Fresh Leafy Vegetables and Parasitic Contamination: Practical Solutions

This study aimed at investigating the parasitic contamination of fresh leafy vegetables in Tehran, Iran, during 2020-2021. A cross-sectional study was conducted and 180 fresh leafy vegetables (including leek, watercress, mint, spring onion, radish, basil, parsley, lettuce, and spinach) were collected randomly in the five regions of Tehran, Iran. Each 200-g sample was soaked with tap water containing detergent, and the obtained sediment was centrifuged and examined for parasitic stages using a light microscope. The overall rate of parasitic contamination was 19.4%, with Trichostrongylus and Toxocara eggs being the most prevalent parasites (3.9%) and the highest rate of parasitic contamination was observed in spinach (40%), whereas no contamination was found in spring onions. Except for radish, other vegetable samples had multiple parasitic infections. Due to the contamination of vegetables, it is necessary to have a suitable method to reduce the parasites. Consequently, policymakers should safeguard public health by consistently monitoring contaminants in food and prioritizing education and research on methods to mitigate their presence in the food chain.

Health risk assessment of heavy metal pollutants in Iranian hen eggs: a systematic review and meta-analysis

Eggs are a high-quality, nutrient-dense source of protein that is available at a relatively low price and the contamination of eggs by heavy metals is an important issue in public health. This review aimed to assess the risk of heavy metal pollutants in Iranian hen eggs. Original full-text available studies in Iran, detecting levels of Pb, Cd, As, and Hg in whole or part of the egg, and published between January 2000 and March 2023 were selected based on the inclusion criteria. The random-effect model was used to estimate the pooled concentrations of Pb, Cd, As, and Hg in Iranian eggs in meta-analysis. The incremental lifetime cancer risk (ILCR) and the target hazard quotient (THQ) were estimated by both calculation and Monte Carlo simulations to determine the carcinogenic and non-carcinogenic risk of egg consumption, respectively. The pooled concentrations of heavy metals in Iranian hen eggs from nine articles (11 datasets: 10 studies on Pb, 7 on Cd, and 5 on As and Hg concentrations) were Pb 0.29 (95% CI 0.20-0.39) mg kg-1, Cd 0.04 (95% CI 0.03-0.06) mg kg-1, As 0.05 (95% CI 0.03-0.07) mg kg-1, and Hg 0.03 (95% CI 0.02-0.04) mg kg-1. THQ did not show the non-carcinogenic risk; however, the ILCR for Pb concentration showed the threshold carcinogenic risk (mean ILCR = 8.94e - 4 and 9.0E - 4 by calculation and Monte Carlo simulations, respectively), with the greater risk for Cd (mean ILCR = 2.02e - 2). The carcinogenic risk of Pb and Cd concentration in Iranian hen eggs shows the urgent need for programs and policies to lower the risk for consumers by providing healthier feeding.

Iron, Copper, and Magnesium Concentration in Hair and Risk of Esophageal Cancer: A Nested Case-Control Study

BACKGROUND

An association has already been hypothesized between iron, copper, and magnesium status assessed through food frequency questionnaires (FFQs) and the risk of esophageal squamous cell carcinoma (ESCC). However, self-reported dietary assessment methods are prone to measurement errors. We studied the association between iron, copper, and magnesium status and ESCC risk, using hair samples as a long exposure biomarker.

METHODS

We designed a nested case-control study within the Golestan Cohort Study, that recruited about 50000 participants in 2004-2008, and collected biospecimens at baseline. We identified 96 incident cases of ESCC with available hair samples. They were age-matched with cancer-free controls from the cohort. We used inductively coupled plasma mass spectrometry (ICP-MS) to measure iron, copper, and magnesium concentrations in hair samples. We used multiple logistic regression models to determine odds ratios and 95% confidence intervals.

RESULTS

Median concentrations of iron, copper, and magnesium were 35.4, 19.3, and 41.7 ppm in cases and 25.8, 18.3, and 50.0 ppm in controls, respectively. Iron was significantly associated with the risk of ESCC in continuous analysis (OR=1.41, 95% CI=1.03-1.92), but not in the tertiles analyses (ORT3 vs. T1=1.81, 95% CI=0.77-4.28). No associations were observed between copper and magnesium and ESCC risk, in either the tertiles models or the continuous estimate (copper: ORT3 vs. T1=2.56, 95% CI=1.00-6.54; magnesium: ORT3 vs. T1=0.75, 95% CI=0.32-1.78).

CONCLUSION

Higher iron status may be related to a higher risk of ESCC in this population.

Economic Sanctions Affecting Household Food and Nutrition Security and Policies to Cope With Them: A Systematic Review

BACKGROUND

This review was conducted to identify the impact of economic sanctions on household food and nutrition security and policies to cope with them in countries exposed to sanctions.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020 were used to identify, select, appraise, and synthesize studies. Electronic databases in addition to Persian ones have been systematically searched for all related documents published until March 2022. Exclusion criteria were: lack of data related to food insecurity in countries subject to sanction and very low quality of the article. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal checklists. The results were presented as qualitative and quantitative syntheses.

RESULTS

Of 1428 identified studies, 36 publications remained in the review, which belong to Iran (n=8), Cuba (n=8), Russia (n=7), Iraq (n=7), and Haiti (n=6), respectively. Declining gross domestic product (GDP), devaluation of the national currency, and the quality of food, increase in inflation, unemployment, and consumer prices, infant and under 5 years mortality, energy, and protein deficiency, and the poverty rate were reported as sanction consequences. The most important strategies to improve food security were the humanitarian assistance provided by the international community (Haiti), equity and priority for vulnerable groups mainly by expanding the healthcare system (Cuba), adopting a food ration system in the oil-for-food program, and fixing the price of food baskets (Iraq), import substitution and self-sufficiency (Russia), support domestic production, direct and indirect support and compensation packages for vulnerable households (the approach of resistance economy in Iran).

CONCLUSION

Due to the heterogeneity of studies, meta-analysis was not possible. Since inadequate physical and economic food access caused by sanctions affects especially disadvantaged and vulnerable groups, planning to improve food security and providing support packages for these groups seems necessary.

Consumer health risk assessment of Arsenic and Mercury in hen eggs through Monte Carlo simulations

BACKGROUND

This study was conducted to assess the concentration of heavy metals (arsenic and mercury) and estimate the probability that consumption of hen egg products collected in Iran has carcinogenic or non-carcinogenic consequences.

