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Context: Genetic and environmental factors contribute to the incidence of metabolic syndrome (MetS). This study aimed to review all findings of studies conducted in framework of the Tehran lipid and glucose study (TLGS) regarding the association of dietary factors with cardio-metabolic risk factors., Evidence Acquisition: All English-language studies were searched using PubMed and Scopus databases from 2000 to 2017. Finally, 105 relevant papers were included in this review., Results: Whole grains, legumes, nuts and healthy dietary patterns (DPs) reduced risk of MetS, while white rice, salty/sweet snacks increased this. The western DP had a significant interaction with APOC3, APOA1 and MC4R polymorphisms in relation to MetS. After 6.5 years of follow-up, odds of reaching menarche ≤ 12 years was significantly higher in girls with higher intakes of milk, calcium, magnesium, and phosphorous. Among children and adolescents, higher adherence to the dietary approaches to stop hypertension (DASH)-style diet decreased the risk of abdominal obesity, whereas increased adherence to the western DP could contribute to general and abdominal obesity. A three-year follow-up of adult participants showed that higher intakes of phytochemical-rich foods were inversely related to development of insulin resistance. Higher adherence to the healthy DPs was associated with the reduced risk of hyperlipidemia and hypertention. Nutrition interventions postponed rise in the prevalence of MetS. The DASH diet resulted in weight reduction compared to control diet., Conclusions: Higher adherence to healthy food choices was associated with reduced odds of MetS, abdominal obesity, dyslipidemia and hypertension. The western DP accentuated the association of polymorphisms with MetS.

Background: The purpose of the present study was to investigate the longitudinal association of total polyphenol and its main four subclasses intake with metabolic syndrome (MetS) and its components., Methods: The present prospective study was conducted on 1265 Tehranian adults, aged 19-74 years. Usual dietary intake was evaluated using a validated food-frequency questionnaire. MetS was defined using NCEP ATP III guidelines. Intakes of total polyphenol and its four main subclasses, including flavonoids, phenolic acids, stilbenes, and lignans, were estimated using Phenol-Explorer database., Results: Median (interquartile range [IQR]) of total polyphenol intake and its subclasses, including flavonoids, phenolic acids, lignans, and stilbenes, was 1422 (967-2137), 69.5 (45.5-99.8), 75.7 (52.2-115), 3.8 (1.9-6.9), and 0.2 (0.1-0.5) mg/day, respectively. After adjustment for confounding factors, participants in the highest tertile of flavonoid intake had 31% lower risk of developing MetS (odds ratio [OR] 0.69; 95% CI 0.48-0.98) and 36% lower risk of hypertriglyceridemia (OR 0.64; 95% CI 0.48-0.99) during 6 years of follow-up. Total polyphenol intake and other subclasses of polyphenol were not associated with MetS and its components., Conclusion: Higher intake of flavonoids was inversely associated with risk of developing MetS and hypertriglyceridemia in a Tehranian population.

