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Purpose: This study aims to assess the association of Healthy Eating Index (HEI) with levels of fasting blood sugar (FBS) and lipid profile in normoglycemic and elevated FBS patients. Design/methodology/approach: This case-control study was conducted on 144 participants, namely, 72 normoglycemic subjects (FBS < 100 mg/dl) and 72 high-glycemic patients (FBS ≥ 100 mg/dl) aged 20–60 years of age, who were selected from the nutrition and diet clinics in Tehran city. The dietary intake was collected by using a validated food frequency questionnaire to determine the HEI score. Findings: The mean±SD age and body mass index of participants were 47.1 ± 12.7 years and 29.6 ± 6.0 kg/m2, respectively. The median (interquartile range) of HEI scores in the normoglycemic group and the high-glycemia group were 19.34 (15.24–24.31) and 16.53 (13.35–24.07), respectively. In the overall population, the findings of the multi-variable linear regression model indicated a positive association between the HEI score and high-density lipoprotein-cholesterol (HDL-C) (ß = 0.34; 95%CI: 0.05–0.64, P = 0.01). However, there is no significant association between HEI and HDL-C in normoglycemic (ß = 0.19; 95%CI: −0.31, 0.69, P = 0.45) and hyperglycemic subjects (ß = 0.28; 95%CI: −0.10–0.66, P = 0.15). Furthermore, the association of HEI with levels of FBS, triglycerides (TGs) and low-density lipoprotein-cholesterol (LDL-C) was not significant in any of the analyzed groups, including the total population, normoglycemic individuals and hyperglycemic subjects. Originality/value: This study was the first study to assess the role of HEI and its components with levels of FBS and lipid profile in normoglycemic and hyperglycemic individuals in Iran. The findings suggested that higher adherence to HEI may be associated with an increase in the HDL-C level. However, HEI could not predict FBS, TGs and LDL-C levels in the adult population. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity and overweight have become major public health problems worldwide. To combat this problem, effective, sustainable, and consistent strategies are needed. In this study, the long-term effect of a school-based intervention for weight reduction was evaluated in primary school students in Tehran, Iran. Methods: This was a cluster randomized controlled trial (RCT) conducted in 12 primary schools in a low- to middle-class district in Tehran, Iran. The participants were 334 overweight or obese primary school students (girls =164) based on World Health Organization standards, equally distributed in the intervention (n=167) and comparison (n=167) groups. It was a multi-component intervention and included nutrition education and increased physical activity (PA), a lifestyle modification program for parents, and changing the food items sold in canteens of the schools. Body mass index Z-score [BMI-Z] was determined as the primary outcome and measured at baseline, three months after baseline, at post-test (after 18 weeks), and follow-up (13-month). In total, 205 students (59.5%) completed the follow-up. Analyses were carried out based on the intention-to-treat principle using linear mixed models. Results: After 13 months, the BMI Z-score decreased in both intervention and comparison groups. However, the change was more significantly observed in the intervention group (adjusted change: 0.098, 95% CI: (0.03-0.16) compared with comparison group (P=0.003(. The intervention had a more significant effect on BMI Z-score among girls (adjusted change: 0.36, 95% CI: (0.27-0.45) compared with the comparison group (P<0.001) (than among boys (adjusted change: -0.14, 95% CI: (-0.23--0.05) compared with the comparison group (P=0.002). Conclusion: The intervention was an effective way to reduce BMI in the girls and the effect lasted for a relatively long time. [ABSTRACT FROM AUTHOR]

