Abstract
Background:
Dyslipidemia is a disease and conditions associated with obesity, which is a chronic health problem. The study aimed to determine the 5-year incidence of dyslipidemia in obese and nonobese participants in Central Iran.
Materials and Methods:
Using multistage cluster sampling, 9964 participants aged 20-70 years in Yazd, Iran, were recruited between 2014 and 2015. Those with dyslipidemia were excluded, and nondyslipidemia individuals were included in the study. After a 5-year follow-up, the obese and nonobese participants were evaluated for incident dyslipidemia. We used logistic regression to estimate the 5-year incidence rates of dyslipidemia.
Results:
During the study’s follow-up, dyslipidemia was diagnosed in 4.4% of participants (n = 355). The increase in the incidence of dyslipidemia in obese women was 86.1% (179 people) more than in obese men, with 32.7% (n = 48). The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for dyslipidemia in obese men and women were 1.32 (0.90-1.94) and 2.81 (1.78-4.43). The results of the logistic regression analysis showed that obesity was associated with a higher risk of dyslipidemia in the participants after adjusting for confounding factors. However, there was no difference in the findings between those under 60 and those over 60.
Conclusions:
The cohort study indicated that during a 5-year period, obesity was linked to a higher incidence of dyslipidemia in the adult population. Thus, by combining effective policies with obesity prevention initiatives, it is possible to reduce the incidence of dyslipidemia, cardiovascular illnesses, and the mortality associated with these conditions.
Keywords: Cohort study, dyslipidemia, incidence, obesity
INTRODUCTION
Dyslipidemia, coronary heart disease (CHD), and hypertension are all common health problems associated with obesity.[1] Disruption of body lipids leads to dyslipidemia, which in turn leads to several diseases, including cardiovascular disorders. Dyslipidemia is on the rise due to obesity prevalence.[2] In general, obesity raises serum triglyceride levels, lowers HDL levels, and generally raises serum total LDL levels.[3]
Based on a study conducted in 2010, elevated blood lipid levels were strongly associated with obesity. Dyslipidemia and obesity were both associated with an increased risk of coronary artery disease (CAD). In the study by Shah et al.,[4] weight loss was necessary for those with high body mass indexes or normal BMI, but high waist circumferences or waist circumference ratios.
Various cultural characteristics, socioeconomic factors, and ethnicities affect the prevalence of dyslipidemia.[5] Globally, the prevalence of dyslipidemia is rising, with estimates ranging from 2.7% to 51.9%.[6,7] According to a study in Yazd in 2011, the prevalence of hypercholesterolemia was 12.1% and dyslipidemia was 58.5%. According to the results of the study, overweight and dyslipidemia were the two most common cardiovascular risk factors identified.[8] In addition, according to another study in Yazd in 2021, the prevalence of high cholesterol, LDL, and HDL were obtained at 3.2%, 3.2%, and 25.6%, respectively, and increasing BMI was significantly associated with increasing dyslipidemia.[9]
The risk of dyslipidemia and obesity is very common in the Yazd province. Consequently, having high prevalence rates of these risk factors in Yazd may prove to be one of the biggest problems for the people of this province regarding their health.[8,10] Unless we understand the status of dyslipidemia and its relationship with obesity, we will be unable to program and treat appropriately. As such, we examined the incidence of dyslipidemia in a Yazd population aged 20-70 years old based on obesity (YaHs cohort).
MATERIALS AND METHODS
Sample group
According to preliminary data from 2014 to 2015, Yazd, Iran, 9,964 adult participants aged 20 to 70 years contributed to the cohort. Participants were selected using cluster random sampling, with each cluster of 50 individuals equally divided between men and women. Over 5 years from the study’s inception, these groups consisted of 10 individuals per year (5 men and 5 women) in the following age ranges: 20–29, 30–39, 40–49, 50–59, and 60–69 years. The detailed study profile was published in a separate paper. However, 200 clusters×50 individuals per cluster = 10,000 individuals. A total of 9,964 participants were successfully recruited, corresponding to a 94.9% response rate.[11]
Ethics statement
The Ethics Committee of Shahid Sadoughi University of Medical Sciences approved this study (Ethics Code: IR.SMU.SPH.REC.1400p. 082). All participants provided informed consent during both the initial and follow-up phases of the study.
