Top

Published in:

Open Access 01-12-2009 | Study protocol

Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II

Authors: Fereidoun Azizi, Arash Ghanbarian, Amir Abbas Momenan, Farzad Hadaegh, Parvin Mirmiran, Mehdi Hedayati, Yadollah Mehrabi, Saleh Zahedi-Asl, the Tehran Lipid and Glucose Study Group

Published in: Trials | Issue 1/2009

Abstract

Background

The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based program for prevention of non-communicable disorders (NCD) by development of a healthy lifestyle and reduction of NCD risk factors. The study begun in 1999, is ongoing, to be continued for at least 20 years. A primary survey was done to collect baseline data in 15005 individuals, over 3 years of age, selected from cohorts of three medical heath centers. A questionnaire for past medical history and data was completed during interviews; blood pressure, pulse rate, and anthropometrical measurements and a limited physical examination were performed and lipid profiles, fasting blood sugar and 2-hours-postload-glucose challenge were measured. A DNA bank was also collected. For those subjects aged over 30 years, Rose questionnaire was completed and an electrocardiogram was taken. Data collected were directly stored in computers as database software- computer assisted system. The aim of this study is to evaluate the feasibility and effectiveness of lifestyle modification in preventing or postponing the development of NCD risk factors and outcomes in the TLGS population.

Design and methods

In phase II of the TLGS, lifestyle interventions were implemented in 5630 people and 9375 individuals served as controls. Primary, secondary and tertiary interventions were designed based on specific target groups including schoolchildren, housewives, and high-risk persons. Officials of various sectors such as health, education, municipality, police, media, traders and community leaders were actively engaged as decision makers and collaborators. Interventional strategies were based on lifestyle modifications in diet, smoking and physical activity through face-to-face education, leaflets & brochures, school program alterations, training volunteers as health team and treating patients with NCD risk factors. Collection of demographic, clinical and laboratory data will be repeated every 3 years to assess the effects of different interventions in the intervention group as compared to control group.

Conclusion

This controlled community intervention will test the possibility of preventing or delaying the onset of non-communicable risk factors and disorders in a population in nutrition transition.

Trial registration

ISRCTN52588395

Available only for authorised users

Ghassemi H, Harrison G, Mohammad K: An accelerated nutrition transition in Iran. Public Health Nutr. 2002, 5 (1A): 149-55. 10.1079/PHN2001287.CrossRefPubMed

Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M, Ghanbili J, Ghanbarian A, Mehrabi Y, Saadat N, Salehi P, Mortazavi N, Heydarian P, Sarbazi N, Allahverdian S, Saadati N, Ainy E, Moeini S: Cardiovascular risk factors in an Iranian urban population: Tehran Lipid and Glucose Study (Phase 1). Soz Praventivmed. 2002, 47 (6): 408-426.CrossRefPubMed

Sarraf-Zadegan N, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M, Khalili A, Mostafavi S, Khami M, Hassanvand R: Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol. 1999, 54 (6): 327-33.PubMed

Mendis S, Abegunde D, Yusuf S, Ebrahim S, Shaper G, Ghannem H, Shengelia B: WHO study on Prevention of Recurrences of Myocardial Infarction and Stroke (WHO-PREMISE). Bull World Health Organ. 2005, 83 (11): 820-9. Epub 2005 Nov 10PubMedPubMedCentral

Hadaegh F, Harati H, Ghanbarian A, Azizi F: Prevalence of coronary heart disease among Tehranian adults: Tehran Lipid and Glucose Study. East Mediterr Health J.

Unwin N, Alberti KG: Chronic non-communicable diseases. Ann Trop Med Parasitol. 2006, 100 (5–6): 455-64. 10.1179/136485906X97453.CrossRefPubMed

Darnton-Hill I, Nishida C, James WP: A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutr. 2004, 7 (1A): 101-21. 10.1079/PHN2003584.CrossRefPubMed

Nissinen A, Berrios X, Puska P: Community-based noncommunicable disease interventions: lessons from developed countries for developing ones. Bull World Health Organ. 2001, 79 (10): 963-70. Epub 2001 Nov 1PubMedPubMedCentral

Azizi F, Rahmani M, Emami H, Madjid M: Tehran Lipid and Glucose Study: Rationale and Design. CVD prevention. 2000, 3: 242-47.

