diabetes, waist and hip circumferences, physical activity, fruit/vegetable intake, aspirin and statin use, and history of cardiovascular diseases and cancers. In total, 8487 participants (72.2% men) were opiate users for a median (IQR) of 10 (4-20) years. During 548 940 person-years-median of 11.3 years, >99% success follow-up-3079 cardiovascular deaths occurred, with substantially higher rates in opiate users than non-users (1005 vs. 478 deaths/100 000 person-years). Opiate use was associated with increased cardiovascular mortality, with adjusted HR (95% CI) of 1.63 (1.49-1.79). Overall 10.9% of cardiovascular deaths were attributable to opiate use. The association was independent of the traditional cardiovascular risk factors.

Conclusion: Long-term opiate use was associated with an increased cardiovascular mortality independent of the traditional risk factors. Further research, particularly on mechanisms of action, is recommended.
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http://dx.doi.org/10.1093/eurjpc/zwaa006DOI Listing
September 2020

Dietary quality using four dietary indices and lung cancer risk: the Golestan Cohort Study (GCS).

Cancer Causes Control 2021 Feb 21. Epub 2021 Feb 21.

Stony Brook Cancer Center, New York, NY, USA.

Purpose: The lung cancer incidence in Iran has increased almost ten times over the past three decades. In addition to the known causes such as smoking and certain occupational exposure, dietary quality has been suggested to play a role in lung cancer. We aim to explore the association between dietary pattern and lung cancer risk among a Middle East population.

Methods: Data came from Golestan Cohort Study which included 48,421 participants with 136 lung cancer cases diagnosed during a median follow-up of 12 years. Multivariable Cox proportional hazards regression models were used to calculate the HRs and 95% CI of lung cancer risk by tertile of the four dietary index scores-the Health Eating Index (HEI)-2015, the Alternative Health Eating Index (AHEI)-2010, the Alternative Mediterranean Diet (AMED), and the Dietary Approach to Stop Hypertension (DASH)-Fung.

Results: A higher DASH-Fung score was inversely associated with risk of lung cancer after adjusting for potential confounders (tertile three vs. tertile one: HR = 0.59 (0.38-0.93); p for trend = 0.07), and p with smoking was 0.46. Similar findings were observed among current smokers with the HEI-2015 score (tertile three vs. tertile one: HR = 0.22 (0.08-0.60): p for trend < 0.01), and p between smoking and the HEI-2015 score was 0.03.

Conclusion: In the GCS, consuming a diet more closely aligned with the DASH diet was associated with a reduced risk of lung cancer, which appeared to be independent of smoking status. There was also an inverse link between the HEI-2015 score and lung cancer risk among current smokers. Our finding is particularly important for the Middle East population, as diet may play an important role in cancer prevention and overall health.
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http://dx.doi.org/10.1007/s10552-021-01400-wDOI Listing
February 2021

Survival features, prognostic factors, and determinants of diagnosis and treatment among Iranian patients with pancreatic cancer, a prospective study.

PLoS One 2020 4;15(12):e0243511. Epub 2020 Dec 4.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Investigating the survival features, and determinants of treatment and stage at presentation in Iran.

Methods: 461 patients with pancreatic ductal adenocarcinoma (PC) were prospectively enrolled from Shariati hospital, Tehran, Iran, between 2011-2018. All patients underwent endoscopic ultrasonography, computed tomography scanning, and physical examination. Validated questionnaire was completed for the participants and all were actively followed on monthly basis.

Results: Median survival time was 6.5 months, and 1-, and 5-year survival rates were 26.2%, and 1.5%. Patients who were older (p<0.001), illiterate (p = 0.004), unmarried (p = 0.003), rural inhabitant (p = 0.013), opium user (p = 0.039), and had lower body mass index (BMI) (p = 0.002) had lower overall survival. Tumors located in the head of pancreas were more commonly diagnosed at lower stages (p<0.001). Only 10.4% of patients underwent surgery who were more commonly educated (p<0.001), married (p = 0.005), had a tumor located in the head of pancreas (p = 0.016), and were diagnosed at lower stages (p<0.001). After adjustment for potential confounders and risk factors, rural inhabitance (HR: 1.33 (95% CI: 1.01-1.74)), having more symptoms (HR for each increasing symptom: 1.06 (1.02-1.11)), using opium (HR: 1.51 (1.04-2.20)), having a tumor located in the body of pancreas (HR: 1.33 (1.02-1.75)), and having an advanced tumor stage (HR: 2.07 (1.34-3.19)) remained significantly associated with increased risk of mortality. After the adjusting for potential confounders, we did not find significant relationships between smoking, alcohol intake, and BMI with the risk of death among patients with pancreatic cancer.

Conclusions: Iranian patients with PC have very poor long-term survival. Besides tumor's stage and location, socioeconomic disparities could affect the probabilities of receiving treatment and/or survival in these patients. Opium use is an independent risk factor for mortality among PC patients in Iran.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243511PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717574PMC
January 2021

Circulating plasma fatty acids and risk of pancreatic cancer: Results from the Golestan Cohort Study.

Clin Nutr 2020 Sep 15. Epub 2020 Sep 15.

Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background & Aims: Pancreatic cancer (PC) with a dismal prognosis is considered as a fatal malignancy, attracting the scientists' attention to study its causes and pathogenesis pathways. Given the lack of enough evidence and conflicting findings about the association of PC risk with plasma fatty acids, we aimed to explore the associations of circulating plasma fatty acids with the risk of PC in a cohort study.

Methods: From about 50,000 subjects participated in this cohort study in 2004-2008, fifty incident cases of PC were recruited and 150 controls matched by age, sex and residence place (urban/rural) were randomly selected. The plasma fatty acids composition was measured by gas chromatography with Flame Ionization Detector (GC-FID) in plasma samples collected at the baseline of cohort study. Multivariable conditional logistic regression was used to estimate OR (with 95% CI) of PC risk associated with plasma levels of fatty acids considering known potential risk factors for PC.

Results: Our findings showed that total saturated fatty acids and total industrial trans fats were not associated with the risk of PC; whereas, statistically significant inverse associations were found between high plasma levels of total mono-unsaturated fatty acids (MUFAs), omega-3 and ruminant trans fatty acids with the risk of PC [OR = 0.31 (0.11-0.89), OR  = 0.30 (0.10-0.91) and OR = 0.15 (0.04-0.49), respectively]. Omega-6 fatty acids especially high plasma levels of Arachidonic acid was positively associated with the risk of PC [OR = 11.07 (3.50-35.02)].

Conclusion: Except for the plasma circulating whole fats, the levels of different classes of fats may significantly change pancreatic cancer susceptibility. Unsaturated fatty acids including omega-3-PUFA and MUFA are considered as protective biomarkers in PC prevention. On the contrary, omega-6-fatty acids are positively associated with the risk of PC.
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http://dx.doi.org/10.1016/j.clnu.2020.09.002DOI Listing
September 2020

Habitual dietary intake of flavonoids and all-cause and cause-specific mortality: Golestan cohort study.

Nutr J 2020 09 28;19(1):108. Epub 2020 Sep 28.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Flavonoids are the most important group of polyphenols with well-known beneficial effects on health. However; the association of intake of total flavonoid or their subclasses with all-cause or cause-specific mortality is not fully understood. The present study aims to evaluate the association between intake of total flavonoid, flavonoid subclasses, and total and cause-specific mortality in a developing country.

Methods: A total number of 49,173 participants from the Golestan cohort study, who completed a validated food frequency questionnaire at recruitment, were followed from 2004 till 2018. Phenol-Explorer database was applied to estimate dietary intakes of total flavonoid and different flavonoid subclasses. Associations were examined using adjusted Cox proportional hazards models.

Results: During a mean follow-up of 10.63 years, 5104 deaths were reported. After adjusting for several potential confounders, the hazard ratios (HRs) of all-cause mortality for the highest versus the lowest quintile of dietary flavanones, flavones, isoflavonoids, and dihydrochalcones were 0.81 (95% confidence interval = 0.73-0.89), 0.83(0.76-0.92), 0.88(0.80-0.96) and 0.83(0.77-0.90), respectively. However, there was no association between total flavonoid intake or other flavonoid subclasses with all-cause mortality. In cause-specific mortality analyses, flavanones and flavones intakes were inversely associated with CVD mortality [HRs: 0.86(0.73-1.00) and 0.85(0.72-1.00)] and isoflavonoids and dihydrochalcones were the only flavonoid subclasses that showed a protective association against cancer mortality [HR: 0.82(0.68-0.98)].