Background: Micronutrients, such as vitamin A, vitamin D, iron, and zinc have several useful functions in the body and are necessary for normal growth and development, especially among children. Unfortunately, recent research has showed different levels of deficiency of these two vitamins among children. Objectives: This study aimed to compare the prevalence of micronutrient deficiencies, including vitamin A, vitamin D, iron, and zinc, among under-2- and 6-year-old children in Iran in two National Integrated Micronutrient Surveys (NIMS-I, NIMS-II). Methods: In NIMS studies, sampling was done using a single-stage cluster sampling method. The country was divided into 11 study zones. Using simple random sampling, more than 4,400 individuals (about 400 samples in each zone) were included in each study (NIMS-I, NIMS-II). At least 4-mL venous blood samples were taken from all children and transferred to the central laboratory of Tehran University of Medical Sciences (TUMS) with special identification code for further analysis. Then, the levels of vitamin A, vitamin D, iron, and zinc were measured. Results: In NIMS-I, the prevalence of vitamin A deficiency among under-2-year-old children was 0.5%, which significantly increased to 18.3% in NIMS-II. Regarding vitamin D deficiency, the rate of deficiency was 3.7% in NIMS-I and 23.3% in NIMS-II, which was statistically significant. In none of the NIMS studies (I and II), vitamin A was measured in under-6-year-old children. Also, in the NIMS-I study, vitamin D was not measured among under-6-year-old children, and in NIMS-II study, the prevalence of vitamin D deficiency was 6l.8%. Zinc deficiency among under-2-year-old children in both studies was nearly the same (l9.l% vs. l9.4%); but in NIMS-II study, zinc deficiency among under-6-year-old children was 13.6%, which significantly decreased compared to the NIMS-I (31%). Iron deficiency status among under-2-year-old children significantly decreased from 37.8% in NIMS-I to 17.1% in NIMS-II. A significant reduction in iron deficiency status was also observed in the NIMS-II study compared to the NIMS-I in under-6-year-old children (9.9% in NIMS-II compared l8.2% in NIMS-I). Conclusions: The increase in both vitamin A and vitamin D deficiency rates in NIMS study is alarming. Due to the special roles of these two vitamins in health, special considerations and effective actions are needed in this respect. Data from two national studies indicated a decrease in the prevalence of iron deficiency in both age groups, which could be due to the successful implementation of nutritional intervention programs in Iran, such as iron supplementation and iron fortification. [ABSTRACT FROM AUTHOR]