METHODS

A total of eighty-four hen eggs from 21 major brands were randomly selected from among thirty local supermarkets in two seasons (winter (January) and summer (August) 2022). Arsenic (As) and Mercury (Hg) was determined by using ICP-MS. The human health risk assessment refers to the formulation of the USEPA standard focused on Estimated Daily Intake (EDI), International Lifetime Cancer Risk (ILCR), Target Hazard Quotient (THQ), and Monte Carlo simulation (MCS) as a probabilistic method. Data analysis was carried out using the statistical software SPSS. Differences in mean concentrations of As and Hg in two seasons were tested by paired t-test.

RESULTS

Over two seasons, the average As and Hg concentrations in hen eggs were 0.79 and 0.18 µg.kg^-1, respectively. Seasonal difference in As concentration (p = 0.451) was not significant, whereas that of Hg concentration (p < 0.001) was significant. The calculated value of EDI was 0.29 µg As/day and 0.06 µg Hg/day. The EWI in the maximum scenario of as level in hen eggs was estimated to be 8.71 µg As and 1.89 µg Hg/month for Iranian adults. THQ's mean for As and Hg in adults was determined to be 0.00385 and 0.00066, respectively. In addition, ILCRs by MCS for As were 4.35E-4.

CONCLUSION

In total, the result indicates that there was not a significant risk of developing cancer; the calculation of THQ was still below the accepted level of 1, indicating that there was no risk while, according to most regulatory programs (ILCR > 10^- 4) shows a threshold carcinogenic risk of arsenic through consuming in hen eggs. Therefore, policymakers need to be aware that it is prohibited to establish chicken farms in heavily polluted urban areas. It is essential to regularly conduct examinations to measure the presence of heavy metals in both ground waters used for agriculture and the feed provided to chickens. Additionally, it is advisable to focus on raising public awareness about the importance of maintaining a healthy diet.

Food insecurity, body mass index, socio-economic status, and food intake in lactating and non-lactating mothers with children under two years

BACKGROUND

food insecurity (FI) is considered as an essential public health problem which may have detrimental effects on people's health. The aim of present study was to evaluate FI, body mass index, quantity and quality of food intake in lactating and non-lactating mothers with children under two years.

METHODS

in this cross-sectional study 307 mothers (237 lactating and 70 non-lactating) were participated. Socio-economic and demographic information were gathered by questionnaires. FI of families was evaluated by the questionnaire of the United States Department of Agriculture (USDA) Household Food Security. For assessing quality and quantity of food intake of mothers, dietary diversity score (DDS), diet quality index-international (DQI-I) and nutrient adequacy ratio (NAR) were calculated. Weight and height of participants were measured and body mass index (BMI) was calculated. Finally, Chi-squared test, analysis of variance (ANOVA) and linear regression were used for statistical analysis.

RESULTS

in this study the rate of underweight, normal weight, overweight, and obesity in mothers was 0.3%, 39.2%, 42.3%, and 18.2%, respectively. Among the determinants of BMI, household food security status had the greatest effect (Beta=-1.584, P < 0.001) and mother age had the least effect (Beta = 0.101, P = 0.013). Mother's occupational and educational status, having facilities, physiological status of mother, and house size had significant correlation with NAR. Mother's occupational and educational status, and having facilities had significant relationship with DDS, too. Also, the significant correlation of Mother's education, having facilities, and physiological status of mother with DQI-I were found.

CONCLUSIONS

we found that Household food security status had the most effect on BMI of mothers. In this study, the best nutrient adequacy and dietary diversity were found in the obese group and the most diet quality was found in the normal weight group.

Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households?

Objective

This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households.

Methods

The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications.

Results

Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated.

Conclusion

The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.

Community-based participatory interventions to improve food security: A systematic review

Introduction

This systematic review aimed to evaluate community-based participatory (CBP) interventions to improve food security and/or its dimensions to highlight the scope and characteristics of interventions and extract the characteristics of effective interventions.

Methods

The electronic databases, including PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Google Scholar, were searched from 1980 to 30 August 2022 for relevant studies. We included randomized controlled trials (RCTs), cluster randomized controlled trials (cRCTs), controlled before and after studies (CBAs), non-randomized controlled trials (nRCT), and interrupted time series (ITS) studies to identify the community-based participatory interventions. The indicators of food and nutrition security into four dimensions, as well as food insecurity measured as score and/or prevalence of food insecurity based on validated perception-based measures were considered outcome. Two reviewers independently evaluated the studies for eligibility, extracted data, and evaluated the risk of bias in the included studies using the Effective Public Health Practice Project (EPHPP). The quality of included reports was categorized as strong (when there were no weak ratings), moderate (when one factor was rated as weak), or weak (when two or more factors were rated as weak). A descriptive analysis of the findings was performed.

Results

A total of twelve studies were included. The quality of all eligible studies (n = 12) was rated as moderate/weak. Most CBP interventions were guided by formative research (n = 9, 75%). Two main groups for utilized strategies were identified: agricultural and nutrition strategies. Agricultural strategies included agricultural education, preparing and improving soil and seeds, promoting and supporting gardening/harvesting utilizing traditional skills based on the local culture, and agroecological practices. Nutrition strategies included store and shopping programs, farmers' markets, fresh fruit and vegetable programs, nutrition education programs for mothers, and food vouchers. The main outcomes improved in the CBP interventions were food security (n = 2) and its dimensions, including availability (n = 3), access (n = 5), and utilization (n = 2). All agroecological practices achieved statistically significant outcomes in the intended food security target(s). However, nutritional interventions were not effective for some access components such as mean adequacy ratio, fruit and vegetable intake, and nutrition environment of the stores. No studies evaluated stability outcome components of food security.

Discussion

CBP interventions guided by formative research data and agroecological practices were promising strategies to improve food security and its dimensions. Insufficient data on the stability components of food security and weak design studies were the considerable gaps in the research evidence reviewed. More research employing randomized experimental designs with adequate sample size and high retention rates is required.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020189477].

Food insecurity and dental caries prevalence in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Food insecurity (FI) is associated with dietary practices, which can act as a risk factor for dental caries.

AIM

This study aimed to investigate the relationship between FI and dental caries prevalence in children and adolescents.

DESIGN

MEDLINE (via PubMed), EMBASE, SCOPUS, ISI web of knowledge, Cochrane, and ProQuest Dissertations & Theses Global database (up to April 19, 2022) as well as reference lists were searched. Eligible studies compared dental caries prevalence in food-secure and food-insecure individuals younger than 19 years. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using a modified Newcastle-Ottawa Scale. Meta-analysis was performed, and the pooled odds ratio (OR) was calculated at 95% confidence interval (95% CI).

