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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]

Abstract Background Although Iran is a high-risk region for esophageal squamous cell carcinoma (ESCC), dietary factors that may contribute to this high incidence have not been thoroughly studied. The aim of this study was to evaluate the effect of macronutrients, vitamins and minerals on the risk of ESCC. Methods In this hospital-based case-control study, 47 cases with incident ESCC and 96 controls were interviewed and usual dietary intakes were collected using a validated food frequency questionnaire. Data were modeled through unconditional multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), controlling for age, sex, gastrointestinal reflux, body mass index, smoking history (status, intensity and duration), physical activity, and education. Results ESCC cases consumed significantly more hot foods and beverages and fried and barbecued meals, compared to the controls (p < 0.05). After adjusting for potential confounders, the risk of ESCC increased significantly in the highest tertiles of saturated fat [OR:2.88,95%CI:1.15-3.08], cholesterol [OR:1.53, 95%CI: 1.41-4.13], discretionary calorie [OR:1.51, 95%CI: 1.06-3.84], sodium [OR:1.49,95%CI:1.12-2.89] and total fat intakes [OR:1.48, 95%CI:1.09-3.04]. In contrast, being in the highest tertile of carbohydrate, dietary fiber and (n-3) fatty acid intake reduced the ESCC risk by 78%, 71% and 68%, respectively. The most cancer-protective effect was observed for the combination of high folate and vitamin E intakes (OR: 0.02, 95%CI: 0.00-0.87; p < 0.001). Controls consumed 623.5 times higher selenium, 5.48 times as much β-carotene and 1.98 times as much α-tocopherol as the amount ESCC cases consumed. Conclusion This study suggests that high intake of nutrients primarily found in plant-based foods is associated with a reduced esophageal cancer risk. Some nutrients such as folate, vitamin E and selenium might play major roles in the etiology of ESCC and their status may eventually be used as an epidemiological marker for esophageal cancer in Iran, and perhaps other high-risk regions.

Chronic graft-versus-host disease (cGvHD) is a multisystem disorder that occurs in recipients of allogeneic hematopoietic (alloHCT) stem cell transplants and is characterized by both inflammatory and fibrotic manifestations. It begins with the recognition of host tissues by the non-self (allogeneic) graft and progresses to tissue inflammation, organ dysfunction and fibrosis throughout the body. Oral cavity manifestations of cGVHD include mucosal features, salivary gland dysfunction and fibrosis. This review synthesizes current knowledge on the pathogenesis, diagnosis and management of oral cGVHD, with a focus on emerging trends and novel therapeutics. Data from various clinical studies and expert consensus are integrated to provide a comprehensive overview.

Hybrid methods are a suitable option for extracting dietary patterns associated with health outcomes. This study aimed to identify the dietary patterns of Brazilian adults (20-59 years old; n = 28,153) related to dietary components associated with the risk of obesity. Data from the 2017-2018 Brazilian National Dietary Survey were analyzed. Food consumption was obtained through 24 h recall. Dietary patterns were extracted using partial least squares regression, using energy density (ED), percentage of total fat (%TF), and fiber density (FD) as response variables. In addition, 32 food groups were established as predictor variables in the model. The first dietary pattern, named as energy-dense and low-fiber (ED-LF), included with the positive factor loadings solid fats, breads, added-sugar beverages, fast foods, sauces, pasta, and cheeses, and negative factor loadings rice, beans, vegetables, water, and fruits (≥|0.15|). Higher adherence to the ED-LF dietary pattern was observed for individuals >40 years old from urban areas, in the highest income level, who were not on a diet, reported away-from-home food consumption, and having ≥1 snack/day. The dietary pattern characterized by a low intake of fruits, vegetables, and staple foods and a high intake of fast foods and sugar-sweetened beverages may contribute to the obesity scenario in Brazil.

This study aimed to model how substituting foods consumed by Canadians for alternatives with more favourable nutrient profiling (NP) scores would impact dietary intakes. The Ofcom NP system, developed to help the UK Office of Communication differentiate foods that can be advertised to children, was applied to foods consumed by Canadians aged 2 years and older in the 2015 Canadian Community Health Survey (CCHS) ( n = 19,447). Foods were substituted for similar options from the Euromonitor branded food composition database (Scenario 1) or from the primarily aggregated food profiles in the CCHS survey food composition database (Scenario 2) with either the most favourable (optimistic; 1A and 2A) or a more favourable Ofcom score (realistic; 1B and 2B). Mean intakes of Ofcom scores, calories, saturated fat, sugars, and sodium from these scenarios were compared to baseline. Only 2.9% of foods consumed had a similar Euromonitor option with a lower Ofcom score. Scenarios 1A, 1B, and 2A had lower Ofcom scores, calorie, sodium, saturated fat, and sugar intakes compared to baseline. Scenario 2B had lower levels of all outcome measures, except for an increase in calories compared to baseline. Selection of foods with more favourable NP scores has the potential to decrease the Canadian intake of nutrients of concern.

Objective: To test whether adherence to the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) or a dietary pattern in-line with the 2015-2020 Dietary Guidelines for Americans (DGA) was associated with obesity., Design: 24-h dietary recall data from the Canadian Community Health Survey (CCHS)-Nutrition, 2004 and 2015 cycles, were analysed. Diet quality index scores were computed for the Mediterranean-Style Dietary Pattern Score (MSDPS), a DASH index and the 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Higher scores indicated greater adherence. Association between scores and obesity was examined using logistic regression, adjusting for age, sex, physical activity, smoking status, sequence of dietary recall and alcohol and energy intake., Setting: Canada (excluding territories and the institutionalised population)., Participants: Canadian adults (≥ 18 years), non-pregnant and non-breast-feeding; 11 748 from CCHS 2004 and 12 110 from CCHS 2015. The percentage of females in each sample was 50 %., Results: Mean MSDPS, DASH and DGAI scores were marginally but significantly higher in CCHS 2015 than in CCHS 2004. Those affected by obesity obtained lower scores for all indexes in CCHS 2004 (OR 10th v . 90th percentile for DASH: 2·23 (95 % CI 1·50, 3·32), DGAI: 3·01 (95 % CI 1·98, 4·57), MSDPS: 2·02 (95 % CI 1·14, 3·58)). Similar results were observed in CCHS 2015; however, results for MSDPS were not significant (OR 10th v . 90th percentile for DASH: 2·45 (95 % CI 1·72, 3·49), DGAI: 2·73 (95 % CI 1·85, 4·03); MSDPS: 1·30 (95 % CI 0·82, 2·06))., Conclusion: Following DASH or the 2015-2020 DGA was associated with a lower likelihood of obesity. Findings do not indicate causation, as the data are cross-sectional.

