Search

Objective: Middle Eastern and North African countries are undergoing nutrition transition, a transition which is associated with an increased burden of non-communicable diseases. This necessitates the evaluation of dietary patterns in these regions. The present study aimed to assess changes in dietary patterns in Middle Eastern and North African countries between 1961 and 2007.Design: Availability of energy and fifteen main food items during 1961-2007 was examined using FAO food balance sheets from the FAOSTAT database.Setting: Fifteen countries including nine in the Middle East and six in North Africa were selected and the average availability of total energy and different food items in these regions were compared.Results: Over the 47 years studied, energy and food availability (apart from animal fats and alcoholic beverages) has increased in the Middle East and North Africa. In both regions the proportion of energy derived from meat and vegetable oils has increased significantly while that from cereals decreased significantly. In addition, the proportion of energy from milk and dairy products and vegetables has shown an ascending trend in North Africa while the proportion of energy from fruits has shown a descending trend in the Middle East.Conclusions: The study results reveal an unfavourable trend towards a Westernized diet in the Middle East and, to a certain extent, in North Africa. Tailored nutritional education encouraging healthy eating for prevention of the burden of chronic diseases in these countries seems essential. [ABSTRACT FROM AUTHOR]

Objective: To analyse dietary compliance with WHO/FAO nutritional objectives, identify food subgroups that contribute to discrepancies between dietary intakes and recommendations, and assess food patterns and risk factor profiles at common nutritional targets.Design: The study was a population-based, cross-sectional assessment of the dietary patterns of Tehranian adults. Usual dietary intake was assessed in relation to common nutritional targets of public health (fat, saturated fat, dietary fibre, fruit and vegetables) using a validated FFQ. Metabolic syndrome (MetS) risk factors were diagnosed based on the Iranian-modified diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel III.Setting: The Tehran Lipid and Glucose Study (2005-2008).Subjects: A total of 2510 individuals (1121 men and 1389 women), aged between 19 and 70 years.Results: Generally, 68·5 % of total grain ounce-equivalents were derived from refined grains, with rice making up 36·6 % of all grains consumed. Solid fat (61·1 %) contributed more to discretionary energy than did added sugars (38·9 %). There was a twofold difference in fruit and vegetable consumption between the lowest and highest quartile categories of dietary fibre intake. The probability of having MetS was significantly lower in the highest quartile of fibre intake v. the lowest (OR = 0·69, 95 % CI 0·58, 0·84 v. OR = 0·92, 95 % CI 0·80, 1·03; P -trend < 0·001), whereas it was higher in the highest quartile of SFA intake v. the lowest (OR = 0·92, 95 % CI 0·78, 0·98 v. OR = 0·71, 95 % CI 0·62, 0·89; P-trend = 0·01).Conclusions: Complying with common nutritional targets of public health is inversely associated with MetS risk factors in Tehranian adults. These results may initiate measures for future development of regional food-based dietary guidelines. [ABSTRACT FROM AUTHOR]