Measurements
A reassessment of the cohort study’s first phase (baseline), conducted in 2019–2020, collected data on participants’ socioeconomic status, physical activity, smoking habits, and biochemical test results.
Anthropometry
Waist circumference, weight, and height were measured using standardized techniques. The waist circumference was measured at the midpoint between the top edge of the iliac crest and the lower edge of the last rib using a nonstretch tape measure and recorded to the nearest 0.5 cm. The weight was measured using a basic Omron body analyzer and a portable digital scale (Omron Inc., Nagoya, Japan), with an accuracy of 0.1 kg. Height was measured with a tape measure, with participants standing barefoot against a straight wall in the Frankfurt position, ensuring their heels, buttocks, and shoulders were in contact with the wall. The body mass index (BMI, kg/m²) was calculated using the formula: weight (kg) divided by height squared (m²). Obesity was defined as a BMI of at least 30 kg/m², with a waist circumference greater than 102 cm for men and 88 cm for women.
Dyslipidemia status
Blood fat levels were measured using Pars Azmoon kits and a Ciba Corning autoanalyzer. Dyslipidemia was defined using at least one of the following conditions: high-density lipoprotein cholesterol <40 mg/dl, low-density lipoprotein cholesterol ≥140 mg/dl, fasting triglyceride ≥150 mg/dl, total cholesterol ≥200 mg/d, diagnosed by a physician, and taking glucose-lowering drugs.
Other covariates
The study categorized smoking history, educational level, physical activity, medical history, and marital status into two or three categories.
Exclusion criteria
The study excluded participants with dyslipidemia at baseline, those with missing covariates, or those without follow-up information.
Statistical analysis
Data analysis was conducted using STATA version 14.0 (StataCorp LP, College Station, TX, USA) and SPSS version 25.0 (IBM, New York, USA). Descriptive results for categorical variables were presented as numbers (percentages), and for continuous variables, as means (standard deviations). The Chi-square test was used for categorical variables, while the Student’s t-test or analysis of variance (ANOVA) was used for continuous variables. A multivariate analysis of the determinants of dyslipidemia incidence over 5 years was performed using logistic regression, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). The multivariate analysis was adjusted for factors such as age, sex, physical activity, medical history (yes/no), marital status (single/married), smoking history (never, former, current), and education level. Statistical significance was set at P < 0.05.
RESULTS
Recruitment and demographics of the sample
A total of 9,964 participants were selected for the cohort study between 2014 and 2015. Initially, 226 participants (1.1%) had missing data. The overall prevalence of dyslipidemia at baseline was 16%. During the follow-up phase, 8,110 participants (82.9%) were eligible, of whom 17 (1.1%) were excluded from the incidence calculations due to lack of follow-up. After repeated measurements during 2019-2020, 8,093 participants (51.47% men and 48.53% women) were included in the final analysis. The results showed that 4.4% (n = 355) of the adult population developed dyslipidemia after 5 years [Figure 1]. The characteristics of the dyslipidemia incidence in men and women over the 5-year period are presented in Supplementary Table 1. Significant differences were observed between men and women in terms of BMI, waist circumference, smoking history, medical history, marital status, education, physical activity, and obesity (P < 0.05).
Figure 1.
The prevalence and 5-year incidence of dyslipidemia in the participants
Supplementary 1.
