Only a few studies have attempted to assess the relationship between junk food consumption and cardiometabolic risk factors in Iranian children and adolescents; therefore, the aim of our study was to determine the association between junk food intake and cardiometabolic risk factors in this population.
This is a cross-sectional study.
A total of 14,400 students were selected from 30 provinces of Iran using multistage, stratified cluster sampling method. Information about student’s lifestyle, health behaviors and health status was obtained through a validated questionnaire. Blood pressure was measured and anthropometric indices were calculated. Blood samples were drawn from 3,303 students for biochemical tests. In our study, sugar-sweetened beverages, salty snacks, sweets and fast foods were considered as junk foods.
The mean age of participants was 12.42 ± 2.97 years. Those with metabolic syndrome were more likely to live in urban areas (P = 0.004) and have higher BMI (P < 0.0001). Junk food intake was not related to metabolic syndrome; however, it was associated with increased odds of high BP (OR 1.23, 95% CI 1.09, 1.39), high SBP (OR 1.38, 95% CI 1.09, 1.75), and high DBP (OR 1.18, 95% CI 1.04, 1.35), overweight (OR 1.22, 95% CI 1.08, 1.39) and excess weight (OR 1.14, 95% CI 1.04, 1.25).
Junk food consumption plays an important role in childhood overweight and is related to high blood pressure in this population.
Level of evidence
Level III, case-control analytic studies.
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Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J et al (2002) The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709–2716. https://doi.org/10.1001/jama.288.21.2709
Ejtahed HS, Qorbani M, Motlagh ME, Angoorani P, Hasani-Ranjbar S, Ziaodini H et al (2017) Association of anthropometric indices with continuous metabolic syndrome in children and adolescents: the CASPIAN-V study. Eat Weight Disord. https://doi.org/10.1007/s40519-017-0455-0
Kelishadi R (2007) Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev 29(1):62–76. https://doi.org/10.1093/epirev/mxm003
Gupta A, Kapil U, Singh G (2018) Consumption of junk foods by school-aged children in rural Himachal Pradesh, India. Indian J Public Health 62(1):65–67. https://doi.org/10.4103/ijph.IJPH_343_16
Namazi N, Djalalinia S, Mahdavi-Gorabi A, Asayesh H, Mansourian M, Noroozi M, Qorbani M (2018) Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0534-x
Kelishadi R, Gouya MM, Adeli K, Ardalan G, Gheiratmand R, Majdzadeh R et al (2008) Factors associated with the metabolic syndrome in a national sample of youths: CASPIAN Study. Nutr Metab Cardiol Dis 18(7):461–470. https://doi.org/10.1016/j.numecd.2007.02.014
Asghari G, Yuzbashian E, Mirmiran P, Mahmoodi B, Azizi F (2015) Fast food intake increases the incidence of metabolic syndrome in children and adolescents: Tehran lipid and glucose study. PLoS One 10:e0139641. https://doi.org/10.1371/journal.pone.0139641
Bahadoran Z, Mirmiran P, Golzarand M, Hosseini-Esfahani F, Azizi F (2012) Fast food consumption in Iranian adults; dietary intake and cardiovascular risk factors: Tehran Lipid and Glucose Study. Arch Iran Med 15:346–351
Mirmiran P, Bahadoran Z, Delshad H, Azizi F (2014) Effects of energy-dense nutrient-poor snacks on the incidence of metabolic syndrome: a prospective approach in Tehran Lipid and Glucose Study. Nutrition 30(5):538–543. https://doi.org/10.1016/j.nut.2013.09.014
Costa CS, Del-Ponte B, Assuncao MCF, Santos IS (2018) Consumption of ultra-processed foods and body fat during childhood and adolescence: a systematic review. Public Health Nutr 21(1):148–159. https://doi.org/10.1017/S1368980017001331