In vitro and in vivo studies have shown that punicic acid, a type of conjugated fatty acid and the main constituent of pomegranate seed oil (PSO), has anti-atherogenic effects. The present study aimed at determining the effect of PSO treatment on serum lipid profiles. This double-blind placebo-controlled randomised clinical trial included fifty-one hyperlipidaemic subjects, diagnosed according to National Cholesterol Education Program definition, and randomly assigned to the PSO and the control groups. The PSO and placebo groups received 400 mg PSO and placebo twice daily, respectively and were followed up for 4 weeks. Serum concentrations of lipids and lipoproteins were measured before and 4 weeks after intervention. Mean concentration of TAG and the TAG:HDL cholesterol (HDL-C) ratio were significantly decreased after 4 weeks in the PSO group as compared with baseline values (2.75 (sd 1.40) v. 3.45 (sd 1.56) mmol/l, P = 0.009 and 5.7 (sd 4.6) v. 7.5 (sd 5.0), P = 0.031, respectively). The treatment effect was statistically significant in the PSO group as compared with controls in diminution of cholesterol:HDL-C ratio (5.4 (sd 1.5) v. 5.9 (sd 1.4), P < 0.05) adjusted for baseline values. We found a mean difference for PSO v. placebo in HDL-C concentration (0.13 v. - 0.02 mmol/l) and cholesterol:HDL-C ratio ( - 0.42 v. 0.01, P < 0.05). Serum cholesterol, LDL cholesterol and glucose concentrations and body composition variables remained unchanged. It is concluded that administration of PSO for 4 weeks in hyperlipidaemic subjects had favourable effects on lipid profiles including TAG and TAG:HDL-C ratio. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relationship between dietary diversity score (DDS) and cardiovascular risk factors in Tehranian adults.Methods: In this population-based cross-sectional study, a representative sample of 581 subjects (295 males and 286 females) aged over 18 years, residents of Tehran, participated. Hypercholesterolaemia, hypertriglyceridaemia and low high-density lipoprotein cholesterol were defined according to the Adult Treatment Panel III guidelines of the National Cholesterol Education Program. Diabetes was defined as fasting plasma glucose concentration > or = 126 mg dl(-1) or 2-h post challenge glucose concentration > or = 200 mg dl(-1). Hypertension was defined on the basis of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Dietary diversity was defined according to the Diet Quality Index revised.Results: Mean (+/- standard deviation) DDS was 6.15 +/- 1.02. The probability of having diabetes (odds ratio (OR) among quartiles: 1.45, 1.26, 1.11 and 1.00, respectively; P for trend = 0.04) and hypertriglyceridaemia (OR = 1.41, 1.23, 1.05 and 1.00, respectively; P for trend=0.04) decreased with increasing quartile of the diversity score for whole grains. The probability of having obesity (OR among quartiles: 1.39, 1.06, 1.03 and 1.00, respectively; P for trend = 0.03), hypercholesterolaemia (OR = 1.46, 1.28, 1.11 and 1.00, respectively; P for trend = 0.03), hypertension (OR = 1.32, 1.17, 1.13 and 1.00, respectively; P for trend = 0.03) and high low-density lipoprotein cholesterol (LDL-C) (OR = 1.25, 1.12, 1.07 and 1.00, respectively; P for trend = 0.04) decreased with increasing quartile of the diversity score for vegetables. The probability of having hypercholesterolaemia, high LDL-C, hypertension and diabetes decreased with quartile of the DDS. But the probability of being obese increased with quartile of the DDS (P for trend = 0.03).Conclusion: DDS was inversely associated with cardiovascular risk factors in this cross-sectional study. Increased diversity scores of diets, to increase the variety score for vegetables, may be emphasised in programmes attempting to bring about changes in lifestyle. [ABSTRACT FROM AUTHOR]

Objective: To compare the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict cardiovascular risk factors in an urban adult population of Tehranian women.Design: Population-based cross-sectional study.Setting: Tehran, the capital of Iran.Subjects: This study was conducted on 5073 women aged 18-74 years, participants of the Tehran Lipid and Glucose Study. Demographic data were collected. Anthropometric indices were measured according to standard protocols. Cut-off points of BMI, WC, WHR and WHtR were considered as 25 kg m(-2), 80 cm, 0.8 and 0.5, respectively. Blood pressure was measured and hypertension was defined based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Biochemical analyses were conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose > or = 126 mg dl(-1) or 2-hour plasma glucose > or = 200 mg dl(-1) and dyslipidaemia based on the third report of the National Cholesterol Education Program Expert Panel. The presence of 'at least one risk factor' from the three major cardiovascular risk factors (hypertension, dyslipidaemia and diabetes) was also evaluated.Results: Mean (+/-standard deviation) age of women was 39.9+/-14.6 years; mean BMI, WC, WHR and WHtR were 27.1+/-1.5 kg m(-2), 86.5+/-13.5 cm and 0.83+/-0.08 and 0.55+/-0.08, respectively. Of the four anthropometric measures, WC had the highest sensitivity and specificity to identify subjects with risk factors in both the 18-39 year and the 40-74 year age categories. WC was seen to have a higher percentage of correct prediction than BMI, WHR and WHtR.Conclusion: It is concluded that WC is the best screening measure for cardiovascular risk factors, compared with BMI, WHR and WHtR, in Tehranian adult women. [ABSTRACT FROM AUTHOR]