10.

Azizi F, Salehi P, Etemadi A, Zahedi-Asl S: Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study. Diabetes Res Clin Pract. 2003, 61 (1): 29-37. 10.1016/S0168-8227(03)00066-4.CrossRefPubMed

11.

Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F: High prevalence of the metabolic syndrome in Iranian adolescents. Obesity (Silver Spring). 2006, 14 (3): 377-82. 10.1038/oby.2006.50.CrossRef

12.

Kannel WB: Contributions of the Framingham Study to the conquest of coronary artery disease. Am J Cardiol. 1988, 62 (16): 1109-12. 10.1016/0002-9149(88)90558-9.CrossRefPubMed

13.

The Pooling Project Research Group: The relationship of blood pressure, serum cholesterol, smoking habits; relative weight and ECG abnormalities to incidence of major coronary events: Final report of the Pooling Project. American Heart Association. 1978, Dollas Am Heart Association-Monograph, 60:

14.

Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S, Tolooie H, Poormoghaddas M, Sadeghi M, Tavassoli A, Rafiei M, Kelishadi R, Rabiei K, Bashardoost N, Boshtam M, Asgary S, Naderi G, Changiz T, Yousefie A: Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol. 2003, 58 (4): 309-20. 10.2143/AC.58.4.2005288.CrossRefPubMed

15.

Puska P, Tuomilehto J, Nissinen A, Salonen J: Ten years of the North Karelia project. Acta Med Scand Suppl. 1985, 701: 66-71.PubMed

16.

Bhalla V, Fong CW, Chew SK, Satku K: Changes in the levels of major cardiovascular risk factors in the multi-ethnic population in Singapore after 12 years of a national non-communicable disease intervention programme. Singapore Med J. 2006, 47 (10): 841-50.PubMed

17.

WHO, European Collaborative Group: An international controlled trail in the multifactorial prevention of coronary heart disease. Int J Epidemiol. 1974, 3 (3): 219-24. 10.1093/ije/3.3.219.CrossRef

18.

Resnicow K, Jackson A, Wang T: A motivational interviewing intervention to increase fruit and vegetable intake through black churches: results of the eat for life trial. Am J Public health. 2001, 91: 1686-93. 10.2105/AJPH.91.10.1686.CrossRefPubMedPubMedCentral

19.

Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J: Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity. BMJ. 2001, 323 (7320): 1027-9. 10.1136/bmj.323.7320.1027.CrossRefPubMedPubMedCentral

20.

Bonita R, de Courten M, Dwyer T, Jamrozik K, Winkelmann R: Surveillance of risk factors for noncommunicable diseases: The WHO STEPwise approach. Summary. 2001, Geneva, World Health Organization

21.

Rose G, McCartney P, Reid DD: Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med. 1977, 31: 42-8.PubMedPubMedCentral

22.

Prineas RJ, Crow RS, Blackburn H: The Minnesota code manual of electrocardiographic findings: standards and procedures for measurements and classification. 1982, Boston: John Wright PCG Inc

23.

Prineas RJ, Castle CH, Curb JD, Harrist R, Lewin A, Stamler J: Hypertension detection and follow-up program. Baseline electrocardiographic characteristics of the hypertensive participants. Hypertension. 1983, 5: IV160-89.CrossRefPubMed

24.

World Health Organization: Guideline for controlling and monitoring. The Tobacco Epidemic. Geneva. 1998

25.

Ainsworth BE, Jacobs DR, Leon AS: Validity and reliability of self-reported physical activity status: the Lipid Research Clinics questionnaire. Med Sci Sports Exerc. 1993, 25 (1): 92-8. 10.1249/00005768-199301000-00013.CrossRefPubMed

26.

Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN, Bennett PH, Kuller LH: Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 1999: 13:401–11. Reprined in: Modifiable Activity Questionnaire. Med J Sports Exerc. 1997, 29: S73-S78.

27.

The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure [published erratum appears in Arch Intern Med 1998 Mar 23; 158(6):573]. Arch Intern Med. 1997, 157 (21): 2413-46. 10.1001/archinte.157.21.2413.

28.

National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents: Update on the 1987 Task Force report on High Blood Pressure in Children and Adolescents: A Working Group report from the National High Blood Pressure Education Program. Pediatrics. 1996, 98: 649-58.

29.

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000, 320: 1240-43. 10.1136/bmj.320.7244.1240.CrossRefPubMedPubMedCentral

30.

Franklin FA, Dashti N, Franklin CC: Evaluation and management of dyslipoproteinemia in children. Endocrinology and Metabolism Clinics of North America. 1998, 27: 641-54. 10.1016/S0889-8529(05)70031-1.CrossRefPubMed

31.

US Department of Health and Human Services, Public Health Service: National Cholesterol Education Program: highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. National Institutes of Health, National Heart, Lung, and Blood Institute. J Am Osteopath Assoc. 1992, 92: 380-88.

32.

World Health Organization: Diabetes Mellitus: report of a WHO Study Group. Tech Rep Ser No 727. 1985, Geneva: World Health Organization

33.

Kimiagar SM, Ghaffarpour M, Houshiar-Rad A, Hormorzdyari H, Zellipourl : Food consumption pattern in the Islamic Republic of Iran and its relation to coronary heart disease. East mediterr health J. 1998, 539-547.

34.

Ghaffarpour M, houshiar-Rad A, Kianfar H: the manual for household measures, cooking yields factors and Edible portion of food. 1999, Tehran: keshavarzi press

35.

Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC: Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. 1992, 135: 1114-26.PubMed

36.

Willett WC: Nutritional epidemiology. 1998, New York: Oxford University press, 2CrossRef

37.

Esmaillzadeh A, Mirmiran P, Azizi F: Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. Eur J Clin Nutr. 2005, 59 (3): 353-62. 10.1038/sj.ejcn.1602080.CrossRefPubMed

38.

Friedwald WT, Levy RI, Fredridson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972, 18: 499-502.

39.

Truett GE, Walker JA, Ttuett AA, Mynatt RL, Heeger P, Warman M: Preparation of PCR-Quality DNA with Hot Sodium Hydroxide and Tris (HOTSHOT). Biotechniques. 2000, 29: 52-54.PubMed

40.

ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients With Chronic Stable Angina). 10.1161/01.CIR.0000047041.66447.29 . http://circ.ahajournals.org/cgi/content/full/107/1/149

41.

ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). 10.1161/01.CIR.0000037106.76139.53. http://circ.ahajournals.org/cgi/content/full/106/14/1893

42.

Steps in therapeutic lifestyle change (TLC). ATP III materials. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf

43.

DASH diet. http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm

44.

Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F: Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care. 2006, 29 (4): 954-10.2337/diacare.29.04.06.dc06-0052.CrossRef

45.

Laquartra I: Nutrition for weight management. Krause's food, nutrition and diet therapy. Edited by: Mahan LK, Escott-stump S. 2004, Saunders: Philadelphia, 11

46.

American Diabetes Association: Nutrition Recommendations and Interventions for Diabetes A position statement of the American Diabetes Association. Diabetes Care. 2007, 30 (Supplement 1): 48-65. 10.2337/dc07-S048.CrossRef

47.

Miller WR, Rollnick S: Motivational interviewing: Preparing people to change addictive behaviors. 1991, New York. Guilford Press

48.