Aims: The aim of this study was to investigate the association between legumes and starchy vegetables, including 1. potatoes and 2. other starchy vegetables (corn, squash, green pea, and green lima beans), and GDM among Tehranian women., Methods: Our study included 1026 pregnant women, aged 18-45 years, who consecutively attended prenatal clinics in five hospitals affiliated to universities of medical sciences in Tehran. The diagnosis of GDM was based on the criteria set by the American Diabetes Association. Dietary intakes were assessed during gestational age ≤6 weeks with a validated food frequency questionnaire., Results: Of the 1026 pregnant women, 6.9% developed GDM. With respect to potato, higher consumption was negatively associated with GDM risk; OR for those who consumed ≥2.1 servings/week was 0.53 (95% CI 0.29-0.97), an association which disappeared after adjustment for confounding factors. For legumes, higher consumption was negatively associated with GDM; OR for those who consumed ≥3.3 servings/week was 0.38 (95% CI 0.19-0.74), also an association that did not change appreciably after adjustment for confounding factors. There was no significant association with the consumption of total starchy or other starchy vegetables with GDM., Conclusions: Higher consumption of legumes during reproductive age decrease the risk of GDM during pregnancy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This study aimed to assess the association of various types of nut per se, and total nut consumption with the incidence of metabolic syndrome (MetS). A 6.2 ± 0.7-year population-based prospective study was conducted among 1265 adults, aged 19-74 years, participants of the Tehran Lipid and Glucose Study. A 168-item semi-quantitative food frequency questionnaire was used to collect information on nut consumption. MetS was defined according to the Joint Interim Statement guidelines and 276 new cases of MetS were identified. Median ± interquartile range of nut consumption was 2.08 (0.88-5.68) servings/week. After adjusting for family history of diabetes, age, gender, smoking, physical activity, fasting serum glucose at baseline, serum high density lipoprotein cholesterol (HDL-C) at baseline, energy intake, fiber, macronutrients, cholesterol intake, fruit, vegetables, dairy products and body mass index (BMI), a statistically significant decrease was observed in MetS in the third (≥5 servings/week) tertile of nuts (odds ratio: 0.68, 95% CI: 0.44-0.91, p trend: 0.03) compared with the lowest (≤1 serving/week). Walnut consumption showed a significant, inverse association with MetS risk; associations for other nut varieties were not significant. For each additional serving/week of walnuts consumed, incidence of MetS decreased by 3% (ORs: 0.97 CI: 0.93-0.99), after adjusting for confounding factors. Total nut consumption, especially walnuts, reduces the risk of MetS., Competing Interests: The authors declare no conflict of interest.

The aim of this study was to evaluate the association between fast food consumption and gestational diabetes mellitus (GDM) among Tehranian women. This study was conducted over a 17-month period, on a random sample of pregnant women ( n = 1026), aged 18-45 years, attending prenatal clinics in five hospitals affiliated with universities of medical sciences, located in different districts of Tehran, Iran. Dietary data were collected during gestational age ≤6 weeks, using a 168-item valid and reliable food frequency questionnaire. Consumption of total fast foods including hamburgers, sausages, bologna (beef), pizza and French fries was calculated. Between 24 and 28 weeks of gestation, all pregnant women underwent a scheduled 100 g 3 h oral glucose tolerance test. GDM was defined according to the American Diabetes Association definition. The mean age and pre-pregnancy body mass index BMI of participants were 26.7 ± 4.3 years and 25.4 ± 4.5 Kg/m², respectively. A total of 71 women developed GDM. After adjustment for confounders, the OR (95% CI) for GDM for total fast food consumption was 2.12 (1.12-5.43) and for French fries it was 2.18 (1.05-4.70). No significant association was found between hamburgers, sausages, bologna (beef), pizza and GDM. Fast food consumption in women of reproductive age was found to have undesirable effects in the prevalence of GDM.