Conclusion: The results of our study suggest that certain subclasses of flavonoids can reduce all-cause mortality and mortality rate from CVD and cancer.
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http://dx.doi.org/10.1186/s12937-020-00627-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523365PMC
September 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Authors:
Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Nicholas L S Roberts Dillon O Sylte Gregory J Bertolacci Matthew Cunningham Nathaniel J Henry Kate E LeGrand Ahmed Abdelalim Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Aidin Abedi Kedir Hussein Abegaz Akine Eshete Abosetugn Abdelrahman I Abushouk Oladimeji M Adebayo Jose C Adsuar Shailesh M Advani Marcela Agudelo-Botero Tauseef Ahmad Muktar Beshir Ahmed Rushdia Ahmed Miloud Taki Eddine Aichour Fares Alahdab Fahad Mashhour Alanezi Niguse Meles Alema Biresaw Wassihun Alemu Suliman A Alghnam Beriwan Abdulqadir Ali Saqib Ali Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Amir Almasi-Hashiani Nihad A Almasri Khalid Altirkawi Yasser Sami Abdeldayem Amer Catalina Liliana Andrei Alireza Ansari-Moghaddam Carl Abelardo T Antonio Davood Anvari Seth Christopher Yaw Appiah Jalal Arabloo Morteza Arab-Zozani Zohreh Arefi Olatunde Aremu Filippo Ariani Amit Arora Malke Asaad Beatriz Paulina Ayala Quintanilla Getinet Ayano Martin Amogre Ayanore Ghasem Azarian Alaa Badawi Ashish D Badiye Atif Amin Baig Mohan Bairwa Ahad Bakhtiari Arun Balachandran Maciej Banach Srikanta K Banerjee Palash Chandra Banik Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Akbar Barzegar Mohsen Bayati Shahrzad Bazargan-Hejazi Neeraj Bedi Masoud Behzadifar Habte Belete Derrick A Bennett Isabela M Bensenor Kidanemaryam Berhe Akshaya Srikanth Bhagavathula Pankaj Bhardwaj Anusha Ganapati Bhat Krittika Bhattacharyya Zulfiqar A Bhutta Sadia Bibi Ali Bijani Archith Boloor Guilherme Borges Rohan Borschmann Antonio Maria Borzì Soufiane Boufous Dejana Braithwaite Nikolay Ivanovich Briko Traolach Brugha Shyam S Budhathoki Josip Car Rosario Cárdenas Félix Carvalho João Mauricio Castaldelli-Maia Carlos A Castañeda-Orjuela Giulio Castelpietra Ferrán Catalá-López Ester Cerin Joht S Chandan Jens Robert Chapman Vijay Kumar Chattu Soosanna Kumary Chattu Irini Chatziralli Neha Chaudhary Daniel Youngwhan Cho Jee-Young J Choi Mohiuddin Ahsanul Kabir Chowdhury Devasahayam J Christopher Dinh-Toi Chu Flavia M Cicuttini João M Coelho Vera M Costa Saad M A Dahlawi Ahmad Daryani Claudio Alberto Dávila-Cervantes Diego De Leo Feleke Mekonnen Demeke Gebre Teklemariam Demoz Desalegn Getnet Demsie Kebede Deribe Rupak Desai Mostafa Dianati Nasab Diana Dias da Silva Zahra Sadat Dibaji Forooshani Hoa Thi Do Kerrie E Doyle Tim Robert Driscoll Eleonora Dubljanin Bereket Duko Adema Arielle Wilder Eagan Demelash Abewa Elemineh Shaimaa I El-Jaafary Ziad El-Khatib Christian Lycke Ellingsen Maysaa El Sayed Zaki Sharareh Eskandarieh Oghenowede Eyawo Pawan Sirwan Faris Andre Faro Farshad Farzadfar Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Pietro Ferrara Florian Fischer Morenike Oluwatoyin Folayan Artem Alekseevich Fomenkov Masoud Foroutan Joel Msafiri Francis Richard Charles Franklin Takeshi Fukumoto Biniyam Sahiledengle Geberemariyam Hadush Gebremariam Ketema Bizuwork Gebremedhin Leake G Gebremeskel Gebreamlak Gebremedhn Gebremeskel Berhe Gebremichael Getnet Azeze Gedefaw Birhanu Geta Agegnehu Bante Getenet Mansour Ghafourifard Farhad Ghamari Reza Ghanei Gheshlagh Asadollah Gholamian Syed Amir Gilani Tiffany K Gill Amir Hossein Goudarzian Alessandra C Goulart Ayman Grada Michal Grivna Rafael Alves Guimarães Yuming Guo Gaurav Gupta Juanita A Haagsma Brian James Hall Randah R Hamadeh Samer Hamidi Demelash Woldeyohannes Handiso Josep Maria Haro Amir Hasanzadeh Shoaib Hassan Soheil Hassanipour Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Delia Hendrie Fatemeh Heydarpour Martha Híjar Hung Chak Ho Chi Linh Hoang Michael K Hole Ramesh Holla Naznin Hossain Mehdi Hosseinzadeh Sorin Hostiuc Guoqing Hu Segun Emmanuel Ibitoye Olayinka Stephen Ilesanmi Leeberk Raja Inbaraj Seyed Sina Naghibi Irvani M Mofizul Islam Sheikh Mohammed Shariful Islam Rebecca Q Ivers Mohammad Ali Jahani Mihajlo Jakovljevic Farzad Jalilian Sudha Jayaraman Achala Upendra Jayatilleke Ravi Prakash Jha Yetunde O John-Akinola Jost B Jonas Kelly M Jones Nitin Joseph Farahnaz Joukar Jacek Jerzy Jozwiak Suresh Banayya Jungari Mikk Jürisson Ali Kabir Amaha Kahsay Leila R Kalankesh Rohollah Kalhor Teshome Abegaz Kamil Tanuj Kanchan Neeti Kapoor Manoochehr Karami Amir Kasaeian Hagazi Gebremedhin Kassaye Taras Kavetskyy Gbenga A Kayode Peter Njenga Keiyoro Abraham Getachew Kelbore Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ibrahim A Khalil Rovshan Khalilov Maseer Khan Ejaz Ahmad Khan Junaid Khan Tripti Khanna Salman Khazaei Habibolah Khazaie Roba Khundkar Daniel N Kiirithio Young-Eun Kim Yun Jin Kim Daniel Kim Sezer Kisa Adnan Kisa Hamidreza Komaki Shivakumar K M Kondlahalli Ali Koolivand Vladimir Andreevich Korshunov Ai Koyanagi Moritz U G Kraemer Kewal Krishan Barthelemy Kuate Defo Burcu Kucuk Bicer Nuworza Kugbey Nithin Kumar Manasi Kumar Vivek Kumar Narinder Kumar Girikumar Kumaresh Faris Hasan Lami Van C Lansingh Savita Lasrado Arman Latifi Paolo Lauriola Carlo La Vecchia Janet L Leasher Shaun Wen Huey Lee Shanshan Li Xuefeng Liu Alan D Lopez Paulo A Lotufo Ronan A Lyons Daiane Borges Machado Mohammed Madadin Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Venkatesh Maled Deborah Carvalho Malta Navid Manafi Amir Manafi Ana-Laura Manda Narayana Manjunatha Fariborz Mansour-Ghanaei Mohammad Ali Mansournia Joemer C Maravilla Amanda J Mason-Jones Seyedeh Zahra Masoumi Benjamin Ballard Massenburg Pallab K Maulik Man Mohan Mehndiratta Zeleke Aschalew Melketsedik Peter T N Memiah Walter Mendoza Ritesh G Menezes Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Hayimro Edemealem Merie Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Ted R Miller G K Mini Andreea Mirica Erkin M Mirrakhimov Mehdi Mirzaei-Alavijeh Prasanna Mithra Babak Moazen Masoud Moghadaszadeh Efat Mohamadi Yousef Mohammad Aso Mohammad Darwesh Abdollah Mohammadian-Hafshejani Reza Mohammadpourhodki Shafiu Mohammed Jemal Abdu Mohammed Farnam Mohebi Mohammad A Mohseni Bandpei Mariam Molokhia Lorenzo Monasta Yoshan Moodley Masoud Moradi Ghobad Moradi Maziar Moradi-Lakeh Rahmatollah Moradzadeh Lidia Morawska Ilais Moreno Velásquez Shane Douglas Morrison Tilahun Belete Mossie Atalay Goshu Muluneh Kamarul Imran Musa Ghulam Mustafa Mehdi Naderi Ahamarshan Jayaraman Nagarajan Gurudatta Naik Mukhammad David Naimzada Farid Najafi Vinay Nangia Bruno Ramos Nascimento Morteza Naserbakht Vinod Nayak Javad Nazari Duduzile Edith Ndwandwe Ionut Negoi Josephine W Ngunjiri Trang Huyen Nguyen Cuong Tat Nguyen Diep Ngoc Nguyen Huong Lan Thi Nguyen Rajan Nikbakhsh Dina Nur Anggraini Ningrum Chukwudi A Nnaji Richard Ofori-Asenso Felix Akpojene Ogbo Onome Bright Oghenetega In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Ahmed Omar Bali Obinna E Onwujekwe Heather M Orpana Erika Ota Nikita Otstavnov Stanislav S Otstavnov Mahesh P A Jagadish Rao Padubidri Smita Pakhale Keyvan Pakshir Songhomitra Panda-Jonas Eun-Kee Park Sangram Kishor Patel Ashish Pathak Sanghamitra Pati Kebreab Paulos Amy E Peden Veincent Christian Filipino Pepito Jeevan Pereira Michael R Phillips Roman V Polibin Suzanne Polinder Farshad Pourmalek Akram Pourshams Hossein Poustchi Swayam Prakash Dimas Ria Angga Pribadi Parul Puri Zahiruddin Quazi Syed Navid Rabiee Mohammad Rabiee Amir Radfar Anwar Rafay Ata Rafiee Alireza Rafiei Fakher Rahim Siavash Rahimi Muhammad Aziz Rahman Ali Rajabpour-Sanati Fatemeh Rajati Ivo Rakovac Sowmya J Rao Vahid Rashedi Prateek Rastogi Priya Rathi Salman Rawaf Lal Rawal Reza Rawassizadeh Vishnu Renjith Serge Resnikoff Aziz Rezapour Ana Isabel Ribeiro Jennifer Rickard Carlos Miguel Rios González Leonardo Roever Luca Ronfani Gholamreza Roshandel Basema Saddik Hamid Safarpour Mahdi Safdarian S Mohammad Sajadi Payman Salamati Marwa R Rashad Salem Hosni Salem Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Abdur Razzaque Sarker Arash Sarveazad Brijesh Sathian Monika Sawhney Mehdi Sayyah David C Schwebel Soraya Seedat Subramanian Senthilkumaran Seyedmojtaba Seyedmousavi Feng Sha Faramarz Shaahmadi Saeed Shahabi Masood Ali Shaikh Mehran Shams-Beyranvand Aziz Sheikh Mika Shigematsu Jae Il Shin Rahman Shiri Soraya Siabani Inga Dora Sigfusdottir Jasvinder A Singh Pankaj Kumar Singh Dhirendra Narain Sinha Amin Soheili Joan B Soriano Muluken Bekele Sorrie Ireneous N Soyiri Mark A Stokes Mu'awiyyah Babale Sufiyan Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Biruk Wogayehu Taddele Yonatal Mesfin Tefera Arash Tehrani-Banihashemi Gebretsadkan Hintsa Tekulu Ayenew Kassie Tesema Tesema Berhe Etsay Tesfay Rekha Thapar Mariya Vladimirovna Titova Kenean Getaneh Tlaye Hamid Reza Tohidinik Roman Topor-Madry Khanh Bao Tran Bach Xuan Tran Jaya Prasad Tripathy Alexander C Tsai Aristidis Tsatsakis Lorainne Tudor Car Irfan Ullah Saif Ullah Bhaskaran Unnikrishnan Era Upadhyay Olalekan A Uthman Pascual R Valdez Tommi Juhani Vasankari Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Yuan-Pang Wang Taweewat Wiangkham Haileab Fekadu Wolde Dawit Habte Woldeyes Temesgen Gebeyehu Wondmeneh Adam Belay Wondmieneh Ai-Min Wu Grant M A Wyper Rajaram Yadav Ali Yadollahpour Yuichiro Yano Sanni Yaya Vahid Yazdi-Feyzabadi Pengpeng Ye Paul Yip Engida Yisma Naohiro Yonemoto Seok-Jun Yoon Yoosik Youm Mustafa Z Younis Zabihollah Yousefi Chuanhua Yu Yong Yu Telma Zahirian Moghadam Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Hamed Zandian Fatemeh Zarei Zhi-Jiang Zhang Yunquan Zhang Arash Ziapour Sanjay Zodpey Rakhi Dandona Samath Dhamminda Dharmaratne Simon I Hay Ali H Mokdad David M Pigott Robert C Reiner Theo Vos

