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Despite several studies examining single dietary fats on type 2 diabetes (T2D) incidence, little is known about the effects of multiple fatty acids on the risk of T2D. We aimed to address this question in the Tehran Lipid and Glucose Study (TLGS) population. Dietary intakes of participants without T2D (n=2,139) were assessed using the validated food frequency questionnaire. To assess the risk of T2D after 6 years of follow-up, we used multivariate Cox proportional hazard regression models. Three major dietary fat patterns were: (1) high amounts of dietary cholesterol, saturated fats, oleic acid, linoleic acid, linolenic acid, and trans fats; (2) high amounts of long-chain polyunsaturated fats; and (3) high amounts of dietary cholesterol and saturated fats. Dietary total fat intake hazard ratio [HR=1.31, 95% confidence interval (CI)=0.77~2.23 and HR=0.69, 95% CI=0.27~1.76, in the second and third tertile, respectively] was not related to the development of T2D. Animal- and plant-based dietary fat intakes were additionally not related to the risk of T2D. After adjustment for confounding variables, there was no significant association between dietary fat pattern score and T2D incidence. Whereas, the third pattern had a borderline negative association with diabetes development (HR=0.56, 95% CI=0.29~1.07). These novel data suggest that dietary fat composition may modify the risk of T2D incidence.

Background: Diabetes mellitus (DM) is an independent risk-factor for cardiovascular diseases. Physical activities (PAs) could reverse this risk factor. However some factors could influence adherence to PAs. Our study investigates the association of household socioeconomic status and neighborhood support system with adherence to cardiovascular fitness among persons with diabetes mellitus (DM) in Ghana.Methods: Facility-based cross-sectional-study was conducted among 530 T2DM patients in Ghana. Structured-questionnaires were used to collect demographic, anthropometric, and clinical variables. Household socioeconomic status (SES) was assessed using wealth-composite index and adherence to PAs measured using WHO PA-short form questionnaires. SPSS version-22 was used in data analysis.Results: There were significant mean difference in low (P = 0.010) and high (P = 0.0001) social/neighborhood supports according to place of residence. After adjusting for age and diabetes duration, high SES (quintile 3) Adjusted Odd Ratio (AOR) =0.68, 95% confidence interval (95%CI) (0.22, 0.07), moderate SES (quintile 3), AOR=3.16, 95%CI (1.01, 9.89) and high social support system (quintile 2) AOR =3.29, 95%CI (1.02, 10.58) were significant for adherence to cardiovascular fitness. Furthermore Low SES (quintile 3) AOR= 3.52, 95%CI (1.44, 8.59) and low social support system (quintile 1) AOR=1.05, 95%CI (1.05, 1.09) were significant for adherence to sedentary lifestyle among persons with diabetes mellitus. Conclusion: SES, and Social/neighborhood support systems are associated with adherence to cardiovascular fitness. Health care workers should prioritized these variables as modifiable factors in diseases preventions and health promotion

Background: Exclusive breastfeeding (EBF), especially during the first six months of life, is one of the primary health indicators in infants. Objectives: The present study intended to describe the frequency of EBF in infants and its determinants until six months after birth. Methods: This longitudinal study was conducted on 673 mother-newborn pairs visiting obstetrics and gynecology departments of two main hospitals in Zanjan. Information on the frequency of EBF up to six months, socio-demographic and reproductive information, and attitudes of mothers towards breastfeeding was gathered using questionnaires. Data were analyzed using chi-square test and logistic regression in SPSS. Results: The proportion of neonates who were receiving EBF at discharge was 95.7%. The EBF proportions in the second week, the first, fourth, and sixth months were 95%, 88.1%, 80.7%, and 77.3%, respectively. The multivariate analysis of data indicated that living in urban areas (P = 0.02), lower education of mothers (P = 0.008), having more than three years of birth interval (P = 0.006), no experience of breastfeeding in mothers (P = 0.01), no prior decision for breastfeeding in mothers (P < 0.0001), and use of artificial nipples (P = < 0.0001) were independently associated with non-EBF. Conclusions: In this study, despite a high proportion of EBF at discharge, we found that the proportion of EBF reduced during six months. The determinants of non-EBF at six months, including urban and less educated mothers, highlight a need to promote awareness regarding EBF and perform interventions for women at a greater risk for early breastfeeding cessation.

BACKGROUND: Diabetes mellitus (DM) is an independent risk-factor for cardiovascular diseases. Plant-based dietary-patterns have been shown to reverse the effects of these cardiovascular risk-factors. Our study therefore aimed to investigate the potential roles moringa, moringa-plantain combined, and other plant based dietary-patterns could play in controlling glycaemia among persons with type-2-diabetes Mellitus (T2DM). METHODS: Facility-based cross-sectional-study was conducted among 530 T2DM patients from August 2018 to September 2019 in Ghana. Structured-questionnaires were used to collect demographic, anthropometric, and clinical variables. Adherence to plant-based dietary-patterns were assessed using 3-day food record. SPSS version-20 was used to analyse the data. RESULTS: BMI, HbA1c%, HDL-cholesterol and LDL-cholesterol were significantly correlated with adherence to plant-based dietary-patterns (p-value

Background: Although major dietary patterns and sleep quality independently affect psychiatric disorders, their interactive association on depression is not clear. This study assesses the independent association of dietary patterns and sleep quality on depression, and also investigates their interactive associations on depression among overweight and obese women in Iran Methods: Cross-sectional study was conducted among 304 participants, age 18 and above in 2018 at Tehran Iran. Usual dietary intake was collected with 174-FFQ. Participants’ biochemical parameters and depression were measured using standard protocol. Major dietary patterns were extracted by factor analysis and grouped into Fruits&Vegetable group (healthy dietary pattern), High Fat diary&Red Meat group (unhealthy dietary pattern) and Crackers&High Energy Drinks group (western dietary patterns). Results: After adjusting for confounders poor sleep was associated with moderate and high depression; AOR (95%CI): 0.41(0.19-0.90) and 0.29(0.13-0.60) respectively. However, healthy dietary patterns (tertiles 2nd and 3rd) interact with sleep for depression; AOR (95%CI): 4.168(1.166-14.992) and 2.966(1.068-8.234) respectively. Unhealthy dietary pattern tertiles 2nd and 3rd interact with sleep for depression; AOR (95%CI): 2.925(1.055-8.113) and 4.216(1.182-15.042) respectively and Western dietary pattern tertile 3rd interacts with sleep for depression; AOR (95%CI): 4.264(1.494-12.169). Conclusion: Sleep deprivation could be associated with depression. However, sleep quality could interacts with dietary patterns to be associate with depression among overweight and obese people.

Diabetes mellitus (DM) is an independent risk-factor for cardiovascular diseases. Plant-based dietary-patterns have been shown to positively impact the effects this cardiovascular risk-factor. The purpose of this study is to investigate the association of adherence to moringa, plantains, moringa-plantain combined, and other plant based dietary-patterns with glycemic-control among persons with type-2-diabetes Mellitus (T2DM). Facility-based cross-sectional-study was conducted among 530 T2DM patients in Ghana. Structured-questionnaires were used to collect demographic, anthropometric, and clinical variables. Adherence to plant-based dietary-patterns were assessed with 24-hour dietary-recall questionnaire. SPSS version-22 was used in data analysis. BMI, HbA1c%, HDL-cholesterol and LDL-cholesterol were significantly correlated with adherence to plant-based dietary-patterns (p-value < 0.05). After adjusting for confounders, adherence to: Plantain diets, standardized regression coefficient β (95%CI): -0.098 (-0.321, -0.022), Yam, β (95%CI): 0.148 (0.066, 0.496), Moringa diets β (95%CI): -0.095 (-0.325,-0.011) and Bean-diets β (95%CI): -0.112 (-0.577-.007) were significantly associated with glycemic control. Also adherence to: Plantain-moriga combined diets β (95%CI): -0.406 (-0.413, -0.049) and Plantain-beans combined diets β (95%CI): -0.128 (-0.188, -0.038) were significantly associated with glycemic control. Adherence to Plantain, Yam, Beans, Plantain-moriga combined diets, and Plantain-beans combined diets could be associated with glycemic control. Keywords: Diabetes mellitus, Adherence, Moringa, Plantain, Glycemic control, Ghana.

