Journal of Education and Health Promotion

Abstract BACKGROUND: Obesity and overweight in children and adolescents have become a global problem
in recent years. Adolescence increases the likelihood of obesity in adulthood and associated illnesses.
Nowadays, health literacy is one of the greatest determinants of the health. This study was conducted
to evaluate the correlation between body mass index (BMI) and health literacy in high school students.
MATERIALS AND METHODS: In this descriptive‑analytical study, 430 high school students were
enrolled in a multi‑stage random method in Yazd city in the center of Iran. The data were collected
through The Health Literacy Measure for Adolescents and calculate BMI with measurement of
height and weight of adolescents. The data were then analyzed using SPSS 25 and descriptive and
inferential statistics (Chi‑square and multivariate regression).
RESULTS: The results showed that the mean score of BMI (21.76 ± 3.76) was in a normal range.
The score of health literacy was at the borderline level (58.44 ± 13.79). BMI was not significantly
correlated with health literacy (P = 0.09). BMI was significantly different in terms of age, high school
grade, school type, and health status. School type and health status predict 37% of the variance of
BMI (R2 = 37%) and the best predictor was health status (P < 0.05).
CONCLUSIONS: The results of the present study showed that BMI was not correlated with health
literacy and student health literacy was at the borderline level. It is necessary to carry out further
studies on the causes and facilitators and the barriers to increasing health literacy. Furthermore,
educational interventions are needed to prevent the increase of BMI in adolescents and identify
determining factors.

Abstract BACKGROUND: Type 2 diabetes mellitus (DM) is a multifactorial disease and can be described as a
noncommunicable disease of epidemic magnitude. Little is known about the predictors of depression
in this population, especially among the Indian population. This study explores the predictors for
depression in patients with type 2 DM.
MATERIALS AND METHODS: A cross‑sectional study was performed for a period of 7 months
during 2018–2019. The data were collected from 250 subjects at the diabetic clinic and psychiatry
outpatient department of a tertiary care teaching hospital. T2DM with an age group of 18–60 years
were included. Exclusion criteria were clinical evidence of any significant Axis I psychiatric disorder
according to the International Classification of Diseases‑10 Diagnostic Criteria for Research other
than depression and substance use disorders. Data were analyzed with multiple linear regression
analysis using SPSS‑23 version.
RESULTS: Male and female patients were 127 (50.80%) and 123 (49.20%), respectively. The
prevalence of depression was 49.20% among 250 patients with T2DM. Female patients had higher
depression than male patients. We found age (P = 0.013), female gender (P = 0.041), locality of the
patient (P = 0.021), body mass index (BMI) (P = 0.018), and fasting blood sugar (FBS) (P = 0.045)
as significant predictors of depression among T2DM patients.
CONCLUSIONS: The study concludes that females and elderly patients were more affected by
depression. The predictors of depression were age, gender, locality, BMI, and FBS among diabetic
patients. The findings indicate to screen the patients of T2DM for depression, predominantly female
and elderly patients, at regular intervals as per clinical demand.

Abstract INTRODUCTION: Over the past decades, the pattern of diseases in human societies had changed
from infectious diseases to noncommunicable diseases (NCDs), and according to the report by the
World Health Organization, the highest burden of disease is attributed to NCDs. The study was
conducted to determine the status of hypertension, type‑2 diabetes, lipid disorders, and body mass
index (BMI) among the patients aged over 30 years admitted to health centers of Karaj, Iran.
MATERIALS AND METHODS: In this cross‑sectional study, the population included 2947 men and
women aged 30 years and above admitted to six health‑care centers in Karaj. The questionnaire
includes demographic characteristics and had the questions on hypertension, diabetes and their
risk factors, like lipid disorders and BMI was administered. The data were analyzed in SPSS,
version 23, software using descriptive (frequency, percentage, mean, and standard deviation) and
analytical (Chi‑square and analysis of variance) tests (P < 0.01).
RESULTS: About 10% of the participants had diabetes and 15% of the participants had hypertension.
About 32% of the participants had dyslipidemia and 87% of the participants were overweight or obese
and over 35% were obese. Furthermore, with the increase in BMI, the prevalence of lipid disorder,
hypertension, and type‑2 diabetes increased in the studied population (P < 0.01).
CONCLUSION: According to the results, a high percentage of people had hypertension, type‑2
diabetes, hyperlipidemia, and BMI in the population. Gender segregation showed that lipid disorders,
overweight, and obesity in women were more than in men and percentage of people with hypertension
among male were significantly higher than in females. In the case of type‑2 diabetes, the results
showed no statistically significant differences between men and women. The results may be helpful
in developing educational strategies and prevention and control of these diseases.