Purpose: The purpose of this study was to examine the association of alcohol consumption with intraocular pressure (IOP) and glaucoma and to assess whether any associations are modified by a glaucoma polygenic risk score (PRS)., Methods: Cross-sectional analysis of data from the Canadian Longitudinal Study on Aging Comprehensive Cohort, consisting of 30,097 adults ages 45 to 85 years, was done. Data were collected from 2012 to 2015. Alcohol consumption frequency (never, occasional, weekly, and daily) and type (red wine, white wine, beer, liquor, and other) were measured by an interviewer-administered questionnaire. Total alcohol intake (grams/week) was estimated. IOP was measured in mm Hg using the Reichert Ocular Response Analyzer. Participants reported a diagnosis of glaucoma from a doctor. Logistic and linear regression models were used to adjust for demographic, behavioral, and health variables., Results: Daily drinkers had higher IOP compared to those who never drank (β = 0.45, 95% confidence interval (CI) = 0.05, 0.86). An increase in total weekly alcohol intake (per 5 drinks) was also associated with higher IOP (β = 0.20, 95% CI = 0.15, 0.26). The association between total alcohol intake and IOP was stronger in those with a higher genetic risk of glaucoma (P for interaction term = 0.041). There were 1525 people who reported being diagnosed with glaucoma. Alcohol consumption frequency and total alcohol intake were not associated with glaucoma., Conclusions: Alcohol frequency and total alcohol intake were associated with elevated IOP but not with glaucoma. The PRS modified the association between total alcohol intake and IOP. Findings should be confirmed in longitudinal analyses.

This study aimed to determine whether higher intakes of Na, added sugars and saturated fat are prospectively associated with all-cause mortality and CVD incidence and mortality in a diverse population. The nationally representative Canadian Community Health Survey-Nutrition 2004 was linked with the Canadian Vital Statistics - Death Database and the Discharge Abstract Database (2004-2011). Outcomes were all-cause mortality and CVD incidence and mortality. There were 1722 mortality cases within 115 566 person-years of follow-up (median (interquartile range) of 7·48 (7·22-7·70) years). There was no statistically significant association between Na density or energy from saturated fat and all-cause mortality or CVD events for all models investigated. The association of usual percentage of energy from added sugars and all-cause mortality was significant in the base model with participants consuming 11·47 % of energy from added sugars having 1·34 (95 % CI 1·01, 1·77) times higher risk of all-cause mortality compared with those consuming 4·17 % of energy from added sugars. Overall, our results did not find statistically significant associations between the three nutrients and risk of all-cause mortality or CVD events at the population level in Canada. Large-scale linked national nutrition datasets may not have the discrimination to identify prospective impacts of nutrients on health measures.

Using 5 diet quality indexes, we estimated the mortality and life expectancy lost, at the national level, attributable to poor dietary patterns, which had previously been largely unknown. We used the Canadian Community Health Survey 2004, linked to vital statistics (n = 16,212 adults; representing n = 22,898,880). After a median follow-up of 7.5 years, 1,722 deaths were recorded. Population attributable fractions were calculated to estimate the mortality burden of poor dietary patterns (Dietary Guidelines for Americans Adherence Index 2015, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative Healthy Eating Index, and Mediterranean Style Dietary Pattern Score). Better diet quality was associated with a 32%-51% and 21%-43% reduction in all-cause mortality among adults aged 45-80 years and ≥20 years, respectively. Projected life expectancy at 45 years was longer for Canadians adhering to a healthy dietary pattern (average of 5.2-8.0 years (men) and 1.6-4.1 (women)). At the population level, 26.5%-38.9% (men) and 8.9%-22.9% (women) of deaths were attributable to poor dietary patterns. Survival benefit was greater for individuals with higher scores on all diet indexes, even with relatively small intake differences. The large attributable burden was likely from assessing overall dietary patterns instead of a limited range of foods and nutrients., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: There is increasing recognition of the value of linking food sales databases to national food composition tables for population nutrition research., Objectives: Expanding upon automated and manual database mapping approaches in the literature, our aim was to match 1,179 food products in the Canadian data subset of Euromonitor International's Passport Nutrition to their closest respective equivalents in Health Canada's Canadian Nutrient File (CNF)., Methods: Matching took place in two major steps. First, an algorithm based on thresholds of maximal nutrient difference (between Euromonitor and CNF foods) and fuzzy matching was executed to offer match options. If a nutritionally appropriate match was available among the algorithm suggestions, it was selected. When the suggested set contained no nutritionally sound matches, the Euromonitor product was instead manually matched to a CNF food or deemed unmatchable, with the unique addition of expert validation to maximize meticulousness in matching. Both steps were independently performed by at least two team members with dietetics expertise., Results: Of 1,111 Euromonitor products run through the algorithm, an accurate CNF match was offered for 65% of them; missing or zero-calorie data precluded 68 products from being run in the algorithm. Products with 2 or more algorithm-suggested CNF matches had higher match accuracy than those with one (71 vs. 50%, respectively). Overall, inter-rater agreement (reliability) rates were robust for matches chosen among algorithm options (51%) and even higher regarding whether manual selection would be required (71%); among manually selected CNF matches, reliability was 33%. Ultimately, 1,152 (98%) Euromonitor products were matched to a CNF equivalent., Conclusion: Our reported matching process successfully bridged a food sales database's products to their respective CNF matches for use in future nutritional epidemiological studies of branded foods sold in Canada. Our team's novel utilization of dietetics expertise aided in match validation at both steps, ensuring rigor and quality of resulting match selections., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gilbert, Morrison, Chen, Punian, Bernstein and Jessri.)

Introduction: The Canadian Community Health Survey (CCHS) - Nutrition 2004 (n=35,107; interview dates from January 2004 to January 2005) linked to the Canadian Vital Statistics - Death Database (CVSD) (2011) represents a novel linkage of a population-based, nationally representative nutrition survey with routinely collected mortality records (including date and cause of death). The linkage was done through individual tax data in Canada, and contains longitudinal records for 29,897 Canadians aged 0 years and older-1,753 of whom died-in the 10 provinces of Canada. The median follow-up time was 7.49 years, with 102,953 person-years among males and 114,876 person-years among females (unweighted), and included a special sampling survey weight (for linked data) to account for those who did not agree to share and link their information. The CCHS - Nutrition 2004 linked to CVSD has been used to evaluate associations between lifestyle and sociodemographic characteristics and mortality. Using these data, statistical methods have been developed and tested to control random and systematic measurement errors when evaluating the relationship between different dietary exposures (evaluated using repeated 24-hour dietary recalls) and health outcomes. The linked data are available through Statistics Canada's Research Data Centres.