Background: Psychological distress is a pervasive condition that interacts with other factors to influence adherence to treatment regimens, yet information-gap exists on how psychological-distress interact with Type-2-Diabetes Mellitus (T2DM) patients’ perceptions about their disease state and treatment benefits for adherence to dietary-recommendation. This study therefore investigates how T2DM patients’ psychological-distress interacts with perception about disease state and treatment benefits for adherence to dietary-recommendation. Methods: Facility-based cross-sectional-study was conducted among 530 T2DM patients at six health-facilities in Ghana. Structured-questionnaires were used to collect socio-demographics data, and Health Belief Model (HBM) questionnaires used to assess perceived-beliefs. Perceived-Dietary-Adherence-Questionnaire (PDAQ) for T2DM patients was used to assess adherence to dietary-recommendation. SPSS version-22 was used in data analysis.Results: Weight, diabetes-duration, total-cholesterol, HbA1c and fasting-blood-sugar were statistically significant for adherence to dietary-recommendation (P-value Conclusion: Psychological-distress can interact with patients’ perceptions for adherence to dietary recommendation. Therefore, health care workers globally should be mindful of this and offer professional care.

Background: Musculoskeletal pains (MPs) is a widespread public problem that can affect 13.5% to 47% of total population. Dietary changes have strong effects (positive and negative) on a person’s health. Sulfur amino acids (SAAs) as a part of protein structure, can be one of the precursors of neurotransmitters, antioxidative metabolic intermediates such as glutathione, effect on inflammation and finally play a role in severity and frequency of MPs. This article will discuss the relationship between dietary sulfur amino acids intake with severity and frequency of pain in patients with MPs. Methods: This study was a matched case–control study designed. The target population were 175 men and woman. Anthropometric measurements and pain assessment were collected with questionnaires. Dietary data were collected using 7 days 24-hour recall. ANOVA and Spearman correlation was also performed to examine the relationship between independent and outcome variables. For data analysis, P-value

Background: Childhood malnutrition is the main risk factor for impaired mental and physical growth and several diseases and leads to premature death worldwide. Therefore, reducing childhood malnutrition is a top priority in most countries. In this regard, several studies have explored the effects of nutritional intervention on reducing childhood malnutrition, although mostly in controlled conditions and with small sample sizes. Data on community-based interventions are limited. In this study, we investigated the effects of providing hot meals at lunchtime on the growth of children in day care centers in rural areas of the city of Birjand, Iran. Methods: This was a quasi-experimental study. Hot meals were offered for 6 months to all the children (n = 1809) in day care centers of rural Birjand. Height and weight of the children were measured before and after the intervention. Z-score indicators were calculated using WHO Anthro and Anthro plus software packages. SPSS was used for data analyses. Results: Prevalence of wasting and stunting decreased after the intervention in both sexes. The decrease in stunting prevalence was significantly greater in boys than in girls. However, proportions of various categories of height-for-age Z-score (HAZ) did not change significantly in either sex. In both sexes, weight, height, body mass index, and weight-for-age improved significantly after the intervention. The prevalence of obesity and overweight did not change after the intervention. Conclusion: Based on the findings, providing hot food at lunchtime in day care centers can reduce wasting and stunting in children in rural regions of Birjand, Iran.

Introduction Psychological distress is a pervasive mental condition among persons with chronic noncommunicable diseases. Aim To examine whether interactions between patients’ psychological distress and adherence to dietary recommendations predict glycemic controls among persons with type 2 diabetes mellitus in Ghana. Methods Facility‐based cross‐sectional study involving 530 persons with type 2 diabetes mellitus was conducted between October 2018 and September 2019. Six health facilities were randomly selected and normal‐weight persons with type 2 diabetes mellitus (T2DM) at baseline consecutively recruited from patients’ registers. Structured questionnaires were used to collect sociodemographic data. Glycemic control was the main outcome variable, and was determined using HbA1c%. Statistical Package for Social Sciences version 22 was used in data analysis. Results Systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), total cholesterol, and fasting blood sugar were statistically significant for glycemic control (HbA1c%) (p‐value

BackgroundDietary recommendation help persons with diabetes adopt to healthy eating habits to achieve optimal glycemic control. Socioeconomic-status and neighborhood support system can influence adherence to dietary recommendation. The purpose of our study is to assess the association of household-socioeconomic status and neighborhood-support system with adherence to dietary recommendation among persons with type 2 diabetes mellitus (T2DM).MethodsFacility-based cross-sectional-survey was conducted in Brong Ahafo region, Ghana. Six hospitals were randomly selected and 530 individuals with T2DM consecutively recruited from the selected hospitals for the study. Structured-questionnaires were used to collect socio-demographic variables. Adherence to dietary-recommendation was the outcome-variable, and was assessed using perceived dietary-adherence questionnaire.ResultsAge (years) (P-value = 0.005), Physical-Activity level (P-value = 0.024) Receive-moderate Social-Support (P-value = 0.004) and High-Socioeconomic status (P-value = 0.046) were significantly correlated with adherence to dietary-recommendation. Age (years) regression coefficient (β) -0.089, 95%CI (− 0.12, − 0.001), Being married β0.103, 95%CI (0.002, 0.02), moderate and low-social support system β 0.309, 95%CI (0.17, 0.38) and β-0.192, 95%CI (− 0.26, − 0.06) respectively, and high-socioeconomic status β 0.197, 95%CI (0.06, 0.25) were significantly associated with adherence to dietary-recommendation.ConclusionSocial-support system and socioeconomic-status could be associated with adherence to dietary-recommendation. Therefore, health workers should consider patients’ social support system and socioeconomic status as modifiable factors for optimum adherence.

Background The prevalence of obesity and its two important phenotypes, the metabolically healthy obese (MHO) and the metabolically unhealthy obese (MUO) are 10.9, 9.1, and 1.8%, respectively, among children and adolescents in Iran. Data on the link between diet quality indices and obesity phenotypes in children and adolescents is scarce. The present study aimed to assess the association of the Dietary Approaches to Stop Hypertension (DASH) score with MHO and MUO, as well as with cardiometabolic risk factors (RFs) in children and adolescents with excess weight. Methods This cross-sectional study was conducted on 341 children and adolescents with excess weight aged 6–13 years, selected from primary schools of Tehran. The DASH score was determined based on eight components using a valid and reliable food frequency questionnaire. Anthropometric measures, insulin, fasting plasma glucose, lipid profile, and physical activity levels were collected. MUO was classified based on two definitions: having 2 or more cardiometabolic RFs, or being insulin resistant determined by a homeostatic model assessment of insulin resistance (HOMA-IR) ≥ 3.16. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for MUO phenotypes and cardiometabolic RFs in each tertile of the DASH score after adjustment for confounders. Results The mean ± SD for age and DASH score was 9.3 ± 1.7 years and 24.0 ± 4.9, respectively. The prevalence of MUO was 62.2% based on RFs, and 43.4% based on HOMA-IR. Participants in the highest tertile of the DASH score had significantly decreased odds for MUO based on HOMA-IR (OR = 0.49; 95% CI: 0.28–0.87) compared with those in the lowest tertile, after adjustment for confounders. However, there were no associations between the DASH score and any of cardiometabolic RFs, or MUO based on RFs (OR = 0.68; 95% CI: 0.38–1.20). Conclusion The DASH score was inversely associated with MUO based on HOMA-IR, but not associated with MUO based on cardiometabolic RFs in this sample of children and adolescents. A DASH-style diet may have favourable effects on insulin sensitivity among children and adolescents with excess weight. Universal definitions for MHO/MUO are required, and longitudinal studies recommended to shed light upon this subject.