Characteristics of the 5-year incidence of dyslipidemia in men and women, Yazd Health Study, 2015−2020
| Variable | Incident Dyslipidemia |
P | |
|---|---|---|---|
| Men | Women | ||
| BMI (Kg/m2) | 26.7±5.6 | 29.8±4.6 | <0.01 |
| WC (CM) | 97.7±11.2 | 99.2±12.9 | <0.01 |
| Age (years) | |||
| <60 | 30 (3.8) | 115 (5.5) | <0.01 |
| ≥60 | 18 (7.5) | 64 (15.1) | |
| Smoking history | |||
| Never | 35 (4.6) | 157 (6.6) | <0.01 |
| Former | 2 (5.3) | 0 (0.0) | |
| Current | 10 (5.2) | 2 (4.8) | |
| Medical history | 10 (5.0) | 34 (7.3) | <0.01 |
| Education | |||
| Primary | 27 (5.2) | 153 (9.6) | <0.01 |
| Diploma | 13 (4.0) | 15 (2.4) | |
| Academic | 7 (4.2) | 10 (3.7) | |
| Marital status | |||
| Single | 1 (1.1) | 19 (7.1) | <0.01 |
| married | 45 (4.8) | 143 (6.4) | |
| Physical activity | |||
| Never | 30 (6.3) | 113 (8.0) | <0.01 |
| Once a week | 3 (2.7) | 20 (7.7) | |
| Twice a week | 6 (3.5) | 19 (5.5) | |
| Three to four times a week | 5 (4.8) | 6 (3.1) | |
| Five times a week | 4 (2.6) | 17 (6.0) | |
| Obese | |||
| Yes | 48 (4.7) | 179 (7.1) | <0.01 |
| No | 99 (3.2) | 29 (2.1) | |
Results are expressed as the number of participants (percentage) or as mean±standard deviation. Between-group comparisons were performed using the Student’s t-test or chi-square analysis
The characteristics of the 5-year incidence of dyslipidemia among men and women by age are presented in Supplementary Table 2. The table reveals that individuals with higher BMI and WC have a higher risk of dyslipidemia over 5 years (P < 0.05).
Supplementary 2.
Univariate and multivariate regression analysis of the association between BMI and waist circumference and the 5-year risk of hypertension stratified by age
| Bivariate | P | Multivariate | P | |
|---|---|---|---|---|
| <60 years | ||||
| BMI <30 | 1.0 (ref.) | <0.01 | 1.0 (ref.) | 0.003 |
| BMI ≥30 | 2.23 (1.71−2.92) | 1.58 (1.17−2.13) | ||
| ≥60 years | ||||
| BMI <30 | 1.0 (ref.) | 0.94 | 1.0 (ref.) | 0.51 |
| BMI ≥30 | 1.02 (0.67−1.53) | 0.85 (0.53−1.37) | ||
| Men | ||||
| <60 years | ||||
| wc <102 | 1.0 (ref.) | 0.04 | 1.0 (ref.) | 0.02 |
| wc ≥102 | 1.57 (1.01−2.43) | 1.29 (0.80−2.08) | ||
| ≥60 years | ||||
| wc <102 | 1.0 (ref.) | 0.88 | 1.0 (ref.) | 0.38 |
| wc ≥102 | 1.05 (0.58−1.90) | 1.32 (0.71−2.46) | ||
| Women | ||||
| <60 years | ||||
| wc <88 | 1.0 (ref.) | <0.01 | 1.0 (ref.) | 0.002 |
| wc ≥88 | 3.44 (2.17−5.46) | 2.94 (1.75−4.93) | ||
| ≥60 years | ||||
| wc <88 | 1.0 (ref.) | 0.16 | 1.0 (ref.) | 0.09 |
| wc ≥88 | 1.80 (0.79−4.09) | 2.30 (0.88−6.05) | ||
Results are expressed as odds ratio and (95% confidence interval). The analysis was conducted using logistic regression. The multivariate model was adjusted for gender, physical activity, medical history, marital status, smoking, and education
Five-year incidence of dyslipidemia
The results regarding the incidence of dyslipidemia according to the overall obesity status and stratified by gender are summarized in Table 1. The 5-year incidence of dyslipidemia in obese men, women, and overall participants was 32.7%, 86.1%, and 63.9%, respectively. There were significant differences in the obese and nonobese participants in developing the 5-year incidence of dyslipidemia in men, women and overall participants (<0.05).