Background: Hybrid methodologies have gained continuing interest as unique data reduction techniques for establishing a direct link between dietary exposures and clinical outcomes., Objectives: We aimed to compare partial least squares (PLS) and reduced rank regression (RRR) in identifying a dietary pattern associated with a high cardiovascular disease (CVD) risk in Canadian adults, construct PLS- and RRR-based simplified dietary patterns, and assess associations between the 4 dietary pattern scores and CVD risk., Methods: Data were collected from 24-h dietary recalls of adult respondents in the 2 cycles of the nationally representative Canadian Community Health Survey (CCHS)-Nutrition: CCHS 2004 linked to health administrative databases (n = 12,313) and CCHS 2015 (n = 14,020). Using 39 food groups, PLS and RRR were applied for identification of an energy-dense (ED), high-saturated-fat (HSF), and low-fiber-density (LFD) dietary pattern. Associations of the derived dietary pattern scores with lifestyle characteristics and CVD risk were examined using weighted multivariate regression and weighted multivariable-adjusted Cox proportional hazard models, respectively., Results: PLS and RRR identified highly similar ED, HSF, and LFD dietary patterns with common high positive loadings for fast food, carbonated drinks, salty snacks, and solid fats, and high negative loadings for fruit, dark green vegetables, red and orange vegetables, other vegetables, whole grains, and legumes and soy (≥|0.17|). Food groups with the highest loadings were summed to form simplified pattern scores. Although the dietary patterns were not significantly associated with CVD risk, they were positively associated with 402-kcal/d higher energy intake (P-trends < 0.05) and higher obesity risk (PLS: OR: 2.09; 95% CI: 1.62, 2.70; RRR: OR: 1.76; 95% CI: 1.44, 2.17) (P-trends < 0.0001) in the fourth quartiles., Conclusions: PLS and RRR were shown to be equally effective for the derivation of a high-CVD-risk dietary pattern among Canadian adults. Further research is warranted on the role of major dietary components in cardiovascular health., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Little is known about the role of emerging plant-based dietary patterns in cardiovascular disease (CVD) risk at the national population level., Objectives: The objectives of this research were to assess the validity and reliability of newly established plant-based dietary indices, and to evaluate their associations with CVD risk among Canadian adults., Methods: Data were obtained from repeated 24-h dietary recalls of adult participants in the cross-sectional, nationally representative Canadian Community Health Survey cycle 2004 linked to health administrative databases (n = 12,323) and cycle 2015 (n = 14,026). Plant-based diet quality was assessed with a revised Plant-based Dietary Index (PDI), EAT-Lancet Reference Diet (ERD) score, and the latest Dietary Guidelines for Americans Adherence Index (DGAI) 2020. Weighted multivariate analyses were used for testing associations between diet quality and lifestyle characteristics, and weighted multivariable-adjusted Cox proportional hazards models for associations with CVD risk., Results: Construct validity was confirmed for the revised PDI and DGAI 2020 (but not the ERD) because participants in the highest (healthiest) quartile, compared to those in the lowest (least healthy), were more likely to be female (mean ± SE: 52.63% ± 1.27% compared with 44.80% ± 1.65% for revised PDI; 59.37% ± 2.01% compared with 40.84% ± 1.71% for DGAI 2020), older (mean ± SE: 50.55 ± 0.39 y compared with 45.56 ± 0.43 y for revised PDI; 51.57 ± 0.39 y compared with 46.35 ± 0.54 y for DGAI 2020), to have postsecondary education (mean ± SE: 32.36% ± 1.55% compared with 21.12% ± 1.31% for revised PDI; 34.17% ± 2.69% compared with 17.87% ± 0.98% for DGAI 2020), and less likely to be daily smokers (mean ± SE: 8.21% ± 1.0% compared with 17.06% ± 1.45% for revised PDI; 7.36% ± 1.71% compared with 21.53% ± 1.58% for DGAI 2020) (P-trend < 0.0001). No significant associations were observed between dietary index scores and CVD risk., Conclusions: The revised PDI and DGAI 2020 provided valid and meaningful measures of plant-based eating among Canadians, whereas the validity of the ERD was not directly confirmed. Adherence to the plant-based dietary patterns was not associated with CVD risk. Future large-scale studies are necessary to further evaluate the role of plant-based eating in CVD prevention., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Objective: The aim of this study was to describe sugary drink (beverages with free sugars), sugar-sweetened beverage (beverages with added sugars, SSB) and 100% juice (beverages with natural sugars) consumption across socioeconomic position (SEP) among Canadians., Methods: We conducted a cross-sectional analysis of 19,742 respondents of single-day 24-h dietary recalls in the nationally representative 2015 Canadian Community Health Survey-Nutrition. Poisson regressions were used to estimate the prevalence of consuming each beverage type on a given day. Among consumers on a given day, linear regressions were used to estimate mean energy intake. Models included household education, food security and income quintiles as separate unadjusted exposures. Sex-specific models were estimated separately for children/adolescents (2-18 years) and adults (19 +)., Results: Among female children/adolescents, the prevalence of consuming sugary drinks and, separately, SSB ranged from 11 to 21 and 8 to 27 percentage-points higher among lower education compared to 'Bachelor degree or above' households. In female adults, the prevalence of consuming sugary drinks and, separately, SSB was 10 (95% CI: 1, 19) and 14 (95% CI: 2, 27) percentage-points higher in food insecure compared to secure households. In males, the prevalence of consuming 100% juice was 9 (95% CI: - 18, 0) percentage-points lower among food insecure compared to secure households. Social inequities in energy intake were observed in female adult consumers, among whom mean energy from sugary drinks was 27 kcal (95% CI: 3, 51) higher among food insecure compared to secure and 35 kcal (95% CI: 2, 67) higher from 100% juice among 'less than high school' education compared to 'Bachelor degree or above' households., Conclusion: Social inequities in sugary drink consumption exist in Canada. The associations differed by SEP indicator. Equitable interventions to reduce consumption are warranted., (© 2022. Crown.)

Background: Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications., Methods: The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history., Results: A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a 'healthy profile' was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada., Conclusion: Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development., (© 2022. The Author(s).)

Granular cell tumour (GCT) is a rare soft tissue lesion which many consider to have malignant potential of yet unknown aetiopathogenesis. Oral GCT lesions may occur in an area of leucoplakia and are predominantly present on the tongue. This case study highlights an uncommon presentation of this condition located on the buccal mucosa and illustrates the need for meticulous evaluation of suspicious lesions. Due to the malignant risk associated with GCT lesions, it is important to make the correct diagnosis and ensure complete surgical excision for these cases. Ongoing long-term follow-up is also indicated to monitor for recurrence or malignancy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Canalicular adenoma (CAD) is an uncommon benign tumor of minor salivary glands with predilection for the upper labial mucosa. An 80-year-old female presented with nine submucosal nodules of the upper labial mucosa and bilateral buccal mucosa. Histopathologic examination revealed multifocal circumscribed tumor islands with a tubular growth pattern within a loose hypocellular myxoid background stroma. Interconnecting rows of columnar tumor cells imparted a canalicular morphology. In addition to the characteristic histopathologic findings, a comprehensive immunohistochemical panel supported a final diagnosis of multifocal CAD. Synchronous multifocality in CAD is an infrequent finding and this sine qua non clinicopathologic correlation article exemplifies such a case., (© 2021. Crown.)