Resumo Fundamento Os glicocorticóides (GCs) são amplamente prescritos para o tratamento de numerosos distúrbios clínicos devido às suas propriedades anti-inflamatórias e imunomoduladoras, e um dos efeitos indesejáveis mais comuns desses medicamentos é a dislipidemia. Objetivo Avaliar o efeito da quercetina, um flavonoide derivado de plantas, no perfil lipídico de ratos tratados com glicocorticóides em altas doses. Métodos Um total de 32 ratos Sprague-Dawley foram distribuídos aleatoriamente entre quatro grupos (8 ratos por grupo) e tratados por 6 semanas com uma das seguintes opções : (i) solução salina normal; (ii) 40 mg/kg de succinato sódico de metilprednisolona (MP); (iii) MP + 50 mg/kg de quercetina; (iv) MP + 150 mg/kg de quercetina. O MP foi injetado por via subcutânea e a quercetina foi administrada por gavagem oral 3 dias por semana. No final do estudo, o perfil lipídico dos animais foi medido através de kits enzimáticos. Os dados foram analisados e a significância estatística foi estabelecida em p

Given that average salt intake among Iranians is approximately 10–15 g per day particularly from sodium hidden in bread, cheese, and fast food; lowering this mineral has been followed up seriously in this country for almost 10 years (since 2009). The main objective of the present study was to provide an opportunity to recognize unwanted and unfavorable outcomes of implementing decisions and policies together with associated problems of salt reduction in bread in order to achieve national and global health promotion goals. Thus, this qualitative and retrospective policy analysis was completed to evaluate the policy of salt reduction in bread in Iran. To collect the data, the researchers traveled to six cities in different regions, wherein relevant documents were utilized added to interviews with key actors. Related websites were correspondingly searched to find reports on this policy. Moreover, the researchers referred to some organizations in-person to search documents in this area. Five group discussions were also held to obtain public opinions in this regard. Data analysis was further carried out using framework analysis. The findings revealed that allocation of the highest rates of subsidy to wheat, flour, and bread had led to elimination of competitiveness in wheat, flour, and bread supply chain in Iran. Despite the presence of proper structures as coordinators of other organizations working on public health, there was no intersectoral collaboration in terms of maintaining health of bread products and lowering salt content in this staple food. With regard to changes in priorities of the Iranian Ministry of Health and Medical Education, attempts made to improve bread quality had also failed. In addition, first-line staff (i.e. bakers) had viewed formulation and implementation of the given policy as a top-down one. Given the ambiguities in establishment of new standards, there were similarly contradictions in execution of the policy at various levels. With reference to education provided at a national level, it was concluded that some people had become more sensitive to salt reduction in bread to some extent.

Introduction We examined the association of adipose triglyceride lipase (ATGL) and hormone-sensitive lipase (HSL) gene expressions, as the key regulators of lipolysis, with dietary fat quantity and composition in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). Methods In this observational study, samples were collected from patients undergoing elective abdominal surgery. Participants were categorized into two groups based on their body mass index (BMI) status. Dietary, anthropometric, and biochemical data were collected before surgery. Linear regression was performed to determine the association of dietary fat content with ATGL and HSL gene expressions in SAT and VAT. Results 152 individuals with a mean ± SD age of 40.7 ± 13.2 years and a median (inter-quartile range) BMI of 39.4 (26.5–45.3 kg/m2) participated in this study, of whom 54 were non-obese (BMI Conclusion ATGL and HSL mRNA expressions in SAT were associated with dietary fat quantity and composition among non-obese adults.

Background: The association between vitamin D status and inflammatory biomarkers and lipid profile is not well known, especially in adolescents. Therefore, the aim of the current study is to investigate the association of vitamin D status with serum lipids and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, in male adolescents. Methods and materials: A sample of seventy-one high school male students, aged 17 years old, from a high school in Tehran were enrolled in the study. They were divided into four groups including group with serum vitamin D below 25 (ng/mL) (SVD &lt, 25, n = 36), 25 and above (ng/mL) (SVD &ge, n = 35), negative-hsCRP (n = 48), and positive-hsCRP (n = 23). Weight, height, body mass index, dietary intake, serum lipids, and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, were measured. Results: In the (SVD &lt, 25) group, the serum level of TNFR-2 was significantly higher compared to that in the (SVD &ge, 25) group. There was a significant negative association between serum TNFR-2 and vitamin D levels in the whole sample. We found significant lower levels of IL-10 in positive-hsCRP group compared to the negative-hsCRP group. In addition, there was a significant negative correlation between the serum vitamin D level and hsCRP in both hsCRP groups. The HDL level was lower in the (SVD &lt, 25) group compared to that in the (SVD &ge, 25) group. Finally, there was a negative correlation between the serum HDL and hsCRP levels in the positive-hsCRP subjects. Conclusion: Based on the findings it can be concluded that serum vitamin D affects HDL and inflammation status. Although serum levels of HDL and inflammation status are both predictors of metabolic syndrome and cardiovascular disease, further studies are needed to prove it, especially in adolescents.

Background: Effects of vitamin D on biomarkers of cardiometabolic disorders among obese individuals are highly variable between studies. Comparing the effects of vitamin D supplementation in metabolically healthy (MHO) vs. metabolically unhealthy (MUHO) obesity using metabolomics may yield mechanistic insights into the observed heterogeneity. Objective: To quantify small molecular changes shortly after vitamin D intervention in MHO and MUHO individuals with sub-optimal levels of vitamin D ( Methods: In two randomized double-blind clinical trials, 110 MHO and 105 MUHO individuals were separately and randomly assigned to receive a daily dose of vitamin D supplement (4000 IU) or placebo. These MHO/MUHO phenotypes were defined using the Adult Treatment Panel-III criteria. Obesity-related metabolites (n=104) were measured at baseline and after four months of supplementation, using liquid chromatography coupled to a triple quadrupole mass spectrometry. Multiple linear regression models were fit to assess changes in metabolite levels, adjusting for appropriate covariates as well as controlling for multiple testing. Results: In the MUHO group (n=78), we identified ten metabolites (citrulline, acyl-lysophosphatidylcholines C16:0, C16:1, C18:0 and C18:1, diacyl-phosphatidylcholines C32:0, C34:1, C38:3 and C38:4 and sphingomyelin C40:4) that were significantly altered (P=4.9×10-4 to P=0.007) in response to vitamin D therapy. In the MHO group (n=82), no significant metabolite changes were observed after the intervention. Conclusion: Findings from our study contribute to the understanding of biological variation in Vitamin D metabolism across different obesity phenotypes. Upon successful validation, these insights can increase precision of clinical approaches to metabolic derangements in obesity. This study was registered at www.irct.ir as IRCT2015061522762N1. Disclosure M. Bagheri: None. S. Aslibekyan: Employee; Self; 23andMe. A. Djazayery: None. F. Farzadfar: None. Funding Tehran University of Medical Sciences

Background: Low-grade systematic inflammation triggers atrial wall thickening, which predisposes to several cardiovascular events. Since diet is a strong moderator of systematic inflammation, the literature review-based dietary inflammatory index (DII®) score has been recently introduced for evaluating inflammatory properties of an individual’s diet. The aim of the present study was to assess the association of DII, with carotid intima media thickness (cIMT) among overweight or obese children and adolescents. Methods: A total of 339 children and adolescents (48% girls) aged from 6 to 13 years, with WHO body mass index z-score >1 were enrolled in this cross-sectional study. A valid and reliable semi-quantitative food frequency questionnaire was used to collect dietary intakes and calculate DII score. cIMT was measured in the common carotid artery with high-resolution ultrasonography. Results: In this cross-sectional study, the mean ± SD age of participants was 9.3 ± 1.7 years. Among participants, 68% were obese and 83% were in the pubertal stage. DII ranged from –5.43 to 4.42, with the mean of –2.83 in the lowest, and 1.25 in the highest tertile of DII. When fit as a continuous variable, DII score had no significant association with cIMT after adjusting for potential confounders. However, the participants in the highest DII score tertile compared to the lowest had 2.46-fold increased risk of high cIMT in the multivariable adjusted model (p for trend = 0.02). Discussion/Conclusion: Higher DII scores were associated with increased risk of high cIMT.