Abstract BACKGROUND: Underweight is still prevalent in developing countries like India. Prepregnancy body
mass index (BMI) is used as the standard against which the measurements are made in pregnancy.
AIM: To study the association between early pregnancy BMI and feto‑maternal outcome among
nulliparous women
METHODOLOGY: This is a prospective observational study, with a sample size of 294. The antenatal
patients were categorized into four categories of BMI according to the WHO classification, and
pregnancy outcomes were compared. Data were analyzed using SPSS Software Version 17.0.
Statistical tools used were percentages and mean, and categorical variables were analyzed by
Chi‑square statistics.
RESULTS: 48.94% of the patients enrolled in the study had normal early pregnancy BMI, and 44.22%
and 6.8% were underweight and overweight, respectively. Obese women who gained more weight
were at a higher risk of preterm delivery, cesarean section, and more time required for resumption
of normal routine. Underweight women were at higher risk of postterm delivery, low birth weight,
and increased hospital stay.
CONCLUSION: Adverse maternal and fetal outcomes are seen more commonly with the extremes
of BMI.

Abstract INTRODUCTION: Overweight and obesity as a major public health issue can lead to adverse
health consequences during the life span. This study aimed to measure socioeconomic inequality
in unhealthy weight among school students in Kermanshah, west of Iran.
METHODS: The cross‑sectional study measured the socioeconomic‑related inequalities in unhealthy
weight among 1404 secondary school students aged 11–16 years in Kermanshah in 2018. Unhealthy
weight is defined as body mass index of >25 kg/m2
 in the study. Socioeconomic‑related inequality
in unhealthy weight was calculated using the concentration index (Cn
). A logistic regression model
was used to estimate the marginal effect of independent variables.
RESULTS: The prevalence of unhealthy weight for the total sample was 0.13 (95% confidence
interval [CI]: 0.11–0.14). Of these, the prevalence of unhealthy weight for girls and boys was
0.11 (95% CI: 0.09–0.14) and 0.15 (95% CI: 0.12–0.18), respectively. The value of Cn
 for the
total sample was 0.12 (95% CI: 0.03–0.2), which indicates a higher concentration of unhealthy
weight among the high socioeconomic status (SES) students. Two factors of SES (49.11%) and
gender (40.08%) had the largest contribution to socioeconomic inequality in unhealthy weight among
the study students.
CONCLUSIONS: Socioeconomic‑related inequality in unhealthy weight was concentered among
high‑SES students in the study. Thus, public health policies need to be formulated to change sedentary
lifestyles and unhealthy dietary patterns among students with higher SES.

Abstract INTRODUCTION: With the advancement of bioelectrical impedance analysis method, body fat
can be estimated with portable devices at home. These devices are popular in home body fat
monitoring (HBFM). However, improper use of the device may provide erroneous result.
AIM: This study aimed to find out the level of competency of the operator in HBFM.
MATERIALS AND METHODS: A cross‑sectional survey was conducted with 34 individuals
(males = 11, females = 23) during March–December, 2017. A pretested questionnaire was used to
collect information by expert interviewer. Data were collected about premeasurement precautions,
steps followed in body fat measurement proper, and postmeasurement action. Survey data were
expressed in mean, standard deviation, and percentage and statistically tested by unpaired t‑test and
Chi‑square test according to necessity with α =0.05. Analyses were done in GraphPad Prism 6.01.
RESULTS: Premeasurement precautions for maintaining proper hydration level were not followed
by majority of the participants. Avoidance of exercise in preceding 12 h was not followed by
94.12% (χ2 = 26.47, P < 0.0001), voiding bladder before the measurement was not followed by
88.24% ( χ2 = 19.88, P < 0.0001), and avoidance of diuretics (e.g., chocolate, caffeine) was not
practiced by 82.35% (χ2 = 14.24, P = 0.0002). Prescribed steps for measurement proper were followed
by majority of the operators. However, 61.76% (χ2 = 1.88, P = 0.17) forgot to keep log of the readings.
CONCLUSION: Clinicians, fitness instructors, and nutritionists should emphasize on premeasurement
factors for educating their clients for HBFM. This would help proper tracking of body fat level.