Background: Hybrid methods of dietary patterns analysis have emerged as a unique and informative way to study diet-disease relationships in nutritional epidemiology research., Objective: To identify an obesogenic dietary pattern using weighted partial least squares (wPLS) in nationally representative Canadian survey data, and to identify key foods and/or beverages associated with the defined dietary pattern., Design: Data from one 24-hr dietary recall data from the cross-sectional Canadian Community Health Survey-Nutrition (CCHS) 2015 (n = 12,049) were used. wPLS was used to identify an obesogenic dietary pattern from 40 standardized food and beverage categories using the variables energy density, fibre density, and total fat as outcomes. The association between the derived dietary pattern and likelihood of obesity was examined using weighted multivariate logistic regression. Key dietary components highly associated with the derived pattern were identified., Results: Compared to quartile one (i.e. those least adherent to an obesogenic dietary pattern), those in quartile four had 2.40-fold increased odds of being obese (OR = 2.40, 95% CI = 1.91, 3.02, P-trend< 0.0001) with a monotonically increasing trend. Using a factor loading significance cut-off of ≥|0.17|, three food/beverage categories loaded positively for the derived obesogenic dietary pattern: fast food (+0.32), carbonated drinks (including energy drinks, sports drinks and vitamin water) (+0.30), and salty snacks (+0.19). Seven categories loaded negatively (i.e. in the protective direction): whole fruits (-0.40), orange vegetables (-0.32), "other" vegetables (-0.32), whole grains (-0.26), dark green vegetables (-0.22), legumes and soy (-0.18) and pasta and rice (-0.17)., Conclusion: This is the first study to apply weighted partial least squares to CCHS 2015 data to derive a dietary pattern associated with obesity. The results from this study pinpoint key dietary components that are associated with obesity and consumed among a nationally representative sample of Canadians adults., Competing Interests: The authors have declared that no competing interests exist.

Background: The release of the Canadian Community Health Survey (CCHS), Nutrition 2015 provides a unique opportunity since CCHS 2004 to investigate food choices of Canadian children and adolescents at a national level., Objective: This study examined the quality and quantity of food choices of children ages 2-8 years and adolescents 9-18 years, using Health Canada's Surveillance Tool Tier System 2014. It is hypothesized that Canadian children and adolescents are consuming diets poor in nutritional quality based on evidence from the last national nutrition survey in 2004., Design: Intakes from CCHS 2015, 24-h dietary recall were categorized into Health Canada's Tiers 1-4, based on CNF/CFG classification system and thresholds for nutrients to limit i.e., total fat, saturated fats, sugars, and sodium to assess quality of food choices. Additionally, dietary intakes were grouped according to Canada's 2007 food guide servings as the 2019 food guide was not available., Results: Majority of foods reported by children 2-18 years were categorized as Tier 2 and Tier 3 foods. Investigation of energy contributions from the Tier 4 and "other foods" represented 21-25% of daily calorie intake and of these foods, high fat and/or high sugar foods contributed majority of daily calories to these categories., Conclusions: This study showed Canadian children 2-18 years are consuming diets high in nutrients recommended to limit. Evidence from this study provides a unique opportunity to improve the nutritional quality of foods, and the food choices of children.

Background : High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada's voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods : We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey-Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results : In children aged 2-8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: -45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9-18 (96 mg/day, 95%CI: -149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: -30,327; female: -45 mg/day, 95%CI: -141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians' are above the CDRR thresholds. Conclusion : Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels.

Background: Cardiovascular toxicity as a consequence of nicotine from conventional tobacco cigarette smoking is well documented. However, little is known about the cardiovascular consequences of nicotine e-vaping. We review the literature and report a case series of three cases of major adverse cardiovascular clinical effects post nicotine e-vaping., Case Summary: Three patients with known peripheral arterial disease who switched from heavy cigarette smoking consumption to a high-intensity dose of nicotine e-vaping all developed further arterial complications within 6-30 months., Discussion: With the recent epidemic of e-vaping in young individuals and the national outbreak of e-vaping use-associated lung injury (EVALI), the dangers of e-vaping are now coming to light. The pulmonary effects are now well described, and this paper highlights three new cases of cardiovascular toxicity associated with e-vaping. The potential role of nicotine e-vaping and the risk of coronavirus disease-2019 (COVID-19) will also be discussed., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The 2014 Health Canada's Surveillance Tool, Tier System (HCST) is a nutrient profiling model developed to evaluate adherence of food choices to dietary recommendations. With the recent release of the nationally representative Canadian Community Health Survey-Nutrition (CCHS-N) 2015, this study used HCST to evaluate nutritional quality of the dietary intakes of Canadians in the CCHS-N. Dietary intakes were ascertained using 24-hour dietary recalls from Canadians adults ≥19 years ( N = 13,605). Foods were categorized into four Tiers based on degree of adherence to dietary recommendations according to thresholds for sodium, total fat, saturated fats, and sugars. Tier 1 and Tier 2 represented "recommended foods", Tier 3 represents foods to "choose less often", and Tier 4 represented foods "not recommended". Across all dietary reference intakes (DRI) groups, most foods were categorized as Tier 1 for Vegetable and Fruits (2.2-3.8 servings/day), Tier 2 for Grain Products (2.9-3.4 servings/day), Tier 3 for Milk and Alternatives (0.7-1 serving/day) or for Meat and Alternatives (1.1-1.6 servings/day). Consumption of foods from Tier 4 and "other foods" such as high fat/sugary foods, sugar-sweetened beverages, and alcohol, represented 24-26% and 21-23% kcal/day, for males and females, respectively. Canadians are eating more foods categorized as Tier 1-3, rather than Tier 4. Adults with the highest intakes of Tier 4 and "other foods" had lower intakes of macronutrients and increased body mass index. These findings can be used by policy makers to assist in identifying targets for food reformulation at the nutrient level and quantitative guidance to support healthy food choices.

People often wonder, "How do pathologists identify the patterns that lead to a diagnosis [...].

Background:  Although bariatric surgery is the most effective treatment for severe obesity, weight regain may still occur. While non-modifiable factors associated with weight regain have been explored, modifiable factors responsible for weight regain are understudied. This scoping review aimed to identify modifiable behaviors associated with weight regain after bariatric surgery. Methods:  A systematic search was conducted in Medline, Google Scholar, Cochrane, National Collaborating Centre for Methods and Tools (NCCMT) and Practice-based Evidence in Nutrition (PEN) which included articles published between January 1990 and February 2 2017, for studies examining "weight regain" after bariatric surgery. A total of 293 citations were retrieved. Eligible articles must have examined modifiable factors and addressed weight regain, or a long-term post-operative phase in which weight regain may occur. After removing duplicates, 22 studies were included for thematic analysis. Results:  Key modifiable factors associated with weight regain were identified and categorized under the following themes: poor dietary adherence (e.g. excessive calorie, carbohydrate, and alcohol intake), maladaptive eating behaviors (e.g. grazing, binging), lack of on-going follow-up with the bariatric team and insufficient physical activity. Conclusions:  Health professionals and self-monitoring tools for patients who have undergone bariatric surgery may benefit from these findings to direct their education and interventions to target behavior change., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Kaouk L et al.)

