Nutrition and diabetes, cardiovascular and chronic kidney diseases: findings from 20 years of the Tehran lipid and glucose study

Context: the high prevalence of chronic diseases can be prevented or managed by specific changes in lifestyle patterns of individuals of which dietary factors is emphasized. The objective of this study was to review all findings of the Tehran Lipid and Glucose Study regarding validity and reliability of food frequency questionnaire [FFQ], evaluating dietary quality and association of dietary factors in relation to diabetes, dysglycemia, cardiovascular [CVD] and chronic kidney disease [CKD]

Evidence Acquisition: related documents were searched through PubMed and Scopus databases, in English language from 2000 to 2017. Finally, 52 relevant documents were eligible for inclusion in this review

Results: the FFQ proved to be an acceptable tool for assessing nutrient and food group intakes and rank individuals accurately according to the levels of their dietary intakes. After 8 years of follow-up, the western dietary pattern [DP] was fairly stable but there was instability of traditional Iranian DP. DPs of over two-thirds of Tehranian populations were not in accordance with the dietary recommendations. Higher dietary scores of variety and healthy DPs were also associated with reduced odds of dysglycemia. The main dietary factor related to increased risk of CVDin our population was western DP. Patterns of amino acid intakesmaycontribute to the development of CVD. Higher intakes of several micronutrients and macronutrients, DPs and some vegetables decrease the risk of CKD. In conclusion DPs of most Tehranian adults need improvement

Conclusions: this review showed that higher adherence to healthy food choices was associated with reduced odds of dysglycemia and CVD. Dietary sources of renal-protective nutrients should be encouraged among the general population

Nutrition and cardio-metabolic risk factors: findings from 20 years of the Tehran lipid and glucose study

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

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

Metabolic syndrome: findings from 20 years of the Tehran lipid and glucose study

Context: in recent decades, investigations have been focused on the definition, incidence and predictors of metabolic syndrome [MetS] in Iranians. This study aimed to review systematically investigations on MetS, conducted among the Tehran lipid and glucose study [TLGS] participants

Evidence Acquisition: literature on MetS documented by TLGS studies published from 2000 to 2017 were searched using Pubmed and Scopus database in English language with a combination of following keywords: Metabolic syndrome, TLGS

Results: the harmonized definition of MetS was confirmed, based on the estimated cut point of waist circumference [WC] >/= 95 cm for both genders in Iran. The incidence rate was 550.9/10000 person/years, lower among women [433.5/10000] than men [749.2/10000]. The prevalence of abdominal obesity, high triglycerides [TG], low high density lipoprotein cholesterol [HDL-C], high blood pressure [BP], and high fasting blood glucose [FBG] was 30, 46, 69, 34, and 12%, respectively. The prevalence of MetS in adolescents was 10.1% with no significant difference between boys and girls [10.3% in boys and 9.9% in girls]. A strong association of WC [OR: 2.32, CI: 2.06 - 2.59] and TGs [OR: 1.95, CI: 1.65 - 2.11] with development of MetS was found. In adolescent boys, WC had the highest OR for MetS risk. WHO-defined MetS was a significant predictor of total and cardiovascular mortality both in men [HR: 1.66, CI: 1.23 - 2.24; HR: 1.93, CI: 1.26 - 2.94] and women [HR: 2.01, CI: 1.39 - 2.88; HR: 2.71, CI: 1.44 - 5.09]

Conclusions: our results indicate high incidence of MetS in Tehranian adults and adolescents; high WC also appears to be a strong predictor of MetS. All definitions of MetS predicted cardiovascular disease

effect of interactions of single nucleotide polymorphisms of APOA1/APOC3 with food group intakes on the risk of metabolic syndrome

Background: the aim of this study was to examine the interaction of dietary food groups and genetic variants of APOA1/APOC3, relative to Metabolic Syndrome [MetS] risk in adults

Methods: in this matched nested case-control study, 414 MetS subjects and 414 controls were selected from among participants of Tehran Lipid and Glucose Study. Dietary intake was assessed with the use of a valid and reliable semi-quantitative food frequency questionnaire. Single Nucleotide Polymorphisms [SNPs], APOA1 [rs670, -75G>A and rs5069,+83C>T/APOC3 rs5128 C3238>G] were genotyped by the conventional polymerase chain reaction and restriction fragment length polymorphism

Results: the mean [SD] of age was 40.7 [13] and 41.2 [13] years in male cases and controls versus 44.0 [11] and 44.0 [12] years in female case and controls. A significant interaction between intake quartiles of the sugar group and APOA1 combined group [GA+AA/CT+TT] SNPs was found; The ORs for these genotype carriers were [1, 0.44, 0.36, 0.23; P trend<0.001] in quartiles of intake, relative to other combined genotypes [P interaction=0.02]. MetS risk appeared to be increased significantly in higher quartiles of sweet beverages and fish intakes in the GA+AA/CT+TT/CC genotypes of APOA1/APOC3 SNPs, compared to other genotypes [P interaction=0.01]. The combined effect of genotypes of APOC3/APOA1 showed further decrease in MetS risk in higher quartiles of sugar group intakes [OR: 1, 0.24, 0.26, 0.14, P trend=0.001] relative to other combinations [P interaction=0.008]

Conclusion: results obtained demonstrate that some dietary food groups [sugar, fish, and sweet beverages] modulate the effect of APOA1/APOC3 SNPs in relation to MetS risk

narrative review of obesity and its associated complications in Iranian women

Context: Obesity is a major public health problem worldwide. This review aimed at providing an updated overview of obesity in Iranian women and its associated complications