Table 1.
Five-year incidence of dyslipidemia according to obesity status in men, women, and overall population, Yazd Health Study
| No dyslipidemia | Incident dyslipidemia | P | |
|---|---|---|---|
| Overall (n) | 7738 | 355 | <0.01 |
| Nonobese | 4416 (57.1 %) | 128 (36.1 %) | |
| Obese | 3322 (42.9 %) | 227 (63.9 %) | |
| Men (n) | 4019 | 147 | 0.02 |
| Nonobese | 3040 (75.6 %) | 99 (67.3 %) | |
| Obese | 979 (24.4 %) | 48 (32.7 %) | |
| Women (n) | 3719 | 208 | <0.01 |
| Nonobese | 1376 (37.0 %) | 29 (13.9 %) | |
| Obese | 2343 (63.0 %) | 179 (86.1 %) |
Results are expressed as the number of participants (column percentage). Between-group comparison was performed using the chi-square test
Table 2 shows the association between obesity and dyslipidemia incidence by gender. Compared with the nonobese groups, obesity was associated with an increased risk of dyslipidemia in women (OR = 2.81, 95% CI: 1.78-4.43) and the total population (OR = 1.88, 95% CI: 1.44-2.47) after adjusting for age, sex, physical activity, medical history, marital status, smoking history, and education, but not in men. Those who were obese had a greater risk of dyslipidemia, and this association was confirmed by multivariate analysis.
Table 2.
Bivariate and multivariate analysis of the 5-year incidence of dyslipidemia according to obesity status, overall and stratified by gender, YaHs study, Yazd, Iran
| Bivariate | P | Multivariate | P | |
|---|---|---|---|---|
| Overall | ||||
| Nonobese | 1.0 (ref.) | 0.01< | 1.0 (ref.) | 0.01< |
| Obese | 2.36 (1.89−2.94) | 1.88 (1.44−2.47) | ||
| Men | ||||
| Nonobese | 1.0 (ref.) | 0.02 | 1.0 (ref.) | 0.15 |
| Obese | 1.51 (1.06−2.14) | 1.32 (0.90−1.94) | ||
| Women | ||||
| Nonobese | 1.0 (ref.) | 0.01< | 1.0 (ref.) | 0.01< |
| Obese | 3.63 (2.44−5.38) | 2.81 (1.78−4.43) | ||
Results are expressed as odds ratio and (95% confidence interval). The analysis was conducted using logistic regression. The multivariate model was adjusted for age, physical activity, medical history, marital status, smoking history, and education. For the overall analysis, a further adjustment for gender was conducted
It was noted that when stratifying by age, younger (<60 years) participants with obesity were significantly more likely than older (≥60 years) obese participants to develop dyslipidemia in the future [Table 3].
Table 3.
Bivariate and multivariate analysis of the 5-year incidence of hypertension by obesity status, stratified by age groups
| Bivariate | P | Multivariate | P | |
|---|---|---|---|---|
| <60 years | ||||
| Nonobese | 1.0 (ref.) | 0.01< | 1.0 (ref.) | 0.01< |
| Obese | 2.36 (1.80−3.08) | 1.93 (1.39−2.66) | ||
| ≥60 years | ||||
| Nonobese | 1.0 (ref.) | 0.006 | 1.0 (ref.) | 0.06 |
| Obese | 1.75 (1.18−2.59) | 1.64 (0.99−2.72) | ||
Results are expressed as odds ratio and (95% confidence interval). The analysis was conducted using logistic regression. The multivariate model was adjusted for age, gender, physical activity, medical history, marital status, smoking history, and education
DISCUSSION
As a result of a prospective study conducted on a representative sample of the Iranian population, it was estimated that the incidence of dyslipidemia was 4.4% after 5 years, and obesity was found to be significantly associated with dyslipidemia in women and overall participants.