Occasion and location of food environment has an influence on dietary habits, nutritional quality and overall health and nutrition-related chronic disease risk. Eating occasion and location was assessed in 20,402 Canadians aged ≥ 2 years, with a focus on energy, saturated fat, added sugars, and sodium intake by age group. Data showed >80% of children, compared to ~60% of adolescents and adults, consumed three meals (breakfast, lunch, dinner) plus snacks in a day. Dinner contributed the most calories [ranging from 395 ± 11 kcal (2⁻3 year olds) to 952 ± 27 kcal (men 19⁻30 years)], saturated fat [7.4 ± 0.2% energy (2⁻3 year olds) to 9.1 ± 0.3% energy (women 31⁻50 years)], and sodium [851 ± 24 mg (2⁻3 year olds) to 1299 ± 69 mg (men 19⁻30 years)], while snacks contributed the most added sugars [22 ± 1 kcal (men >70 years) to 45 ± 1 kcal (2⁻3 year olds)]. By eating location, most Canadians (>90%) reported consuming food from home. Subsequently, home was associated with the majority of energy [1383 ± 23 kcal (women >70 years) to 2090 ± 35 kcal (boys 9⁻13 years)], saturated fat [20.4 ± 0.4%E (men 51⁻70 years) to 24.2 ± 0.4%E (2⁻3 year olds)], added sugars [77 ± 3 kcal (men 19⁻30 years) to 117 ± 2 kcal (2⁻3 year olds)], and sodium [2137 ± 59 mg (women 19⁻30 years) to 2638 ± 45 mg (men 51⁻70 years)] intakes. Reported eating behaviours suggest action is needed at individual and population levels to alter food purchasing and consumption habits, specifically with regards to snacking habits and foods prepared at home.

The Healthy Eating Index (HEI) is a diet quality index shown to be associated with reduced chronic disease risk. Older versions of the HEI have been adapted for Canadian populations; however, no Canadian modification of the Healthy Eating Index-2010 (HEI-2010) has been made. The aims of this study were: (a) to develop a Canadian adaptation of the HEI-2010 (i.e., Healthy Eating Index-Canada 2010 (HEI-C 2010)) by adapting the recommendations of the HEI-2010 to Canada's Food Guide (CFG) 2007; (b) to evaluate the validity and reliability of the HEI-C 2010; and (c) to examine relationships between HEI-C 2010 scores with diet quality and the likelihood of being obese. Data from 12,805 participants (≥18 years) were obtained from the Canadian Community Health Survey Cycle 2.2. Weighted multivariate logistic regression was used to test the association between compliance to the HEI-C 2010 recommendations and the likelihood of being obese, adjusting for errors in self-reported dietary data. The total mean error-corrected HEI-C 2010 score was 50.85 ± 0.35 out of 100. Principal component analysis confirmed multidimensionality of the HEI-C 2010, while Cronbach's α = 0.78 demonstrated internal reliability. Participants in the fourth quartile of the HEI-C 2010 with the healthiest diets were less likely to consume refined grains and empty calories and more likely to consume beneficial nutrients and foods ( p -trend < 0.0001). Lower adherence to the index recommendations was inversely associated with the likelihood of being obese; this association strengthened after correction for measurement error (Odds Ratio: 1.41; 95% Confidence Interval: 1.17-1.71). Closer adherence to Canada's Food Guide 2007 assessed through the HEI-C 2010 was associated with improved diet quality and reductions in the likelihood of obesity when energy intake and measurement errors were taken into account. Consideration of energy requirements and energy density in future updates of Canada's Food Guide are important and necessary to ensure broader application and usability of dietary quality indexes developed based on this national nutrition guideline., Competing Interests: The authors declare no conflict of interest.

Background: Analyzing the effects of dietary patterns is an important approach for examining the complex role of nutrition in the etiology of obesity and chronic diseases. Objectives: The objectives of this study were to characterize the dietary patterns of Canadians with the use of a priori, hybrid, and simplified dietary pattern techniques, and to compare the associations of these patterns with obesity risk in individuals with and without chronic diseases (unhealthy and healthy obesity). Design: Dietary recalls from 11,748 participants (≥18 y of age) in the cross-sectional, nationally representative Canadian Community Health Survey 2.2 were used. A priori dietary pattern was characterized with the use of the previously validated 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Weighted partial least squares (hybrid method) was used to derive an energy-dense (ED), high-fat (HF), low-fiber density (LFD) dietary pattern with the use of 38 food groups. The associations of derived dietary patterns with disease outcomes were then tested with the use of multinomial logistic regression. Results: An ED, HF, and LFD dietary pattern had high positive loadings for fast foods, carbonated drinks, and refined grains, and high negative loadings for whole fruits and vegetables (≥|0.17|). Food groups with a high loading were summed to form a simplified dietary pattern score. Moving from the first (healthiest) to the fourth (least healthy) quartiles of the ED, HF, and LFD pattern and the simplified dietary pattern scores was associated with increasingly elevated ORs for unhealthy obesity, with individuals in quartile 4 having an OR of 2.57 (95% CI: 1.75, 3.76) and 2.73 (95% CI: 1.88, 3.98), respectively ( P -trend < 0.0001). Individuals who adhered the most to the 2015 DGAI recommendations (quartile 4) had a 53% lower OR of unhealthy obesity ( P -trend < 0.0001). The associations of dietary patterns with healthy obesity and unhealthy nonobesity were weaker, albeit significant. Conclusions: Consuming an ED, HF, and LFD dietary pattern and lack of adherence to the recommendations of the 2015 DGAI were associated with a significantly higher risk of obesity with and without accompanying chronic diseases., (© 2017 American Society for Nutrition.)

Background: Dietary pattern analysis represents a departure from the traditional focus on single foods and nutrients and provides a comprehensive understanding of the role of the diet in chronic disease prevention and etiology. Dietary patterns of Canadians have not been evaluated comprehensively with the use of an updated a priori dietary quality index., Objectives: We aimed to update the Dietary Guidelines for Americans Adherence Index (DGAI) on the basis of the 2015 Dietary Guidelines for Americans (DGA), to evaluate the construct validity and reliability of the revised index, and to examine whether closer adherence to this index is associated with a lower risk of obesity with or without an accompanying chronic disease., Design: Data from 11,748 participants (≥18 y of age) in the cross-sectional Canadian Community Health Survey cycle 2.2 were used in weighted multivariate analyses. Multinomial logistic regression was used to test the association between diet quality and obesity risk., Results: With the use of principal component analyses, the multidimensionality of the 2015 DGAI was confirmed, and its reliability was shown with a high Cronbach's α = 0.75. Moving from the first to the fourth (healthiest) quartile of the 2015 DGAI score, there was a trend toward decreased energy (2492 ± 26 compared with 2403 ± 22 kcal, respectively; ±SE) and nutrients of concern (e.g., sodium), whereas intakes of beneficial nutrients increased (P-trend < 0.05). In the age- and sex-adjusted model, a lack of adherence to the 2015 DGA recommendations increased the OR of being unhealthy obese from 1.42 (95% CI: 1.02, 1.99) in quartile 3 to 2.08 (95% CI: 1.49, 2.90) in quartile 2 to 2.31 (95% CI: 1.65, 3.23) in the first quartile of the 2015 DGAI score, compared with the fourth quartile (healthiest) (P-trend < 0.0001). The odds of being obese without a chronic disease (healthy obese) and having a chronic disease without being obese also increased in the lowest DGAI quartile compared with the highest DGAI quartile, albeit not as much as in the unhealthy obese group., Conclusion: The 2015 DGAI provides a valid and reliable measure of diet quality among Canadians., (© 2016 American Society for Nutrition.)