RESULTS

Among the 1350 retrieved records, 10 cross-sectional reports were selected for systematic review. Six studies involving 8631 participants were included in the meta-analysis. More than half of the reports were published within the period 2019-2021. All studies except one were judged as low risk of bias. Overall, the prevalence of dental caries was greater among the food-insecure children and adolescents (OR: 2.01, 95% CI: 1.52-2.65, p < .001, I² : 73.5%). Similarly, all three categories of FI were significantly associated with caries experience (marginal FI: OR: 1.88, 95% CI: 1.56-2.27, p < .001, I² : 0.0%; low FI: OR: 2.42, 95% CI: 1.42-4.14, p = .001, I² : 74.4%; very low FI: OR: 2.37, 95% CI: 1.88-3.00, p < .001, I² : 0.0%).

CONCLUSION

The results showed a significant association between FI status and dental caries in both childhood and adolescence; however, there was a lack of longitudinal studies for a better understanding of this association. Health policies leading to reduction in FI may also aim to reduce dental caries.

Seafarers' mental health status and life satisfaction: Structural equation model

Background

A variety of factors influence seafarers' health. Such factors might affect their satisfaction with life.

Aims

To examine the relationships between seafarers' mental health status and satisfaction with life by using a structural equation method.

Methods

In this survey, 470 seafarers were selected via convenience sampling method from two shipping companies. Validated questionnaires including Satisfaction with Life Scale (SWLS), generalized anxiety disorder-7 (GAD-7), Post-traumatic Stress Disorder-8 (PTSD-8), Patient Health Questionnaire-9 (PHQ-9), General Health Questionnaire-12 (GHQ-12), Perceived Health status and Depression-Anxiety-Stress scale-21 (DASS-21) were used to assess different aspects of well-being and life satisfaction. The stratified path analysis method was applied to analyze the data.

Results

439 seafarers (200 officers and 237 non-officers) with a mean age of 34.5 (SD: 8.05) participated in the current study. The GHQ score directly affected satisfaction with life in both officers (β = 0.35) and non-officers (β = 0.40). Also, perceived health status directly and indirectly affected satisfaction with life among officers (β = 0.19) and non-officers (β = 0.06). While officers working days per month indirectly impacted satisfaction with life through the general anxiety disorder, perceived health status, depression, anxiety, stress and current mental health. In non-officers, generalized anxiety disorder had the most potent indirect effects on satisfaction with life through perceived health status and current mental health.

Conclusion

Perceived health status, directly and indirectly, affected seafarers' satisfaction with life. Measures should be taken in order to improve seafarers' perceived health status and its effects on satisfaction with life.

Determinants and consequences of food insecurity in families having children under the age of 2 years

Background: Today, food insecurity is recognized as an important public health problem that can have detrimental effects on families. Aim: The aim of this study was to assess the determinants and consequences of food insecurity in families having children under the age of 2 years. Method: In this cross-sectional study, 307 mothers and their children under the age of 2 years were selected by stratified random sampling. Demographic and socioeconomic data were collected by completing questionnaires through face-to-face interview. Household food insecurity (HFI) status was determined using the United States Department of Agriculture (USDA) household food security questionnaire. Results: Based on the results, 67.4% of families were high food secure. Low and very low food security was 25.7% and 6.9%, respectively. House size (Beta = -0.019, 95% CI: -0.029, -0.009), father's job (Beta = -4.758, 95% CI:-6.777, -2.738), father education (Beta = -0.370, 95% CI: -0.717, -0.023), and economic status (Beta = -0.628, 95% CI: -0.809, -0.448) were significantly related to the USDA total food insecurity score (p < 0.05). Regression analysis showed that children birth weight, father's body mass index (BMI), and mother's waist circumference had a significant positive correlation with weight for age (Z-score) of children. Children's birth weight, father's BMI, and HFI status had significant and positive correlation with weight for length (Z-score). Moreover, the significant association between children's birth height, mother's BMI, and mother's waist circumference with length for age (Z-score) were observed (p < 0.05). Conclusion: We found the father's job was the most effective factor in food insecurity and economic status of the family was in the second place. Also, HFI had a relationship with weight status of children under the age of 2 years.

COVID-19 pandemic and food security in different contexts: A systematic review protocol

Background

Given the unprecedented nature of the COVID-19 crisis and the importance of early implementation of prevention programs, it is essential to understand better its potential impacts on various food security dimensions and indicators.

Methods

Research databases, including Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Public Health Register, PubMed/MEDLINE, SCOPUS, EMBASE, CINAHL, Web of science, and Google Scholar, will be searched using a search strategy and keywords developed in collaboration with librarians. The review will include all field and community trials and observational studies in all population groups. Searching electronic databases, study selection, and data extraction will be conducted by two researchers independently. Four critical appraisal tools will be used to assess the quality of included studies according to the study design: The Joanna Briggs Institute (JBI) Prevalence Critical Appraisal tool, the JBI critical appraisal checklist for randomized control/pseudo-randomized trial, descriptive/case series, and comparable cohort/case-control. These tools were initially designed for use in systematic reviews. A narrative synthesis will be implemented to summarize findings if meta-analyses are not appropriate.

Discussion

The current systematic review results can be used to predict the effect of COVID-19 on the individuals’ and households’ food security, especially in vulnerable populations, and develop effective interventions. This review can provide information for policymakers to better understand the factors influencing the implementation of these interventions and inform decision-making to improve food security.

Systematic review registration

The present study registration number in the international prospective register of systematic reviews (PROSPERO) is CRD42020185843.

Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the Global Dietary Database

Background

Methods

Findings

Interpretation

Funding

Evaluation of the effects of the national diabetes control and prevention program on a sample of iranian people with type 2 diabetes

Diabetes prevention programs have been developed in the different countries and it is therefore necessary to gain a better understanding of factors affecting the effectiveness of these programs for each society. Accordingly, the purpose of this study was to evaluate the effect of the National Diabetes Control and Prevention Program (NDCPP) on the biochemical and anthropometric indices among a sample of Iranian patients with type 2 diabetes mellitus (T2DM). A total of 384 patients with T2DM from the primary health care system of Tehran and Tabriz cities during January to June 2020, were included in the study. A two-part questionnaire consisting of items related to socio-economic and demographic characteristics was used and biochemical and anthropometric indices were measured at the beginning and the end of the 3-month intervention period. There was a significant difference in fasting blood sugar (FBS), hemoglobin glycosides (HbA1 C), systolic blood pressure (SBP) and weight before and after the NDCPP (P <  0.001). Also, there was significant improvement in carbohydrate (P = 0.015) and protein intake (P = 0.027) after the NDCPP compared to before the study. No significant difference was observed in waist circumference (WC) (P = 0.689), body mass index (P = 0.784), diastolic blood pressure (P = 0.647), and other dietary nutrient intake before and after the NDCPP. Repeated measure ANOVA revealed a significant decrease in FBS (Time effect P = 0.019) and weight (Time effect P = 0.006) after the NDCPP. Also, residing in different cities had a significant effect on FBS (time×city effect P <  0.001), HbA1 C (time×city effect P <  0.001), and SBP (time×city effect P = 0.037) after the NDCPP. The NDCPP resulted in weight loss, improved HbA1 C, and FBS. These findings suggested that NDCPP had a positive effect on controlling T2DM among Iranian population and can be considered as a way to prevent complications of T2DM.

A mixed-method study of edible oil waste from farm to table in Iran: SWOT analysis

The increasing trend of food waste is one of the serious challenges throughout the world. The purpose of this study is to investigate the status of edible oil waste (EOW) from farm to table using the SWOT (strengths, weaknesses, opportunities, and threats) analysis in Iran (2021). First, semi-structured, interviews were conducted with 11 experts in the edible oil industry. Then a cross-sectional study was done on 40 restaurant managers through telephone interviews about the restaurant's discarded edible oils. Finally, an online study was undertaken among 121 households regarding their waste cooking oil at home. Two categories in five themes with 20 subthemes were explored based on the participant's perspectives. Lack of up-to-date knowledge and appropriate technology were the main reasons for making waste from farm to factory. EOW is used optimally in other industries. The results showed that 92% of the restaurants sell the EOW for poultry feeds without refinement. The majority of the households [52%] throw EOW in the garbage and 21% dump their discarded oils in the sewage. By SWOT analysis, the challenges of EOW from farm to table were identified. There is no specific policy plan for collecting and recycling EOW. The waste oil used in poultry feed without refinement can enter the human body and the possible oxidation toxicity of this waste can pose public health risks. Policymakers can use the SWOT analysis for setting laws and regulations for EOW to ensure its safe disposal and promote its use for biodiesel to provide a healthy community.

Global overview of dietary outcomes and dietary intake assessment methods in maritime settings: a systematic review

BACKGROUND

Seafaring is a risky occupation with high prevalence of risk factors for non-communicable diseases. Food intake and eating habits are important cornerstones regarding health and health promotion. The aim of this study was to provide an overview of dietary intake and dietary intake assessment methods of seafarers and suggestions for applicable assessment tools.

METHODS

We systematically searched PubMed and NLM Gateway (for MEDLINE), Web of Science, and SCOPUS up to February 2020 using standard keywords including nutrition OR diet OR meal AND maritime settings. Two independent reviewers extracted the data. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal checklist.

RESULTS

From 4449 studies initially identified, 26 articles were included in the final review. Qualitative data (e.g. on unhealthy eating) had been gathered using in-depth individual or group interviews, participant observations, and phone-based chats. Composition of menu analysis, 24 h dietary recall, food diaries/ diet records, dietary habits questionnaire, food stores and food waste of the ship were used to assess the quantitative outcomes (e.g. dietary intakes). Access to meat, processed meat and egg, frozen and canned food items, sugary drinks, alcohol, greasy and salty food was high. In contrast, consumption of fruit, vegetables, dairy products, and cereals was lower than recommended.

CONCLUSIONS

Eating habits and dietary intakes in maritime settings are unhealthy. Subjective dietary assessment methods combining menu analysis with new technologies (e.g. mobile-based) might be an applicable method in this hard to reach setting which is the vessels.

Analysis for policy to overcome barriers to reducing the prevalence of vitamin a deficiency among children (15-23 months) in Iran

BACKGROUND

About 30% of children < 5 years old are estimated to experience vitamin A deficiency worldwide. Globally, vitamin A deficiency can be reduced by five major interventions: supplementation, dietary modification, fortification, promotion of both public health, and breastfeeding. This prospective policy analysis (Prospective policy analysis focuses on the future outcomes of a proposed policy. Adapted from Patton, CV, and Sawicki DS. Basic Methods of Policy Analysis and Planning, Prentice-Hall, Inc. New Jersey,1993). (Patton A, Carl V, and David S. Basic methods of policy analysis and planning, prentice-hall, 3th ed. 2012) aimed to identify evidence-based policy options to minimize prevalence (VAD) among 15-23 months-children in Iran.

METHODS

Thirty-eight semi-structured face-to-face interviews were held with experts at high, middle, and low managerial levels in Iran's health system, as well as at Schools of Nutrition Sciences and dietetics, using purposive and snowball sampling. All interviews were recorded by a digital voice recorder and then transcribed, codified, and eventually analyzed using a mixed approach (inductive-deductive) by MAXQDA software version 10.

RESULTS

Most policies related to VAD reduction in this age group are supplementation, expansion of education, and awareness. Three main factors affecting VAD reduction policies emerged from the analysis: basic factors (governance, infrastructure, and organization), underlying factors (social factors, economy), and immediate factors (services). Due to its cross-sectoral nature, evaluating the results of the implementation of this policy requires strong and coherent inter-sectoral cooperation. The existing primary healthcare network (PHC) is a crucial means for successful implementation of policies to address VAD in Iran.

CONCLUSIONS

In addition to supplementation and assistance in this age group, other policies should be also planned to reduce VAD in various regions. In addition to the Ministry of Health & Medical Education (MoHME), other actors need to be involved, we advocate, throughout the entire policymaking process of policy-making to reduce VAD in Iran.

A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic

The restaurant business has turned into a dynamic and ever‐growing industry. So, food safety must be a priority for these establishments, especially during the COVID‐19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self‐reported practice (KAP) of restaurant food handlers during the COVID‐19 pandemic. This quasi‐experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher's exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self‐reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA. Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID‐19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.