Background and Objectives: Increased dietary inflammatory index can be one of the factors affecting brain function and occurrence of academic failure in adolescents. There are evidence that diet modification in adolescents and antiinflammatory diets play important roles in improving intelligence quotient and further academic achievements in adolescents. The aim of this study was to investigate relationships between dietary inflammatory index and intelligence quotient in adolescent girls. Materials and Methods: In this cross-sectional study, 162 female students were selected using cluster sampling. Raven intelligence quotient test was used to measure student intelligence quotient. Dietary inflammatory index score was calculated through food data collected using 3-day food recalls. Results: The mean age of the 162 students was 16.3 y ± 1.06 and the mean value of using intelligence was 103 ± 9.8. Nearly 74% of the students had moderate intelligence and 17% were smart.The mean dietary inflammatory index score in these individuals was -0.08 ± 1.54. No significant relationships were seen between dietary inflammatory index and intelligence quotient in the crude model and after adjusting for confounding variables. Conclusions: No significant relationships were reported between diet inflammatory index score and intelligence quotient in adolescents. Extensive and prospective studies on genetic and environmental factors affecting intelligence quotient are recommended. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The main objective of the Second National Integrated Micronutrient Survey (NIMS-II) was to assess the nutritional status of four micronutrients, namely iron, zinc, and vitamins A and D, and also to conduct an anthropometric assessment of selected groups of children, adolescents, pregnant women, and adults, disaggregated by sex and residential area in nationally representative samples. This paper reports the design of the study along with preliminary findings. Methods: In this study, 32 770 individuals were selected by using single-stage cluster sampling. Venous blood samples were collected on site for laboratory analysis; interviews were conducted, and anthropometric measurements were performed. Results: The prevalence of anemia was highest (17.1%) among 15- to 23-month-old children; vitamin A deficiency was 18.3% in this age group. As regards iron deficiency anemia, the prevalence in all age/sex groups was less than 5%, ranging from 0.5% in 6-year-old children to 4.2% in 15- to 23-month-old children. Zinc and vitamin D deficiencies were highest among pregnant women (8% and 85.3%, respectively). Finally, the prevalence of overweight and obesity among adults was 40.3% and 29.2%, respectively. Conclusion: Results of this study can help in designing nutritional intervention programs for nationwide implementation. Of all micronutrient deficiencies, vitamin D deficiency was the most prevalent in all study groups. Thus, appropriate actions should be taken in our community. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The food frequency questionnaire (FFQ), as a way to assess the dietary intake in comparison with other methods, is easier to analyze and takes less time and is less costly. Our aim in this study was to develop and validate an FFQ for estimating the intakes of selected antioxidants in elderly Iranian people. Materials and Methods: A total of 185 elderly people were randomly selected. Three-day food records were completed by the subjects and collected every 2 months and dietary intake levels of zinc, selenium, carotenes and vitamins C and E were estimated. Based on the food records data, geographic location, and age, an FFQ was designed to estimate antioxidant intakes during 1 year. In addition, for controlling energy intake, 2-day food records were also collected with the food frequency questionnaire. To assess the reliability, 40 individuals were asked to complete the FFQ twice with an interval of 3 months in between. Results: Intraclass correlation coefficient (ICC) between the two FFQs for antioxidant C, antioxidant E, carotene, selenium, and zinc were 0.62, 0.47, 0.51, 0.54, and 0.58, respectively (P < 0.05). In addition, Pearson correlation coefficients between the FFQ and the food records, after controlling energy for vitamin C, vitamin E, carotene, selenium, and zinc, were 0.46, 0.48, 0.38, 0.55, and 0.47 respectively (P < 0.001). Conclusion: According to the results of this study, considering the fact that the FFQ was designed for the elderly and the special conditions (patience, memory, etc.) and vulnerability of this age group, the questionnaire is relatively valid and reliable to use. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of daily intake of vitamin D-fortified yogurt drink (doogh) on central obesity indicators in subjects with type 2 diabetes (T2D) and the possible modulation of this effect by vitamin D receptor (VDR) Cdx-2 genotypes. A total of sixty T2D subjects were randomly allocated to two groups to receive either plain doogh (PD; n 29, containing 170 mg Ca and no vitamin D/250 ml) or vitamin D3-fortified doogh (FD; n 31, containing 170 mg Ca and 12·5 μg/250 ml) twice a day for 12 weeks. 25-hydroxyvitamin D (25(OH)D), glycaemic as well as adiposity indicators were evaluated before and after the intervention. VDR-Cdx-2 genotypes in extended number of T2D subjects in the FD group (n 60) were determined as AA, GA and GG. After 12 weeks, in FD compared with PD, serum 25(OH)D increased (+35·4 v. −4·8 nmol/l; P<0·001) and mean changes of waist circumference (WC; −1·3 v. +1·6 cm; P=0·02), body fat mass (FM; −1·9 v. +0·60 %; P=0·008), truncal fat (TF; −1·1 v. 0·13 %; P=0·003) and visceral adipose tissue (−0·80 v. +0·37 AU; P<0·001) decreased significantly. Circulating 25(OH)D was raised only in the AA group (34·8 nmo/l in AA group v. −6·4 nmol/l in AG and −1·6 nmol/l in GG groups; P<0·001), which was accompanied by a significant decrease in changes of WC (P=0·004), FM% (P=0·01) and TF% (P<0·001) in the AA genotype. Daily intake of vitamin D-FD for 12 weeks improved the central obesity indices in T2D subjects, and the improvement was more pronounced in the carriers of the AA genotype of VDR-Cdx-2. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a world-wide health problem and development of interventions to prevent or control it is a priority. Obesity is prevalent and on the increase among school-students in Iran, too. As the first step for development of an intervention, the current study was designed to complete our understanding of ideas, attitudes, beliefs, and preferences of primary school children in Tehran, Iran. Methods: Twenty-seven primary school-students (11 boys, 16 girls) in grade-five, most of whom were overweight or obese, participated in four focus-group discussions (FGDs). All FGD notes were analyzed to find the main themes. Results: Nine themes in three main categories emerged after analysis. The themes in the category of barriers of losing weight included environmental, psychological and physiological barriers. Category of intervention components included nutrition improvement, physical activity promotion, social support and education. Setting and deliverer of the intervention were included in the intervention conditions category. The children proposed a multi-component approach for development of an intervention. They mentioned nutrition and physical activity improvement, social support and education as the main elements of an effective intervention. Conclusions: The findings indicate that obese children need to be supported against different barriers of losing weight, mainly social barriers, especially humiliation by the community. [ABSTRACT FROM AUTHOR]