Background: Health Canada's Surveillance Tool (HCST) Tier System was developed in 2014 with the aim of assessing the adherence of dietary intakes with Eating Well with Canada's Food Guide (EWCFG). HCST uses a Tier system to categorize all foods into one of four Tiers based on thresholds for total fat, saturated fat, sodium, and sugar, with Tier 4 reflecting the unhealthiest and Tier 1 the healthiest foods. This study presents the first application of the HCST to examine (i) the dietary patterns of Canadian children, and (ii) the applicability and relevance of HCST as a measure of diet quality., Methods: Data were from the nationally-representative, cross-sectional Canadian Community Health Survey 2.2. A total of 13,749 participants aged 2-18 years who had complete lifestyle and 24-hour dietary recall data were examined., Results: Dietary patterns of Canadian children and adolescents demonstrated a high prevalence of Tier 4 foods within the sub-groups of processed meats and potatoes. On average, 23-31 % of daily calories were derived from "other" foods and beverages not recommended in EWCFG. However, the majority of food choices fell within the Tier 2 and 3 classifications due to lenient criteria used by the HCST for classifying foods. Adherence to the recommendations presented in the HCST was associated with closer compliance to meeting nutrient Dietary Reference Intake recommendations, however it did not relate to reduced obesity as assessed by body mass index (p > 0.05)., Conclusions: EWCFG recommendations are currently not being met by most children and adolescents. Future nutrient profiling systems need to incorporate both positive and negative nutrients and an overall score. In addition, a wider range of nutrient thresholds should be considered for HCST to better capture product differences, prevent categorization of most foods as Tiers 2-3 and provide incentives for product reformulation.

The association of dietary exposures with health outcomes may be attenuated or reversed as a result of energy intake (EI) misreporting. This study evaluated several methods for dealing with implausible recalls when analysing the association between dietary factors and obesity. We examined data from 16,187 Canadians aged ≥12 years in the nationally representative Canadian Community Health Survey 2.2. Under- and over-reporting were defined as the ratio of EI:estimated energy requirement <0·7 and >1·42, respectively. Multinomial logistic regression-generalised logit model was conducted to test the utility of different methods for handling misreporting, including (a) adjusting for variables related to misreporting, (b) excluding misreported recalls, (c) adjusting for reporting groups (under-, plausible and over-reporters), (d) adjusting for propensity score and (e) stratifying the analyses by reporting groups. In the basic model, EI showed a negative association with overweight (OR 0·988; 95% CI 0·979, 0·998) and obesity (OR 0·989; 95% CI 0·977, 0·999). Similarly, the association between total energy density and overweight (OR 0·670; 95% CI 0·487, 0·923) and obesity (OR 0·709; 95% CI 0·495, 1·016) was inverse. Among all methods of handling misreporting, adjusting for the reporting status revealed the most satisfactory results, where a positive association between EI and overweight (OR 1·037; 95% CI 1·019, 1·055) and obesity (OR 1·109; 95% CI 1·082, 1·137) was observed (P<0·0001), as well as direct positive associations between energy density and percentage energy from solid fats and added sugars with obesity (P<0·05). The results of this study can help advance knowledge about the relationship between dietary variables and obesity and demonstrate to researchers and nutrition policy makers the importance of adjusting for recall plausibility in obesity research, which is highly relevant in light of global obesity epidemic.

Background and Objectives: We conducted a hospital-based, case-control study to examine the association between Mediterranean diet (MD) and the risk of multiple sclerosis (MS) in Iran., Methods and Study Design: A total of 70 patients with MS and 142 controls underwent face-to-face interviews in the major neurological clinics of Tehran, Iran. Adherence to a MD was assessed using the 9-unit dietary score, to evaluate the level of conformity of the individual's diet to the Mediterranean dietary pattern. Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI)., Results: Higher consumption of fruits (OR=0.28, 95% CI: 0.12-0.63, p-value: 0.002) and vegetables (OR=0.23, 95% CI: 0.10-0.53, p-value: 0.001) were significantly associated with reduced MS risk. In both age adjusted and multivariate adjusted model, the OR of MS decreased significantly in the third as compared to the first tertile of MD score (age adjusted OR: 0.21, 95% CI: 0.06-0.67; p-trend: 0.01, Multivariate adjusted OR: 0.23, 95% CI: 0.06-0.89, p-trend: 0.04)., Conclusions: Our study suggests that a high quality diet assessed by MD may decrease the risk of MS.

The 2014 Health Canada Surveillance Tool (HCST) was developed to assess adherence of dietary intakes with Canada's Food Guide. HCST classifies foods into one of four Tiers based on thresholds for sodium, total fat, saturated fat and sugar, with Tier 1 representing the healthiest and Tier 4 foods being the unhealthiest. This study presents the first application of HCST to assess (a) dietary patterns of Canadians; and (b) applicability of this tool as a measure of diet quality among 19,912 adult participants of Canadian Community Health Survey 2.2. Findings indicated that even though most of processed meats and potatoes were Tier 4, the majority of reported foods in general were categorized as Tiers 2 and 3 due to the adjustable lenient criteria used in HCST. Moving from the 1st to the 4th quartile of Tier 4 and "other" foods/beverages, there was a significant trend towards increased calories (1876 kcal vs. 2290 kcal) and "harmful" nutrients (e.g., sodium) as well as decreased "beneficial" nutrients. Compliance with the HCST was not associated with lower body mass index. Future nutrient profiling systems need to incorporate both "positive" and "negative" nutrients, an overall score and a wider range of nutrient thresholds to better capture food product differences.

The aim of this study was to examine the barriers to following complementary feeding guidelines among Middle Eastern mothers and the cultural considerations of practitioners from an emic perspective. This is a two-phase focused ethnographic assessment of infant feeding among 22 Middle Eastern mothers in Western Canada who had healthy infants aged <1 year. Data were collected through four focus groups conducted in Arabic/Farsi, and were further complemented by comprehensive survey data collected in the second phase of study. Mothers' main criterion for choosing infant foods was whether or not foods were Halal, while food allergens were not causes for concern. Vitamin D supplements were not fed to 18/22 of infants, and mashed dates (Halawi), rice pudding (Muhallabia/Ferni) and sugared water/tea were the first complementary foods commonly consumed. Through constant comparison of qualitative data, three layers of influence emerged, which described mothers' process of infant feeding: socio-cultural, health care system and personal factors. Culture was an umbrella theme influencing all aspects of infant feeding decisions. Mothers cited health care professionals' lack of cultural considerations and lack of relevance and practicality of infant feeding guidelines as the main reasons for ignoring infant feeding recommendations. Early introduction of pre-lacteal feeds and inappropriate types of foods fed to infants among immigrant/refugee Middle Eastern mothers in Canada is cause of concern. Involving trained language interpreters in health teams and educating health care staff on cultural competency may potentially increase maternal trust in the health care system and eventually lead to increased awareness of and adherence to best practices with infant feeding recommendations., (© 2013 John Wiley & Sons Ltd.)