Background: Northern rural areas of Tehran have been shown to have severe iodine deficiency in our previous studies. In 1989 the inhabitants of these villages received an injection of iodised oil, followed by iodised salt distribution in 1993. The aim of the present study was to evaluate the effect of the iodine supplementation on iodine-deficient schoolchildren with hypothyroidism in these villages.Methods: In total, 571 students aged 6-14 years were studied. Goitre was graded according to the World Health Organization classification. Serum concentrations of thyroid hormones (thyroxine (T4) and triiodothyronine (T3)) and thyroid-stimulating hormone (TSH) were determined using commercial kits, and urinary iodine was measured using a digestion method. The results were compared with data from our previous study in 1989.Results: Total goitre rate decreased by 42% in 1999 compared with that in 1989. A significant decrease in Grade 2 goitre concomitant with an increase in Grade 1 goitre was seen (P < 0.001). Values of the variables studied before (1989) and 10 years after iodine supplementation (1999) were: median urinary iodine excretion, 2.0 vs. 19.0 microg dl(-1) (P < 0.001); T4, 6.5 +/- 2.0 vs. 8.4 +/- 1.6 microg dl(-1) (P < 0.001); T3, 177 +/- 38.0 vs. 145 +/- 29.0 ng dl(-1) (P < 0.001); TSH, 10.8 +/- 15.1 vs. 1.8 +/- 0.8 microU ml(-1) (P < 0.001). No correlation was found between thyroid hormones and TSH on the one hand, and goitre and urinary iodine, on the other. Serum T4, T3 and TSH concentrations were within normal ranges in all schoolchildren in 1999.Conclusion: This study showed that euthyroidism induced by administration of iodised oil in iodine-deficient schoolchildren with hypothyroidism is sustained following the consumption of iodised salt. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of major dietary patterns with the risk of impaired glucose and insulin homeostasis during a 3-year follow-up., Design: Fasting serum insulin (FSI), fasting (FSG) and 2 h serum glucose (2h-SG) were measured at baseline and again after 3 years. Dietary intakes were evaluated using a validated 168-item semi-quantitative FFQ and major dietary patterns were obtained using principal component analysis. Logistic regression models were used to estimate the occurrence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), pre-diabetes (IGT/IFG), β-cell dysfunction and hyperinsulinaemia across tertiles of dietary patterns, with adjustment for potential confounding variables., Setting: Tehran Lipid and Glucose Study., Subjects: Iranian men and women (n 904)., Results: Mean age of participants was 38·7 (sd 11·3) years and 44·6 % were men. Major dietary patterns were Western, traditional and healthy, which explained 25·2 % of total variance in food intake. There was a positive association between Western and traditional scores with 3-year change in 2h-SG, while the healthy pattern was negatively related to 3-year changes in FSG, 2h-SG, FSI and homeostasis model assessment of insulin resistance. Highest compared with the lowest tertile of the Western dietary pattern was accompanied by a higher risk for development of IGT (OR=3·09; 95 % CI 1·28, 7·50); a higher score on the healthy dietary pattern was associated with a significantly reduced risk of hyperinsulinaemia (OR=0·53; 95 % CI 0·28, 0·94)., Conclusions: Our findings showed that adherence to a Western dietary pattern may be a risk factor for the development of IGT, while a healthy dietary pattern may prevent hyperinsulinaemia.

Objective: Iodine deficiency still remains a major public health concern worldwide despite global progress in its elimination. The aims of the present study were to evaluate dietary iodine status in the mother and one adult member of each family and the association between mothers' knowledge, attitude and behaviour and the dietary iodine status of adult family members in Tehran., Design: In this cross-sectional study, 24 h urinary iodine and Na concentrations and the iodine content of household salt were measured. Mothers' knowledge, attitude and behaviour were assessed using a questionnaire administered in face-to-face interviews., Setting: Health-care centres from four distinct areas of Tehran., Subjects: Mother-adult family member pairs aged ≥ 19 years (n 290), enrolled through randomized cluster sampling., Results: In mothers and adult family members, median 24 h urinary iodine concentration was 73 (interquartile range (IQR) 36-141) µg/l and 70 (IQR 34-131) µg/l, dietary iodine intake was 143 (IQR 28-249) µg/d and 130 (IQR 26-250) µg/d and dietary salt intake was 8.0 (IQR 5.9-10.2) g/d and 7.5 (IQR 5.3-10.0) g/d, respectively. Significant correlations were observed between mothers' attitude and behaviour and the 24 h urinary iodine concentration, dietary iodine intake and iodine content of salt of adult family members. In multiple analysis, lower quartiles of salt iodine content and salt intake and inappropriate behaviour scores in mothers increased the risk of urinary iodine concentration <100 µg/l in adult family members., Conclusions: The present study showed that mothers' behaviour, but not knowledge and attitude, was among major contributors to the suboptimal dietary iodine status observed in adult family members.

Objective: To determine the effectiveness of implementation of a prevention programme via mobile phone text messaging in enhancing knowledge, attitudes and practice concerning iodine deficiency and iodized salt consumption., Design: In a randomized controlled trial, participants were subjected to a brief tele-educational support regarding iodine deficiency and the importance of iodized salt consumption. The intervention group received daily text messages via mobile phone for 6 weeks. Knowledge, attitude and practice scores, urinary iodine concentration and salt iodine content were assessed at baseline and 8 weeks after the intervention., Setting: Participants were recruited from health-care centres in Tehran, the capital city of Iran., Subjects: For the present study 205 females aged ≥18 years were randomly assigned to the intervention (n 95) and control (n 110) groups., Results: A significant difference was found in median knowledge scores between the intervention and control groups at follow-up (P = 0.004). There was also a significant difference in median attitude scores between the intervention and control groups (P = 0.02). The intervention group did not differ significantly in median practice score, urinary iodine concentration and salt iodine content from the control group., Conclusions: Text messaging interventions are effective in improving individuals' knowledge and attitudes regarding preventive health-care topics.

