Association between dietary intake of branched-chain amino acids and sarcopenia and its components: a cross-sectional study.

There is no previous study that investigated the association between dietary intake of total and individual branched-chain amino acids (BCAAs) and odds of sarcopenia. The present study aimed to examine the association between dietary intake of BCAAs and sarcopenia and its components among Iranian adults. The data for this cross-sectional study was collected in 2011 among 300 older people (150 men and 150 female) with aged ≥ 55 years. We used a Block-format 117-item food frequency questionnaire (FFQ) to evaluate usual dietary intakes. BCAAs intake was calculated by summing up the amount of valine, leucine and isoleucine intake from all food items in the FFQ. The European Sarcopenia Working Group (EWGSOP) definition was used to determine sarcopenia and its components. Mean age of study participants was 66.8 years and 51% were female. Average intake of BCAAs was 12.8 ± 5.1 g/day. Prevalence of sarcopenia and its components was not significantly different across tertile categories of total and individual BCAAs intake. We found no significant association between total BCAAs intake and odds of sarcopenia (OR for comparison of extreme tertiles 0.48, 95% CI 0.19-1.19, P-trend = 0.10) and its components (For muscle mass 0.83, 95% CI 0.39-1.77, P-trend = 0.63; for hand grip strength 0.81, 95% CI 0.37-1.75, P-trend: 0.59; for gait speed 1.22, 95% CI 0.58-2.57, P-trend = 0.56). After adjusting for potential confounders, this non-significant relationship did not alter. In addition, we did not find any significant association between individual BCAAs intake and odds of sarcopenia or its components. We found no significant association between dietary intakes of BCAAs and sarcopenia in crude model (OR 0.60; 95% CI 0.29-1.26). After controlling for several potential confounders, the result remained insignificant (OR 0.48; 95% CI 0.19-1.19). In this cross-sectional study, no significant association was observed between dietary intakes of total and individual BCAAs and odds of sarcopenia and its components.

The Relationship Between Food-Based Pro-inflammatory Diet and Sarcopenia: Findings From a Cross-Sectional Study in Iranian Elderly People.

Background: Sarcopenia has rarely been linked to Food-based Inflammatory Potential of the Diet (FIPD) in earlier studies. This study was performed to examine the association of FIPD and sarcopenia and its components. Method: In the cross-sectional research, dietary intakes of 300 randomly-selected elderly adults aged 55 years or older were collected through a validated food frequency questionnaire. We constructed FIPD score based on average consumptions of 28 food items. According to The European Working Group on Sarcopenia definition, sarcopenia and its components such as muscle strength, muscle mass, and gait speed were defined. Result: No significant difference was found between the prevalence of sarcopenia (P = 0.05), low muscle mass (P = 0.27), low handgrip strength (P = 0.72), and lower gait speed (P = 0.14) across tertiles of FIPD score. Moreover, we did not find significant differences among means of handgrip strength (P = 0.65), muscle mass (P = 0.33), and walking speed (P = 0.89) across FIPD categories. However, binary logistic regression analysis indicated a significant positive relationship between FIPD score and odds of sarcopenia; such that subjects in the top vs. those in the bottom FIPD tertile had 155% greater chance of having sarcopenia (OR: 2.55; 95% CI: 1.17-5.55). After controlling for all confounding factors, this association strengthened (OR: 2.67; 95% CI: 1.18-6.01). Conclusion: We found that greater FIPD score, which means a more pro-inflammatory diet, was positively linked with sarcopenia.

Food insecurity, dietary acid load, dietary energy density and anthropometric indices among Iranian children.

OBJECTIVES: Food insecurity significantly influences diet quality which in turn has an impact on individual health. This study aimed to determine the association of food insecurity, dietary energy density (DED), dietary acid load (DAL), and the anthropometric status of children. STUDY DESIGN: A cross-sectional study. METHODS: This study was conducted in 788 6-year-old girls who were referred to health care centers affiliated with Tehran University of Medical Sciences in the south of Tehran from October 2017 to March 2018. Food frequency questionnaires (168 food items) were assessed to calculate DAL and DED. Food insecurity was assessed using the 18-item United States Department of Agriculture questionnaire. Weight and height of children were measured as anthropometric indices. RESULTS: Protein and energy intake were higher in participants with a higher DAL and DED, respectively. Energy, fat, carbohydrate, fiber, potassium, phosphorus, calcium, iron, folate, vitamin B12, mono- and poly-unsaturated fatty acid intake was inversely related to DAL. Children characterized as food insecure were more likely to be defined as thin (OR 5.36; 95% CI 3.41-8.40) than overweight (OR 0.18; 95% CI 0.12-027) and obese (OR 0.28; 95% CI 0.08-0.98, respectively). There was no significant association between DED, potential renal acid load (PRAL), and food security status. Moreover, there was no significant association between anthropometric measure and PRAL. CONCLUSION: Findings from our study revealed that there was no association between DAL and food insecurity. However, food insecure children were more likely to be characterized as thin than children categorized as food secure. More studies need to be performed in both genders to confirm our findings. LEVEL OF EVIDENCE: Level V cross-sectional descriptive study.