Inj Prev 2020 Oct 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Joint effect of diabetes and opiate use on all-cause and cause-specific mortality: the Golestan cohort study.

Int J Epidemiol 2020 Aug 18. Epub 2020 Aug 18.

Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Many diabetic individuals use prescription and non-prescription opioids and opiates. We aimed to investigate the joint effect of diabetes and opiate use on all-cause and cause-specific mortality.

Methods: Golestan Cohort study is a prospective population-based study in Iran. A total of 50 045 people-aged 40-75, 28 811 women, 8487 opiate users, 3548 diabetic patients-were followed during a median of 11.1 years, with over 99% success follow-up. Hazard ratio and 95% confidence intervals (HRs, 95% CIs), and preventable death attributable to each risk factor, were calculated.

Results: After 533 309 person-years, 7060 deaths occurred: 4178 (10.8%) of non-diabetic non-opiate users, 757 (25.3%) diabetic non-users, 1906 (24.0%) non-diabetic opiate users and 219 (39.8%) diabetic opiate users. Compared with non-diabetic non-users, HRs (95% CIs) for all-cause mortality were 2.17 (2.00-2.35) in diabetic non-opiate users, 1.63 (1.53-1.74) in non-diabetic opiate users and 2.76 (2.40-3.17) in diabetic opiate users. Among those who both had diabetes and used opiates, 63.8% (95% CI: 58.3%-68.5%) of all deaths were attributable to these risk factors, compared with 53.9% (95% CI: 50%-57.4%) in people who only had diabetes and 38.7% (95% CI: 34.6%-42.5%) in non-diabetic opiate users. Diabetes was more strongly associated with cardiovascular than cancer mortality. The risk of early mortality in known cases of diabetes did not depend on whether they started opiate use before or after their diagnosis.

Conclusions: Using opiates is detrimental to the health of diabetic patients. Public awareness about the health effects of opiates, and improvement of diabetes care especially among individuals with or at risk of opiate use, are necessary.
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http://dx.doi.org/10.1093/ije/dyaa126DOI Listing
August 2020

Vitamin D deficiency associated with reproductive factors in northern Iranian women: The PERSIAN Guilan Cohort Study (PGCS).

Clin Nutr ESPEN 2020 08 22;38:271-276. Epub 2020 Apr 22.

Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Background: One of the public health concerns is Vitamin D deficiency. The aim of this study was to determine the prevalence of vitamin D inadequacy and to determine its reproductive factor correlates in northern Iranian women.

Methods: This study, conducted on 5096 females aged 35-70 years. The study was based on data from PERSIAN Guilan Cohort Study (PGCS), a prospective, population-based cohort study in Guilan, Iran. History of reproductive and gynecologic factors, including age at menarche, age at first marriage, number of pregnancies or live births, age at first pregnancy, duration of breastfeeding, number of abortions, age and type of menopause status, use of oral contraceptives or hormone replacement therapy, history of hysterectomy, tubectomy or oophorectomy and history of gestational diabetes and hypertension was collected. Serum 25(OH) vitamin D was measured.

Results: The mean 25(OH)-D concentration was 21.78 ng/mL, and 53.5% of women had vitamin D inadequacy. The multivariate analyses revealed that younger age (36-45 years) [>66 years adjusted odds ratio (aOR) = 2.1, 95% CI 1.7-2.7, 56-65 years aOR = 1.7, 95% CI 1.3-2.1 and 46-55 years aOR = 1.4, 95% CI 1.1-1.7], not consuming oral contraceptives [aOR = 1.1, 95% CI 1.05-1.3] and pre-menopausal status [aOR = 1.4, 95% CI 1.2-1.6] were significantly independently associated with vitamin D inadequacy.

Conclusion: Vitamin D inadequacy is common in northern Iranian women. The reproductive factors that independently correlated with vitamin D statues are oral contraceptive consumption and menopausal statue.
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http://dx.doi.org/10.1016/j.clnesp.2020.03.022DOI Listing
August 2020

Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran.

Int J Health Policy Manag 2020 Jul 15. Epub 2020 Jul 15.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region.

Methods: We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models' discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level.

Results: After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766- 0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%).

Conclusion: Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women.
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http://dx.doi.org/10.34172/ijhpm.2020.103DOI Listing
July 2020

Household Fuel Use and the Risk of Gastrointestinal Cancers: The Golestan Cohort Study.

Environ Health Perspect 2020 06 17;128(6):67002. Epub 2020 Jun 17.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Three billion people burn nonclean fuels for household purposes. Limited evidence suggests a link between household fuel use and gastrointestinal (GI) cancers.

Objectives: We investigated the relationship between indoor burning of biomass, kerosene, and natural gas with the subsequent risk of GI cancers.

Methods: During the period 2004-2008, a total of 50,045 Iranian individuals 40-75 years of age were recruited to this prospective population-based cohort. Upon enrollment, validated data were collected on demographics, lifestyle, and exposures, including detailed data on lifetime household use of different fuels and stoves. The participants were followed through August 2018 with loss.

Results: During the follow-up, 962 participants developed GI cancers. In comparison with using predominantly gas in the recent 20-y period, using predominantly biomass was associated with higher risks of esophageal [hazard ratio (HR): 1.89; 95% confidence interval (CI): 1.02, 3.50], and gastric HR: 1.83; 95% CI: 1.01, 3.31) cancers, whereas using predominantly kerosene was associated with higher risk of esophageal cancer (HR: 1.84; 95% CI: 1.10, 3.10). Lifetime duration of biomass burning for both cooking and house heating (exclusive biomass usage) using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.14; 95% CI: 1.07, 1.21), esophageal (10-y HR: 1.19; 95% CI: 1.08, 1.30), gastric (10-y HR: 1.11; 95% CI: 1.00, 1.23), and colon (10-y HR: 1.26; 95% CI: 1.03, 1.54) cancers. The risks of GI cancers combined, esophageal cancer, and gastric cancer were lower when biomass was burned using chimney-equipped heating-stoves (strata difference , 0.003, and 0.094, respectively). Duration of exclusive kerosene burning using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.05; 95% CI: 1.00, 1.11), and esophageal cancer (10-y HR: 1.14; 95% CI: 1.04, 1.26).