Purpose: This study was carried out to investigate the effect of vitamins E and C on cognitive performance among the elderly in Iran. Methods: 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. Background: Demographic characteristics, anthropometric variables food consumption, cognitive function by Mini-Mental State Examination (MMSE), and some of the oxidative stress biomarkers were examined. Results: Antioxidant supplementation reduced malondialdehyde level ( P < 0.001) and raised total antioxidant capacity ( P < 0.001) and glutathione ( P < 0.01). The serum 8-hydroxydeoxyguanosine remained unchanged ( P < 0.4). 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

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. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

BACKGROUND: School feeding programs are important interventions for improving the nutritional status of students. Therefore, this study was conducted to evaluate the effects of milk supplementation on physical, mental and school performance of students. METHODS: This case-control population-based intervention was conducted on 469 students from 4 schools in a medium socio-economic status region in Tehran. The schools were chosen by Iranian ministry of education and training and they were allocated in case and control groups randomly. All the students in the first to third classes in the intervention schools were daily consumed sterilized and homogenized milk for three months (250 ml each). Anthropometric measurements were done according to the standard methods. For evaluating the mental function, the Raven's Coloured Progressive Matrices (CPM) and Wechsler Intelligence Scale for children (verbal, non-verbal, total Intelligent Quotient) were conducted on students. School performance was assessed by grade-point averages of each student. RESULTS: The weight of children was significantly different between control and intervention group at the end of the study among girls (23.0 ± 3.8 vs. 23.8 ± 4.3 kg; p < 0.05). Psychological tests' scores were significantly different between the control and the intervention groups (p < 0.05) at the end of the trial among boys. The grade-point average was significantly different at the end of the trial between the intervention and the control group among girls (p < 0.05), CONCLUSIONS: School feeding programs focus on milk supplementation had beneficial effects on the physical function and school performances specifically among girls in Iran. [ABSTRACT FROM AUTHOR]

Background: Some studies have indicated impaired metabolism of Insulin-like growth factor-1 (IGF-1) and zinc in type-1 diabetic patients. However, no results have been reported to date on the relationship between IGF-1 and serum zinc levels in children and adolescents with type-1 diabetes mellitus. Therefore, the objectives of this cross-sectional study were to compare IGF-1 levels in type-1 diabetic children and adolescents with that of healthy controls, and also to determine whether there is a relationship between IGF-1 and serum zinc levels. Methods: Thirty children and adolescents with type-1 diabetes mellitus and 30 age- and sex-matched healthy controls participated in the study. Serum IGF-1, serum zinc, fasting blood sugar, hemoglobin A1C (HbA1C) were measured by enzyme-linked immunosorbent assay, flame atomic absorption spectrophotometry, enzymatic colorimetry and ion-exchange chromatography methods, respectively. Results: The mean level of serum IGF-1 (ng/l) in the diabetics was significantly lower than in the controls (208.2 ± 15.7 and 317.0 ± 33.2, respectively; p=0.001). No relationship was found between the IGF-1 levels and serum zinc or the amount of glycemic control. Conclusion: IGF-1 levels of the diabetic children and adolescents were significantly lower compared to those of healthy controls and were independent of serum zinc levels and the amount of glycemic control. [ABSTRACT FROM AUTHOR]

Background The correlation between body iron stores and inflammation with insulin resistance in type 2 diabetes is not thoroughly investigated, especially in the Persian population. Methods A cross-sectional study was designed in Tehran, Iran. Fifty-four people with type 2 diabetes and 53 matched healthy participants were included. Serum ferritin, total iron binding capacity, insulin resistance, C-reactive protein and tumor necrosis factor-α were measured in both groups. Results Diabetic patients had higher insulin resistance, hemoglobin A1C and serum ferritin. Significant positive correlations were observed between insulin resistance with serum ferritin and tumor necrosis factor-α and between serum ferritin and tumor necrosis factor-α in diabetic patients. Conclusions Inter-relationship between insulin resistance, serum ferritin and TNF-α was found in type 2 diabetic patients. Serum iron even in the normal range had positive correlation with insulin resistance. It may be because the normal ranges determined for serum ferritin are too wide and the criteria for iron overload are too high. [ABSTRACT FROM AUTHOR]