The incidence of dyslipidemia over 5 years
According to a study in Korea, the incidence of dyslipidemia during an average follow-up of 14 years was 78.4%.[12] Also, according to a study in Chongqing in 2012,[13] the incidence of dyslipidemia in the population was reported as 35.01%. These incidence rates in the mentioned studies were higher than those in this study. Additionally, according to a study in Manitoba (2015),[14] there were 28 new cases of dyslipidemia during follow-up among 112 participants without dyslipidemia at baseline (25%).
In this study, obese women were at a greater risk of dyslipidemia than men after 5 years. According to a study conducted in 2021, dyslipidemia was 1.8 times more common among women in Kerman compared to men.[15] These results are consistent with the current study and some published studies by Qpoku and Tabatabaei-Malazy.[16,17]
The adjusted odds ratio of dyslipidemia was 1.32 times in obese men and 2.81 times in obese women and 1.88 times in the general population, more than in nonobese people. There was a positive and significant relationship between obesity and dyslipidemia in women and the general population (P < 0.01), but this relationship was not significant in men (P = 0.30).
In the study of Ebrahimi et al.[18] (2016), abdominal obesity and BMI > 25 increased the chance of dyslipidemia and triglycerides. According to this study, with an increase in body mass index (BMI >30), the odds ratios of dyslipidemia and triglycerides were 1.95 times and 1.81 times, respectively. In addition, abdominal obesity (WC) increased the odds ratio of dyslipidemia and triglyceride in women when compared to men by 1.34 times and 1.65 times, respectively. According to the study by Latifi et al.[19] (2016), after increasing BMI, the risk of TG and high cholesterol increased by 12 times and 5.5 times, respectively. In addition, this study showed that obesity and overweight increase TG and cholesterol levels. Additionally, Shah et al. (2010)[4] found that the LDL, HDL and TG levels were significantly correlated with obesity and the amount of blood lipid increase was strongly related to obesity. According to the study by Ahmadi et al.[9] (2021), in Yazd, it has been determined that children and adolescents, normal, overweight, and obese in terms of BMI, are 3.5 times, 5 times, and 16.1 times more at risk of dyslipidemia.
According to this study, during a 5-year follow-up, we found that there is a relationship between the risk of dyslipidemia in obese women and men. Obese participants had the highest risk of developing dyslipidemia compared with nonobese participants, which was similar to the findings in previous studies.[20,21] Dyslipidemia associated with obesity has an increase in triglycerides, VLDL, HDL and increased small dense LDL particles. Therefore, diet modifications and lifestyle changes are essential for controlling obesity-related dyslipidemia.[22]
According to our findings, there was an association between obesity and an increased risk of dyslipidemia in participants under 60 years of age. Clarice et al. (2000)[23] reported that young men and women with higher BMI have higher levels of high blood cholesterol and low HDL. Also, according to the study by Latifi et al.[19] (2016) the risk of dyslipidemia, high cholesterol, and high LDL increased until the age of 60 years.
Implications for public health
Central obesity and abdominal obesity were two indicators predicting the occurrence of dyslipidemia in the Central Iranian population under 60 years of age. Compared with older obese participants, younger obese participants appeared to have a higher risk of dyslipidemia. A key message for public health would be that younger people are more likely to have dyslipidemia than older people due to their lifestyles and diets. Therefore, community programs that educate individuals on the importance of a balanced diet and regular exercise are key in tackling this issue. Yet, for many, medication may still be necessary.
Strengths and limitations
This is the first study to estimate the incidence of dyslipidemia in a large population in Central Iran and between obese and nonobese participants.
In this study, there were some limitations. It is possible that the exact time of the incidence of dyslipidemia was lost due to the repeated measurement after 5 years. Additionally, we were not able to check the population during the follow-up, so lifestyle factors such as dietary habits, smoking, and physical activity could have changed.