Payab M, Kelishadi R, Qorbani M, Motlagh ME, Ranjbar SH, Ardalan G et al (2015) Association of junk food consumption with high blood pressure and obesity in Iranian children and adolescents: the CASPIAN-IV Study. J Pediatr (Rio J) 91:196–205. https://doi.org/10.1016/j.jped.2014.07.006
Kardinaal AFM, van Erk MJ, Dutman AE, Stroeve JHM, van de Steeg E, Bijlsms S et al (2015) Quantifying phenotypic flexibility as the response to a high-fat challenge test in different states of netabolic health. FASEB 29(11):4600–4613. https://doi.org/10.1096/fj.14-269852
Rouhani MH, Mirseifinezhad M, Omrani N, Esmaillzadeh A, Azadbakht L (2012) Food consumption, quality of diet, and obesity among isfahanian adolescent girls. J Obes 2012:597924. https://doi.org/10.1155/2012/597924
Silden KE (2018) Impact of competitive foods in public schools on child nutrition: effects on adolescent obesity in the United States an integrative systematic literature review. Glob Health Action 11(1):1477492. https://doi.org/10.1080/16549716.2018.1477492
Guzel S, Keser A, Hatun S (2018) Investigating the nutritional value of foods targeting children. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0497-y
Malik VS, Schulze MB, Hu FB (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 84(2):274–288. https://doi.org/10.1093/ajcn/84.1.274
Kelishadi R, Motlagh ME, Roomizadeh P, Abtahi SH, Qorbani M, Taslimi M et al (2013) 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. Ann Nutr Metab 62:257–265. https://doi.org/10.1159/000346489
Motlagh ME, Ziaodini H, Qorbani M, Taheri M, Aminaei T, Goodarzi A et al (2017) Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: the CASPIANV Study. Int J Prev Med 8:4. https://doi.org/10.4103/2008-7802.198915
World Health Organization (2017) Expert Committee on physical status. Physical Status: The use and interpretation of anthropometry. WHO 1995. http://apps.who.int/iris/bitstream/10665/37003/1/WHO_TRS_854.pdf. Accessed 6 Feb 2017
Kelishadi R, Majdzadeh R, Motlagh ME, Heshmat R, Aminaee T, Ardalan G et al (2012) Development and evaluation of a questionnaire for assessment of determinants of weight disorders among children and adolescents: the CASPIAN IV study. Int J Prev Med 3:699–705. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482997/ [Accessed 2.7.18]
World Health Organization (2017) Waist circumference and waist- hip ratio: report of a WHO expert consultation. WHO, Genava 2008. http://whqlibdoc.who.int/publications/2011/9789241501491_eng.pdf. Accessed 6 Feb 17
American Academy of Pediatrics (2004) National high blood pressure education program working group on high blood pressure in children and adolescents. Pediatrics 114:2iv. http://pediatrics.aappublications.org/content/114/Supplement_2/iv. Accessed 2 July 2018
McNamara JR, Schaefer EJ (1987) Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. Clin Chim Acta 166:1–8. https://doi.org/10.1016/0009-8981(87)90188-4
Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S et al (2007) The metabolic syndrome in children and adolescents. Lancet 369:2059–2061. https://doi.org/10.1016/S0140-6736(07)60958-1
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002) Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 106(25): 3143-421. https://doi.org/10.1161/circ.106.25.3145
Li C, Ford ES, Mokdad AH, Cook S (2006) Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics 118(5):e1390-e80. https://doi.org/10.1542/peds.2006-1062
WHO multicentre growth reference study group (2006) WHO child growth standards based on length/height, weight and age. Acta Paediatr 450:76–85. http://www.who.int/childgrowth/standards/Growth_standard.pdf. Accessed 2 June 2018
Petroff D, Kromeyer-Hauschild K, Wiegand S, l’Allemand-Jander D, Binder G, Schwab K-O et al (2015) Introducing excess body weight in childhood and adolescence and comparison with body mass index and waist-to-height ratio. Int J Obes 39:52–60. https://www.nature.com/articles/ijo2014170. Accessed 2 June 18