Discussion: Household burning of biomass or kerosene, especially without a chimney, was associated with higher risk of some digestive cancers. Using chimney-equipped stoves and replacing these fuels with natural gas may be useful interventions to reduce the burden of GI cancers worldwide. https://doi.org/10.1289/EHP5907.
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http://dx.doi.org/10.1289/EHP5907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299082PMC
June 2020

Opium use and subsequent incidence of cancer: results from the Golestan Cohort Study.

Lancet Glob Health 2020 05;8(5):e649-e660

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Evidence is emerging for a role of opiates in various cancers. In this study, we aimed to investigate the association between regular opium use and cancer incidence.

Methods: This study was done in a population-based cohort of 50 045 individuals aged 40-75 years from northeast Iran. Data on participant demographics, diet, lifestyle, opium use, and different exposures were collected upon enrolment using validated questionnaires. We used proportional hazards regression models to estimate hazard ratios (HRs) and corresponding 95% CIs for the association between opium use and different cancer types.

Findings: During a median 10 years of follow-up, 1833 participants were diagnosed with cancer. Use of opium was associated with an increased risk of developing all cancers combined (HR 1·40, 95% CI 1·24-1·58), gastrointestinal cancers (1·31, 1·11-1·55), and respiratory cancers (2·28, 1·58-3·30) in a dose-dependent manner (p<0·001). For site-specific cancers, use of opium was associated with an increased risk of developing oesophageal (1·38, 1·06-1·80), gastric (1·36, 1·03-1·79), lung (2·21, 1·44-3·39), bladder (2·86, 1·47-5·55), and laryngeal (2·53, 1·21-5·29) cancers in a dose-dependent manner (p<0·05). Only high-dose opium use was associated with pancreatic cancer (2·66, 1·23-5·74). Ingestion of opium (but not smoking opium) was associated with brain (2·15, 1·00-4·63) and liver (2·46, 1·23-4·95) cancers in a dose-dependent manner (p<0·01). We observed consistent associations among ever and never tobacco users, men and women, and individuals with lower and higher socioeconomic status.

Interpretation: Opium users have a significantly higher risk of developing cancers in different organs of the respiratory, digestive, and urinary systems and the CNS. The results of this analysis show that regular use of opiates might increase the risk of a range of cancer types.

Funding: World Cancer Research Fund International, Cancer Research UK, Tehran University of Medical Sciences, US National Cancer Institute, International Agency for Research on Cancer.
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http://dx.doi.org/10.1016/S2214-109X(20)30059-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196888PMC
May 2020

The survival rate of hepatocellular carcinoma in Asian countries: a systematic review and meta-analysis.

EXCLI J 2020 13;19:108-130. Epub 2020 Jan 13.

GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Hepatocellular carcinoma or Liver cancer (LC) is the sixth most common cancer and the fourth cause of death worldwide in 2018. There has not been a comprehensive study on the survival rate of patients with LC in Asia yet. Therefore, the present study was conducted to evaluate the survival rate of patients with LC in Asian countries. The methodology of the present study is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. The researchers searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until July 1, 2018. We also searched Google Scholar for detecting grey literature. The Newcastle-Ottawa Quality Assessment Form was used to evaluate the quality of selected papers. A total of 1425 titles were retrieved. 63 studies met the inclusion criteria. Based on the random-effect model one-year, three-year and five-year survival rate of LC were 34.8 % (95 % CI; 30.3-39.3), 19 % (95 % CI ; 18.2-21.8) and 18.1 % (95 % CI ;16.1-20.1) respectively. According to the results of our study, the LC survival rate in Asian countries is relatively lower than in Europe and North America.
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http://dx.doi.org/10.17179/excli2019-1842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003639PMC
January 2020

Opiate and Tobacco Use and Exposure to Carcinogens and Toxicants in the Golestan Cohort Study.

Cancer Epidemiol Biomarkers Prev 2020 03 8;29(3):650-658. Epub 2020 Jan 8.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Background: There is little information on human exposure to carcinogens and other toxicants related to opiate use, alone or in combination with tobacco.

Methods: Among male participants of the Golestan Cohort Study in Northeast Iran, we studied 28 never users of either opiates or tobacco, 33 exclusive cigarette smokers, 23 exclusive users of smoked opiates, and 30 opiate users who also smoked cigarettes (dual users; 21 smoked opiates and 9 ingested them). We quantified urinary concentrations of 39 exposure biomarkers, including tobacco alkaloids, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC), and used decomposition to parse out the share of the biomarker concentrations explained by opiate use and nicotine dose.

Results: Dual users had the highest concentrations of all biomarkers, but exclusive cigarette smokers and exclusive opiate users had substantially higher concentrations of PAH and VOC biomarkers than never users of either product. Decomposition analysis showed that opiate use contributed a larger part of the PAH concentrations than nicotine dose, and the sum of 2- and 3-hydroxyphenanthrene (∑-phe) resulted almost completely from opiate use. Concentrations of most VOC biomarkers were explained by both nicotine dose and opiate use. Two acrylamide metabolites, a 1,3-butadiene metabolite and a dimethylformamide metabolite, were more strongly explained by opiate use. Acrylamide metabolites and ∑-phe were significantly higher in opiate smokers than opiate eaters; other biomarkers did not vary by the route of opiate intake.

Conclusions: Both cigarette smokers and opiate users (by smoking or ingestion) were exposed to many toxicants and carcinogens.

Impact: This high exposure, particularly among dual opiate and cigarette users, can have a substantial global public health impact.
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http://dx.doi.org/10.1158/1055-9965.EPI-19-1212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839071PMC
March 2020

Celiac Crisis in a Young Woman: Raising Awareness of a Life-Threatening Condition.

Middle East J Dig Dis 2019 Oct 5;11(4):230-233. Epub 2019 Nov 5.

Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.

Celiac crisis is a rare, acute, and life-threatening presentation of celiac disease. Its clinical presentations consist of severe watery non-bloody diarrhea, electrolyte disturbances (i.e. hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and metabolic acidosis), hypoproteinemia, and dehydration. Here we present a 33-year-old woman who referred with profuse diarrhea, weight loss, hemodynamic instability, hypokalemia, hypoproteinemia, ascites, pancytopenia, and iron deficiency anemia. She used herbal medicines for constipation and had severe weakness after her childbirth. The patient was diagnosed as having celiac disease through pathological and serological evaluations 10 months earlier. Diagnosis of celiac crisis after ruling out the other causes of resistant celiac was made and she was treated with steroids.
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http://dx.doi.org/10.15171/mejdd.2019.154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895852PMC
October 2019

Oral microbial community composition is associated with pancreatic cancer: A case-control study in Iran.

Cancer Med 2020 01 21;9(2):797-806. Epub 2019 Nov 21.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Oral microbiota may be related to pancreatic cancer risk because periodontal disease, a condition linked to multiple specific microbes, has been associated with increased risk of pancreatic cancer. We evaluated the association between oral microbiota and pancreatic cancer in Iran.

Methods: A total of 273 pancreatic adenocarcinoma cases and 285 controls recruited from tertiary hospitals and a specialty clinic in Tehran, Iran provided saliva samples and filled out a questionnaire regarding demographics and lifestyle characteristics. DNA was extracted from saliva and the V4 region of the 16S rRNA gene was PCR amplified and sequenced on the MiSeq. The sequencing data were processed using the DADA2 plugin in QIIME 2 and taxonomy was assigned against the Human Oral Microbiome Database. Logistic regression and MiRKAT models were calculated with adjustment for potential confounders.

Results: No association was observed for alpha diversity with an average of 91.11 (standard deviation [SD] 2.59) sequence variants for cases and 89.42 (SD 2.58) for controls. However, there was evidence for an association between beta diversity and case status. The association between the Bray-Curtis dissimilarity and pancreatic cancer was particularly strong with a MiRKAT P-value of .000142 and specific principal coordinate vectors had strong associations with cancer risk. Several specific taxa were also associated with case status after adjustment for multiple comparisons.

Conclusion: The overall microbial community appeared to differ between pancreatic cancer cases and controls. Whether these reflect differences evident before development of pancreatic cancer will need to be evaluated in prospective studies.
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http://dx.doi.org/10.1002/cam4.2660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970053PMC
January 2020

A Case-Control Study of Breast Cancer in Northeast of Iran: The Golestan Cohort Study.

Arch Iran Med 2019 07 1;22(7):355-360. Epub 2019 Jul 1.

Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.

Background: The incidence and survival of breast cancer (BC) vary across countries. This study aimed to determine risk factors for BC and estimate the overall survival rate in BC patients of the Golestan Cohort Study (GCS).

