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2. Relation between dietary macronutrient and fiber intake with metabolic syndrome in Tehranian adults: Tehran Lipid and Glucose Study Hosseinpour S, Mirmiran P, hosseinpanah F, Azizi F Obesity research center, Research Institute for Endocrine Science, Sahid Beheshti University of Medical Sciences

3. introduction Adult treatment panel (ATP) III guidelines  High serum triglyceride levels (TG≥150 mg/dl)  Low HDL-C (<40 mg/dl for men and <50 mg/dl for women)  Elevated blood pressure ( ≥130 and/or ≥85 mm Hg)  Abnormal glucose hemeostasis (FBG ≥100 mg/dl)  Abdominal obesity American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement Criteria of abdominal obesity were specified by nationality or ethnicity on best available population estimate *In men ≥89 cm In women ≥91 cm Grundy et al. Circulation 2005; 112 Delavari et al. Diabetes care 2009; 32: 1092

4. introduction (con`s) MetS Increased risk of developing :  Diabetes  Cardiovascular Disease  Chronic kidney Diesease  Cancer (breast, colorectal)  Stroke and cerebrovasculare disease(in Asia) Prevalence of MetS  In representative sample in Tehran 42% in women 24% in men  In nationwide study in 30 province 35.6% Three years follow-up 2% Metabolic syndrome is growing into a significant public health problem Azizi et al. Diabetes Res Clin Pract 2003; 61 Delavari et al. Diabetes Care 2009; 32

5. introduction (con`s) Attributable factor APOBrs12535 LTA rs915654 ACACB rs4766587 genetic diet Physical activity Smoking Environmental and behavior Metabolic syndrome Feldeisen et al. Appl Physiol Nutr Metab 2007; 32 Galisteo et al. J Nutr Biochem 2008; 19

6. objective Examines the cross-sectional associations between macronutrients and fiber intake With metabolic syndrome in Tehranian adults.

7. Materials and methods study design and sample Representative sample of district 13 of Tehran,Tehran lipid and glucose study, third examination : 15 005 Participants with complete FFQ data : 3 568 Exclusion criteria Diabetes, CVD (n=811) Reported energy intake 3500 Kcal/d (n=322) Age 55 (n=1000 ) Final population for analysis (n=1435)

8. Materials and methods (cont’) Assessment of criteria  Dietary intake FFQ (valid and reliable)  Anthropometric Weight, Height, Waist, Hip, BMI, WHR  Biochemical assessment FBG TG HDL-C  Medical history

9. Materials and methods (cont’) Statistical analysis Characteristic of participants were compared by sex using t test, and chi-square. logestic regression was used to study associations among quartile of macronutrient and fiber intakes with MetS, adjusted for age, smoking, energy intake and druge use, BMI and WHR. Odds Ratio of developing MetS were evaluate across quartile of macronutrients and fiber.

10. results

11. Baseline characteristics of the subject by sex. variable Male (n=632) Female (803) Age (y)36.8 ± 10.635.2 ± 10.9 Weight (kg)74.6 ± 13.8 66.8 ± 12.9 * BMI (kg/m 2 )26.8 ± 4.525.7 ± 5.2 Waist girth (cm)93.5 ± 10.8 83.5 ± 13.4 * WHR0.93 ± 0.06 0.81 ± 0.08 * Triglycerides (mg/dl)150 ± 94.9124 ± 81 * HDL-C (mg/dl)39.3 ± 9.4 46.1 ± 10.3 * Systolic blood pressure (mm Hg)113.3 ± 13.4105.5 ± 14.4 Diastolic blood pressure (mm Hg)74.5± 10.670.5 ± 10.3 Fasting blood sugar (mg/dl)90.4 ± 21.489.1 ± 22.8 Physical activity (MET_hr/Week)40.7± 61.832.3 ± 41.0* Current Estrol druge use (%)1.8%6% Metabolic syndrome (%)38.231.2* Smoking status(%) Non smoker Current smoker Ex-smoker 64 21.5 14.5 94 3.5 2.5 * Significantly different from male, P<0.05