Background: Deficiency of vitamin D, an anti-inflammatory micronutrient with some favorable effects on lipid profiles, has been found to be highly prevalent in adolescents. We aimed to investigate the effect of a school-based vitamin D supplementation regimen on the correction of vitamin D deficiency as well as lipid and inflammatory profiles of healthy adolescent boys. Methods: In this randomized single-blind placebo-controlled trial, seventy-one healthy adolescent boys (age 17 years old) were recruited from one high school in Tehran, Iran, and randomly assigned to two groups. The supplement group received vitamin D pearls at a dose of 50,000 IU monthly for 6 months, this dose is indeed defined by the Ministry of Health in Iran for a potential national school-based vitamin D supplementation program. The other group was given placebo pearls for the same duration. Before and after the treatment, the serum levels of 25-hydroxy vitamin D (25(OH) D), parathyroid hormone (PTH), retinol, lead (Pb), the lipid profile and the inflammatory biomarkers were measured and compared. Results: Between-groups statistical analysis showed that a dose (50,000 IU/month) vitamin D significantly increased the serum levels of 25-hydroxyvitamin D (25 (OH) D) (p &lt, 0.001) and decreased serum levels of PTH (p = 0.003). No significant change was observed in serum levels of retinol and Pb. Between-group analysis revealed that the serum levels of TG (P = 0.001) decreased while an increase in serum levels of HDL (p = 0.021) was observed (p&thinsp, &lt, 0.05). Both the within- and between-group analysis showed that serum tumor necrosis factor receptor 2 (TNFR2) concentration declined while serum interleukin-10 (IL-10) increased in response to vitamin D supplementation (p&thinsp, 0.05). Conclusion: A supplementation regimen of (50,000 IU/month) vitamin D in a context with high rates of vitamin deficiency has shown positive impacts on the serum vitamin D, lipid profile and inflammatory biomarkers in healthy adolescent boys.

Objective Vitamin D deficiency has been reported to be associated with the incidence of type 1 and type 2 diabetes and worsening of diabetes complications. This study was designed to investigate the effect of vitamin D treatment on the expression of five key genes involved in the development of diabetic cardiomyopathy. Methods Twenty-four male Sprague-Dawley rats were randomly divided into three groups. The first group served as control and the other two groups received an intraperitoneal injection of 45 mg/kg streptozotocin (STZ) to develop diabetes. Then groups were treated for 4 weeks either with placebo or vitamin D (two injections of 20,000 IU/kg). Serum levels of glucose, insulin, HbA1c, and advanced glycation end products (AGEs), as well as the gene expression of AGE cellular receptor (RAGE), glyoxalase, aldose reductase, O-GlcNAc transferase (OGT), and glutamine-fructose-6-phosphate aminotransferase (GFAT) and nuclear factor-kB (NF-kB) activity of nuclear extracts were assessed at the end of experiment. Results Increment in serum cholecalciferol could improve hyperglycaemia and hypoinsulinemia in diabetic rats. In addition, a significant reduction was observed in RAGE, OGT, and GFAT gene expression and NF-kB activity in cardiac myocytes. Conclusions Vitamin D might contribute in reducing diabetic cardiomyopathy not only by improving blood glucose and insulin levels but also via downregulating AGE and hexosamine pathways and decreasing NF-kB activity in heart tissue.

Objective The objective of this study was to investigate the association of serum levels of 25(OH)D3 (vitamin D), retinol (vitamin A) and zinc with stunting in a large sample of Iranian toddlers. Study design This was a cross-sectional study. Methods A total of 4261 children, aged 10–36 months, who had Iranian birth certificates were included in the present study. Weight and height were measured by experienced professionals in accordance with standard protocols. Stunting was defined as a height-for-age z-score of Results The mean age of the study participants was 19.2 ± 8.4 months. A significant inverse association was found between serum retinol concentrations and the odds of stunting such that after controlling for potential confounders, toddlers in the highest quartile of serum retinol levels had 29% lower odds of stunting than those in the lowest quartile (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.53–0.97). Furthermore, a significant inverse association was found between serum levels of retinol and stunting in girls (OR: 0.57, 95% CI: 0.34–0.94), urban toddlers (OR: 0.66, 95% CI: 0.44–0.99) and those who did not use nutritional supplements (OR: 0.70, 95% CI: 0.52–0.95). Although serum 25(OH)D3 levels were not significantly associated with stunting in the overall study population, we found a positive association among toddlers who used nutritional supplements. No significant association was found between serum levels of zinc and stunting. Conclusion We found a significant inverse association between serum levels of retinol and stunting in toddlers aged 10–36 months.

Background: Designing cancer prevention programs needs information on knowledge, attitude, and practice of the community. Unfortunately, this information is not available in Iran. Materials and Methods: We developed a questionnaire (NUTCANKAPQ) to assess the knowledge, attitude, and practice of Iranian women regarding cancer prevention dietary habits. We recruited women who had referred to public health-care centers in Tehran, Iran. To assess validity, we applied face, content, and construct validity methods. We performed test–retest approaches to assess reliability, and internal consistency of the questionnaire was assessed through Cronbach's alpha and intraclass correlation coefficients (ICCs). Results: Qualitative content validity was carried out by an expert panel, and internal consistency was deemed satisfactory (Cronbach's alpha, >0.6). We also observed high reliability in the questionnaire (ICC = 0.85). The mean (± standard deviation) scores for knowledge, attitude, and practice of study participants were 28.3 (±14.1), 67.1 (±18.9), and 53.7 (±8.3), respectively. The result of exploratory factor analysis, Kaiser–Meyer–Olkin (KMO), implied that the model was reasonably fit (KMO > 0.6). The final questionnaire included seventy items. Conclusion: NUTCANKAPQ is a valid and reliable tool for the assessment of cancer-related nutrition knowledge, attitude, and practice among the Iranian population. Application of NUTCANKAPQ may provide important clues for policy-making and improvement of cancer prevention programs among the Iranian population.

Depression and anxiety are major health problems throughout the world. Metabolic changes in type 2 diabetes mellitus induces and aggravates mental disorders, such as depression and anxiety. Saffron as a therapeutic herb may attenuate Comorbid Depression- Anxiety (CDA). So, this trial is designed to investigate the effect of saffron alcoholic extract on symptoms of CDA in type 2 diabetic patients.Fifty-four outpatients suffered from mild to moderate CDA diagnosed by using Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), were assessed by Hamilton Depression and anxiety measurements, the Pittsburgh Sleep Quality Index (PSQI), and the Satisfaction with Life Scale (SWLS). The participants of this double-blind, placebo-controlled, single center and randomized trial were randomly assigned to intake 30 mg/day saffron or placebo capsules for 8 weeks.After the intervention, mild to moderate CDA, anxiety and sleep disturbance, but not depression alone, were relieved significantly in the saffron group (P 0.05), whereas, the changes were not significant in the placebo group. Anthropometric measures and blood pressure parameters of the patients in either groups did not change significantly (P 0.05) during the intervention. Moreover, dietary intake and physical activity did not differ during the study in the two groups. Changes in the life satisfaction were not significant.The results indicate the beneficial effect of saffron on the mild to moderate CDA in type 2 diabetic patients.