Methods: This case-control study was performed among participants of the GCS. Cases (N = 99) consisted of women who were diagnosed with BC and controls (n = 400) were selected out of women participating in the same cohort and had not developed any cancer during the follow-up period. Controls were frequency matched to case on both place of residency and 5-year categories of age.

Results: Considering confounding variables, logistic regression analysis manifested a reverse association between parity and BC (OR [odds ratio] = 0.87, 95% CI: 0.80-0.95, P = 0.001). In addition, we found women who had family history of any cancer (OR = 1.63, 95% CI: 1.02-2.60, P = 0.04) and long term oral contraceptive (OCP) use (≥10 years) (OR = 3.17, 95% CI: 1.27-7.95, P = 0.01) were at higher risk of BC. Of the total patients, 23 (23.2%) were died due to BC after a mean follow-up of 102.4 ± 5.31 months. Using the Kaplan-Meier analysis, the 5-year survival in these patients was 74%.

Conclusion: In the Golestan Cohort population, long term OCP use and family history of cancer were risk factors for BC, while parity was a protective factor. The 5-year survival of BC patients in the GCS is still lower relative to Europe and the United States.
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July 2019

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

Authors:
Christina Fitzmaurice Degu Abate Naghmeh Abbasi Hedayat Abbastabar Foad Abd-Allah Omar Abdel-Rahman Ahmed Abdelalim Amir Abdoli Ibrahim Abdollahpour Abdishakur S M Abdulle Nebiyu Dereje Abebe Haftom Niguse Abraha Laith Jamal Abu-Raddad Ahmed Abualhasan Isaac Akinkunmi Adedeji Shailesh M Advani Mohsen Afarideh Mahdi Afshari Mohammad Aghaali Dominic Agius Sutapa Agrawal Ayat Ahmadi Elham Ahmadian Ehsan Ahmadpour Muktar Beshir Ahmed Mohammad Esmaeil Akbari Tomi Akinyemiju Ziyad Al-Aly Assim M AlAbdulKader Fares Alahdab Tahiya Alam Genet Melak Alamene Birhan Tamene T Alemnew Kefyalew Addis Alene Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Fatemeh Allah Bakeshei Majid Abdulrahman Hamad Almadi Amir Almasi-Hashiani Ubai Alsharif Shirina Alsowaidi Nelson Alvis-Guzman Erfan Amini Saeed Amini Yaw Ampem Amoako Zohreh Anbari Nahla Hamed Anber Catalina Liliana Andrei Mina Anjomshoa Fereshteh Ansari Ansariadi Ansariadi Seth Christopher Yaw Appiah Morteza Arab-Zozani Jalal Arabloo Zohreh Arefi Olatunde Aremu Habtamu Abera Areri Al Artaman Hamid Asayesh Ephrem Tsegay Asfaw Alebachew Fasil Ashagre Reza Assadi Bahar Ataeinia Hagos Tasew Atalay Zerihun Ataro Suleman Atique Marcel Ausloos Leticia Avila-Burgos Euripide F G A Avokpaho Ashish Awasthi Nefsu Awoke Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Henok Tadesse Ayele Ebrahim Babaee Umar Bacha Alaa Badawi Mojtaba Bagherzadeh Eleni Bagli Senthilkumar Balakrishnan Abbas Balouchi Till Winfried Bärnighausen Robert J Battista Masoud Behzadifar Meysam Behzadifar Bayu Begashaw Bekele Yared Belete Belay Yaschilal Muche Belayneh Kathleen Kim Sachiko Berfield Adugnaw Berhane Eduardo Bernabe Mircea Beuran Nickhill Bhakta Krittika Bhattacharyya Belete Biadgo Ali Bijani Muhammad Shahdaat Bin Sayeed Charles Birungi Catherine Bisignano Helen Bitew Tone Bjørge Archie Bleyer Kassawmar Angaw Bogale Hunduma Amensisa Bojia Antonio M Borzì Cristina Bosetti Ibrahim R Bou-Orm Hermann Brenner Jerry D Brewer Andrey Nikolaevich Briko Nikolay Ivanovich Briko Maria Teresa Bustamante-Teixeira Zahid A Butt Giulia Carreras Juan J Carrero Félix Carvalho Clara Castro Franz Castro Ferrán Catalá-López Ester Cerin Yazan Chaiah Wagaye Fentahun Chanie Vijay Kumar Chattu Pankaj Chaturvedi Neelima Singh Chauhan Mohammad Chehrazi Peggy Pei-Chia Chiang Tesfaye Yitna Chichiabellu Onyema Greg Chido-Amajuoyi Odgerel Chimed-Ochir Jee-Young J Choi Devasahayam J Christopher Dinh-Toi Chu Maria-Magdalena Constantin Vera M Costa Emanuele Crocetti Christopher Stephen Crowe Maria Paula Curado Saad M A Dahlawi Giovanni Damiani Amira Hamed Darwish Ahmad Daryani José das Neves Feleke Mekonnen Demeke Asmamaw Bizuneh Demis Birhanu Wondimeneh Demissie Gebre Teklemariam Demoz Edgar Denova-Gutiérrez Afshin Derakhshani Kalkidan Solomon Deribe Rupak Desai Beruk Berhanu Desalegn Melaku Desta Subhojit Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Mesfin Tadese Tadese Dinberu Shirin Djalalinia David Teye Doku Thomas M Drake Manisha Dubey Eleonora Dubljanin Eyasu Ejeta Duken Hedyeh Ebrahimi Andem Effiong Aziz Eftekhari Iman El Sayed Maysaa El Sayed Zaki Shaimaa I El-Jaafary Ziad El-Khatib Demelash Abewa Elemineh Hajer Elkout Richard G Ellenbogen Aisha Elsharkawy Mohammad Hassan Emamian Daniel Adane Endalew Aman Yesuf Endries Babak Eshrati Ibtihal Fadhil Vahid Fallah Omrani Mahbobeh Faramarzi Mahdieh Abbasalizad Farhangi Andrea Farioli Farshad Farzadfar Netsanet Fentahun Eduarda Fernandes Garumma Tolu Feyissa Irina Filip Florian Fischer James L Fisher Lisa M Force Masoud Foroutan Marisa Freitas Takeshi Fukumoto Neal D Futran Silvano Gallus Fortune Gbetoho Gankpe Reta Tsegaye Gayesa Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Getnet Azeze Gedefaw Belayneh K Gelaw Birhanu Geta Sefonias Getachew Kebede Embaye Gezae Mansour Ghafourifard Alireza Ghajar Ahmad Ghashghaee Asadollah Gholamian Paramjit Singh Gill Themba T G Ginindza Alem Girmay Muluken Gizaw Ricardo Santiago Gomez Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Ayman Grada Maximiliano Ribeiro Guerra Andre Luiz Sena Guimaraes Prakash C Gupta Rahul Gupta Kishor Hadkhale Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Lolemo Kelbiso Hanfore Josep Maria Haro Milad Hasankhani Amir Hasanzadeh Hamid Yimam Hassen Roderick J Hay Simon I Hay Andualem Henok Nathaniel J Henry Claudiu Herteliu Hagos D Hidru Chi Linh Hoang Michael K Hole Praveen Hoogar Nobuyuki Horita H Dean Hosgood Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohammedaman Mama Hussen Bogdan Ileanu Milena D Ilic Kaire Innos Seyed Sina Naghibi Irvani Kufre Robert Iseh Sheikh Mohammed Shariful Islam Farhad Islami Nader Jafari Balalami Morteza Jafarinia Leila Jahangiry Mohammad Ali Jahani Nader Jahanmehr Mihajlo Jakovljevic Spencer L James Mehdi Javanbakht Sudha Jayaraman Sun Ha Jee Ensiyeh Jenabi Ravi Prakash Jha Jost B Jonas Jitendra Jonnagaddala Tamas Joo Suresh Banayya Jungari Mikk Jürisson Ali Kabir Farin Kamangar André Karch Narges Karimi Ansar Karimian Amir Kasaeian Gebremicheal Gebreslassie Kasahun Belete Kassa Tesfaye Dessale Kassa Mesfin Wudu Kassaw Anil Kaul Peter Njenga Keiyoro Abraham Getachew Kelbore Amene Abebe Kerbo Yousef Saleh Khader Maryam Khalilarjmandi Ejaz Ahmad Khan Gulfaraz Khan Young-Ho Khang Khaled Khatab Amir Khater Maryam Khayamzadeh Maryam Khazaee-Pool Salman Khazaei Abdullah T Khoja Mohammad Hossein Khosravi Jagdish Khubchandani Neda Kianipour Daniel Kim Yun Jin Kim Adnan Kisa Sezer Kisa Katarzyna Kissimova-Skarbek Hamidreza Komaki Ai Koyanagi Kristopher J Krohn Burcu Kucuk Bicer Nuworza Kugbey Vivek Kumar Desmond Kuupiel Carlo La Vecchia Deepesh P Lad Eyasu Alem Lake Ayenew Molla Lakew Dharmesh Kumar Lal Faris Hasan Lami Qing Lan Savita Lasrado Paolo Lauriola Jeffrey V Lazarus James Leigh Cheru Tesema Leshargie Yu Liao Miteku Andualem Limenih Stefan Listl Alan D Lopez Platon D Lopukhov Raimundas Lunevicius Mohammed Madadin Sameh Magdeldin Hassan Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Ali Manafi Navid Manafi Wondimu Ayele Manamo Morteza Mansourian Mohammad Ali Mansournia Lorenzo Giovanni Mantovani Saman Maroufizadeh Santi Martini S Martini Tivani Phosa Mashamba-Thompson Benjamin Ballard Massenburg Motswadi Titus Maswabi Manu Raj Mathur Colm McAlinden Martin McKee Hailemariam Abiy Alemu Meheretu Ravi Mehrotra Varshil Mehta Toni Meier Yohannes A Melaku Gebrekiros Gebremichael Meles Hagazi Gebre Meles Addisu Melese Mulugeta Melku Peter T N Memiah Walter Mendoza Ritesh G Menezes Shahin Merat Tuomo J Meretoja Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Kebadnew Mulatu M Mihretie Ted R Miller Edward J Mills Seyed Mostafa Mir Hamed Mirzaei Hamid Reza Mirzaei Rashmi Mishra Babak Moazen Dara K Mohammad Karzan Abdulmuhsin Mohammad Yousef Mohammad Aso Mohammad Darwesh Abolfazl Mohammadbeigi Hiwa Mohammadi Moslem Mohammadi Mahdi Mohammadian Abdollah Mohammadian-Hafshejani Milad Mohammadoo-Khorasani Reza Mohammadpourhodki Ammas Siraj Mohammed Jemal Abdu Mohammed Shafiu Mohammed Farnam Mohebi Ali H Mokdad Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Maryam Moossavi Ghobad Moradi Mohammad Moradi-Joo Maziar Moradi-Lakeh Farhad Moradpour Lidia Morawska Joana Morgado-da-Costa Naho Morisaki Shane Douglas Morrison Abbas Mosapour Seyyed Meysam Mousavi Achenef Asmamaw Muche Oumer Sada S Muhammed Jonah Musa Ashraf F Nabhan Mehdi Naderi Ahamarshan Jayaraman Nagarajan Gabriele Nagel Azin Nahvijou Gurudatta Naik Farid Najafi Luigi Naldi Hae Sung Nam Naser Nasiri Javad Nazari Ionut Negoi Subas Neupane Polly A Newcomb Haruna Asura Nggada Josephine W Ngunjiri Cuong Tat Nguyen Leila Nikniaz Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Shirin Nosratnejad Malihe Nourollahpour Shiadeh Mohammed Suleiman Obsa Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Mojisola Morenike Oluwasanu Abidemi E Omonisi Obinna E Onwujekwe Anu Mary Oommen Eyal Oren Doris D V Ortega-Altamirano Erika Ota Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Jagadish Rao Padubidri Smita Pakhale Amir H Pakpour Adrian Pana Eun-Kee Park Hadi Parsian Tahereh Pashaei Shanti Patel Snehal T Patil Alyssa Pennini David M Pereira Cristiano Piccinelli Julian David Pillay Majid Pirestani Farhad Pishgar Maarten J Postma Hadi Pourjafar Farshad Pourmalek Akram Pourshams Swayam Prakash Narayan Prasad Mostafa Qorbani Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Mahdi Rahimi Muhammad Aziz Rahman Fatemeh Rajati Saleem M Rana Samira Raoofi Goura Kishor Rath David Laith Rawaf Salman Rawaf Robert C Reiner Andre M N Renzaho Nima Rezaei Aziz Rezapour Ana Isabel Ribeiro Daniela Ribeiro Luca Ronfani Elias Merdassa Roro Gholamreza Roshandel Ali Rostami Ragy Safwat Saad Parisa Sabbagh Siamak Sabour Basema Saddik Saeid Safiri Amirhossein Sahebkar Mohammad Reza Salahshoor Farkhonde Salehi Hosni Salem Marwa Rashad Salem Hamideh Salimzadeh Joshua A Salomon Abdallah M Samy Juan Sanabria Milena M Santric Milicevic Benn Sartorius Arash Sarveazad Brijesh Sathian Maheswar Satpathy Miloje Savic Monika Sawhney Mehdi Sayyah Ione J C Schneider Ben Schöttker Mario Sekerija Sadaf G Sepanlou Masood Sepehrimanesh Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Hosein Shabaninejad Mohammad Shahbaz Masood Ali Shaikh Amir Shamshirian Morteza Shamsizadeh Heidar Sharafi Zeinab Sharafi Mehdi Sharif Ali Sharifi Hamid Sharifi Rajesh Sharma Aziz Sheikh Reza Shirkoohi Sharvari Rahul Shukla Si Si Soraya Siabani Diego Augusto Santos Silva Dayane Gabriele Alves Silveira Ambrish Singh Jasvinder A Singh Solomon Sisay Freddy Sitas Eugène Sobngwi Moslem Soofi Joan B Soriano Vasiliki Stathopoulou Mu'awiyyah Babale Sufiyan Rafael Tabarés-Seisdedos Takahiro Tabuchi Ken Takahashi Omid Reza Tamtaji Mohammed Rasoul Tarawneh Segen Gebremeskel Tassew Parvaneh Taymoori Arash Tehrani-Banihashemi Mohamad-Hani Temsah Omar Temsah Berhe Etsay Tesfay Fisaha Haile Tesfay Manaye Yihune Teshale Gizachew Assefa Tessema Subash Thapa Kenean Getaneh Tlaye Roman Topor-Madry Marcos Roberto Tovani-Palone Eugenio Traini Bach Xuan Tran Khanh Bao Tran Afewerki Gebremeskel Tsadik Irfan Ullah Olalekan A Uthman Marco Vacante Maryam Vaezi Patricia Varona Pérez Yousef Veisani Simone Vidale Francesco S Violante Vasily Vlassov Stein Emil Vollset Theo Vos Kia Vosoughi Giang Thu Vu Isidora S Vujcic Henry Wabinga Tesfahun Mulatu Wachamo Fasil Shiferaw Wagnew Yasir Waheed Fitsum Weldegebreal Girmay Teklay Weldesamuel Tissa Wijeratne Dawit Zewdu Wondafrash Tewodros Eshete Wonde Adam Belay Wondmieneh Hailemariam Mekonnen Workie Rajaram Yadav Abbas Yadegar Ali Yadollahpour Mehdi Yaseri Vahid Yazdi-Feyzabadi Alex Yeshaneh Mohammed Ahmed Yimam Ebrahim M Yimer Engida Yisma Naohiro Yonemoto Mustafa Z Younis Bahman Yousefi Mahmoud Yousefifard Chuanhua Yu Erfan Zabeh Vesna Zadnik Telma Zahirian Moghadam Zoubida Zaidi Mohammad Zamani Hamed Zandian Alireza Zangeneh Leila Zaki Kazem Zendehdel Zerihun Menlkalew Zenebe Taye Abuhay Zewale Arash Ziapour Sanjay Zodpey Christopher J L Murray