The short-term effects of COVID-19 outbreak on dietary diversity and food security status of Iranian households (A case study in Tehran province)

Currently, the COVID-19 outbreak is spreading fast in 185 countries and has engaged most people around the world. COVID-19 imposes severe and tragic consequences on people's health due to the high rate of spread and potentially fatal impacts. In this study, the association of socio-economic factors with food security and dietary diversity is assessed before and during the COVID-19 pandemic. Data from 299 respondents were collected by an online standard questionnaire. Household Dietary Diversity Score (HDDS) and Household Food Insecurity Access Scale (HFIAS) were calculated. A multinomial regression model was applied to determine factors associated with HDDS and HFIAS before and during COVID-19 outbreak. Food security of Iranian households improved during the initial COVID-19 pandemic period (P < 0.001). Households reduced consumption of some food groups during the COVID-19 pandemic compared to the pre-COVID-19 period. Key socio-economic factors associated with food insecurity during the COVID-19 pandemic included personal savings, household income, employment status of head of household, and nutrition knowledge of head of household. During the COVID-19 outbreak, household size, head of household's occupation, personal savings, and number of male children were significantly associated with dietary diversity. Distributing free food baskets to poor households, extending e-marketing, providing nutrition consultations, and organizing donations to support infected households may increase household dietary diversity and improve food security status during a pandemic such as COVID-19. Vulnerable populations in countries experiencing food insecurity, such as Iran, should be supported - not just by providing medical care and personal protective equipment, but also with flexible safety nets and food-based intervention programs to respond to population needs.

A Mixed-Method Study on COVID-19 Prevention in Iranian Restaurants

Background: In the face of the COVID-19, as a public health emergency, the restaurant industry is struggling to organize itself. The aim of this study is to determine the knowledge, attitude, and practice and also the perceptions of restaurants' customers and managers toward COVID-19 prevention. Methods: This cross-sectional study was conducted using the mixed-method approach. Two online questionnaires were undertaken through WhatsApp Messenger among the 210 customers and 50 managers of restaurants. Multivariate linear regression analysis was conducted to identify the predictors of knowledge, attitude, and practice toward COVID-19 prevention. Then semi-structured, in-depth phone interviews were conducted with 45 subjects to identify their perceptions about the restaurant industry during the COVID-19 pandemic. Results: The majority of customers had moderate knowledge (72.4%), positive attitude (90.5%), and desirable practice (38.6%); whereas the majority of managers had sufficient knowledge (50%), negative attitude (82%), and acceptable practice (58%) toward the prevention of COVID-19 in restaurants. Multiple linear regression analysis showed with increasing each 10 years in the age of the customers, the practice score significantly decreased (Beta = -0.155, p < 0.05). Moreover, qualitative results revealed three categories (1. restaurant industry, 2. social media, and 3. government) in 9 themes with 32 sub-themes which were explored based on the perception of the participants toward COVID-19 prevention in restaurants. Conclusion: The majority of restaurant customers and managers have sufficient knowledge and acceptable practice, but a positive attitude among customers and a negative attitude among managers about the prevention of COVID-19 were shown. There is an urgent need to understand public awareness about preventing COVID-19 in restaurants at these critical moments. The results seek to provide strategies for the policymakers and restaurant industry to plan the specific educational intervention about how to manage future crises and public health improvement.

A critical review of national diabetes prevention and control programs in 12 countries in Middle East

BACKGROUND

Diabetes mellitus has been known as one of the most significant systemic diseases with severe consequences and challenges to human health.

AIM

The primary aim of the current paper was to review the diabetes prevention programs in the Middle East countries, and secondary compare their goals and success rate and conclude possible upcoming strategies.

METHODS

All reports and documents regarding to diabetes prevention and control programs in the region were collected by searching Web of Science, PubMed, MEDLINE, Google Scholar, Scopus and EMBASE for articles up to 2020. The health policy triangle framework was used to analyze diabetes policies and programs. In the Middle East, a shift from rural to urban life, socioeconomic development, sedentary lifestyles, and high fat and sugary foods consumption led to increasing in obesity and diabetes rate, which have become a real challenge.

RESULTS

To decrease the burden of diabetes, preventive strategies with proper local socio-cultural context are needed. Evaluation of current policies and identifying stakeholders' views can help to improve the current strategies for the prevalence of diabetes and its complications.

CONCLUSIONS

It can provide local and global insight to evidence-informed decision-making for future policy reforms to enhance effectiveness of the program.

An Evaluation of Four Years Implementation of National Nutrition and Food Security Policy in Iran: Lessons Learned

Background:

National Nutrition and Food Security Policy of Iran was developed and ordered by Office of Community Nutrition Improvement, in cooperation with National Nutrition and Food Technology Research Institute and National Institute of Health Research in 2012. This study was aimed at evaluating the success of the operationalization of the Policy between 2012 and 2015 and using the lessons learned in future policies.

Methods:

The participatory evaluation was conducted by taking part of all main partners including trustee organizations involved in implementation of the document, specialists and academic researchers, people's deputies, health service, headquarters experts at Ministry of Health. Three qualitative methods including reviewing evidences, interviews, and focus group discussions have been used to gather information. The degree of achievement of the document's strategic objectives, as well as the degree of adaptation of the document implementation to the desired state, has been determined.

Results:

The mean percentage of progress in achieving outcomes and adaptation of the deployment method to ideal criteria (for 2016) of the National Document on Food and Nutrition Security from 2013 to 2017 are 52.6% and 41%, respectively. The best success was found in the existence of an evidence-based program (70%), a coalition of policy implementation (66.1%), and indicators for monitoring the progress of the document (61.1%). The least success was related to the weakness of public justification and public participation (20%) and lack of ranking and encouraging partners' function (24%). Lack of approval of the national document at the High Council for Health and Food Security of the country (HCHFS) was the important factor which led to less progress of the document.

Conclusions:

It is recommended to target avoiding structural changes while saving time, strengthening intersectoral capacity for collaboration, encouraging partners, and empowering the environment of the provinces in the coming years.