Christiansen DH, Husking JD, Dannenberg ALOD: Computer-Assisted data collection in Multicenter Epidemiologic Research: The Atherosclerosis Risk in Communities (ARIC) study. Controlled Clin Trials. 1990, 11: 101-115. 10.1016/0197-2456(90)90004-L.CrossRefPubMed

49.

Genest J, McNamara JR, Ordovas JM, Jenner JL, Silberman SR, Anderson KM, Wilson PW, Salem DN, Schaefer EJ: Lipoprotein cholesterol, apolipoprotein A-I and B and lipoprotein (a) abnormalities in men with premature coronary artery disease. J Am Coll Cardiol. 1992, 19: 792-802.CrossRefPubMed

50.

Sarrafzadegan N, Najafian J: Prionties in cardiovascular prevention in Iran. Iran Health J. 1998, 1 (Suppl 1): 131-

51.

Fakhrzadeh H, Poorebrahim R, Amininik S: Prevalence of arterial hypertension in Busher port. Iranian Health J. 1998, 1 (suppl 4): 215-

52.

Pay S, Ozcan N, Tokgozoglu SL: Elevated Lp(a) is the most frequent familial lipoprotein disorder leading to premature myocardial infarction in a country with low cholesterol levels. Int J Cardiol. 1997, 60: 301-5. 10.1016/S0167-5273(97)00107-1.CrossRefPubMed

53.

Kannel WB: The role of lipids and blood pressure in the development of coronary heart disease. The Framingham study. G Ital Cardiol. 1974, 4: 123-37.PubMed

54.

Gordon DJ, Knoke J, Probstfield JL, Superko R, Tyroler HA: High-density lipoprotein cholesterol and coronary heart disease in hypercholesterolemic men: the Lipid Research Clinics Coronary Primary Prevention Trial. Circulation. 1986, 74: 1217-25.CrossRefPubMed

55.

Chen Z, Peto R, Collins R, MacMahon S, Lu J, Li W: Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ. 1991, 303: 276-82.CrossRefPubMedPubMedCentral

56.

Ballantyne CM: Low-density lipoproteins and risk for coronary artery disease. Am J Cardiol. 1998, 82: 3Q-12Q. 10.1016/S0002-9149(98)00769-3.CrossRefPubMed

57.

Kwiterovich PO: The antiatherogenic role of high-density lipoprotein cholesterol. Am J Cardiol. 1998, 82: 13Q-21Q. 10.1016/S0002-9149(98)00808-X.CrossRefPubMed

58.

Gyarfas I: Review of community intervention studies on cardiovascular risk factors. Clin Exp Hypertens A. 1992, 14 (1–2): 223-37. 10.3109/10641969209036184.PubMed

59.

Azizi F, Emami H, Salehi P, Ghanbarian A, Mirmiran P, Mirbolooki M, Azizi T: Cardiovascular risk factors in the elderly: the Tehran Lipid and Glucose Study. J Cardiovasc Risk. 2003, 10 (1): 65-73. 10.1097/00043798-200302000-00011.CrossRefPubMed

60.

Tuomilehto J, Knowler WC, Zimmet P: Primary prevention of non-insulin-dependent diabetes mellitus. Diabetes Metab Rev. 1992, 8: 339-53.CrossRefPubMed

61.

Knowler WC, Narayan KM, Hanson RL, Nelson RG, Bennett PH, Tuomilehto J, Schersten B, Pettitt DJ: Preventing non-insulin-dependent diabetes. Diabetes. 1995, 44: 483-8. 10.2337/diabetes.44.5.483.CrossRefPubMed

62.

Yates T, Khunti K, Bull F, Gorely T, Davies MJ: The role of physical activity in the management of impaired glucose tolerance: a systematic review. Diabetologia. 2007, 50 (6): 1116-26. 10.1007/s00125-007-0638-8.CrossRefPubMedPubMedCentral

63.