Gallbladder disease is one of the most prevalent gastrointestinal disorders that may result from a complex interaction of genetic and environmental factors. This study examined the association of dietary patterns with gallstone disease among Iranian women. This case-control study was conducted in general teaching hospitals in Tehran, Iran. Participants were 101 female cases and 204 female controls aged 40-65 years who were admitted for problems other than GBD. Dietary patterns were identified using principal components analysis based on food frequency questionnaire. Compared to the control group, cases were less educated, less physically active, and consumed more total energy (p<0.02). Having ≥ 3 livebirths increased the risk of gallstone by more than 5 times, followed by having rapid weight loss, being single, having familial history of gallstone, and consuming high total energy. Two distinct dietary patterns were identified in women (healthy and unhealthy). After adjustment for several confounding variables, healthy dietary pattern was associated with a decreased risk of gallstone disease (OR=0.14, 95% CI 0.048-0.4) while unhealthy dietary pattern was associated with an increased risk (OR=3.77, 95% CI 1.52-9.36). These findings confirm that dietary pattern approach provides potentially useful and relevant information on the relationship between diet and disease. Identifying risk factors will provide an opportunity for prevention of gallbladder disease in developing countries facing an increased risk of obesity.

Food insecurity is a mounting concern among Canadian post-secondary students. This study was conducted to evaluate the content of food hampers distributed by University of Alberta Campus Food Bank (CFB) and to assess the cost savings to students, using these hampers. Contents of hampers distributed among 1,857 students and their dependants since 2006 were evaluated against Canada's Food Guide (CFG) recommendations and Dietary Reference Intakes (DRI). Hampers were aimed at serving university students and one to five members of their households located in Edmonton, Western Canada. One thousand eight hundred fifty-seven clients in Alberta, Canada, were included in the study. Although all hampers provided adequate energy, their fat and animal protein contents were low. Compared to the CFG recommendations, the requirements of milk and alternatives and meat and alternatives were not sufficiently met for clients using > or = 3-person hampers. None of food hampers (i.e. one- to five-person hampers) met the DRI recommendations for vitamin A and zinc. Clients of CFB received Canadian dollar (CN$) 14.88 to 64.3 worth of non-perishable food items in one- to five-person hampers respectively. Hampers provided from the CFB need improvement. Nutrients missing from the food hampers could be provided from fresh fruits, vegetables, dairy, and meat products; however, these foods are more expensive than processed food items. The CFB provides a significant amount of savings to its clients even without considering the additional perishable donations that are provided to clients. Interpretation of our data required the assumption that all clients were consuming all of their hampers, which may not always be the case. Clients that do not fully consume their hampers may benefit less from the food bank.

Objective: Breast cancer is the most common type of cancer in women worldwide. Several studies have examined the role of single nutrients and food groups in breast cancer pathogenesis but fewer investigations have addressed the role of dietary patterns. Our main objective was to identify the relationship between major dietary patterns and breast cancer risk among Iranian women., Design: Hospital-based case-control study., Setting: Shohada Teaching Hospital, Tehran, Iran., Subjects: Overall, 100 female patients aged 30-65 years with breast cancer and 174 female hospital controls were included in the present study. Dietary intake was assessed using a valid and reliable semi-quantitative FFQ consisting of 168 food items., Results: Two dietary patterns were identified explaining 24·31 % of dietary variation in the study population. The 'healthy' food pattern was characterized by the consumption of vegetables, fruits, low-fat dairy products, legumes, olive and vegetable oils, fish, condiments, organ meat, poultry, pickles, soya and whole grains; while the 'unhealthy' food pattern was characterized by the consumption of soft drinks, sugars, tea and coffee, French fries and potato chips, salt, sweets and desserts, hydrogenated fats, nuts, industrial juice, refined grains, and red and processed meat. Compared with the lowest tertile, women in the highest tertile of the 'healthy' dietary pattern score had 75 % decreased risk of breast cancer (OR = 0·25, 95 % CI 0·08, 0·78), whereas women in the highest tertile of the 'unhealthy' dietary pattern had a significantly increased breast cancer risk (OR = 7·78, 95 % CI 2·31, 26·22)., Conclusions: A healthy dietary pattern may be negatively associated with breast cancer risk, while an unhealthy dietary pattern is likely to increase the risk among Iranian women.

The role of under- and overreporting of energy intake in determining the dietary patterns is yet unclear, especially in the Middle Eastern countries. This study identifies the prevalence of misreporting among Tehranian women aged 18-45 years and to compare the dietary intake patterns of plausible and all energy reporters. Dietary intakes and anthropometric data were collected. FitMate metabolic analyzer and Goldberg equation were used in determining the under/overreporting of energy intake. Underreporters were more likely to be overweight and older compared to plausible reporters. Three dietary patterns emerged for all reporters, and two were identified for plausible reporters. Using only plausible reporters to determine dietary patterns was not similar to using all reporters. The proportion of underreporters was 59.3% in the mixture cluster, 30.4% in the unhealthy cluster, and 35.3% in the healthy cluster (p < 0.05). Underreporting of energy intake is not uniformly distributed among dietary pattern clusters and tends to be less severe among subjects in the unhealthy cluster. Our data suggested that misreporting of energy intake might affect the dietary pattern analysis.

Background: Prostate cancer is the most frequently occurring cancer among males in economically developed countries. Among the several risk factors that have been suggested, only age, ethnicity, diabetes, and family history of prostate cancer are well-established and primary prevention of this disease is limited. Prior studies had shown that dietary intake could be modified to reduce cancer risk. We conducted a hospital-based, case- control study to examine the association between dietary patterns and prostate cancer risk in Iran., Materials and Methods: A total of fifty patients with prostate cancer and a hundred controls underwent face-to-face interviews. Factor analysis was used to determine the dietary patterns. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: We defined two major dietary patterns in this population: 'western diet'(high in sweets and desserts, organ meat, snacks, tea and coffee, French fries, salt, carbonated drinks, red or processed meat) and 'healthy diet' (high in legumes, fish, dairy products, fruits and fruit juice, vegetables, boiled potatoes ,whole cereal and egg). Both Healthy and western pattern scores were divided into two categories (based on medians). Higher scores on Healthy pattern was marginally significantly related to decreased risk of prostate cancer (above median vs below median, OR =0.4, 95%CI=0.2-1.0). An increased risk of prostate cancer was observed with the higher scores on the Western pattern (above median vs below median, OR=4.0, 95%CI=1.5-11.0)., Conclusions: The results of this study suggested that diet might be associated with prostate cancer among Iranian males.

Background: Findings of epidemiologic studies on the relationship between fruit and vegetable consumption and prostate cancer (PCa) risk have been inconclusive. We therefore examined the association between intake of fruits and vegetables and PCa risk in Iran., Materials and Methods: In this hospital based, case-control study, a total of 50 patients with PCa and 100 controls underwent face-to-face interviews. Regression analysis was used to examine the relation between fruit and vegetable intake and PCa risk., Results: A protective independent effect was observed for the highest tertile of total fruit and vegetable (OR: 0.33, CI: 0.04-0.30, p value<0.001), total fruit (OR: 0.30, CI: 0.06-0.4, p value=0.03) and total vegetable (OR: 0.31, CI: 0.02-0.21, p value<0.001) consumption. Within the group of fruits, a significant inverse association was observed for apple and pomegranate (p trends were 0.01 and 0.016, respectively). In the vegetable group, a significant inverse association was observed for tomatoes (p trend<0.001) and cabbage (p trend=0.021)., Conclusions: The results of the present study suggested that fruits and vegetable intake might be negatively associated with PCa risk.