A systematic review and meta-analysis of lead and cadmium concentrations in cow milk in Iran and human health risk assessment

The aim of the current research was to systematically review and summarize the studies that evaluated the concentration of lead (Pb) and cadmium (Cd) in cow milk in different regions of Iran and to perform a meta-analysis of the findings. Moreover, the non-carcinogenic and carcinogenic risks of Pb and Cd through milk consumption in adult and child consumers were assessed. As a result of a systematic search in the international and national databases between January 2008 and October 2018, 17 reports involving 1874 samples were incorporated in our study for meta-analysis. The pooled concentrations of Pb and Cd were estimated to be 13.95 μg mL^-1 (95% CI 9.72-18.11 μg mL^-1) and 3.55 μg mL^-1 (95% CI - 2.38-9.48 μg mL^-1), respectively, which were lower than the WHO/FAO and national standard limits. The estimated weekly intake (EWI) of Pb and Cd through consuming milk was 16.65 and 7 μg day^-1 for adults of 70 kg and 45 and 34 μg day^-1 for children of 26 kg, respectively, which was well below the risk values set by Joint FAO/WHO Expert Committee on Food Additives (JECFA). The maximum target hazard quotient values (THQs) of Pb and Cd were 5.55E-5 and 5.55E-5 for adults and 5.55E-5 and 5.55E-5 for children, respectively, which were lower than 1 value, suggesting that Iranian consumers are not exposed to non-carcinogenic risk through consuming milk. Moreover, the incremental lifetime cancer risk (ILCR) of Pb estimated to be 2.96E-04 in adults and 1.0E-03 in children, indicating that consumers in Iran are at threshold carcinogenic risk of Pb through consuming milk (ILCR > 10^-4). Therefore, planning and policy making for the sustainable reduction of these toxic metals in milk, particularly in industrial regions of Iran, are crucial.

Challenges of Cooking Oils in Fast-Food Restaurants of Iran: Views of Consumers

The purpose of this study was to explore Tehranian women’s perceptions about the quality and safety of cooking oils in fast-food restaurants and their behavior toward these challenges in 2018. A qualitative study with eight focus group discussions was conducted among 82 women using content analysis and constant comparison methods. Three categories emerged with 4 themes and 27 subthemes: (a) high usage of frying foods, (b) fast-food restaurants, and (c) building community trust. The majority of women had desirable knowledge about the disadvantages of cooking oils used in fast-food restaurants. The participants mentioned that the most challenging problem of fast-food restaurants was the reused cooking oils. Therefore, the health policy-makers should consider to develop a guideline for improving the cooking oils’ quality and safety in fast-food restaurants. It is recommended that the restaurant inspection system should be examined to identify appropriate ways of ensuring food safety.

Socioeconomic determinants of excess weight and central obesity among Iranian women: Application of information, motivation, and behavioral skills model

INTRODUCTION

In developing countries, there is an increased risk of incidence of noncommunicable diseases due to general and abdominal obesity. Therefore, this study aimed to assess socioeconomic determinants of excess weight and central obesity among women in Tehran city based on information motivation behavioral skills model (IMB).

MATERIALS AND METHODS

A cross-sectional study was conducted among 260 women aged between 20 and 49 years old using cluster sampling. A skilled interviewer completed socioeconomic status (SES), food insecurity, and IMB questionnaires. Analysis of variance, Chi-square tests, and regression model were used for statistical analysis. The multiple logistic regression analysis was used to identify independent predictors of the excess weight and central obesity using SPSS 21.

RESULTS

The mean and standard deviation of participants' age was 34.7 (±7.59) years old. The prevalence of overweight and obesity in adult women was estimated 35% and 21.2%, respectively. The prevalence of abdominal obesity was 34.6%. Independent predictors of overweight/obesity in women were age (odds ratio [OR] =1.09, 95% confidence interval [CI] =1.03-1.14), educational level (OR = 2.35, 95% CI = 1.05-5.27), and total expenditure (OR = 3.14, 95% CI = 1.06-9.37). Whereas, independent predictors for increased the likelihood of central obesity were age (OR = 1.12, 95% CI = 1.06-1.18), marital status (OR = 6.44, 95% CI = 1.94-21.40), low education (OR = 0.38, 95% CI = 0.16-0.91), number of rooms (OR = 1.19, 95% CI 1.03-3.45), and self-regulation score (OR = 0.94, 95% CI = 0.88-1.00).

CONCLUSIONS

The socioeconomic determinants, especially age, level of education, and expenditure, as well as self-regulation, play an important role in excess weight and central obesity among women. Therefore, further research is needed to reach women in different SES groups with a variety of interventions through concurrent triangulation of longitudinal studies and qualitative research.

Challenges of Edible Oils From Farm to Industry: Views of Stakeholders

OBJECTIVE

The purpose of this study is to explore stakeholders' views about quality and safety of edible oils from farm to industry and propose policy options to address these challenges.

METHODS

Semistructured, face-to-face interviews were conducted with 11 experts in the edible oil industry. Participants were selected through purposive and snowball sampling. Open-ended interview questions were used to identify the edible oils' challenges from farm to industry. All interviews were recorded and final transcripts were re-read to obtain categories until themes were developed using directed content analysis and constant comparison methods.

RESULTS

Six categories in 14 themes with 49 sub themes were explored based on the perspectives of the stakeholders who were responsible for edible oil industry: (1) safety, (2) imports, (3) factory, (4) edible oils' monitoring, (5) edible oil industry, and (6) building consumer trust. The participants' views showed that to increase the quality and safety of edible oils, the following approaches are required: updating food safety regulations, effective inspection, monitoring and surveillance systems, updating laboratory equipment, and controlling the media advertising.

CONCLUSIONS

In order to build and maintain effective edible oil safety systems, strong links must be established between all sectors responsible. The key players need to have access to reliable and up-to-date information so that timely collective action can be taken. It is recommended that governments face up to this task and lead the way. The research findings seek to offer policy options for government and the stakeholders for challenging future strategies for edible oil industry.

A qualitative study on physical health threatening factors of Iranian seafarers working on ocean going tankers

BACKGROUND

Seafaring is a highly physically demanding profession in a risky environment due to exposure to unique job health related risk factors. The purpose of the study is to describe physical health threatening factors of Iranian seafarers working on tankers.

MATERIALS AND METHODS

A qualitative content analysis with inductive approach was performed on 17 Iranian male seafarers in 2016. Subjects were selected by purposive sampling, which continued until data saturation. Data were gathered using semi-structural questionnaire via in-depth-interviews. All interviews were transformed into computer files. Analysis was done based on conventional content analysis approach.

RESULTS

Mean job history and age of the participants was 11.9 ± 7.2 and 35.8 ± 9.3 years, respectively. Two main themes emerged during analysis of data and categories were created. The themes are (1) physical health threatening factors at the ship; (2) high risk ranks at the ship.

CONCLUSIONS

The need for addressing nutrition at sea was acknowledged by seafarers. Also, it seems that revision of some regulations regarding seafarers' medical examination, oral health and heart diseases is necessary.

Factors affecting health-promoting lifestyle profile in Iranian male seafarers working on tankers

BACKGROUND

Seafaring is a risky occupation that is associated with a high incidence of lifestyle-related diseases. The present study was carried out to examine health promotion behaviour and its associated factors in seafarers of the National Iranian Tanker Company.

