title: 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.
abstract: OBJECTIVE
  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.
authors: Pediatrics Department, Faculty of Medicine and Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. kelishadi@med.mui.ac.ir
authors: Roya
authors: R
authors: Kelishadi
authors: Mohammad Esmaeil
authors: ME
authors: Motlagh
authors: Peyman
authors: P
authors: Roomizadeh
authors: Seyed-Hossein
authors: SH
authors: Abtahi
authors: Mostafa
authors: M
authors: Qorbani
authors: Mahnaz
authors: M
authors: Taslimi
authors: Ramin
authors: R
authors: Heshmat
authors: Tahereh
authors: T
authors: Aminaee
authors: Gelayol
authors: G
authors: Ardalan
authors: Parinaz
authors: P
authors: Poursafa
authors: Mehrdad
authors: M
authors: Karimi
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000352:Africa, Northern / Q000453:epidemiology; D015992:Body Mass Index; D002648:Child; D002657:Child Development; D003906:Developing Countries; D004032:Diet / Q000009:adverse effects / Q000208:ethnology; D050171:Dyslipidemias / Q000208:ethnology / Q000503:physiopathology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D008877:Middle East / Q000453:epidemiology; D008954:Models, Biological; D009765:Obesity / Q000208:ethnology / Q000503:physiopathology; D012307:Risk Factors; D057185:Sedentary Behavior / Q000208:ethnology; D012959:Socioeconomic Factors; D013223:Statistics as Topic