Evidence Acquisition: In this narrative review study, related systematic reviews or meta-analysis studies of high ranking journals conducted from 2000 to 2016 were searched in the PubMed, Medline, and Scopus with the following keywords: "women OR female" AND "weight OR overweight OR obesity", "risk factors OR complications", "reproduction OR cancer OR cardiovascular disease OR diabetes OR gestational diabetes OR maternal obesity OR fertility OR pregnancy OR polycystic ovary syndrome" OR management

Results: In Iran, women have shown a constantly higher risk of obesity compared to men. After a 9- year follow-up, the age-standardized incidence rate [95% CI] of diabetes was 10.1 [7.24 - 13.9] in women. The increases in overweight and obesity in menopausal women have an important role in endometrial, colon, and breast cancer. Obesity increases the risk of endometrial cancer 2.4 to 4.5 folds compared to the normal weight women. Maternal obesity increases the risk of gestational hypertension 4.5 to 8.7 times compared to normal weight women. An increasing number of obese women becoming pregnant is associated with short- and long-term maternal and child outcomes. The prevalence of childhood obesity in children of obese women aged 3 to 5 years increases up to 25%; and these children have an almost 6- fold chance of being obese in young adulthood. Weight reduction of obese women is accompanied with lower incidence of obesity complications. The most effective interventions are multiple behavioral management activities

Conclusions: Considering the large population of young people in Iran and the lack of any effective preventive policy, the burden of obesity and its associated outcomes will be problematic in the near future

Legume intake is inversely associated with metabolic syndrome in adults

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. 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 - Adult Treatment Panel III. 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 < 35]. 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% Cl: 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% Cl: 0.12-0.81, P < 0.05]. Legume intake is inversely associated with the risk of having MetS and some of its components

Fast food consumption in Iranian adults; dietary intake and cardiovascular risk factors: Tehran lipid and glucose study

Although fast food consumption has drastically increased in Iran in recent years; there is a paucity of data in relation to the association between fast food consumption, dietary intake, and cardiovascular risk factors. This study aims to determine fast food consumption status among young and middle-aged Iranian adults, and to assess its impact on dietary intake and cardiovascular disease [CVD] risk factors. This cross-sectional population-based study was conducted on 1944 young and middle-aged adults [840 men and 1104 women], who participated in the Tehran Lipid and Glucose Study [2006-2008]. We collected dietary data by using a validated 168 item, semi-quantitative food frequency questionnaire. Total fast food consumption was calculated by summing up weekly consumption of the most commonly consumed fast foods in Iran. Mean consumption of fast food was 161g/week [95% CI: 147-175] for young adults and 108 g/week [95% CI: 101-115] for middle-aged adults. Mean dietary intakes of energy, fat, saturated fat, cholesterol, sodium, meat, and soft drinks increased significantly [P < 0.05], while carbohydrate and refined grain consumption decreased [P < 0.01] across tertiles of fast food in both age groups. In young adults, dietary energy density and protein intake increased significantly [P < 0.01] where as intake of non-starchy vegetables and carotenoids decreased [P < 0.05]. In middle-aged adults dietary intakes of fiber, folate, calcium, and fruits significantly decreased across fast food tertiles [P < 0.05]. After adjustment for confounders, there was an association between fast food consumption and body mass index [BMI; beta = 0.104; P < 0.01] and waist circumference [WC; beta= 0.083; P < 0.01] in young adults, and serum triglycerides [beta = 0.072; P < 0.05], high density lipoprotein cholesterol [HDL-C; beta = -0.051; P < 0.05], and atherogenic index of plasma [beta = 0.056; P < 0.05] in middle-aged adults. The results show that increased consumption of fast foods is associated with poor dietary intake and some of the CVD risk factors in Iranian adults

[Comparison of trends in dietary pattern in Iran, Middle Eastern and North African countries from 1961 to 2005]

Nutrition transition is a global change in quality and quantity of dietary pattern and is the most important underlying cause of chronic diseases. The aim of this study was to determine the trend of dietary pattern in Iran, Middle East and North African countries and comparing them using the nutritional data of Food and Agriculture Organization of United Nations [FAO] between 1961 and 2005. Information relating to food availability in the studied countries was obtained by using food balance sheets of FAOSTAT. Per capita food consumption for each food group in each category was obtained by dividing the available per capita energy to total population. Regional differences and trends change were evaluated using SPSS software. During the 45 years of assessment, availability of energy and all food items [except for alcohol in Iran and North Africa and solid fat in Middle East] has increased significantly. In this periods in Iran, available energy from fruits, meat and oil has increased significantly, while energy from dairy and discretionary calorie has decreased [p<0.05]. In the Middle East region, grain and fruits contribution to energy intake has decreased and contribution of oil and meat to total diet has increased [p<0.05]. In North African countries, contribution of grain group to energy intake has decreased and contribution of meat, vegetables, milk and oils has increased significantly [p<0.05]. Iranian dietary habits has had some positive changes through increase in fruit intake and decrease in free sugar consumption; however, high energy intake and decreased in dairy consumption can predispose Iranians to increased risk of chronic diseases. High energy, free sugar, meat and dairy consumption in Middle East and North Africa show the shift in dietary pattern toward an unhealthy western diet. However, future investigations are suggested