MATERIALS AND METHODS

A cross-sectional study was performed on 200 Iranian male seafarers in 2015. A self-administered socio-demographic and Health Promotion Lifestyle Profile II (HPLP-II) questionnaire was completed. One-way analysis of variance was used to identify significant differences among the various departments. The t-test was utilised to compare the HPLP-II scores according to the demographic variables. Multiple linear regression analysis was performed to assess the association between demographic variables and the overall HPLP-II score, in addition to the six health-promoting lifestyle subscale scores.

RESULTS

The mean age of the participants was 35.93 ± 9.51 years. Most of the seafarers were categorised as having a moderate (32%) or good lifestyle (61.5%). The mean lifestyle score was 136.14 ± 19.90, with the subscale spiritual growth showing the highest score (26.16 ± 5.03) and the subscale exercise behaviour showing the lowest score (19.95 ± 4.23). The lowest score for nutrition was found among the seafarers working in the engine department (engine: 20.41 ± 4.50, deck: 23.52 ± 4.97, and galley: 24.83 ± 4.64) (p < 0.05). Working in the engine department was found to have a significant negative effect on the nutrition score (B = -3.57, p < 0.05). Moreover, educational level was found to have a significant positive effect on spiritual growth (B = 2.97, p < 0.05).

CONCLUSIONS

The findings suggest that health-related issues in this occupation, especially workers in the engine room, are a matter of concern.

Prevalence and associated factors of cardio-metabolic risk factors in Iranian seafarers

BACKGROUND

Since Iran's economy is based on the sale of petroleum products, seafaring is considered a crucial job. Little research has been done on issues related to seafarers' health in Iranian maritime industry. The present study investigated the prevalence and associated factors of cardio-metabolic risk factors in seafarers of National Iranian Tanker Company (NITC).

MATERIALS AND METHODS

A cross-sectional study was performed on 234 Iranian male seafarers of NITC in 2015. Metabolic syndrome (MetS) was diagnosed according to the reports of National Committee of Obesity. Three main blood parameters (of elevated total cholesterol, elevated low-density lipoprotein cholesterol, and elevated very low-density lipoprotein cholesterol) and general obesity were included as additional cardio-metabolic risk factors.

RESULTS

The mean age of the participants was 36.0 ± 10.3 years. The prevalence of MetS was 14.9%. The common cardio-metabolic risk factors were excess weight (51.1%), abdominal obesity (38.5%), and smoking (27.8%) among Iranian seafarers. In multivariate analysis, age (OR: 1.05, 95% CI: 1.01-1.09) and body mass index (OR: 1.14, 95% CI: 1.01-1.27) were associated with the increase in hypertension risk.

CONCLUSIONS

Our finding showed that the current prevalence of MetS among Iranian male seafarers working on tankers can affect negatively their health and career at sea.

Development of a Home Food Safety Questionnaire Based on the PRECEDE Model: Targeting Iranian Women

Food safety is an essential public health issue for all countries. This study was the first attempt to design and develop a home food safety questionnaire (HFSQ), in the conceptual framework of the PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) model, and to assess its validity and reliability. The HFSQ was developed by reviewing electronic databases and 12 focus group discussions with 96 women volunteers. Ten panel members reviewed the questionnaire, and the content validity ratio and content validity index were computed. Twenty women completed the HFSQ, and face validity was assessed. Women who were responsible for food handling in their households (n =320) were selected randomly from 10 health centers and completed the HFSQ based on the PRECEDE model. To examine the construct validity, a principal components factor analysis with varimax rotation was used. Internal consistency was determined with Cronbach's α. Reproducibility was checked by Kendall's τ after 4 weeks with 30 women. The developed HSFQ was considered acceptable with a content validity index of 0.88. Face validity revealed that 95% of the participants understood the questions and found them easy to answer, and 90% confirmed the appearance of the HFSQ and declared the layout acceptable. Principal component factor analysis revealed that the HFSQ could explain 33.7, 55.3, 34.8, and 60.0% of the total variance of the predisposing, reinforcing, practice, and enabling components, respectively. Cronbach's α was acceptable at 0.73. For Kendall's τ_c, r = 0.89, with a 95% confidence interval of 0.85 to 0.93. The HFSQ developed based on the PRECEDE model met the standards of acceptable reliability and validity, which can be generalized to a wider population. These results can provide information for the development of effective communication strategies to promote home food safety.

Systematic review of zinc biochemical indicators and risk of coronary heart disease

BACKGROUND

Poor zinc nutritional status is suspected as a risk factor for coronary heart disease (CHD). Since zinc absorption may be influenced by some nutritional and physiologic factors, it would be better to investigate zinc status through biochemical measurements. The objective of the present study was to review recent studies investigating the association of zinc biomarkers with CHD, systematically.

METHODS

The MEDLINE database was used for relevant studies published from January 2009 to December 2013 with appropriate keywords. Articles were included in this study if they were human studies, original articles, and published in English.

RESULTS

Six case-control studies and two prospective cohort studies that measured zinc biomarkers were included in the study. Almost all case-control studies suggest that decreased plasma zinc was associated with increased CHD risk. Cohort studies did not support this relationship.

CONCLUSION

The majority of the evidence for this theory is extracted from case-control studies, which might have bias. Prospective studies and randomized clinical trials are needed to investigate whether poor zinc status is associated with increased CHD risk. Consequently, a protective role of zinc in CHD could not be still established.

Household food insecurity in the Islamic Republic of Iran: a systematic review and meta-analysis

Using a systematic review of all available studies between 1991 and 2011, the prevalence of food insecurity in the Islamic Republic of Iran was estimated. After document evaluation and data aggregation, studies were analysed in separate categories based on the methods used: dietary recall, household income/expenditure or experiential/perception-based surveys. Meta-analysis of dietary-recall studies showed small non-significant increases between 1994 and 2004 in the prevalence of mild (from 8.8% to 9.3%) and moderate food insecurity (from 5.4% to 5.6%). Severe food insecurity was 3.8% and 3.7% in 1994 and 2004 respectively. Prevalence of food insecurity (moderate to severe) based on household income/expenditure surveys was consistently reported to be 10%. A separate meta-analysis of experiential/perception-based studies revealed rates of mild, moderate and severe food insecurity of 28.6%, 14.9% and 6.0% respectively. By combining study results in this manner makes it possible to come up with more realistic estimates for evidence-informed policy-making, until development of a national food insecurity surveillance system.