A particular subgroup of obese adults, considered as metabolically healthy obese (MHO), has a reduced risk of metabolic complications. However, the molecular basis contributing to this healthy phenotype remains unclear. The objective of this work was to identify obesity-related metabolite patterns differed between MHO and metabolically unhealthy obese (MUHO) groups and examine whether these patterns are associated with the development of cardiometabolic disorders in a sample of Iranian adult population aged 18-50 years. Valid metabolites were defined as metabolites that passed the quality control analysis of the study. In this case-control study, 104 valid metabolites of 107 MHO and 100 MUHO patients were separately compared to those of 78 normal-weight metabolically healthy (NWMH) adults. Multivariable linear regression was used to investigate all potential relations in the study. A targeted metabolomic approach using liquid chromatography coupled to triple quadrupole mass spectrometry was employed to profile plasma metabolites. The study revealed that, after Bonferroni correction, branched-chain amino-acids, tyrosine, glutamic acid, diacyl-phosphatidylcholines C32:1 and C38:3 were directly and acyl-carnitine C18:2, acyl-lysophosphatidylcholines C18:1 and C18:2, and alkyl-lysophosphatidylcholines C18.0 were inversely associated with MHO phenotype. The same patterns were observed in MUHO patients except for the acyl-carnitine and lysophosphatidylcholine profiles where acyl-carnitine C3:0 and acyl-lysophosphatidylcholine C16:1 were higher and acyl-lysophosphatidylcholines C18:1, C18:2 were lower in this phenotype. Furthermore, proline, and diacyl-phosphatidylcholines C32:2 and C34:2 were directly and serine, asparagines, and acyl-alkyl-phosphatidylcholine C34:3 were negatively linked to MUHO group. Factors composed of amino acids were directly and those containing lysophosphatidylcholines were inversely related to cardiometabolic biomarkers in both phenotypes. Interestingly, the diacyl-phosphatidylcholines-containing factor was directly associated with cardiometabolic disorders in the MUHO group. A particular pattern of amino acids and choline-containing phospholipids may aid in the identification of metabolic health among obese patients.

Objective Studies have reported elevated serum insulin-like growth factor (IGF)-1 levels followed by ω-3 supplementation in various groups. Considering decreased level of IGF1 in patients with cardiovascular disease (CVD) and protective effects of IGF1 against CVD progression and myocardial infarctions mortality, this study was performed with the aim of determining effects of ω-3 supplementation on serum levels and gene expression of IGF1 and IGF binding protein-3 (IGFBP3) in men with CVD. Methods Sixty-two middle-aged (55.9 ± 6.5 y) non-obese men with CVD followed the study protocol in two groups of ω-3 (n = 31) or placebo (n = 31) supplementation. Participants took ω-3 supplement or placebo (edible paraffin) for 8 wk and were asked not to change their diet or physical activity plan. Anthropometric and lipid profile characteristics, serum IGF1, serum IGFBP3 and also IGF1 and IGFBP3 gene expression in peripheral blood mononuclear cells (PBMCs) were measured in all participants before and after the intervention. Statistical analyses were performed using SPSS software. Results There were no significant differences between the two study groups in age and body mass index at baseline. The groups also had no difference in baseline serum low-density lipoprotein, high-density lipoprotein, very low-density lipoprotein, triacylglycerols, and IGF1. Compared with placebo, ω-3 supplementation increased serum IGF1 levels ( P = 0.01), and decreased serum level of IGFBP3 ( P = 0.02). There was a trending toward an increase in IGF1 expression and nonsignificant decrease in IGFBP3 expression. Conclusions ω-3 supplementation in patients with CVD increases serum IGF1 levels and decreases serum IGFBP3. Further research is warranted to investigate the underlying mechanisms.

Uncertainty remains about the effect of vitamin D therapy on biomarkers of health status in obesity. The molecular basis underlying this controversy is largely unknown. To address the existing gap, our study sought to compare changes in metabolomic profiles of obesity phenotypes (metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO)) patients with sub-optimal levels of vitamin D following vitamin D supplementation. We conducted two randomized double-blind clinical trials on participants with either of the two obesity phenotypes from Tehran province. These phenotypes were determined by the Adult Treatment Panel-III criteria. Patients in each of the MHO (n = 110) and MUHO (n = 105) groups were separately assigned to receive either vitamin D (4000 IU/d) or placebo for 4 months. Pre- and post-supplementation plasma metabolomic profiling were performed using Liquid chromatography coupled to a triple quadrupole mass spectrometry. Multivariable linear regression was used to explore the association of change in each metabolite with the trial assignment (vitamin D/placebo) across obesity phenotypes. Metabolites (n = 104) were profiled in 82 MHO and 78 MUHO patients. After correction for multiple comparisons, acyl-lysophosphatidylcholines C16:0, C18:0, and C18:1, diacyl-phosphatidylcholines C32:0, C34:1, C38:3, and C38:4, and sphingomyelin C40:4 changed significantly in response to vitamin D supplementation only in MUHO phenotype. The interaction analysis revealed that vitamin D therapy was different between the two obesity phenotypes based on acyl-lysophosphatidylcholines C16:0 and C16:1 and citrulline which were altered significantly after supplementation. Changes in metabolites were associated with changes in cardiometabolic biomarkers after the intervention. Vitamin D treatment influenced the obesity-related plasma metabolites only in adults with obesity and metabolically unhealthy phenotype. Therefore, not all patients with obesity may benefit from an identical strategy for vitamin D therapy. These findings provide mechanistic basis highlighting the potential of precision medicine to mitigate diseases in health-care settings.

Background: Recent studies show that Iranians, especially women, do not have enough physical activity and if serious measures are not taken to resolve this problem, the consequences will be harmful to the society. The purpose of this advocacy paper was to determine and explain the responsibilities of all organizations and institutions responsible for promoting physical activity to root out the problem. Methods: After a thorough library search we conducted nine in-depth interviews with the relevant policymakers and government officials, managers, and practitioners in promoting physical activity. All interviews were recorded. To analyze, all of voice files were typed, saved as Word files, and exported to MAXQDA10 software by the research team. To find the main themes, all the files were read carefully several times. Then they were coded, categorized, and organized based on the main objectives of the study. In this way, themes and subthemes were emerged. Results: According to the participants in the study current state of physical activity in the country, especially among women, is not promising. The participants explained about the main obstacles for promotion of physical activity in the country and recommended practical strategies for its promotion. The strategies were suggested in three areas: Promoting culture, social protection, and adjusting current policies to overcome the existing barriers. Conclusion: Regarding the unfavorable state of physical activity in the country presentation of this advocacy document can be an effective step in promoting physical activity, thus reducing chronic diseases and improving general health in the country.

Background. Secreting different adipocytokines, adipose tissue plays an important role in health and disease. Upon omega-3 consumption, changes in the secretion of adipose tissue and its effects on glycemic profile are a controversial subject at the present time.Objectives. We evaluated the effects of eicosapentaenoic acid (epa) alone and in combination with vitamin e on adiponectin and serum glycemic indices in type ii diabetes patients.Design. This double-blind clinical trial divided all patients randomly into four balanced permuted blocks of epa, vitamin e, epa and vitamin e and placebo (corn oil).Subjects and methods. 127 patients with type ii diabetes living in kashan in 2008, 35-50 years old, and 25�bmi �30 were enrolled. Elisa, Glucose oxidase, spectrophotometry, and radioimmunoassay methods were used for measurement of serum adiponectin, fasting blood glucose (fbg), hba1c, and insulin, respectively.Results. Serum adiponectin increased significantly after epa consumption in epa and epa+e groups. Moreover, fbg, hba1c, serum insulin and homeostasis model homa-ir decreased significantly after epa consumption in the two previously mentioned groups.Conclusions. This study showed that epa supplementation affects the secretion of adipose tissue, improves the fbs as well as hba1c values and significantly decreases fasting serum insulin and insulin resistance.

This study was carried out to investigate the effect of vitamins E and C on cognitive performance among the elderly in Iran.About 256 elderly with mild cognitive impairment, aged 60-75 years, received 300 mg of vitamin E plus 400 mg of vitamin C or placebo daily just for 1 year.Demographic characteristics, anthropometric variables food consumption, cognitive function by Mini-Mental State Examination (MMSE), and some of the oxidative stress biomarkers were examined.Antioxidant supplementation reduced malondialdehyde level (P0.001) and raised total antioxidant capacity (P0.001) and glutathione (P0.01). The serum 8-hydroxydeoxyguanosine remained unchanged (P0.4). After adjusting for the covariates effects, MMSE scores following 6- (25.88 ± 0.17) and 12-month antioxidant supplementation (26.8 ± 0.17) did not differ from control group (25.86 ± 0.18 and 26.59 ± 0.18, respectively).Despite significant improvement in most of the oxidative stress biomarkers, antioxidants' supplementation was not observed to enhance cognitive performance. A large number of kinetic and/or dynamic factors could be suspected.

malnutrition. Objectives: In the present study views, experiences and practices of mothers and caregivers about exclusive breast feeding was explored by a qualitative study in Damavand, Iran, a country with a relatively high prevalence of pediatric malnutrition. Materials and Methods: Urban and rural mothers who had under-2-year babies attended 11 FGDs. In addition, six FGDs were arranged for caregivers in urban and rural areas. All FGD notes were analyzed and emerging themes were derived and reported. Results: The findings indicated that although mothers were aware of breastfeeding benefits and regarded it as their responsibility, in few cases, neonates were fed by items other than breast milk. Exclusive breast feeding was not followed precisely. Pregnancy of mothers, lack of knowledge, misinformation and physician instruction were among the reasons why mother may stop breast- feeding. Mothers' and caregivers were aware of the importance of breast feeding in sick children. Conclusions: Mothers’ knowledge of exclusive breast feeding were satisfactory but their practice was not based on recommendations. As physicians play a role in this matter, the need for specific educational modules for them and other health staff is recommended. Meanwhile, parental education and everyone involved in childcare is a priority so that the problem can be overcome.