Aim: The aim of this study was to investigate the association between hydrogenated- (HVOs) and non-hydrogenated vegetable oils (non-HVOs) and butter and the metabolic syndrome (MetS) after 3-years of follow-up in adults., Methods: This study was conducted between 2006-2008 and 2009-2011 within the framework of the Tehran Lipid and Glucose Study, on 1582 adults, aged 19-84 years. Intakes of HVOs, non-HVOs and butter were assessed by a validated semi-quantitative food frequency questionnaire. Based on the consumption of food rich in fat including HVOs, non-HVOs and butter, participants were categorized to consumers and non-consumers., Results: Of 1582 participants during a 3-year follow-up, 15.2% developed MetS. Non-consumption of butter was associated with lower MetS risk compared with its consumption. Among consumers of food rich in fat, intake of HVOs and butter were associated with an increased risk of MetS; ORs in the final multivariate model were 2.70 (95% CI: 1.52-4.78) for HVOs and 2.03 (95% CI: 1.20-3.41) for butter, in the highest, compared to the lowest category of dietary intakes. Intake of non-HVOs was not associated with risk of MetS., Conclusions: Consumption of HVOs and butter were positively associated with an increase risk of MetS., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Intakes of high sugar-sweetened beverages (SSBs) in adults can escalate risk of metabolic syndrome (MetS); however, data of longitudinal studies in children and adolescents are lacking. In this study we assessed consumption of SSBs in relation to incidence of MetS among children and adolescents during a 3.6 year follow-up., Methods: This study was a population-based longitudinal study, in which 424 subjects, aged 6-18 years, from the Tehran Lipid and Glucose Study with complete data on dietary intake, blood pressure, anthropometry, and biochemical indices were followed for 3.6 years. Dietary intake was collected using a valid and reliable food frequency questionnaire. MetS was defined according to the Cook criteria. Sugar sweetened beverages included all kinds of sugar sweetened carbonated soft drinks (SSSDs) and fruit juice drinks., Results: Average daily intakes of SSSD and fruit juice drinks were 38.5 ± 75.0 and 32.3 ± 60.1 g, respectively. After adjustment for confounders, compared to the first quartile, the odds ratio of incident MetS in the highest quartile of SSB and SSSD was 3.20 (95 % CI: 1.06-9.90) and 3.01 (95 % CI: 1.17-7.74), respectively. Regarding incidence of MetS components, compared with the lowest quartile, the highest quartile of SSSDs showed odds ratios of 2.49 (95 % CI: 1.00-6.53) for abdominal obesity and 2.79 (95 % CI: 1.02-7.64) for hypertension. No significant association was found between consumption of fruit juice drink and SSSD with other components of MetS., Conclusions: Children and adolescents with high intakes of carbonated beverages could be at increased risk of MetS, abdominal obesity, and hypertension.

Aims: The aim of this study was to investigate whether the background intakes of total dietary fat, monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) modulate the effects of dietary saturated fatty acids (SFA) on metabolic syndrome (MetS)., Material and Methods: This population-based cross-sectional study was conducted on a representative sample of 4,677 adults, aged 19 to 84 years. MetS was defined according to the ATP III criteria., Results: Median intakes of SFA, MUFA and PUFA were 9.5, 9.6 and 5.6% of total energy. High SFA intakes were associated with higher prevalence of MetS, in both individuals with higher and lower median intakes of total fat, MUFA and PUFA., Conclusions: Our findings indicate that SFA intakes were positively associated with the prevalence of MetS, independent of total dietary fat, MUFA and PUFA intake.

The present randomised cross-over clinical trial investigated the effects of two intervention diets (non-soya legume-based therapeutic lifestyle change (TLC) diet v. isoenergetic legume-free TLC diet) on inflammatory biomarkers among type 2 diabetic patients. A group of thirty-one participants (twenty-four women and seven men; weight 74.5 (SD 7.0) kg; age 58.1 (SD 6.0) years) were randomly assigned to one of the two following intervention diets for 8 weeks: legume-free TLC diet or non-soya legume-based TLC diet. The latter diet was the same as the legume-free TLC diet, except that two servings of red meat were replaced with different types of cooked non-soya legumes such as lentils, chickpeas, peas and beans over a period of 3 d per week. The intervention period was followed by a washout period of 4 weeks, after which the groups followed the alternate treatment for 8 weeks. Concentrations of inflammatory markers were measured at baseline and after the intervention periods. Compared with the legume-free TLC diet, the non-soya legume-based TLC diet significantly decreased high-sensitivity C-reactive protein, IL-6 and TNF-α in overweight diabetic patients. The replacement of two servings of red meat by non-soya legumes in the isoenergetic TLC diet for a period of 3 d per week reduced the plasma concentrations of inflammatory markers among overweight diabetic patients, independent of weight change.