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. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Investigation of the relationship between educational level, body mass index (BMI), waist-to-hip ratio (WHR), physical activity and parity in a group of Iranian men and women living in Tehran. Design: A cross-sectional study in a group of Iranian men and women. The subjects were classified into two educational levels: low education (≤12 y schooling) and high education (>12 y schooling); and BMI, WHR, physical activity and parity (in women) were compared in two groups in men and women, separately. Setting: Metabolic Unit of Tehran University of Medical Sciences in Tehran. Subjects: Three hundred and fifteen men aged 33.1 (22-46) and 403 women aged 27.9 (22-45). Results: After controlling for age and smoking, women with a higher level of education showed a significantly lower mean BMI than less educated women (24.8 ±4.2 vs 28.3 ±4.9, P<0.01), while more educated men had a higher mean BMI than less educated men (28.4 ±4.3 vs 26.7 ±4.5). In multiple regression analysis, physical activity in leisure time in men and years of education in women were the only determinants of BMI. After controlling for BMI, WHR was not related to the level of education in either men or women. Conclusion: The present data indicated an educational difference in BMI for the study population. In Iranian women, like the women in developed countries, the level of education was negatively related to BMI, while in men the association was positive. Sponsorship: This work was financially supported by the Institute of Public Health, Tehran University of Medical Sciences. [ABSTRACT FROM AUTHOR]

Abstract: Iranian indigenous front-line health worker, (FLHW) were locally trained to deliver environmental and primary health care services to mothers and children. After two years, there was a significant decline in crude birth and death rates and in infant and 1-5 year mortality rates in the test area as compared to a control area. One out of four encounters was referred to a health center physician, the remainder being handled by the FLHWs themselves. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: It is reported that women in developing countries reach menopause earlier compared to developed countries. This seems to be due to underestimation of age at menopause as pre-menopause women who will reach menopause at older ages are commonly excluded in cross-sectional settings. In this study, we propose an estimation method which can deal with this bias. We also assessed major determinants of menopause. Methods: The second national integrated micronutrient survey in Iran completed in 2015 is a population-based study with a nationally representative sample of 4,898 Iranian women aged 50 to 60 years. We used data on menopause status and menopausal age (asked retrospectively) to estimate the median survival time. We also used Logistic regression to model menopausal status on the current age and to estimate the median age, at which 50% of women will experience menopause. Demographic, lifestyle, and anthropometric determinants were also examined. Results: The estimated age at menopause was 51.2 (51.0-51.3) years in the logistic model and 50.5 (48.1, 53.7) years in survival analysis. In both models, the age at menopause was significantly lower among rural and underweight women. In addition, survival analysis showed that smokers and women with smaller family size had significantly lower age at menopause. Conclusion: While many studies stress a gap in age at menopause between developed and developing countries, this study with a reliable estimation method showed that such a gap might originate from an underestimation of age at menopause in developing countries rather than a real difference. [ABSTRACT FROM AUTHOR]

In Iran, as in most countries, cardiovascular diseases are the leading cause of death (highest mortality rate), but rank third in terms of disease burden. On the other hand, the relationship between high salt intake, hypertension, and cardiovascular disease has been proven. Food consumption pattern in Iran shows that consumption of salt, pickled foods and salty snacks is common. Regarding the World Health Organization (WHO) target for salt intake (about 5 g per day), the evidence indicates that Iranian people consume 2-3 times more than the recommended amount of salt. Fortunately, serious attention has been paid to this matter since 2009 and along with arrangements for it, support of all relevant sectors (public and private) has been included in the agenda. At present, reduction of salt intake is among the major priorities of planners, policy makers, and experts of the Iranian health services system. On the other hand, many studies in EMRO have shown high levels of daily salt intake in these countries. In this review, the solutions used in the Islamic Republic of Iran at various levels were considered, including determination of salt intake measurement methods, revision in the amount of salt in processed food products, food labeling, promoting awareness of various social groups, gathering support from all relevant sectors, designing a regular public awareness campaign for reducing salt intake, and lessons learned in this regard, that can be helpful to countries in the region. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the association of serum levels of 25(OH)D 3 (vitamin D), retinol (vitamin A) and zinc with stunting in a large sample of Iranian toddlers. This was a cross-sectional study. 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 <-1 standard deviation (SD) based on the World Health Organization (WHO) criteria (the WHO Child Growth Standards median). Serum levels of 25(OH)D 3 , retinol and zinc were examined based on standard methods. 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)D 3 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. We found a significant inverse association between serum levels of retinol and stunting in toddlers aged 10–36 months. • There is a significant inverse association between serum levels of retinol (vitamin A) and stunting in Iranian toddlers. • This inverse association of retinol and stunting is particularly evident in girls and urban toddlers. • Serum levels of vitamin D and zinc were not significantly associated with stunting. [ABSTRACT FROM AUTHOR]