12. Macronutrient and fiber intake in male and female participants. nutrients MaleFemale Energy (kcal/d) 2636±6962283±522* Carbohydrate g/d 387.3±199.8321±158* % of energy 58.6±7.256.4±7.5 Total fat g/d 88.3±44.083.6±45.0* % of energy 30.1±6.832.6±7.3 protein g/d 89.63±45.277.1±37.4* % of energy 13.6±2.513.6±2.6 fiber Total fiber (g/d) 44.5±32.136.3±24.0* Soluble fiber (g/d) 0.6±1.140.5±0.4 Insoluble fiber (g/d) 3.2±8.92.8±5.6 * Significantly different from male, P<0.05. § P=0.07

13. *significantly different from metabolic syndrome, P<0.05

14. Macronutrient and fiber intake by metabolic syndrome in male and female participants. Male(MetS)Female(MetS) nutrients YesNoYesNo Energy (kcal/d)2753±6072553±5782157±6282300±606 Carbohydrate g/d386.4±88.3 340±83.1 * 324±93 293±91 * % of energy66.5±6.9 57.8±6.9 * 58.5±6.9 50.1±7.0 * Total fat g/d85.1±29.389.2±26.181.2±33.184.7±29.1 % of energy30.1±6.830.8±6.730.1±6.833.9±6.9 protein g/d87.1±29.391.2±26.176.2±23.679.2±23.8 % of energy 13.5±2.113.6±2.313.6±2.113.5±2.1 Total fiber (g/d)43.1±19.646.2±19.828.6±19.9 37.5±15.5 § Soluble fiber (g/d)0.5±1.30.7±1.2.5±0.5.5±0.4 Insoluble fiber (g/d)2.3±1.53.9±8.72.7±1.72.9±1.8 * Significantly different from male, P<0.05. § P=0.07

15. Odds ratio and 95% confidence interval (CI) of having metabolic syndrome, by quartile of macronutrient intake based on data from third TLGS. malefemale nutrient1 234 P- value 1 23 4 Carbohydrate (g/d) Model I11.9(0.7-2.3)2.0(0.7-2.4)1.9(1.0-1.7)0.2711.9(0.6-2.2)1.9(0.7-2.3)1.8(0.7-2.1)0.75 Model II11.8(0.7-2.4)1.7(0.6-2.1)1.8(0.8-2.1)0.4011.8(0.4-2.2)1.7(0.6-1.9)1.8(0.4-1.9)0.23 Model III11.7(0.6-1..9)1.9(0.5-2.2)1.7(0.7-2.1)0.7811.8(0.5-2.6)1.0(0.6-2.9)1.7(0.4-2.4)0.40 Carbohydrate (% of energy) Model I11.6(1.4-2.8)1.7(1.5-2.9)1.8(1.6-1.9)0.0711.6(1.4-1.8)1.6(1.4-1.7)1.7(1.5-1.8)0.01 Model II11.4(0.6-1.7)1.9(1.6-2.4)1.7(0.7-2.3)0.7911.0(0.7-1.4)1.5(0.5-1.8)1.7(0.4-1.9)0.30 Model III11.2(0.7-1.4)1.1(0.6-1.9)1.2(0.7-1.6)0.8011.0(0.7-1.5)1.2(0.5-1.5)1.7(0.5-2.1)0.35 Model I: crude model Model II: BMI, WHR Model III: Model II + :adjusted for age, physical activity, total energy intake, smoking, drug use

16. Odds ratio and 95% confidence interval (CI) of having metabolic syndrome, by quartile of fiber, soluble and insoluble intake based on data from third TLGS. menwomen nutrient 1 234 P- value 1 234 Total fiber Model I 11.0(0.8-1.4)0.6(0.5-0.9)0.8(0.6-1.0)0.011 0.7(0.5-0.9) 1.0(0.7-1.4)0.75 Model II 10.9(0.7-1.4)0.7(0.5-1.0)0.8(0.5-1.2)0.161 0.7(0.4-1.0)0.7(0.4-1.1)0.8(0.4-1.6)0.23 Model III 10.8(0.7-1.5)0.7(0.5-1.0)0.8(0.6-1.3)0.271 0.6(0.4-1.1)0.6(0.5-1.3)0.5(0.4-2.4)0.40 Model I: crude model Model II :adjusted for age, physical activity, total energy intake, smoking, drug use Model III: Model II + BMI, WHR Model I: crude model Model II: BMI, WHR Model III: Model II + :adjusted for age, physical activity, total energy intake, smoking, drug use

17. conclusion In Tehranian population, macronutrients and fiber intake is not associated with metabolic syndrome.

18. Tank you for Your attention