JAMA Oncol 2019 12;5(12):1749-1768

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial.

Lancet 2019 08;394(10199):672-683

Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreaticobiliary Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease.

Methods: The PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40-75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle-eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome-occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)-was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985.

Findings: Between Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study-3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5%) of 3421 participants in the polypill group were women, as were 1679 (49·1%) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5% (IQR 48·5-92·2). During follow-up, 301 (8·8%) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9%) of 3421 participants in the polypill group (adjusted hazard ratio [HR] 0·66, 95% CI 0·55-0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49-0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51-1·12; p=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33-0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up-ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group.

Interpretation: Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs.

Funding: Tehran University of Medical Sciences, Barakat Foundation, and Alborz Darou.
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http://dx.doi.org/10.1016/S0140-6736(19)31791-XDOI Listing
August 2019

Comparing Anthropometric Indicators of Visceral and General Adiposity as Determinants of Overall and Cardiovascular Mortality.

Arch Iran Med 2019 06 1;22(6):301-309. Epub 2019 Jun 1.

Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: It is unclear which anthropometric obesity indicator best predicts adverse health outcomes. This study aimed to investigate the association of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and hip-adjusted WC with all-cause and cardiovascular mortality.

Methods: 50045 people aged 40-75 (58% women, median BMI: 26.3 kg /m2 ) participated in the population-based Golestan Cohort Study. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for the association of obesity indicators with mortality. We also examined the association of these indicators with intermediate outcomes, including hypertension, blood glucose, dyslipidemia, carotid atherosclerosis, nonalcoholic fatty liver, and visceral abdominal fat.

Results: After a median follow-up of 10.9 years (success rate: 99.1%), 6651 deaths (2778 cardiovascular) occurred. Comparing 5th to the 1st quintile, HRs (95% CIs) for all-cause and cardiovascular mortality were 1.12 (1.02-1.22) and 1.59 (1.39-1.83) for BMI, 1.16 (1.07-1.27) and 1.66 (1.44-1.90) for WC, 1.28 (1.17-1.40) and 1.88 (1.63-2.18) for WHtR, 1.44 (1.32-1.58) and 2.04 (1.76-2.36) for WHR, and 1.84 (1.62-2.09) and 2.72 (2.23-3.32) for hip-adjusted WC, respectively. Hip-adjusted WC had the strongest associations with the intermediate outcomes.