Iron and vitamin C co-supplementation increased serum vitamin C without adverse effect on zinc level in iron deficient female youth

BACKGROUND

Iron supplementation can decrease the absorption of zinc and influence other antioxidants levels such as vitamin C. This study aimed to investigate the effect of iron supplements alone and in combination with vitamin C on zinc and vitamin C status in iron deficient female students.

METHODS

In a double-blind randomized clinical trail, 60 iron deficient students were selected from 289 volunteers residing in dormitory. After matching, subjects were randomly assigned into two groups: Group I (50 mg elemental iron supplements) and Group II (50 mg elemental iron + 500 mg ascorbic acid). Serum ferritin, iron, serum zinc, and plasma vitamin C concentrations were measured by using enzyme-linked immunosorbent assay, spectrophotometer, atomic absorption spectrometer, and colorimeter, respectively after 6 and 12 weeks supplementation. Student's t-test and repeated measures analysis of variance were applied to analyze the data using SPSS software.

RESULTS

Serum zinc levels had no significant differences between 2 groups at the baseline; however, its concentration decreased from 80.9 ± 4.2-68.9 ± 2.7 μg/dl to 81.2 ± 4.5-66.1 ± 2.9 μg/dl (P < 0.001) in Groups I and II, respectively after 6 weeks of supplementation. Continuous supplementation increased serum zinc concentration to baseline levels (79.0 ± 2.9 μg/dl; P < 0.01) in Group I and 70.5 ± 3.1 μg/dl in Group II following 12 weeks of supplementation. Plasma vitamin C increased from 3 ± 0/1-3.3 ± 0.2 mg/dl to 2.7 ± 0. 1-4.2 ± 0.2 mg/dl (P < 0.01) in Groups I and II, respectively. At the end of study, plasma vitamin C significantly increased from 3.3 ± 0.3-4.7 ± 0.3 (P < 0.01) to 4.2 ± 0.2-7.1 ± 0.2 (P < 0.001) in Groups I and II, respectively.

CONCLUSIONS

Iron supplementation with and without vitamin C led to reduction in serum Zn in iron-deficient female students after 6 weeks. However, the decreasing trend stops after repletion of iron stores and Zn levels returned to the approximately baseline values after 12 weeks.

Major dietary patterns in relation to stunting among children in Tehran, Iran

To the best of our knowledge, no information is available to link major dietary patterns to stunting during childhood, although dietary patterns are associated with chronic diseases. This study was conducted to determine the relationship between major dietary patterns and stunting in the first grade pupils of Tehran in 2009. In this case-control study, 86 stunted children (defined as height-for-age of less than the 5th percentile of CDC2000 cutoff points) were enrolled from among 3,147 first grade pupils of Tehran, selected using a multistage cluster random-sampling method. Participants for the control group (n=308) were selected randomly from non-stunted children (height-for-age more than the 5th percentile of CDC2000 cutoff points), after matching for age, sex, and area of residence. Dietary data were collected using two 24-hour dietary recalls through face-to-face interview with mothers. Factor analysis was used for identifying major dietary patterns. Mean consumption of dairy products (308 +/- 167 vs 382 +/- 232 g/day, p < 0.05), dried fruits and nuts (2.5819 vs 7.15 +/- 26 g/day, p < 0.05) were significantly lower among stunted children than those in the control group. Three major dietary patterns were identified: 'traditional dietary pattern' that was dominated by bread, potato, fats, eggs, flavours, vegetables other than leafy ones, sugar, drinks, and fast food; 'mixed dietary pattern' that was dominated by leafy vegetables, fast foods, nuts, fats, cereals other than bread, fruits, legumes, visceral meats, sugars, eggs, and vegetables other than leafy vegetables; and 'carbohydrate-protein pattern' that was dominated by sweets and desserts, poultry, dairy, fruits, legumes, and visceral meats. No significant relationships were found between traditional and mixed dietary patterns and stunting. Individuals in the third quartile of carbohydrate-protein dietary pattern were less likely to be stunted compared to those in the bottom quartile (OR: 0.31, 95% CI 0.13-0.78, p < 0.05). Adherence to dietary patterns high in protein (e.g. dairy, legumes, and meat products) and carbohydrates (e.g. fruits, sweets, and desserts) might be associated with reduced odds of being stunted among children.

Nutritional knowledge, attitude and practice of Tehranian adults and their relation to serum lipid and lipoproteins: Tehran lipid and glucose study

BACKGROUND/AIM

The high prevalence of non-communicable diseases and their risk factors among the general urban population of Tehran necessitates an urgent implementation of nutritional interventional programs to curtail these risk factors. This study aimed to provide preliminary data on the knowledge, attitude and practices of urban Tehranian adults regarding nutrition and their relation to major non-communicable disease risk factors and to assess the need for educational interventions.

METHODS

This cross-sectional study was performed within the framework of the second phase of the Tehran Lipid and Glucose Study (TLGS). Subjects were 826 individuals, 369 men and 457 women, aged 20-70 years old, selected randomly from among 15,005 participants in the TLGS. Knowledge, attitude and practices of subjects were assessed by a 'knowledge, attitude and practice' questionnaire; height, weight, waist and hip circumferences were measured, and BMI and waist to hip ratio were calculated. Biochemical data including fasting blood glucose, cholesterol, triglycerides and HDL-cholesterol were measured, based on standard protocols, and LDL-cholesterol was calculated. Associations between nutritional knowledge, attitude, practice, sex, age and educational level, and between knowledge, attitude and practice and BMI, waist to hip ratio and levels of lipid and lipoproteins, were determined.

RESULTS

For knowledge 26.5, 52.7 and 20.8%, for attitude, 27.6, 48.9 and 23.5% and for practice, 27.4, 51.7 and 20.9% of individuals had desirable, moderate and weak knowledge scores, respectively. With increases in educational levels, knowledge scores increased (p < 0.001). Attitudes of illiterate and poorly literate groups were weaker than those of other groups (p < 0.001). However, illiterate and poorly literate groups had higher practice scores as compared to middle school and high school graduates (p < 0.001). Mean practice scores of university graduates were higher than high school graduates (p < 0.05). Those aged 30-50 years had higher knowledge scores than older individuals (p < 0.001). LDL- and total cholesterol were correlated to practice scores (p < 0.001, r = 0.23). Subjects with borderline triglyceride levels had better practice scores than normal individuals (p < 0.001).

CONCLUSIONS

The findings revealed that age, educational level and gender are factors that can influence knowledge, attitude and practices, regarding nutrition. It is vital to develop approaches and implement programs to improve the nutritional practices of the population.