Background: Most existing reports indicate that body weight gradually increases following marital status and thereby enhances health status and decreases mortality; however, the association between marital status and the metabolic syndrome (MetS) has not been thoroughly investigated in a longitudinal study., Objectives: The aim of this study was to investigate the potential effects of marital status and marital transition on MetS during a 9.6-year follow-up in Tehran Lipid and Glucose Study., Patients and Methods: For this study, 5221 participants (2060 males and 3161 females), aged 15 to 90 years at baseline, were followed for a median of 9.6 years. Marital status was categorized as consistent marital status and marital transition. We measured MetS risk z score and its components and calculated their changes. Then the effects of marital status and marital transition on MetS risk z score and its components were assessed using multivariable linear regression., Results: In comparison to participants who were married, no significant changes in MetS risk z score was found in single participants. Employed females in the transition to married group had significant increase in MetS risk z score than single employed females. No significant changes in MetS risk z score were observed between widowed/divorced subjects and compared to consistently married subjects., Conclusions: Marital status may affect MetS risk z score differently in both genders.

Background: Although various anthropometric methods are available for assessing body composition, these have not been compared in Iranian adolescents. The objective of the present study was to compare body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and sum of four skinfolds as predictors of percentage body fat (PBF) and diagnosis of excess adiposity in Iranian adolescents., Methods: In this cross-sectional study, all anthropometric measurements were made in133 adolescents (65 boys and 68 girls), aged 10-18 years.PBF was determined using the bioelectrical impedance analysis method. Linear regression and receiver operating characteristic (ROC) analysis were used to analyze the data. Potential covariates including sex, age, and pubertal stage were adjusted., Results: R(2)adj of models for BMI, WC, WHR, WHtR, and skinfolds were 0.67, 0.56, 0.19, 0.56, and 0.56, respectively (P < 0.001). The AUC value of BMI to differentiate between normal and obese adolescents was 0.92 (P < 0.001). The AUC of BMI was significantly higher than those of WC, WHR, and WHtR (P < 0.05)., Conclusions: The performance of BMI is better than other anthropometric indices in predicting PBF and diagnosing excess adiposity in Iranian adolescents.

Aim: The aim of this study was to investigate the association between total polyphenol intake, its subclasses (including flavonoids, phenolic acids, stilbenes and lignans), and the metabolic syndrome (MetS)., Methods: This population-based cross-sectional study was conducted on a representative of 2618 adults, aged 19 to 84 years. Dietary intake was assessed using a validated food-frequency questionnaire and intakes of total polyphenol and four main subclasses of polyphenol including flavonoids, phenolic acids, stilbenes and lignans were determined., Results: Higher consumption of flavonoid intakes was associated with lower odds of enlarged waist circumference, hypertriglyceridemia, low HDL cholesterol, hyperglycemia, hypertension and MetS. Subjects in the highest quartile of lignan intakes had higher odds of having hypertriglyceridemia and hyperglycemia. Subjects in the highest quartile of stilbene intakes had higher odds of having hypertension., Conclusion: Intakes of selected subclasses of polyphenol such as flavonoids are associated with a lower prevalence of MetS among Tehranians.

Background: Data available on the effect of quality (glycemic index [GI]) and quantity (glycemic load [GL]) of carbohydrates on the risk factors of cardiovascular disease (CVD) are inconsistent. The objective of this study was to examine the association between dietary GI, GL, and CVD risk factors among Tehranian adults, the participants of the Tehran Lipid and Glucose Study., Methods: This population- based cross-sectional study was conducted on 2457 subjects (46% men and 54% women), aged 19 to 84 years. Dietary GI and GL were measured using a validated 168- item semiquantitative food frequency questionnaire. Anthropometrics, blood pressure, fasting blood glucose, and lipid profiles were measured., Results: The mean intakes of GI and GL were 68.3 and 244.8, respectively. Rice (26.6%) and bread (19.0%) were the major contributors to dietary GI and GL, respectively. Higher dietary GI and GL were associated with high intakes of carbohydrate, fiber, refined grain, fruits, simple sugar, snack, and desserts. After adjustment for lifestyle and dietary variables, a higher dietary GI was positively associated with triglycerides and high-density lipoprotein (HDL) cholesterol concentrations among obese subjects. Dietary GL was positively associated with fasting and 2-h blood glucose among nonobese subjects, after adjustment for confounders.  , Conclusion: Dietary GI and GL were associated with a few CVD risk factors, and body mass index levels may modulate these associations.