Conclusion: Indicators of visceral adiposity (e.g., hip-adjusted WC) were much stronger predictors of overall and cardiovascular mortality than were indicators of general adiposity (e.g., BMI). The full-strength effect of visceral adiposity becomes apparent only when both WC, as a risk factor, and hip circumference, as a protective factor, are individually and simultaneously taken into consideration.
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June 2019

Gastrointestinal symptoms in patients with diabetes mellitus and non-diabetic: A cross-sectional study in north of Iran.

Diabetes Metab Syndr 2019 May - Jun;13(3):2236-2240. Epub 2019 May 25.

GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran; Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Background And Aim: Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM), which involved in high cost of health care and low quality of life. The aim of this study to investigate the prevalence of GI symptoms in diabetic patients referred to the Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences (Rasht, Iran) using a validated questionnaire.

Methods: In this descriptive, cross-sectional study, 255 diabetic patients and 255 non-diabetic subjects were recruited. Participants were randomly selected. The questionnaire recorded GI symptoms among the study population.

Results: GI symptoms were reported in 91.4% of diabetic patients, and 42.1% of them were male. The common GI symptoms in diabetic patients were flatulence (33.0%), followed by retrosternal pain (14.9%), belching (13.7%), postprandial fullness (12.5%), and constipation (11.4%). Retrosternal pain, constipation, flatulence, loss of appetite, and abdominal distention were more prevalent in diabetic women than men.

Conclusions: DM is associated with high prevalence rate of upper and lower GI symptoms. This effect may be linked to gender and poor glycemic control in diabetic patients, but not to type and duration of diabetes.
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http://dx.doi.org/10.1016/j.dsx.2019.05.028DOI Listing
December 2019

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of total and cause-specific mortality: results from the Golestan Cohort Study.

Int J Epidemiol 2019 12;48(6):1824-1838

Departments of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: To evaluate the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and overall and cause-specific mortality in the Golestan Cohort Study (GCS).

Methods: A total of 50 045 participants aged 40 years or older were recruited from Golestan Province, Iran, from 2004 to 2008 and followed for a mean of 10.64 years. The DASH diet score was calculated for each individual based on food groups. The primary outcome measure was death from any cause.

Results: During 517 326 person-years of follow-up, 6763 deaths were reported. After adjustment for potential confounders, DASH diet score was inversely associated with risk of death from all causes and cancers [hazard ratio (HR): 0.86; 95% confidence interval (CI): 0.75, 0.98; and HR: 0.65; 95% CI: 0.47, 0.90, respectively]. A higher DASH diet score was associated with lower risk of gastrointestinal cancer mortality in men (HR: 0.55; 95% CI: 0.30, 0.99). A greater adherence to DASH diet was also associated with lower other-cancer mortality in women (HR: 0.50; 95% CI: 0.24, 0.99). No association between DASH diet score and cardiovascular disease mortality was observed, except that those dying of cardiovascular disease were younger than 50 years of age and smokers.

Conclusions: Our findings suggest that maintaining a diet similar to the DASH diet is independently associated with reducing the risk of total death, cancers, and especially gastrointestinal cancers in men.
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http://dx.doi.org/10.1093/ije/dyz079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929526PMC
December 2019

An Increased Level of Aryl Hydrocarbon Receptor in Patients with Pancreatic Cancer.

Middle East J Dig Dis 2019 Jan 4;11(1):38-44. Epub 2018 Oct 4.

Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND Aryl-carbon receptor (AhR), a ligand-activated transcription factor, is best known for its ability to mediate the effects of environmental toxins such as 2,3,7,8-tetrachlorodibenzo-p-dioxin. AhR is expressed in several tumor cells and regulates the expression of genes in the signal transduction pathways. In this study, we examined the soluble levels of AhR in patients with pancreatic cancer. METHODS 123 samples, including 59 (48%) samples of pancreatic ductal adenocarcinoma based on histological evidence and 64 (52%) healthy control samples, were evaluated to determine plasma levels of AhR by Enzyme-linked immunoassay. RESULTS The median of AhR among patients was 0.280 ng/mL, which differed considerably from 0.07 ng/mL in the control group ( < 0.001). Significant differences of the AhR were observed between the plasma samples of the patients compared with the healthy group, with respect to male sex ( < 0.001), age groups ( = 0.001), diabetic status ( < 0.001), body mass index (BMI) categories ( = 0.035), and constantly smokers ( < 0.001). We also observed significant differences between the level of AhR expression between men and women ( = 0.01) and ever to never smokers ( = 0.009) in the case group. In addition, the age of 65 and a BMI of 25 or less were significant factors in plasma AhR levels ([1.61 95%CI 1.08-2.38] and [1.84 95%CI 1.22-2.77], respectively). CONCLUSION The results of this study can add diagnostic information to pancreatic cancer involving AhR and the potential efficacy of this receptor in therapeutic strategies.
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http://dx.doi.org/10.15171/mejdd.2018.126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488497PMC
January 2019

A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma.

Int J Cancer 2020 01 20;146(1):18-25. Epub 2019 Mar 20.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Previous studies have reported an association between hot tea drinking and risk of esophageal cancer, but no study has examined this association using prospectively and objectively measured tea drinking temperature. We examined the association of tea drinking temperature, measured both objectively and subjectively at study baseline, with future risk of esophageal squamous cell carcinoma (ESCC) in a prospective study. We measured tea drinking temperature using validated methods and collected data on several other tea drinking habits and potential confounders of interest at baseline in the Golestan Cohort Study, a population-based prospective study of 50,045 individuals aged 40-75 years, established in 2004-2008 in northeastern Iran. Study participants were followed-up for a median duration of 10.1 years (505,865 person-years). During 2004-2017, 317 new cases of ESCC were identified. The objectively measured tea temperature (HR 1.41, 95% CI 1.10-1.81; for ≥60°C vs. <60°C), reported preference for very hot tea drinking (HR 2.41, 95% CI 1.27-4.56; for "very hot" vs. "cold/lukewarm"), and reported shorter time from pouring tea to drinking (HR 1.51, 95% CI 1.01-2.26; for <2 vs. ≥6 min) were all associated with ESCC risk. In analysis of the combined effects of measured temperature and amount, compared to those who drank less than 700 ml of tea/day at <60°C, drinking 700 mL/day or more at a higher-temperature (≥60°C) was consistently associated with an about 90% increase in ESCC risk. Our results substantially strengthen the existing evidence supporting an association between hot beverage drinking and ESCC.
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http://dx.doi.org/10.1002/ijc.32220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477845PMC
January 2020

The application of six dietary scores to a Middle Eastern population: a comparative analysis of mortality in a prospective study.

Eur J Epidemiol 2019 Apr 18;34(4):371-382. Epub 2019 Mar 18.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background The associations between dietary indices and mortality have not been evaluated in populations from the Middle East, which have different dietary patterns compared to the US and Europe. In this study, we evaluated the association between six dietary indices and mortality in the Golestan Cohort Study (GCS) in Iran, which is the largest prospective study in the Middle East with 50,045 participants. Methods The six dietary indices, namely the Healthy Eating Index (HEI-2015), Alternative Healthy Eating Index (AHEI-2010), Alternative Mediterranean Diet (AMED), Dietary Approach to Stop Hypertension created by Fung (DASH-Fung) and Mellen (DASH-Mellen), and the World Cancer Research Fund (WCRF/AICR) index, were applied to data from a food frequency questionnaire, computed and divided into quintiles. Adjusted Cox models were used to estimate hazards ratio (HR) and 95% confidence intervals (CI) for overall and cause-specific mortality, using the lowest quintile as a reference group. Results Among 42,373 participants included in the current analyses, 4424 subjects died during 10.6 years of follow-up. Participants with the highest quintile dietary scores, compared with the lowest quintile dietary scores, had significantly decreased overall mortality in the AHEI-2010, AMED, DASH-Fung, and WCRF/AICR indices (HR 0.88, 95% CI = 0.80-0.97; 0.80, 0.70-0.91; 0.77, 0.70-0.86; and 0.79, 0.70-0.90, respectively). A reduced cardiovascular mortality was found for high AHEI-2010 and DASH-Fung scores (17% and 23%, respectively), and a reduced cancer mortality for high HEI-2015, AMED, and DASH-Fung scores (21, 37 and 25%, respectively). Conclusion Various indices of dietary quality are inversely associated with overall mortality, and selectively with cancer and cardiovascular mortality in the GCS, which contribute to the generalizability and validity of dietary guidelines.
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http://dx.doi.org/10.1007/s10654-019-00508-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707799PMC
April 2019

Urinary Biomarkers of Carcinogenic Exposure among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study.

Cancer Epidemiol Biomarkers Prev 2019 02 8;28(2):337-347. Epub 2019 Jan 8.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland.

Background: How carcinogen exposure varies across users of different, particularly noncigarette, tobacco products remains poorly understood.