Background: Some studies have examined the association between micronutrient deficiencies and overweight in children, but data in this regard are conflicting. This study was done to investigate the association between serum levels of vitamin D, A and zinc with overweight in a large sample of Iranian toddlers. Methods: A total of 4261 toddlers, aged 15-23 months, who had an Iranian birth certificate and attended primary health care, were included in the current cross-sectional study. Weight and height were measured by experts based on standard protocols and body mass index (BMI) was calculated. Based on WHO criteria, overweight was defined as BMI-z-score of ≥1SD. Serum levels of 25(OH)D3, retinol and zinc were measured for each toddler. Binary logistic regression was applied to assess the association of 25(OH)D3, retinol and zinc levels with overweight. Results: Mean age of study participants was 19.2 ± 8.4 months. After controlling for potential confounders, children in the highest quartile of serum 25(OH)D3 levels had lower odds of overweight compared with those in the lowest quartile (OR: 0.79, 95% CI: 0.63--0.99). Furthermore, a marginally significant inverse association was found between serum levels of 25(OH)D3 and overweight among urban toddlers (OR: 0.75, 95%CI: 0.56-1.00). Such a relationship was not seen for rural children. No other significant association was seen between serum levels of retinol and zinc and overweight either before or after controlling for covariates. Conclusion: In conclusion, we found a significant inverse association between serum levels of vitamin D and overweight among toddlers. Further studies, particularly of prospective nature, are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Abstract: 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 12–18years 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. [Copyright &y& Elsevier]

Background: This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities., Methods: This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran's policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study., Results: Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary., Conclusion: Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered., 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 © 2024 Toorang, Amiri, Djazayery, Pouraram and Takian.)

Background: Reports about the magnitude of co-existence of under- and over-nutrition is limited in Afghanistan. This study aimed to assess the prevalence of double burden of malnutrition (DBM) at individual and household level in Afghanistan., Methods: This study was done based on the Afghanistan National Nutrition Survey 2013, which included a representative sample of 126,890 individuals (including more than 18,000 households) throughout Afghanistan. Intra-individual DBM was defined as the co-existence of "overweight/obese" and "stunting or micronutrient deficiencies" (including anemia, vitamin A deficiency, vitamin D deficiency and iodine deficiency). At the household level, DBM was considered as having at least one household member as overweight/obese and at least one another member of that household as undernourished (stunted, wasted, underweight or any micronutrient deficiency). SPSS and Stata software were used in the current analysis. Cross-tabulations was used to estimate the prevalence and its 95% confidence interval(CI). This study was ethically approved at Tehran University of Medical sciences., Results: The overall prevalence of intra-individual DBM was 12.5% (95% CI: 12.1; 12.9). Among the whole study participants at individual level of DBM, 11.7% (11.3; 12.1) of individuals had overweight along with stunting simultaneously and 20.5% (18.8; 22.4) had overweight and micronutrient deficiencies at the same time at individual level. The household level of DBM was found among 28.6% (95% CI: 27.9; 29.4) of households; such that 27.3% (26.6; 28.1) of households had at least one member with overweight and another member with stunting or wasting or underweight. Co-existence of overweight and micronutrient deficiencies at the same household was seen in 38.3% (35.5; 41.2)., Conclusion: This study demonstrated a high prevalence of DBM at individual and household level in Afghanistan. Therefore, developing appropriate national macro-policies and strategies and designing appropriate programs such as public awareness programs, subsidization, food assistance programs, food fortification and dietary supplementation should be implemented by the ministry of public health, inter- related organs and international health agencies to reduce the burden of this problem in this country., Competing Interests: the authors have declared that no competing interests exist., (Copyright: © 2023 Fahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Mental disorders are conditions that affect the usual function of the brain, causing a huge burden on societies. The causes are often unclear, but previous research has pointed out, as is the case with many other diseases, that nutrition could have a major role in it. Amino acids, the building blocks of proteins, are the main precursor of neurotransmitters (the chemical messengers in the brain) malfunction of which is heavily associated with a wide range of brain disorders., Methods: We assumed different sources of dietary protein could have different impacts on mental well-being. Hence, we decided to collect the nutritional data (with a validated and reliable semi-quantitative food-frequency questionnaire) from a sample of 489 Iranian women and investigate the association between animal and plant protein sources and the risk of depression, anxiety, and stress. Symptoms of these mental disorders were assessed using a validated Depression, Anxiety, and Stress Scales (DASS) questionnaire with 21 items., Results: After multivariable adjustment, it was shown that women in the highest tertile of animal protein intake were more likely to show symptoms of depression (OR: 2.63; 95% CI: 1.45, 4.71; P = 0.001), anxiety (OR: 1.83; 95% CI: 1.04, 3.22; P = 0.03), and stress (OR: 3.66; 95% CI: 2.06, 6.50; p < 0.001). While no significant association was seen between plant protein and any of the studied mental disorders., Conclusion: Overall, our findings suggest that a diet high in animal protein could predispose individuals to mental illnesses., (© 2023. The Author(s).)