Kelishadi R, Heshmat R, Farzadfar F, Motlagh ME, Bahreyni M, Safiri S (2017) Prevalence of cardio-metabolic risk factors in a nationally representetive sample of Iranian adolescents: the CASPIAN-III Study. J Cardiovasc Thorac Res 9(1):12–20. https://doi.org/10.15171/jcvtr.2017.02
Tavares LF, Fonseca SC, Garcia Rosa ML, Yokoo EM (2012) Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program. Pub Health Nut 15:82–87. https://doi.org/10.1017/S1368980011001571
Yeo R, Yoon SR, Kim OY (2017) The association between food group consumption patterns and early metabolic syndrome risk in non-diabetic healthy people. Clin Nutr Res 6(3):172–182. https://doi.org/10.7762/cnr.2017.6.3.172
Kelishadi R, Heshmat R, Mansourian M, Motlagh ME, Ziaodini H et al (2018) Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study. Diabetol Metab Syndrome 10:52. https://doi.org/10.1186/s13098-018-0352-3
Wang Y, Wang L, Xue H, Qu W (2016) A review of the growth of the fast food industry in China and its potential impact on obesity. Int J Environ Res Public Health 13(11):1112. https://doi.org/10.3390/ijerph13111112
Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA et al (2014) Fast-food consumption and body mass index in children and adolescents: an international cross-sectional study. BMJ 4:e005813. https://doi.org/10.1136/bmjopen-2014-005813
Dorfman SE, Laurent D, Gounarides JS, Li X, Mullarkey TL, Rocheford EC et al (2009) Metabolic implications of dietary trans-fatty acids. Obesity 17(6):1200–1207. https://doi.org/10.1038/oby.2008.662
Ludwig DS (2011) Technology, diet, and the burden of chronic disease. JAMA 305:1352–1353. https://doi.org/10.1001/jama.2011.380
Malik AH, Akram Y, Shetty S, Malik SS, Yanchou Njike V (2014) Impact of sugar-sweetened beverages on blood pressure. Am J Cardiol 113(9):1574–1580. https://doi.org/10.1016/j.amjcard.2014.01.437
Brown IJ, Stamler J, Horn LV, Robertson CE, Chan Q, Dyer AR et al (2011) Sugar sweetened beverage, sugar intake of individuals and there blood pressure: INTERMAP study. Hypertension 57(4):695–701. https://doi.org/10.1161/HYPERTENSIONAHA.110.165456
Nakagawa T, Hu H, Zharikov S, Tuttle K, Short RA, Glushakova O et al (2006) A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal 290:F625–F631. https://doi.org/10.1152/ajprenal.00140.2005
Blaustein MP, Zhang J, Chen L, Hamilton BP (2006) How does salt retention raise blood pressure? Am J Physiol Regul Integr Comp Physiol 290(3):514–523. https://doi.org/10.1152/ajpregu.00819.2005
Grimsgaard S, Bonaa KH, Jacobsen BK, Bjerve KS (1999) Plasma saturated and linoleic fatty acids are independently associated with blood pressure. Hypertension 34:478–483. https://doi.org/10.1161/hyp.34.3.478
This nationwide survey was performed in Iran with cooperation of Ministry of Education and Training, the Ministry of Health and Medical Education, the Child Health Promotion Research Center, Isfahan University of Medical Sciences and the Endocrinology and Metabolism Research Center of Tehran University.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors declare that there is no conflict of interest.
Study protocols were approved by the Ethics committee of Isfahan University of Medical Sciences, Project number: 194049.
After complete explanation of the study objectives and protocols, written and verbal informed consent was obtained from the parents and students, respectively.
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Azemati, B., Kelishadi, R., Ahadi, Z. et al. Association between junk food consumption and cardiometabolic risk factors in a national sample of Iranian children and adolescents population: the CASPIAN-V study. Eat Weight Disord 25, 329–335 (2020). https://doi.org/10.1007/s40519-018-0591-1
- Junk foods
- Cardiometabolic risk factors
- Metabolic syndrome
- Excess weight