Objective: We examined the association of metabolic syndrome (MetS) and its components with dietary intakes of Mg in Tehran adults., Design: In a cross-sectional study, dietary intakes were assessed using a valid and reliable FFQ. MetS was defined according to the modified guidelines of the National Cholesterol Education Program Adult Treatment Panel III. Waist circumference (WC) was coded according to the newly introduced cut-off points for Iranian adults (≥95 cm for both genders)., Setting: Participants of the Tehran Lipid and Glucose Study (2006-2008)., Subjects: Adults (n 2504; 1120 men and 1384 women) aged 18-74 years., Results: The mean age of participants was 40·8 (SD 14·6) years and 38·2 (SD 13·5) years for men and women, respectively. The reported mean intake of Mg was 349 (SD 109) mg/d. After adjustment for confounding factors, dietary Mg intake was inversely associated with fasting blood glucose (β = -0·08, P = 0·006), TAG (β = -0·058, P = 0·009) and WC (β = -0·013, P = 0·006); however, there were no associations between dietary Mg and diastolic blood pressure, systolic blood pressure or HDL cholesterol. An association was observed between MetS Z-score and Mg intake (crude β = -0·017, P = 0·001), independent of age, gender, smoking, physical activity and BMI; this association was attenuated following further adjustment for dietary factors and menopausal status (β = -0·034, P = 0·061)., Conclusions: Our findings suggest a significant inverse association between dietary Mg, MetS and its components.

Objective: To describe the relative validity and reliability of the FFQ used for assessing nutrient intakes of participants in the Tehran Lipid and Glucose Study (TLGS)., Design: A total of 132 subjects (sixty-one males and seventy-one females) were included in the study. Dietary data were collected monthly by means of twelve 24 h dietary recalls (24hDR). Subjects completed two, 168-item semi-quantitative FFQ. Blood and urine samples were taken every season for measurement of plasma biomarkers and urinary N and K., Results: Mean age and BMI of the participants were 35.5 (sd 16.8) years and 25.5 (sd 5.2) kg/m2, respectively. The mean energy-adjusted and deattenuated correlation coefficients for overall nutrient intake between the 24hDR and FFQ2 were 0.44 and 0.37 in 35-year-olds, respectively, and for individual nutrients ranged from 0.24 to 0.71 in men (mean r = 0.53) and from 0.11 to 0.60 in women (mean r = 0.39). The mean energy-adjusted reliability coefficients varied from 0.48 in 35-year-olds, and ranged from 0.41 to 0.79 in men (mean r = 0.59) and from 0.39 to 0.74 in women (mean r = 0.60). The FFQ2 and 24hDR produced exact agreement rates ranging between 39.6 % and 68.3 % in men and between 39.6 % and 54.1 % in women. The ranges of questionnaire validity coefficients, with the sample correlation between the questionnaires and biochemical marker as the lower limit and the estimate obtained by the method of triads as the upper limit, were 0.21-0.56 (protein) and 0.37-0.61 (K)., Conclusions: The FFQ developed for the TLGS has reasonable relative validity and reliability for nutrient intakes in Tehranian adults.

Objective: To determine the nutritional behaviour of Tehranian adolescents., Subjects and Methods: This study was undertaken on 7669 adolescents (4070 boys and 3599 girls) of 22 junior high schools and high schools as a representative sample of Tehranian adolescents. A validated knowledge, attitudes and practices (KAP) questionnaire and a food-frequency questionnaire (FFQ) were used. Factor analysis was used to determine the key questions., Results: The mean ( +/- standard deviation) age and body mass index of the adolescents was 14 +/- 1 years and 27.2 +/- 11 kg m- 2. Although 82% of girls and 75% of boys had good nutritional knowledge, only 25% of boys and 15% of girls had good nutritional practice. Eighty-five per cent of adolescents knew that drinking too many soft beverages resulted in overweight or obesity, but only 4.5% of them did not drink soft beverages. Although 89% of adolescents knew that crisps and corn balls are not healthy snacks, 45% of them used such snacks during their break time. Thirty-seven per cent of adolescents preferred whole-grain biscuits to creamy wafer ones but only 10% of adolescents used whole-grain biscuits as a snack. The most frequently consumed snacks among Tehranian adolescents were sausage sandwiches, cocoa cola, crisps and corn balls, creamy wafers, cakes, chocolate and toffee., Conclusion: A low percentage of Tehranian adolescents have good nutritional behaviour and in most of them their nutritional practice does not accord with their nutritional knowledge. These results indicate the necessity of nutritional intervention in Tehranian adolescents.