OBJECTIVE Interpopulation as well as interindividual variations in response to vitamin D intake commonly observed in subjects with type 2 diabetes may be related to genetic makeup. One of the candidate genes potentially responsible for this diversity is vitamin D receptor (VDR). This study aimed to investigate the interactive effect of VDR Fok-I polymorphism and vitamin D intake on diverse aspects of diabetic host response. RESEARCH DESIGN AND METHODS Glycemic status, lipid profiles, inflammatory biomarkers, and VDR Fok-I genotypes were determined in diabetic subjects (n = 140) who participated in a randomized controlled trial. Participants consumed two 250-mL bottles per day of yogurt drink (doogh) fortified with 500 IU vitamin D/250 mL for 12 weeks. RESULTS Mean serum 25(OH)D increased by ~30 nmol/L (P < 0.001). The time × intervention effect was significant for 25(OH)D (P = 0.030), HDL (P = 0.011), high-sensitivity C-reactive protein (hsCRP) (P < 0.001), interleukin (IL)-4 (P = 0.008), and IL-6 (P = 0.017) among the genotypic groups. The alleles were defined as ‘‘F’’ or ‘‘f’’ depending on the absence or presence of the restriction site, respectively. The least increment in 25(OH)D was in ff (23.0 ± 3.8 nmol/L) compared with Ff (31.2 ± 3.4 nmol/L) and FF (35.6 ± 2.7 nmol/L) (P for trend = 0.009), but only the difference between ff and FF was significant (P = 0.023). FF group had the largest decrement of both hsCRP and IL-6 compared with Ff (P < 0.001 and P = 0.038) and ff (P = 0.010 and P = 0.048), respectively. CONCLUSIONS We concluded that those of VDR ff genotype may be regarded as “low responders” to vitamin D intake in terms of response of circulating 25(OH)D and certain inflammatory biomarkers. A nutrigenetic approach may, therefore, be needed to protect diabetic patients from vitamin D deficiency.

Background: This study evaluated the effect of an intervention for reducing excess weight gain in primary school-age children in Tehran. Methods: A cluster-randomized controlled trial was conducted in 12 primary schools in Tehran. Three hundred thirty-four pupils, 167 in the intervention and 167 in the comparison group, determined to be overweight or obese based on World Health Organization standards, were recruited for the study. The intervention included nutrition education and increased physical activity (PA) for the pupils, lifestyle modification for parents, and a change in food items sold at the schools’ canteens. The entire intervention lasted approximately 18 weeks. Measures were taken before and immediately after the intervention. Results: The intervention significantly reduced body mass index Z-score and hip circumference ( p = .003 and p < .001, respectively). Waist circumference increased in both groups, but the increase was higher in the comparison group ( p = .001). No significant difference was seen in time spent on TV viewing between groups ( p = .08). Vigorous PA increased in the intervention group ( p < .001), while the comparison group showed an increase in moderate activity only ( p < .001). Energy intake increased significantly in the intervention group ( p < .001). Neither triceps skinfold thickness nor time spent on the computer changed in the intervention group ( p = .51 and p = .1, respectively), while they increased in the comparison group ( p < .001 and p = .004, respectively). Conclusion: The study provides a successful model for the implementation of similar interventions throughout the country.

Background Both vitamin D deficiency and inflammation have been linked to cardiovascular disease, the major cause of death in diabetes. In this study, the effects of daily intake of vitamin D-fortified yoghourt drink (doogh )o n systemic inflammatory biomarkers in subjects with type 2 diabetes (T2D) were investigated. Subjects and methods In this 12-week randomized controlled trial, T2D subjects received either plain doogh (PD; containing 170 mg calcium and no detectable vitamin D/250 mL, n1=50) or vitamin D3-fortified doogh (FD; containing 170 mg calcium and 500 IU/250 mL, n2=50) twice a day. Glycemic status, body fat mass and systemic inflammatory biomarkers including serum highly sensitive C-reactive protein (hsCRP), serum amyloid A (SAA), interleukin(IL)-2, IL-6, IL-10 and tumour necrosis factor (TNF)-a were evaluated at the beginning and after the intervention. Data were expressed as either mean SD or median (interquartile range) whenever they had either normal or non-normal distribution, respectively. Results In the patients receiving the vitamin D fortified drink, compared with those receiving the unfortified drink, a significant increase in serum 25(OH)D was accompanied by significant changes in TNF-a (57.9 (264.6) versus +106.3 (683.2), p=0.044), IL-6 (6.3 (69.2), p=0.002), hsCRP (0.39 (1.50) versus +0.8 (1.52), p

Introduction: Child nutrition status is very important in all societies, which is influenced by the interaction of multiple factors including food security and socioeconomic status in both genders. The aim of this study was to examine the relationship between food security and socioeconomic status with anthropometric indices among 2–5-year-old urban children in eight different cities in Iran. Materials and Methods: In this cross-sectional study, anthropometric Z scores of 7028 children of urban area were measured by using World Health Organization (WHO) Anthro software based on WHO 2007 standards. Family food security was assessed by using HFIAS 9-item questionnaire. Socioeconomic status as well as health factors were analyzed using the SPSS. Results: Based on the present study, significant correlation was observed between sleep time, birth weight, and food security (P < 0.05) with body mass index (BMI), while the rest of the variables including age, family size, number of children, parents’ education, breastfeeding duration, watching TV, playing computer games, playing outdoors, number of main eating, and number of snacks showed no significant relation (P > 0.05). Conclusion: It was shown that 2–5 years old children's life are the most vital and vulnerable to the hazards of undernutrition or overweight and obesity, which could affect the whole health of the person. As food security affects BMI, it is important to focus more on this issue in order to improve child's health status.

Background : Overweight, obesity, and underweight are common child health problems in Iran. Child‑feeding practices are one of the major factors affecting children’s weight through eating behavior and dietary intake. The Comprehensive Feeding Practices Questionnaire (CFPQ), a 49‑item measure comprising 12 subscales, assesses parental child‑feeding practices. It is used to determine factors that may affect the development of overweight, obesity, and underweight and therefore, helps us plan appropriate preventive action. The aim of this study was to revise and adapt CFPQ to be used for 2–5‑year‑old children. Methods : This study including, 300 mothers selected by simple systematic random sampling, was conducted in the rural and urban areas of Birjand city, Iran. Health workers interviewed the mothers and completed questionnaire according to the standard protocol. Exploratory factor analysis (EFA), tests for internal consistency, and test–retest reliability were conducted. Results : EFA resulted in a final questionnaire with 39 items distributed over seven factors, including Healthy Eating Guidance, Modeling, Parent Pressure, Monitoring, Emotion Regulation, Child Control, and Restriction. The internal consistency reliability for the proposal scales was acceptable for five out of the seven factors and all of the seven factors demonstrated excellent test–retest reliability. Conclusions : The revised CFPQ is a valid tool for determining the various aspects of parental feeding practices aiming to prevent overweight, obesity, and underweight among 2–5‑year‑old children. Keywords : Comprehensive Feeding Practices Questionnaire, feeding behaviors, feeding practices, validation studies