The field of cardiometabolic health in Iran has been greatly enriched by the timely and clinically relevant contribution of this study. The high-quality, prospective, and granular analysis of a unique dataset is what makes its innovations stand out, not just one groundbreaking discovery. A strong connection between obesity and the incidence of dyslipidemia in women and the total population can be directly informed by the demonstration of a strong, gender-specific, and age-modified association, which can help guide national health policies and preventive medicine practices in Yazd, Iran. However, to generalize the results of the study to other areas in Iran and other countries, further studies are recommended.
CONCLUSION
In this study, we compared the 5-year incidences of dyslipidemia among men, women, and the general population in Central Iran. Compared with nonobese participants, obesity was associated with an increased incidence of dyslipidemia after 5 years. Dyslipidemia, particularly when associated with obesity, poses a significant health challenge in Central Iran. Efforts to modify the diet, promote active lifestyles, and implement public health interventions are critical in managing this condition. Public awareness and governmental policies will play an essential role in mitigating the risks.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
It is important that the authors thank all their colleagues who participated in the YaHS study, and especially express gratitude to the participants for their patience throughout the study.
Funding Statement
Nil.
REFERENCES
- 1.Jacob BS, Balachandran J, Paul V. A study on prevalence of dyslipidemia in obese patients in a teaching hospital in Kerala. Sch J App Med Sci. 2014;2:642–6. [Google Scholar]
- 2.Alamri A, Almalki MD, Alotaibi WN, Althobait S. The prevalence of dyslipidemia in obese patients. Int J Med Dev Count. 2019;3:6–9. [Google Scholar]
- 3.Ohta T, Nagashima J, Sasai H, Ishii N. Relationship of cardiorespiratory fitness and body mass index with the incidence of dyslipidemia among Japanese women: A cohort study. Int J Environ Res Public Health. 2019;16:4647. doi: 10.3390/ijerph16234647. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Shah S, Devrajani B, Devrajani T, Bibi I. Frequency of dyslipidemia in obese versus non-obese in relation to body mass index (BMI), waist hip ratio (WHR) and waist circumference (WC) Pak J Sci. 2010;62:27–31. [Google Scholar]
- 5.Al-Kaabba AF, Al-Hamdan NA, El Tahir A, Abdalla AM, Saeed AA, Hamza MA. Prevalence and Correlates of Dyslipidemia among Adults in Saudi Arabia: Results from a National Survey. Open J Endocrinol Metab Dis. 2012;2:89–97. [Google Scholar]
- 6.Saadi H, Carruthers SG, Nagelkerke N, Al-Maskari F, Afandi B, Reed R, et al. Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates. Diabetes Res Clin Pract. 2007;78:369–77. doi: 10.1016/j.diabres.2007.04.008. [DOI] [PubMed] [Google Scholar]
- 7.Grabauskas V, Miseviciene I, Klumbiene J, Petkeviciene J, Milasauskiene Z, Plieskiene A, et al. Prevalence of dyslipidemias among Lithuanian rural population (CINDI program) Medicina (Kaunas) 2003;39:1215–22. [PubMed] [Google Scholar]
- 8.Namayandeh SM, Sadr SM, Ansari Z, Rafiei M. A cross-sectional study of the prevalence of coronary artery disease traditional risk factors in Yazd urban population, Yazd healthy heart project. Int Cardiovasc Res J. 2011;5:7–13. [Google Scholar]