Williamson DF, Vinicor F, Bowman BA, Centers For Disease Control And Prevention Primary Prevention Working Group: Primary prevention of type 2 diabetes mellitus by lifestyle intervention: implications for health policy. Ann Intern Med. 2004, 140 (11): 951-7.CrossRefPubMed

64.

Clark M: Is weight loss a realistic goal of treatment in type 2 diabetes? The implications of restraint theory. Patient Educ Couns. 2004, 53 (3): 277-83. 10.1016/j.pec.2003.07.008.CrossRefPubMed

65.

Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC: Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995, 273: 402-7. 10.1001/jama.273.5.402.CrossRefPubMed

66.

Wing RR, Goldstein MG, Acton KJ, Birch LL, Jakicic JM, Sallis JF, Smith-West D, Jeffery RW, Surwit RS: Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes Care. 2001, 24 (1): 1-2. 10.2337/diacare.24.1.117.CrossRef

67.

Marrero DG: Changing patient behavior. Endocr Pract. 2006, 12 (Suppl 1): 118-20.CrossRefPubMed

68.

Dehghan M, Akhtar-Danesh N, Merchant A: Childhood obesity, prevalence and prevention. Nut J. 2005, 4: 24-33. 10.1186/1475-2891-4-24.CrossRef

69.

Ignarro LJ, Balestrieri ML, Napoli C: Nutrition, physical activity, and cardiovascular disease: an update. Cardiovasc Res. 2007, 73 (2): 326-40. 10.1016/j.cardiores.2006.06.030.CrossRefPubMed

70.

Stanner S: New thinking about diet and cardiovascular disease. J Fam Health Care. 2006, 16 (3): 71-4.PubMed

71.

Fitzgibbon ML, Stolley MR, Dyer AR, VanHorn L, KauferChristoffel K: a community based obesity prevention program for minority children. Prev Med. 2002, 34: 289-97. 10.1006/pmed.2001.0977.CrossRefPubMed

72.

Ludwig DS, Pereira MA, Kroenke CH, Hilner JE, Van Horn L, Slattery ML, Jacobs DR: Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA. 1999, 282 (16): 1539-46. 10.1001/jama.282.16.1539.CrossRefPubMed

73.

Kain J, Uauy R, Albala , Vio F, Cerda R, Leyton B: School-based obesity prevention in Chilean primary school children. Int J Obes. 2004, 28: 483-93. 10.1038/sj.ijo.0802611.CrossRef

74.

Budd GM, Volpe SL: School-based obesity prevention: Research, challenges, and recommendations. J Sch Health. 2006, 76 (10): 485-95. 10.1111/j.1746-1561.2006.00149.x.CrossRefPubMed

75.

Centers for Disease Control and Prevention. http://www.cdc.gov/pcd/issues/2005/jan/04_0076.htm

76.

Darnton-Hill I, Nishida C, James WP: A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutr. 2004, 7 (1A): 101-21. 10.1079/PHN2003584.CrossRefPubMed

Title: Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II
Authors: Fereidoun Azizi
Arash Ghanbarian
Amir Abbas Momenan
Farzad Hadaegh
Parvin Mirmiran
Mehdi Hedayati
Yadollah Mehrabi
Saleh Zahedi-Asl
the Tehran Lipid and Glucose Study Group
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Trials / Issue 1/2009
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/1745-6215-10-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II

Abstract

Background

Design and methods

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Design and methods

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2009

Issues in applying multi-arm multi-stage methodology to a clinical trial in prostate cancer: the MRC STAMPEDE trial

Implementation of Internet-based preventive interventions for depression and anxiety: role of support? The design of a randomized controlled trial

Comparison of embedded and added motor imagery training in patients after stroke: study protocol of a randomised controlled pilot trial using a mixed methods approach

VITA-D: Cholecalciferol substitution in vitamin D deficient kidney transplant recipients: A randomized, placebo-controlled study to evaluate the post-transplant outcome

Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol

Incorporating multiple interventions in meta-analysis: an evaluation of the mixed treatment comparison with the adjusted indirect comparison