The objectives of this cross-sectional study were to determine the prevalence of caries, severe caries and gingivitis in Tehran primary-school children and to analyse the relationship between children's oral hygiene habits and prevalence of these oral health diseases. Data were collected on the oral hygiene habits of 1271 Tehran schoolchildren (637 boys, 634 girls) aged 9-13 years. Clinical examinations were performed to determine the decayed, missed and filled teeth (DMFT) and the presence of gingivitis. Total DMFT > or = 1 was observed in 83.3% of children; 55.5% had tDMFT > or = 4 and 87.7% had > or = 1 site affected by gingivitis. Dental visits of 48.2% of children were limited to toothache occasions and parents' lack of belief in the importance of oral health was the most commonly cited reason (P < or = 0.05). The source of oral health education had the strongest independent association with severe dental caries (OR= 2.35; 95% CI: 1.80-2.60); dental flossing frequency was the strongest predicting factor correlated with gingivitis (OR = 3.51; CI: 1.46-8.44).

Background: Despite growing evidence that supports the importance of 6-month exclusive breastfeeding, few Canadian mothers adhere to this, and early weaning onto solids is a common practice. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding to 3 and 6 months., Methods: This prospective cohort study was part of the Alberta Pregnancy Outcomes and Nutrition study (APrON). From an initial sample of 600 pregnant women recruited from Edmonton and Calgary, 402 mothers provided complete details at 3 months postpartum; 300 stayed on to provide information at 6 months postpartum. During pregnancy and at 3 and 6 months postpartum, data on maternal and infant socio-demographic, behavior, and feeding were collected., Results: Even though there was a high rate of "ever having breastfed" (98.6%), exclusive breastfeeding rates for 3 and 6 months were 54.0% and 15.3%, respectively. After controlling for potential confounders, the study showed that mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree (95% CI: 1.30-10.92; p = 0.015). In addition, mother of previous children were more likely to breastfeed exclusively for 6 months (OR: 2.21, 95% CI: 1.08-4.52; p = 0.031). Mothers who were in the highest quartile of the Iowa Infant Feeding Attitude Score were 4.29 and 5.40 times more likely to breastfeed exclusively for 3 months (95% CI: 1.31-14.08; p-trend < 0.001) and 6 months (95% CI: 2.75-10.60; P-trend < 0.001), respectively., Conclusions: The 6-month exclusive breastfeeding rate in Alberta is considerably below national and international breastfeeding recommendations. Professional advice that focuses on prenatal maternal knowledge, attitudes, and misperceptions may promote adherence to World Health Organization breastfeeding guidelines. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, primiparous women may help health practitioners focus their support and education for this group.

The aim of this study was to explore from the Middle-Eastern mothers' perspective, the experience of breastfeeding and their perceptions of attributes of the health care system, community and society on their feeding decisions after migration to Canada. New immigrant mothers from the Middle East (n = 22) were recruited from community agencies in Edmonton, Canada. Qualitative data were collected through four focus groups using an ethnographic approach to guide concurrent data collection and analysis. Survey data were collected on socio-demographic characteristics via pre-tested questionnaires. All mothers, but one who was medically exempt, breastfed their infants from birth and intended to continue for at least 2 years. Through constant comparison of data, five layers of influence emerged which described mothers' process of decision making: culture/society, community, health care system, family/friends and mother-infant dyad. Religious belief was an umbrella theme that was woven throughout all discussions and it was the strongest determining factor for choosing to breastfeed. However, cultural practices promoted pre-lacteal feeding and hence, jeopardising breastfeeding exclusivity. Although contradicted in Islamic tradition, most mothers practised fasting during breastfeeding because of misbeliefs about interpretations regarding these rules. Despite high rates of breastfeeding, there is a concern of lack of breastfeeding exclusivity among Middle-Eastern settlers in Canada. To promote successful breastfeeding in Muslim migrant communities, interventions must occur at different levels of influence and should consider religious beliefs to ensure cultural acceptability. Practitioners may support exclusive breastfeeding through cultural competency, and respectfully acknowledging Islamic beliefs and cultural practices., (© 2012 Blackwell Publishing Ltd.)

The aim of this study was to compare dietary intakes by Tehranian adults with recent dietary guidelines for the Americans. The study made a cross-sectional assessment of the dietary patterns of Tehranian adults using a validated food-frequency questionnaire. It included 2,510 subjects (1,121 men and 1,389 women) aged 19-70 years. They were the participants of the third follow-up survey of the Tehran Lipid and Glucose Study (2005-2008). The dietary patterns were assessed using the latest World Health Organization (WHO)'s nutritional goals and Dietary Guidelines for the Americans Adherence Index (DGAI) 2005. The mean [standard deviation (SD)] DGAI score for this population was 8.31 (1.9). Participants in the highest quartile category of DGAI were more likely to be female, older, non-smoking, and physically active than those in the lowest quartile category (p < 0.001). Percentage of participants meeting the DGA recommendations was low, especially for starchyvegetables (2.3%), orange vegetables (16.2%), lean meat (9.2%), grains (12.0%), and legumes (6.4%). Over-consumption of grains was observed in almost half of the participants while approximately 20% of the subjects over-consumed milk and meat groups. Intakes of most nutrients examined were significantly associated with the DGAI 2005 score (p < 0.001), except for vitamin E, vitamin B12, and vitamin D. The least adherence with the WHO goals was observed with n-3 PUFAs, sodium, fruit, and vegetable intakes. The results revealed that the dietary patterns of most Tehranian adults did not comply with the 2005 DGA and nutritional goals of WHO/Food and Agriculture Organization.

Objectives: To determine the resting metabolic rate (RMR) in a sample of Iranian women, and to evaluate the validity of predictive equations for estimating RMR in normal and obese subjects., Methods: This cross-sectional study was conducted on a total of 187 healthy women aged 18-45 years. Anthropometric data were collected and subjects' RMR was measured by indirect calorimetry for 15 minutes following an overnight fast. RMR was also predicted using various types of formulas based on subjects' height, age, weight or fat-free mass. Body composition was estimated by bioelectric impedance analysis (BIA)., Results: Measured RMR (mean ± SD) was found to be 1473 ± 296 kcal/day. The abbreviation formula overestimated RMR, while other formulas underestimated it. Harris-Benedict formula was valid among all BMI categories (normal weight, overweight, obese and morbidly obese). Two Schofield formulas were valid in normal weight, overweight and morbidly obese subjects; and Cunningham formula was valid only among overweight and obese women. Overweight and obese Iranian women had higher RMR in comparison with normal weight subjects (p<0.01); although after age and weight adjustment, the differences were not significant in any of the BMI categories., Conclusions: The Harris-Benedict for mula provides a valid estimation of RMR at the group level in a range of normal-weight to morbidly obese Iranians. However, at the individual level, errors might be so high that using a measured value has to be preferred over an estimated value.