Abstract BACKGROUND: Relationship among periodontitis, obesity, and chronic diseases may be
multidirectional. Inflammatory diseases such as periodontitis induce the production of pro‑inflammatory
cytokines such as TNF‑α, IL‑1, and IL‑6. It has been suggested that the secretion of TNF‑α by adipose
tissue triggered by lipopolysaccharides from periodontal Gram‑negative bacteria promotes hepatic
dyslipidemia and decreases insulin sensitivity.
AIM: To study the association of obesity with the severity of periodontitis and to compare the blood
glucose levels and plasma lipid profile in obese and non‑obese subjects with chronic periodontitis.
METHODOLOGY: A total of 84 systemically healthy subjects, aged 30–60 years, were included in
the study. Periodontal status of the subjects was assessed by recording Community Periodontal
Index (CPI) and Gingival Index (Loe and Silness, 1963). Body mass index (BMI) and waist
circumference (WC) were used as measures to assess obesity. The fasting plasma lipids level and
fasting blood glucose level were measured. Data were analyzed by unpaired ‘t’test, Fisher’s Exact
test, and Chi‑square test.
RESULTS: There was a statistically significant difference in Gingival Index and Community
Periodontal Index between the obese and non‑obese group. Total cholesterol, triglycerides, and
low‑density lipoprotein (LDL) levels showed significant difference between the two groups. There
was no statistically significant difference in mean age, high‑density lipoprotein (HDL) levels, and
fasting blood glucose levels between the two groups.
CONCLUSION: The present study showed a positive association between obesity and chronic
periodontitis. Further long‑term studies involving larger sample size are required to confirm this
association.

Abstract INTRODUCTION: Association of ABO blood type with body mass index (BMI) was explored in the
past studies, but literature on association of novel obesity markerssuch as total body fat and lean
body mass (LBM) is scarce. The present study aimed to evaluate the relationship of ABO blood
types with novel obesity markers in normal adolescents.
MATERIALS AND METHODS: A cross‑sectional study was done on 387 medical students. Bioimpedance analysis (BIA)‑derived novel obesity markers such as body fat percent (BFP) and lean
body mass (LBM) were recorded. Blood typing was done using slide‑agglutination method. Mean
and SD were calculated; analysis of variance and Chi‑square (χ2
) correlation were used to determine
the relationship between ABO blood types and obesity markers.
RESULTS: Highest propensity for BFP and LBM was seen in blood groups AB and B (25.09 ± 8.92
and 44.45 ± 6.91) respectively. Highly significant (P < 0.001) differences were observed in the values
of BFP and LBM in normal and obese participants across ABO blood types. Prevalence of obesity
did not show significant relationship (χ2 = 2.069; P = 0.913) with ABO blood types.
CONCLUSIONS: Unlike BMI, novel obesity markers (BFP and LBM) significantly differ across ABO
blood groups in normal and obese population. The findings suggest that ABO blood type might have
role in determining body composition. This will be helpful in recognition of the participants at the risk
of obesity on the basis of their blood groups.

Abstract BACKGROUND: Obesity and iron deficiency (ID) are two forms of the most usual nutritional disorders
worldwide. Some studies have discovered a correlation between ID and obesity although more
investigation is required. This study was aimed to determine the association between obesity and
ID anemia (IDA) in Iranian childbearing age women.
MATERIALS AND METHODS: This cross‑sectional study was done on 256 women of reproductive
age in northern Iran. The anthropometric measurements including height and weight were measured,
and body mass index (BMI) was calculated. Low blood index of the hemoglobin (Hb), mean cell
volume (MCV), and mean corpuscular hemoglobin (MCH) were evaluated with ferritin, serum iron,
and total iron‑binding capacity. Baseline data were expressed as means ± standard deviations.
Chi‑square test was applied to compare the categorical variable. Differences between the two groups
were evaluated with independent samples t‑test. A value of P < 0.05 was considered as statistically
significant.
RESULTS: Obesity was in urban women higher than rural women (55.1% vs. 44.9%), and this
difference was significant (P < 0.021). There was found no association between hematological
characteristics and BMI. The data showed that only 13.4% of obese women and 17.1% of the women
with normal weight had IDA (odds ratio = 0.75; 95% confidence interval: 0.39–1.49, P > 0.05).
CONCLUSIONS: According to the results of this study, it seems that the relationship between obesity
and IDA is controversial. Hence, further studies are needed to be done.

Abstract BACKGROUND: The study aimed to investigate the associations between life and health satisfaction
with health‑related quality of life (HRQoL), body mass index (BMI) and chronic disease among people
who are covered by health insurance schemes in Tehran city, Iran.
METHODS: A cross‑sectional study was conducted in Tehran city, Iran, from May to June 2016. A total
of 600 people were included in the study using a cluster sampling technique. The questionnaire that
used for data collection included demographic and socioeconomic variables, questions about health
variables such as chronic disease, weight, height, smoking status, and EQ‑5D‑3L questionnaire.
Two univariate and multivariate regression models performed to examine affecting factors on life
and health satisfaction.
RESULTS: The univariate regression showed that on average female have 0.22 and 0.69 score
lower than males with their life and health satisfaction, respectively. Explanatory variables of
gender, age, level of education, and employment status were not significantly associated with life
and health satisfaction in multiple regression models. However, marital status was correlated with
life satisfaction. Furthermore, HRQoL, BMI and chronic disease and smoking were associated with
dependent variables (P < 0.001).
CONCLUSIONS: The result showed that there was a strong association between BMI, HRQoL, chronic
disease, and life and health satisfaction among participants. Therefore, the Iranian policymakers
need to consider these factors on life and health satisfaction of adults and design health‑promoting
programs to improve health outcomes of them. Further studies should assess the associations
between BMI, HRQoL, chronic conditions, and life and health satisfaction among Iranian adults.