Methods: We randomly selected 165 participants of the Golestan Cohort Study from northeastern Iran: 60 never users of any tobacco, 35 exclusive cigarette, 40 exclusive (78% daily) waterpipe, and 30 exclusive smokeless tobacco (nass) users. We measured concentrations of 39 biomarkers of exposure in 4 chemical classes in baseline urine samples: tobacco alkaloids, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC). We also quantified the same biomarkers in a second urine sample, obtained 5 years later, among continuing cigarette smokers and never tobacco users.

Results: Nass users had the highest concentrations of tobacco alkaloids. All tobacco users had elevated TSNA concentrations, which correlated with nicotine dose. In both cigarette and waterpipe smokers, PAH and VOC biomarkers were higher than never tobacco users and nass users, and highly correlated with nicotine dose. PAH biomarkers of phenanthrene and pyrene and two VOC metabolites (phenylmercapturic acid and phenylglyoxylic acid) were higher in waterpipe smokers than in all other groups. PAH biomarkers among Golestan never tobacco users were comparable to those in U.S. cigarette smokers. All biomarkers had moderate to good correlations over 5 years, particularly in continuing cigarette smokers.

Conclusions: We observed two patterns of exposure biomarkers that differentiated the use of the combustible products (cigarettes and waterpipe) from the smokeless product. Environmental exposure from nontobacco sources appeared to contribute to the presence of high levels of PAH metabolites in the Golestan Cohort.

Impact: Most of these biomarkers would be useful for exposure assessment in a longitudinal study.
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http://dx.doi.org/10.1158/1055-9965.EPI-18-0743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935158PMC
February 2019

Individual and Combined Effects of Environmental Risk Factors for Esophageal Cancer Based on Results From the Golestan Cohort Study.

Gastroenterology 2019 Apr 3;156(5):1416-1427. Epub 2019 Jan 3.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background & Aims: Northeast Iran has one of the highest reported rates of esophageal squamous cell carcinoma (ESCC) worldwide. Decades of investigations in this region have identified some local habits and environmental exposures that increase risk. We analyzed data from the Golestan Cohort Study to determine the individual and combined effects of the major environmental risk factors of ESCC.

Methods: We performed a population-based cohort of 50,045 individuals, 40 to 75 years old, from urban and rural areas across Northeast Iran. Detailed data on demographics, diet, lifestyle, socioeconomic status, temperature of drinking beverages, and different exposures were collected using validated methods, questionnaires, and physical examinations, from 2004 through 2008. Participants were followed from the date of enrollment to the date of first diagnosis of esophageal cancer, date of death from other causes, or date of last follow-up, through December 31, 2017. Proportional hazards regression models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between different exposures and ESCC.

Results: During an average 10 years of follow-up, 317 participants developed ESCC. Opium smoking (HR 1.85; 95% CI 1.18-2.90), drinking hot tea (≥60°C) (HR 1.60; 95% CI 1.15-2.22), low intake of fruits (HR 1.48; 95% CI 1.07-2.05) and vegetables (HR 1.62; 95% CI 1.03-2.56), excessive tooth loss (HR 1.66; 95% CI 1.04-2.64), drinking unpiped water (HR 2.04; 95% CI 1.09-3.81), and exposure to indoor air pollution (HR 1.57; 95% CI 1.08-2.29) were significantly associated with increased risk of ESCC, in a dose-dependent manner. Combined exposure to these risk factors was associated with a stepwise increase in the risk of developing ESCC, reaching a more than 7-fold increase in risk in the highest category. Approximately 75% of the ESCC cases in this region can be attributed to a combination of the identified exposures.

Conclusions: Analysis of data from the Golestan Cohort Study in Iran identified multiple risk factors for ESCC in this population. Our findings support the hypothesis that the high rates of ESCC are due to a combination of factors, including thermal injury (from hot tea), exposure to polycyclic aromatic hydrocarbons (from opium and indoor air pollution), and nutrient-deficient diets. We also associated ESCC risk with exposure to unpiped water and tooth loss.
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http://dx.doi.org/10.1053/j.gastro.2018.12.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507680PMC
April 2019

Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran.

BMJ Open 2018 07 18;8(7):e021479. Epub 2018 Jul 18.

Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: To examine the causes of premature mortality (<70 years) and associated risk factors in the Golestan Cohort Study.

Design: Prospective.

Setting: The Golestan Cohort Study in northeastern Iran.

Participants: 50 045 people aged 40 or more participated in this population-based study from baseline (2004-2008) to August 2017, with over 99% success follow-up rate.

Main Outcome Measures: The top causes of premature death, HR and their 95% CI and population attributable fraction (PAF) for risk factors.

Results: After 444 168 person-years of follow-up (median of 10 years), 6347 deaths were reported, of which 4018 (63.3%) occurred prematurely. Ischaemic heart disease (IHD) accounted for 33.9% of premature death, followed by stroke (14.0%), road injuries (4.7%), stomach cancer (4.6%) and oesophageal cancer (4.6%). Significant risk/protective factors were: wealth score (HR for highest vs lowest quintile: 0.57, PAF for lowest four quintiles vs top quintile: 28%), physical activity (highest vs lowest tertile: 0.67, lowest two tertiles vs top tertile: 22%), hypertension (1.50, 19%), opium use (1.69, 14%), education (middle school or higher vs illiterate: 0.84, illiterate or primary vs middle school or higher: 13%), tobacco use (1.38, 11%), diabetes (2.39, 8%) and vegetable/fruit consumption (highest vs lowest tertile: 0.87, lowest two tertiles vs top tertile: 8%). Collectively, these factors accounted for 76% of PAF in men and 69% in women.

Conclusion: IHD and stroke are the leading causes of premature mortality in the Golestan Cohort Study. Enhancing socioeconomic status and physical activity, reducing opium and tobacco use, increasing vegetable/fruit consumption and controlling hypertension and diabetes are recommended to reduce premature deaths.
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http://dx.doi.org/10.1136/bmjopen-2018-021479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6059279PMC
July 2018

Cardiovascular mortality in a Western Asian country: results from the Iran Cohort Consortium.

BMJ Open 2018 07 5;8(7):e020303. Epub 2018 Jul 5.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Cardiovascular mortality in Western Asia is high and still rising. However, most data documented on risk prediction has been derived from Western countries and few population-based cohort studies have been conducted in this region. The current study aimed to present the process of pooling data and cardiovascular disease (CVD) mortality incidences for four Iranian cohorts.

Methods: From the Iran Cohort Consortium, the Golestan Cohort Study (GCS), Tehran Lipid and Glucose Study, Isfahan Cohort Study (ICS) and the Shahroud Eye Cohort Study (ShECS) were eligible for the current study since they had appropriate data and follow-up visits. Age-standardised CVD mortality rates were estimated for ages 40-80 and 40-65 years. Cox regression was used to compare mortalities among cohorts. Adjusted marginal rates were calculated using Poisson regression.

Results: Overall, 61 291 participants (34 880 women) aged 40-80 years, free of CVD at baseline, were included. During 504 606 person-years of follow-up, 1981 CVD deaths (885 women) occurred. Age-standardised/sex-standardised premature CVD mortality rates were estimated from 133 per 100 000 person-years (95% CI 81 to 184) in ShECS to 366 (95% CI 342 to 389) in the GCS. Compared with urban women, rural women had higher CVD mortality in the GCS but not in the ICS. The GCS population had a higher risk of CVD mortality, compared with the others, adjusted for conventional CVD risk factors.

Conclusions: The incidence of CVD mortality is high with some differences between urban and rural cohorts in Iran as a Western Asian country. Pooling data facilitates the opportunity to globally evaluate risk prediction models.
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http://dx.doi.org/10.1136/bmjopen-2017-020303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042599PMC
July 2018

Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study.

Br J Cancer 2018 07 28;119(2):176-181. Epub 2018 Jun 28.

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Nut consumption has been inversely associated with gastric cancer incidence in US-based studies, but not with oesophageal cancer. However, there is aetiologic heterogeneity, among oesophageal squamous cell carcinoma (ESCC) cases in low-risk vs. high-risk populations. The objective of this study was to evaluate the association between nut consumption and risk of ESCC in a high-risk population.

Methods: The Golestan Cohort Study enroled 50,045 participants in Northeastern Iran, between 2004 and 2008. Intake of peanuts, walnuts and mixed nuts (including seeds) were assessed using a validated food frequency questionnaire at baseline. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals for subsequent ESCC adjusted for potential confounders. Non-consumers of nuts were used as the reference category and the consumers were categorised into tertiles.

Results: We accrued 280 incident ESCC cases during 337,983 person-years of follow up. Individuals in the highest tertiles of total nut consumption, and mixed nut consumption were significantly associated with lower risk of developing ESCC compared to non-consumers (HR = 0.60, 95% CI = 0.39-0.93, p-trend = 0.02, and HR = 0.52, 95% CI = 0.32-0.84, p trend = 0.002, respectively).

Conclusions: We found a statistically significant inverse association between total nut consumption and the risk of ESCC in this high-risk population.
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http://dx.doi.org/10.1038/s41416-018-0148-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048068PMC
July 2018