Objective: Musculoskeletal pain conditions (MPs) are a widespread public problem that can affect 13.5% to 47% of the total population. Dietary changes can have strong effects on person's health; for instance, Sulfur amino acids (SAAs) can act as a precursor of neurotransmitters, antioxidative metabolic intermediates, such as glutathione, impact inflammation, and play a role in severity and frequency of MPs. We evaluated the relationship between dietary SAAs intake with severity and frequency of pain in patients with MPs., Results: This cross-sectional study consisted of 175 men and woman. Anthropometric measurements and pain assessments were conducted via questionnaires. Dietary data were collected using 7 days 24-h recall. ANOVA and Spearman correlation coefficients were used to examine the relationship and correlation, respectively, between exposure and outcome variables. There was a significant correlation between age, weight, waist circumference (WC), waist circumference to height (WHtR), body mass index (BMI), and severity and frequency of MPs among women. There was a correlation between age and severity of pain in men. The present study highlights a positive association between the dietary SAAs and severity of pain, even after adjusting for confounding variables., (© 2022. The Author(s).)

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 < 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  < 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  < 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.

Background: Obesity, widely recognized as a serious health concern, is characterized by profoundly altered metabolism. However, the intermediate metabolites involved in this change remain largely unknown., Objective: We conducted targeted metabolomics profiling to identify moieties associated with adult obesity., Methods: In this case-control study of Iranian adults, 200 obese patients were compared with 100 controls based on 104 metabolites profiled by a targeted metabolomic approach using liquid chromatography coupled to triple quadrupole mass spectrometry (LC-MS/MS). The analysis comprised acylcarnitines, diacyl-phosphatidylcholines (PCaa), acyl-alkyl-phosphatidylcholines (PCae), sphingomyelins (SM), lyso-phospholipids (LPC) and amino acids. We performed multivariable linear regression to identify metabolites associated with obesity, adjusting for age, sex, total energy intake, total physical activity, smoking, and alcohol consumption. The Bonferroni correction was used to adjust for multiple testing., Results: A pattern of 19 metabolites was significantly associated with obesity. Branched chain amino acids, alanine, glutamic acid, proline, tyrosine LPCa C16:1, PCaa C32:1, PCaa C32:2 and PCaa C38:3 were positively, while serine, asparagine, LPCa C18:1, LPCa C18:2, LPCe C18:0, PCae C34:3, PCae C38:4 and PCae C40:6 were negatively associated with obesity (all p < 0.00048)., Conclusions: A metabolomic profile containing 9 amino acids and 10 polar lipids may serve as a potential biomarker of adult obesity. Further studies are warranted to replicate these findings as well as investigate potential changes in this profile after weight reduction.

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.