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First Report on Path Analysis for Cardiometabolic Components in a Nationally Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): The CASPIAN-III Study

Kelishadi R.a · Motlagh M.E.d, e · Roomizadeh P.b · Abtahi S.-H.b · Qorbani M.h, j · Taslimi M.g · Heshmat R.i · Aminaee T.f · Ardalan G.a, f · Poursafa P.c · Karimi M.h
aPediatrics Department, Faculty of Medicine and Child Growth and Development Research Center, bMedical Students Research Center, and cEnvironment Department, Environment Research Center, Isfahan University of Medical Sciences, Isfahan, dPediatrics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, eBureau of Population, Family, and School Health, and fOffice of School Health, Ministry of Health and Medical Education, and gBureau of Health and Fitness, Ministry of Education, Tehran and hDepartment of Public Health, Alborz University of Medical Sciences, Karaj, and iEpidemiology Department, Chronic Diseases Research Center, and jEpidemiology Department, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran Ann Nutr Metab 2013;62:257-265 (DOI:10.1159/000346489)


Background/Aims: This study aimed to test a potential model of the relationship between various cardiometabolic risk factors including obesity, unhealthy diet, low physical activity, dyslipidemia, and high blood pressure in a large population-based sample of children and adolescents. Methods: In this nationwide study, a representative sample of 5,528 students aged 10-18 years was selected by multistage random cluster sampling from 27 provinces of Iran. Demographic, anthropometric, biological, and biochemical factors were determined. Structural equation modeling (path analysis) was applied to evaluate the causal relationship between these variables. Results: The mean age of study participants was 14.7 ± 2.41 years and the mean body mass index (BMI) was 19.4 ± 4.1. Higher socioeconomic status was directly associated with unhealthy diet, low physical activity and BMI in both sexes. Age had a positive direct effect on low physical activity in both sexes. BMI showed the greatest direct effect on total cholesterol, triglyceride, low-density lipoprotein cholesterol, and mean arterial pressure in comparison with the direct effects of unhealthy diet and low physical activity. BMI was associated negatively with high-density lipoprotein cholesterol in both groups. Conclusions: No previous study has used path analysis for determining the interactions examined in this study among a nationally representative sample of children in the Middle East and North Africa (MENA). The results of this study underline the imperative need for the weight loss and lifestyle change from childhood as the first-line preventive strategy for metabolic syndrome and noncommunicable diseases.


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