Background: Studies on the association between legume intake and metabolic syndrome (MetS) are sparse. The objective of this study is to evaluate the association between legume intake, MetS, and its components., Methods: This study was conducted on 80 subjects (48% female) with MetS as cases and 160 age and gender-matched healthy controls. Anthropometric measures, blood pressure, fasting blood glucose, and lipid profiles were evaluated by standard methods. Dietary data were collected using a food frequency questionnaire (FFQ) and legume intake was determined. MetS was defined according to the definition of the Adult Treatment Panel III., Results: The mean (SD) intake of legumes was 1.4 (0.9) servings/week for cases and 2.3 (1.1) servings/week for control subjects (P < 0.05). After adjustment for potential confounders, decreases in mean systolic blood pressure, fasting blood glucose, and increase in HDL cholesterol levels were observed across increasing quartile categories of legume intake. After adjustments for life style and food groups, subjects in the highest quartile of legume intake had lower odds of having MetS compared with those in the lowest quartile [odds ratio (OR): 0.25; 95% CI: 0.11 - 0.64, P < 0.05], an association that weakened after adjustment for body mass index (BMI), but remained significant (OR: 0.28; 95% CI: 0.12 - 0.81, P < 0.05)., Conclusions: Legume intake is inversely associated with the risk of having MetS and some of its components.

Objective: To investigate the association of the intakes of ω-3 (including α-linolenic acid [ALA], eicosapentaenoic acid [EPA] plus docosahexaenoic acid [DHA]) and ω-6 polyunsaturated fatty acids (PUFAs), the interaction, and the ratio of these PUFAs with the metabolic syndrome (MetS) in adults., Methods: This cross-sectional study was conducted in a random sample of participants (n = 2451, 19-84 y old) in the Tehran Lipid Glucose Study. Dietary intake was assessed using a validated semiquantitative food-frequency questionnaire. Anthropometric characteristics, blood pressure, and fasting plasma concentrations of glucose and lipids were measured. The MetS was defined according to the Adult Treatment Panel III guidelines., Results: Among the PUFAs, the ALA and ω-6 PUFA intakes were inversely associated with the MetS. Subjects in the highest quartile of ALA and ω-6 fatty acid intakes had a 38% (odds ratio 0.62, 95% confidence interval 0.41-0.95) and a 0.47% (odds ratio 0.53, 95% confidence interval 0.31-0.89) lower prevalence of MetS, respectively, compared with those in the lowest quartile. The dietary ratio of ω-6 to ω-3 fatty acids was not associated with the MetS. When the interaction between ALA and ω-6 fatty acid was assessed, the ALA intake was associated with a lower prevalence of the MetS, without modification by the ω-6 PUFA intake. Subjects with at least the median ALA intake (1084 mg/d) had a lower prevalence of the MetS, irrespective of an ω-6 PUFA intake lower or higher than the median compared with subjects with intakes below the median for both., Conclusion: The ALA intake was inversely associated with the MetS, irrespective of the background intake of ω-6 PUFAs, in adults., (Copyright © 2012 Elsevier Inc. All rights reserved.)