- 9.Ahmadi N, Hosseini SMS, Yazdi FR, Mirzaei M, Dehghani-Tafti F, Bafghi SMS, et al. Prevalence and predictors of dyslipidemia in children and adolescents in Yazd greater area, Yazd, Iran. Iran Red Crescent Med J. 2021:23. doi: 10.32592/ircmj.2021.23.4.222. [Google Scholar]
- 10.Sadr Bafghi S, Nasirian M, Namayandeh S, Rafiei M, Pakseresht M. The prevalence of abdominal obesity and cardiovascular risk factors in urban population of Yazd. Med J Mashhad Univ Med Sci. 2008;51:61–6. [Google Scholar]
- 11.Mirzaei M, Salehi-Abargouei A, Mirzaei M, Mohsenpour MA. Cohort profile: The Yazd Health Study (YaHS): A population-based study of adults aged 20-70 years (study design and baseline population data) Int J Epidemiol. 2018;47:697–8h. doi: 10.1093/ije/dyx231. [DOI] [PubMed] [Google Scholar]
- 12.Jeong IS, Yun HS, Kim MS, Hwang YS. Incidence and risk factors of dyslipidemia after menopause. J Korean Acad Nurs. 2022;52:214–27. doi: 10.4040/jkan.21188. [DOI] [PubMed] [Google Scholar]
- 13.Gao Y, Zhong XN, Yang YH, Tian KC. [Plasma lipid level and incidence of dyslipidemia in workers of Chongqing enterprises and institutions] Zhonghua Xin Xue Guan Bing Za Zhi. 2012;40:432–5. [PubMed] [Google Scholar]
- 14.Riediger ND, Lukianchuk V, Bruce SG. Incident diabetes, hypertension and dyslipidemia in a Manitoba First Nation. Int J Circumpolar Health. 2015;74:27712. doi: 10.3402/ijch.v74.27712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Najafipour H, Yousefzadeh G, Baneshi MR, Gohari MA, Shahouzehi B, Farokhi MS, et al. Prevalence and 5-year incidence rate of dyslipidemia and its association with other coronary artery disease risk factors in Iran: Results of the Kerman coronary artery disease risk factors study (Phase 2) J Res Med Sci. 2021;26:99. doi: 10.4103/jrms.JRMS_748_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Tabatabaei-Malazy O, Qorbani M, Samavat T, Sharifi F, Larijani B, Fakhrzadeh H. Prevalence of dyslipidemia in Iran: A systematic review and meta-analysis study. Int J Prev Med. 2014;5:373–93. [PMC free article] [PubMed] [Google Scholar]
- 17.Opoku S, Gan Y, Fu W, Chen D, Addo-Yobo E, Trofimovitch D, et al. Prevalence and risk factors for dyslipidemia among adults in rural and urban China: Findings from the China National Stroke Screening and Prevention Project (CNSSPP) BMC Public Health. 2019;19:1–15. doi: 10.1186/s12889-019-7827-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Ebrahimi H, Emamian MH, Hashemi H, Fotouhi A. Dyslipidemia and its risk factors among urban middle-aged Iranians: A population-based study. Diabetes Metab Syndr. 2016;10:149–56. doi: 10.1016/j.dsx.2016.01.009. [DOI] [PubMed] [Google Scholar]
- 19.Latifi SM, Moradi L, Shahbazian H, Aleali AM. A study of the prevalence of dyslipidemia among the adult population of Ahvaz, Iran. Diabetes Metab Syndr. 2016;10:190–3. doi: 10.1016/j.dsx.2016.06.003. [DOI] [PubMed] [Google Scholar]
- 20.Nikparvar M, Khaladeh M, Yousefi H, Kheirandish M. Dyslipidemia and its associated factors in women of the Bandare-Kong cohort study. Research Square. 2020 doi: 10.1038/s41598-021-88680-z. doi: 10.21203/rs.3.rs-56630/v1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Redondo MJ, Foster NC, Libman IM, Mehta SN, Hathway JM, Bethin KE, et al. Prevalence of cardiovascular risk factors in youth with type 1 diabetes and elevated body mass index. Acta Diabetol. 2016;53:271–7. doi: 10.1007/s00592-015-0785-1. [DOI] [PubMed] [Google Scholar]
- 22.Repas T. Obesity and dyslipidemia. S D Med. 2011;64:241–3. 245, 247 passim. [PubMed] [Google Scholar]
- 23.Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res. 2000;8:605–19. doi: 10.1038/oby.2000.79. [DOI] [PubMed] [Google Scholar]