Background: Flour fortification with folic acid is one of the main strategies for improving folate status in women of childbearing age. No interventional trial on the efficacy of folic acid fortification has been conducted so far in Iran. Objectives: To study the effects of flour fortification with folic acid on any reduction in neural tube defects (NTDs) and folate status of women of childbearing age. Methods: In a longitudinal hospital-based study, 13,361 postpartum women were studied after admission for childbirth before and after fortification. In addition, two cross-sectional surveys were conducted before (2006) and after flour fortification (2008). The cluster sampling method was used and 580 women, 15–49 years old, were studied as a representative sample of Golestan province in the north of Iran. Fasting blood samples were collected to measure serum vitamin B12, folate and plasma homocysteine. Sociodemographic data, health characteristics and dietary intake were determined. Results: The mean daily intakes of folate from natural food before and after flour fortification were 198.3 and 200.8 µg/day, respectively. The total folate intake increased significantly from 198.3 to 413.7 µg/day after fortification (p < 0.001). Folate intake increased by an average of 226 µg/day from fortified bread. The mean serum folate level increased from 13.6 to 18.1 nmol/l; folate deficiency decreased from 14.3 to 2.3% (p < 0.001). The incidence rate of NTDs declined by 31% (p < 0.01) in the post-fortification period (2.19 per 1,000 births; December 2007 to December 2008) compared to the pre-fortification period (3.16 per 1,000 births; September 2006 to July 2007). Conclusions: Implementation of mandatory flour fortification with folic acid can lead to a significant increase in serum folate and a significant decrease in NTDs.

Background and aims Cardiovascular diseases are the major cause of mortality among diabetic patients. The concentration of malondialdehyde (MDA) and homocysteine is believed to play a role in cardiovascular diseases. Omega-3 fatty acid supplementation could be effective in some diabetes complications and in the control of the glycemic index. However, it may increase lipid peroxidation. The objective of this study was to determine the effect of omega-3 fatty acids on the concentration of homocysteine and MDA in diabetic patients. Methods and results A randomized double-blind, placebo-controlled clinical trial was conducted on 81 patients with type 2 diabetes. The patients were randomly assigned to either the treatment or control groups. Each subject received three capsules of omega-3 fatty acids or a placebo every day for a period of 2months. The two groups were similar in terms of body mass index and food intake. At the beginning of the study and after 2months of supplementation their levels of HbA 1 c, homocysteine, MDA, C-reactive protein (CRP), total cholesterol, LDL-cholesterol and fasting blood sugar (FBS) were determined. Due to omega-3 fatty acid supplementation, homocysteine was changed significantly in both treatment and control groups up to −3.10μmol/L and 0.10μmol/L respectively, and HbA 1 c decreased by 0.75% in the treatment group and increased by 0.26% in the control group. However, the changes in fasting blood sugar (FBS), malondialdehyde (MDA), C-reactive protein (CRP), total cholesterol and LDL-cholesterol levels were not significant. Conclusion The consumption of omega-3 fatty acid supplements (3g/day) for 2months decreases the levels of homocysteine in diabetic patients with no change in FBS, MDA and CRP levels.

Background: Monitoring of food insecurity is a critical issue for planners and policymakers in the public and private sectors in developing countries. Due to the multifactorial and multidimensional nature of food security and a lack of clarity concerning the causes, specific signs, and consequences of food insecurity, developing a reliable food security index is the major challenge related to monitoring food security. Objectives: The objective of this study was to identify the most appropriate indicators of food security at the provincial level in Iran through the application of an integrated approach including Delphi (classic Delphi) and analytic hierarchy process (AHP) from March to September 2013. Materials and Methods: The sample included 43 senior-level managers and experts at the national and provincial levels from different fields of related sciences; they were selected purposively as Delphi and AHP panel members based on the experts’ opinions and snowballing. In the first round of Delphi, out of 103 identified indicators, 38 were selected by the experts; the indicators were ranked in the second round. In the AHP study, 25 experts assigned weights in a pairwise comparison of the 20 indicators that had the highest priority based on the Delphi results. Using AHP matrix calculations, this list of indicators was ranked based on priority. Results: Out of 38 indicators identified in Delphi, 8 were related to the availability dimension, 14 were related to the access dimension, and 16 were related to the utilization dimension. Out of 20 indicators that were ranked in the AHP study, 6 indicators were related to availability, 7 were related to utilization, and 7 were related to access dimensions. However, the indicators related to availability had an overall higher rank compared to indicators related to access or utilization. Conclusions: This study identified and ranked 20 indicators as the most appropriate indicators of food security measurements at the provisional level in Iran.

Iran is undergoing an epidemiological and nutritional transition. Over the last 2–3 decades, major changes in lifestyle and food consumption patterns have occurred, as well as in the socio-economic situation. Disease patterns have changed and some micronutrient deficiencies and chronic nutritional diseases, including obesity, are on the increase. Considering these, food habits, and the national food system, the Nutrition Department, Ministry of Health and Medical Education and the Iranian Nutrition Society jointly undertook to prepare food-based dietary guidelines (FBDGs). The process consisted of three phases: agreeing on food groups, designing pictorial FBDGs, and field testing them. Three working teams, supported by a large group of advisors consisting of nutritionists, epidemiologists, food/nutrition planners, and other relevant experts were formed. The first draft of the food groups consisted of 7 groups: Bread and Cereals; Meats and Eggs; Pulses; Fruits; Vegetables; Milk and Dairy Products; Miscellaneous (nuts, oils and fats, sugar and sweets, soft drinks). It was sent to 20 nutrition and public health experts for feedback. A suggestion was made to divide the Miscellaneous group into two – oils and fats, and Miscellaneous (sugars and sweets, pickled and salted food items). Three pictorial FBDGs were then designed: a plate, a pyramid, and a rectangle. Thus, three posters were prepared by the working teams and revised by a group of experts, followed by a preliminary evaluation. The final step will be field testing of the three revised, modified designs by the public and experts and their final evaluation.

Effectiveness of school-based interventions to prevent or control overweight and obesity among school children was reviewed for a 11-year period (January 2001 to December 2011). All English systematic reviews, meta-analyses, reviews of reviews, policy briefs and reports targeting children and adolescents which included interventional studies with a control group and aimed to prevent or control overweight and/or obesity in a school setting were searched. Four systematic reviews and four meta-analyses met the eligibility criteria and were included in the review. Results of the review indicated that implementation of multi-component interventions did not necessarily improve the anthropometric outcomes. Although intervention duration is a crucial determinant of effectiveness, studies to assess the length of time required are lacking. Due to existing differences between girls and boys in responding to the elements of the programs in tailoring of school-based interventions, the differences should be taken into consideration. While nontargeted interventions may have an impact on a large population, intervention specifically aiming at children will be more effective for at-risk ones. Intervention programs for children were required to report any unwanted psychological or physical adverse effects originating from the intervention. Body mass index was the most popular indicator used for evaluating the childhood obesity prevention or treatment trials; nonetheless, relying on it as the only indicator for adiposity outcomes could be misleading. Few studies mentioned the psychological theories of behavior change they applied. Recommendations for further studies on school-based interventions to prevent or control overweight/obesity are made at the end of this review.