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

Aims: To evaluate the association between total dietary fiber and its types and sources with the risk of MetS., Methods: This population-based cross-sectional study was conducted on a representative sample of 2457 adults (1327 male and 1130 female), aged 19-84 years. Dietary intake was assessed using a validated semiquantitative food-frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipids were measured according to standard protocols. The MetS was defined according to definition by Adult Treatment Panel III., Results: Multivariate-adjusted odds ratio of MetS between highest and lowest quartiles was 0.53 (95% CI: 0.39-0.74; P for trend <0.05) for total dietary fiber, 0.60 (0.43-0.84; P for trend <0.05) for soluble fiber, and 0.51 (0.35-0.72; P for trend <0.05) for insoluble fiber. Among sources of dietary fiber, fruit fiber (OR: 0.51; 95% CI: 0.37-0.72), cereal fiber (0.74; 0.57-0.97), and legume fiber (0.73; 0.53-0.99) were inversely associated with the risk of MetS, after adjustment for confounding factors. Intake of vegetable fiber and nut fiber were unrelated to the risk of MetS., Conclusions: Total dietary fiber, soluble- and insoluble fiber, fruit fiber, cereal fiber and legume fiber were associated with a protective effect for the presence of MetS among this Tehranian population., (Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: Studies have shown that the excessive fructose intake may induce adverse metabolic effects. There is no direct evidence from epidemiological studies to clarify the association between usual amounts of fructose intake and the metabolic syndrome., Objective: The aim this study was to determine the association of fructose intake and prevalence of metabolic syndrome (MetS) and its components in Tehranian adults., Methods: This cross-sectional population based study was conducted on 2537 subjects (45% men) aged 19-70 y, participants of the Tehran Lipid and Glucose Study (2006-2008). Dietary data were collected using a validated 168 item semi-quantitative food frequency questionnaire. Dietary fructose intake was calculated by sum of natural fructose (NF) in fruits and vegetables and added fructose (AF) in commercial foods. MetS was defined according to the modified NCEP ATP III for Iranian adults., Results: The mean ages of men and women were 40.5 ± 13.6 and 38.6 ± 12.8 years, respectively. Mean total dietary fructose intakes were 46.5 ± 24.5 (NF: 19.6 ± 10.7 and AF: 26.9 ± 13.9) and 37.3 ± 24.2 g/d (NF: 18.6 ± 10.5 and AF: 18.7 ± 13.6) in men and women, respectively. Compared with those in the lowest quartile of fructose intakes, men and women in the highest quartile, respectively, had 33% (95% CI, 1.15-1.47) and 20% (95% CI, 1.09-1.27) higher risk of the metabolic syndrome; 39% (CI, 1.16-1.63) and 20% (CI, 1.07-1.27) higher risk of abdominal obesity; 11% (CI, 1.02-1.17) and 9% (CI, 1.02-1.14) higher risk of hypertension; and 9% (CI, 1-1.15) and 9% (1.04-1.12) higher risk of impaired fasting glucose., Conclusion: Higher consumption of dietary fructose may have adverse metabolic effects.

Objective: The British nutrition screening tool is a questionnaire designed to assess the nutrition status of hospitalized patients by nurses. The aim of this study was to evaluate the validity and reliability of this questionnaire in patients on admission to the hospital in Tehran., Methods: For 6 mo, 446 patients aged over 18 y admitted to different wards of a general hospital were studied within the first 24 h of admission. A nutritionist undertook nutritional assessment in all patients to determine their nutritional status as an objective standard. Then a nurse completed the screening tool for patients. Results obtained using the screening tool were compared with those of the nutritional assessment to calculate the sensitivity, specificity, and predictive values. The interrater reliability of the tool was assessed by two nurses who completed the screening tool separately during the first 24 h following admission of each patient. It was also completed by a nurse within 2-d period of admission to test the intrarater reliability., Results: Study participants included 229 women and 217 men with mean age of 49.5 ± 16.0 y. Sensitivity and specificity of the questionnaire were 86.7% (95% CI: 83.9-90.3%) and 61.7% (95% CI: 57.5-66.5%), respectively. Positive and negative predictive values were 79.1% (95% CI: 68.9-77.1%) and 73.1% (95% CI: 75.1-82.9), respectively. The sensitivity of the tool was over 80% for both genders, for all body mass index grades, and for data obtained from gastroenterology, transplant, oncology, and hematology wards. The interrater reliability of screening tool was interpreted as substantial, being k = 0.68 and k = 0.74 on both the first and second days, respectively. The intrarater reliability of the screening tool was also interpreted as substantial, being k = 0.77., Conclusion: The nutrition screening tool is a simple, valid, and reliable tool that can be used by nurses to facilitate identification of patients requiring nutritional interventions., (Copyright © 2011 Elsevier Inc. All rights reserved.)