Abstract Background: Understanding the association between psychological affective disturbances
and anthropometric parameters, including body mass index (BMI), is important. These issues
may have potential preventive effects on weight reduction in relation to different aspects
of women’s lifestyles and psychopathological states. The present study aimed to predict
BMI based on psychological factors including; depression, anxiety, dietary restraint, and
nutritional habits, in a sample of women with sedentary jobs in several Iranian governmental
organizations. Methods: Two hundred consecutive women aged over 25 years, working on
sedentary or low standing works such as banker, teachers, and employee in the social security
organizations in Isfahan, Iran, were entered the study. To assess the severity of depression
and anxiety symptoms, the Beck Depression Inventory II and the State‑Trait Anxiety Inventory
were used, respectively. To assess nutritional habits, a self‑administered questionnaire was
designed, and to evaluate dietary restraint status, the Ruderman questionnaire was used. To
find the co‑relationship between BMI and each of the psychological components, Pearson’s
correlation coefficient test was applied. Results: To assess the relationship between BMI
and each of the psychological components, a multivariate regression model was used. Only
two components of nutritional habits (b = −0.19, P < 0.001) and dietary restraint (b = 0.51,
P < 0.001) could effectively predict BMI in Iranian women; while depression and anxiety
components had low predictive values for predicting BMI. In total, these four variables could
predict 34% of the variance of the dependent indicator (BMI). Conclusion: Nutritional habits
and dietary restraint have high value for predicting BMI status in women aged more than
25 years working in sedentary jobs, while BMI status could not be predicted by assessing
depression or anxiety severity.

Abstract Background: In the hot weather, overweight and obesity are considered as significant risk
factors for the incidence of cardiac strain in workers. This study is aimed at comparing the
cardiac strain among overweight and normal‑weighted workers, in the hot, humid conditions
of the south of Iran. Materials and Methods: This cross‑sectional study was conducted
on 71 workers in the south of Iran, in the summer of 2010.The heart rate was measured at
rest and at actual work. Cardiac strain based on the working heart rate (WHR), the relative
cardiac cost (RCC), the net cardiac cost (NCC), the load relative cardiovascular (CVL), and
heart rate reduction were analyzed in 35 normal weight people (BMI <25) and 36 people who
were overweight (BMI >25), using descriptive statistics and t‑ tests. Results: In 42% of the
total workers, the body mass index was more than 25. The average temperature of the two
groups was not significantly different. The mean WHR in these two groups was 101 ± 20.3
and 112 ± 18.9, respectively (P = 0.026). Percentages that exceeded the acceptable limits
in parameters of NCC, RCC, WHR, CVL, and the Brouha index, were significantly higher in
overweight people than those in people with normal weight. Conclusions: Based on the study
results, the severity of cardiac strain was higher in overweight workers when compared with
normal weight workers. Hence, in order to decrease the cardiac strain, selecting overweight
individuals for these jobs should be avoided, as also some vital intervention for losing weight,
such as, nutrition education and encouraging them to increase their physical activity, should
be implemented.

Abstract Abstract
Background: Obesity is growing rapidly in our country. Nutrition is an important issue of obesity.
The aim of this study was to determine the association between fruit and vegetable intake
with the waist circumference and the body mass index (BMI) among young female university
students. Materials and Methods: This cross-sectional study was conducted on 236 healthy
female university students aged between 18 and 30 years old, who were selected randomly
from the students of Isfahan University of Medical Sciences, Iran. A previously validated semiquantitative food frequency questionnaire was used to assess the entire dietary component
intake. Physical activity was assessed by daily recording of the physical activities. Findings: The
prevalence of obesity, central adiposity and overweight was 1.7, 0.9 and 8.1%, respectively. The
mean value of BMI and the waist circumference was 21.54 kg/m2
 and 70.37 cm, respectively.
There was an inverse correlation between the fruit and vegetable intake and body weight (r =
-0.1, P = 0.03) as well as BMI (r = -0.1, P = 0.04) and also there was an inverse correlation
between the fruit intake and body weight (r = -0.1, P = 0.01) and BMI (r = -0.1, P = 0.01).
There was no significant correlation between fruit and vegetable as well as fruit or vegetable
separately with the waist circumference. Conclusion: There were significant correlations
between fruit and also fruit and vegetable and body weight and BMI among female university
students. There was no significant correlation between fruit and vegetable as well as fruit or
vegetable separately with waist circumference.