The proportions of underweight, wasted, and stunted children, as well as the infant and under-5 mortality rates, have all exhibited downward trends in the Region over the past 2 decades. This is in part attributable to maternal and child nutrition intervention programmes, especially those in which women were actively involved. Programmes which support and promote breastfeeding, such as the Baby Friendly Hospital Initiative, have also contributed to this trend, although the number of baby friendly hospitals varies considerably between countries. Available information also shows that anemia is quite common among women, many of whom also have a low weight and stature and seem to suffer from osteoporosis. In several countries of the Region a number of micronutrient deficiency control programmes are in progress, such as iron supplementation for pregnant women, fortification of flour and iodization of salt. Iodine deficiency disorders are under control in 2 countries of the Region and legislation for salt iodization is in place in 17 countries. Prevalence of severe malnutrition in children is much lower than that of milder levels, thus, promotion of the nutrition status of mildly to moderately malnourished children could lead to a sizeable reduction in child mortality

Objective: The aim of this study was to determine the role of omega-3 supplementation on NEFA concentration, insulin sensitivity and resistance, and glucose and lipid metabolism in type 2 diabetic patients. Subjects and methods: Forty-four type 2 diabetic patients were randomly recruited into two groups. Group A received 4 g/day omega-3 soft gels, and group B received a placebo for 10 wks. Blood samples were collected after 12-h fast. Physical activity records, three-day food records, and anthropometric measurements were obtained from all participants at the beginning and end of the study. Results: Omega-3 supplementation caused a significant reduction in NEFA in the intervention group compared with the placebo group (P = 0.009). Additionally, the administration of omega-3 resulted in significantly greater changes (Diff) for the intervention group in various parameters, such as insulin and Quicki indices compared with the placebo group (P < 0.05). Conclusions: Omega-3 fatty acid supplementation in type 2 diabetic patients improved insulin sensitivity, probably due to the decrease in NEFA concentrations. Arq Bras Endocrinol Metab. 2014;58(4):335-40 Objetivo: O objetivo deste estudo foi analisar o papel da suplementação com ácidos graxos ômega-3 sobre a concentração de ácidos graxos não esterificados (AGNE), resistência e sensibilidade à insulina e metabolismo de lipídios em pacientes com diabetes melito tipo 2. Sujeitos e métodos: Quarenta e quatro pacientes com diabetes tipo 2 foram recrutados aleatoriamente e alocados em um de dois grupos. O Grupo A recebeu 4 g/dia de ômega-3 na forma de cápsulas gelatinosas e o grupo B recebeu placebo durante 10 semanas. Amostras de sangue foram coletadas após 12 horas de jejum. Registros da atividade física, da dieta de três dias e medidas antropométricas foram obtidos de todos os participantes no início e no final do estudo. Resultados: A suplementação com ômega-3 causou uma redução significativa na AGNE em comparação com grupo placebo (P = 0,008). Além disso, a administração de ômega-3 resultou em alterações significativamente maiores (Dif) em vários parâmetros, tais como a insulina, HOMA-IR e QUICKI, comparando com placebo (P < 0,05). Conclusões: A suplementação com ácidos graxos ômega-3 em pacientes diabéticos tipo 2 melhorou a sensibilidade à insulina, provavelmente devido à diminuição da concentração de AGNE. Arq Bras Endocrinol Metab. 2014;58(4):335-40

The objectives were to evaluate the effects of improvement of vitamin D status on biomarkers of oxidative stress (OS) in type 2 diabetic (T2D) subjects and whether vitamin D receptor (VDR)-FokI polymorphisms could modulate the response to vitamin D3 intake. Subjects with T2D were allocated to one of the two groups to receive either plain doogh (PD; containing 150 mg calcium and no vitamin D/250 ml, n1=50) or vitamin D3-fortified doogh (FD; containing 500 IU/250 ml, n1=50) twice a day for 12 weeks. Outcomes were changes in serum 25-hydroxyvitamin D (25(OH)D), superoxide dismutase, glutathione (GSH), total antioxidant capacity (TAC) and malondialdehyde (MDA). VDR genotypes in 140 T2D subjects in FD were determined by FokI restriction enzyme. After 12 weeks, serum 25(OH)D increased significantly in FD (from 38.5±202.2 to 72.0±23.5, P

Objective: Several studies indicated that techniques to change body weight and appearance were prevalent and different among adolescents. The aim of the study, therefore, was to assess differences in frequency and type of body change techniques used among adolescents by sex and body weight status. Methods: A sample of 758 adolescents aged 12–18 years were recruited from private and public schools in Tehran. Information about socio-demographic background and body change techniques were collected via a self-administered questionnaire. Results: A high percentage of adolescents used body change techniques frequently to alter their body appearance. Girls changed normal eating pattern significantly (p = 0.007) to lose weight more frequently than boys while boys used this method significantly (p = 0.01) to gain weight more frequently than girls. Overweight/obese adolescents exercised significantly to change muscle size (p = 0.03) and changed normal diet to lose weight (p < 0.001) more frequently than normal weight adolescents. The relation between sex and body weight status with body change techniques (p < 0.0) implied that male and female adolescents especially overweight/obese adolescents were frequently trying to change their body appearance. Conclusion: Significant differences existed in using body change techniques according to sex and body weight status and these should be considered in obesity prevention programs for adolescents.

Background Development of type 2 diabetes mellitus (T2DM) is determined by the interactions of genetic and environmental factors. This study was designed to evaluate the possible role of VDR single nucleotide polymorphisms (SNPs) on different aspects of diabetic host response (anthropometric, metabolic, oxidative stress and inflammatory) to daily intake of vitamin D through fortified yogurt drink for 12 weeks. Methods/Design This study comprises two parts: (i) a case-control study; and (ii) an intervention trial. In the first part, VDR polymorphisms (Taq1, FokI, Apa1, Bsm1, and Cdx2) are determined in 350 T2DM patients and 350 non-diabetic subjects. In the second part, the possible effects of daily intake of two servings of vitamin D3-fortified yogurt drink (FYD; 500 IU vitamin D/250 mL) on some selected metabolic (including insulin resistance), inflammatory and oxidative stress biomarkers in 135 T2DM patients are assessed. To relate the resulted changes in the biomarkers to vitamin D replenishment, another group of diabetic patients (n = 45) are also included in the study who receive 2 servings of plain yogurt drink (PYD) a day. The primary outcome is serum level of 25(OH) D, which it is expected to be elevated only in FYD group. Secondary outcomes include improvements in glycemic, metabolic, inflammatory and oxidative stress biomarkers in FYD group compared to PYD group. Three VDR FokI polymorphisms are determined only in FYD group followed by comparison of changes in the biomarkers among these genotypic variants. Discussion The present study, at least in part, elucidates the discrepancies in the results of different vitamin D-diabetes studies pertaining to the genetic variations of the population. If VDR polymorphisms are found to influence the response to our intervention, then knowing distribution of VDR polymorphisms in both diabetic and non-diabetic populations can give a picture of the proportion of the community in whom up to 1000 IU/d vitamin D may not be effective enough to improve insulin resistance and related morbidities. Therefore, they should ideally receive further nutritional support according to their genotype. Trial Registration ClinicalTrials.gov: NCT01236846

Milk is included in school feedingprogrammes in some provinces in Iran, but there are no published reports on its potential impact. The objective of this project, approvedby the Ethical Committee of the University and conducted according to the guidelines laid down in the Declaration of Helsinki, was toinvestigate the effects of a regular daily milk supplement on the mental growth and school performance of female primary school childrenin Tehran.A group of 469 randomly selected female primary school children (6Ð10-year-old) with a medium socio-economic status, similar on theaverage with regard to food consumption and body weights and heights, from four primary schools (two as experimental; n 232 and two ascontrol; n 237) were included in the study. Each child received, daily for a period of 3 months, a 250ml bottle of sterilised homogenisedmilk and drank it under supervision of the teachers. The Raven Colored Progressive Matrices test and the Wechsler Intelligence Scale(verbal, non-verbal and total IQ), two of the standard psychological tests

This study was conducted to assess the nutritional status of infants at birth in Ardebil, Iran. Data were collected on 903 newborns (424 girls and 479 boys) in the only maternity hospital of the town during Mayand April 1989. The results showed the following: (1)‐Weights and lengths of the majority of the newborns (78.8% and 67.3%, respectively) were at least equal to the respective NCHS 50th percentiles. (2) ‐Baby boys were heavier (3207 ± 578g) than baby girls (3117 ± 502g), the difference being statistically significant (P < 0.01). (3) ‐ By weight classification 7.2% suffered from moderate and 0.7% from severe malnutrition, the proportion of mild malnutrition—which can be considered as the lower end of normal—being 17.2% by the length criterion, 4.9% were undernourished; (4) ‐Sex had no effect on the nutritional status. (5) ‐ According to the results of cord blood analysis, the mean Hb and Hct values for sexes combined were 13.4 ± 2.4g/dl and 40.5 ± 6.9%, respectively, over half of the neonates being a...