Nutrition labels' strengths & weaknesses and strategies for improving their use in Iran: A qualitative study.

BACKGROUND: This study aimed to explain the strengths and weaknesses of the Traffic light label (TLL) and nutrition facts label (NFL) and the strategies for improving their use in Iran, based on the perspectives of different stakeholders, including mothers, food quality control experts (FQC), nutritionists and food industry experts. METHODS: We conducted 10 Focus Group Discussions (FGDs) with 63 mothers, 10 semi-structured interviews with FQCs, 1 FGD with 6 nutritionists and 1 FGD with 8 food industry experts. To clarify some of the questions that arose from the interviews, the researcher interviewed three policy makers who had sufficient information about the TLL. The discussions and interviews were transcribed verbatim and MAXQDA10 software was used for coding. RESULTS: The most important findings of this study based on different stakeholders' perspectives were as follows: mothers believed that nutrition labels reduced the consumption of high-calorie products, although they found the TLL to be easier to understand than the NFL because of its red color. However, their weaknesses were their incompatibility with culture and the lack of trust in the information provided by manufacturers. FQCs pointed out the possibility of changing formulations and the appropriateness of the traffic light for patients, but like mothers, they believed that the labels did not suit the governing culture. Further weaknesses were, misleading the consumer, problems in the colorings reported by different laboratories, and different approaches adopted by regulatory experts. The simplicity of understanding TLL for the general public has been suggested by some nutritionists. Nevertheless, the multiplicity of colors of the TLL was the most important weakness presented by nutritionists and food industry experts and the failure to implement nutrition labels was another issue raised by experts. To improve the use of nutrition labels, notification via media especially television, community education and culture building were suggested by all stakeholders. CONCLUSIONS: The findings of this study underscore the importance of implementing the policy of nutrition labeling in Iran. Mothers and nutritionists believed TLL to be more appropriate for the public to understand, however, FQCs and food industry experts believed that NFL was more suitable in guiding consumers toward healthy food choices. Education and information dissemination via media on interpretive TLL may affect consumer behavior toward food purchases.

Potential effect of different nutritional labels on food choices among mothers: a study protocol.

BACKGROUND: The prevalence of non-communicable diseases (NCDs) is increasing in the world. Healthy food choice and adequate physical activity are key factors in preventing NCDs. Food labeling is a strategy that can inform consumers to choose healthier foods at the point of purchase. In this study, we intend to examine the status of existing labels and to clarify their strengths and weaknesses. Then, for the first time in Iran, we will design a type of physical activity equivalent calorie label and will test it on some food groups of packaged products including dairy products, sweetened beverages, cakes, and biscuits. METHODS: This study will be conducted in two phases. In phase 1, nutrition fact labels and traffic light labels will be assessed through focus group discussions and interviews among different groups of mothers, industrialists and nutrition and food industry specialists as to determine strengths and weaknesses of the current labels on packaged products. Then, the initial layout of the physical activity calorie equivalent label will be drawn with respect to the viewpoints received from mothers. Thereafter, we will include the scientific opinions to it for creating the first draft of our new label. In phase 2, a total of 500 mothers of students 6-12 years old randomly assigned to five groups. The study groups will be as follows: (1) without nutrition label group, (2) current traffic light label group, (3) current traffic light label group in which, a brochure will be used to inform mothers, (4) physical activity calorie equivalent label group, and (5) physical activity calorie equivalent label group in which a brochure will be used to inform mothers. Some samples of dairy products, beverages, cakes, and biscuits will be presented. ANOVA and multiple linear regressions will be used to examine the association between the label type and the main consequence (energy of the selected products) and secondary outcome (time). DISCUSSION: The effect of the new food labels will be evaluated based on the differences between the calories of selected food groups. TRIAL REGISTERATION: Iranian Registery of Clinical Trials [IRCT]20,181,002,041,201 N1.

Food insecurity is an important risk factor for type 2 diabetes: a case-control study of new referrals to the University clinics, Shiraz, Southern Iran.

BACKGROUND: The prevalence of food insecurity (FI) as "the limited or uncertain availability of enough food for an always active and healthy life" and diabetes as "the most common metabolic disease" are rising in Iran. The aim was to assess the FI, depression, and socioeconomic status as risk factors for type 2 diabetes (T2D). METHODS: This case-control study was conducted on 135 patients with T2D as cases (99 females, 36 males, mean age 46.83 years) and 135 subjects without diabetes (89 females, 46 males, mean age 45.93 years) as controls. They had been referred to clinics of Shiraz University of Medical Sciences, Shiraz, Iran. The prior major inclusion criterion for diabetes was fasting blood sugar (FBS) ≥126 mg/dl. General, demographic, and socioeconomic characteristics and FI status were assessed using the general and 18-items United States Department of Agriculture (USDA) household food security questionnaires, respectively. Chi-square, t-test, and uni-and multi-variate logistic regression tests and SPSS16 statistical software were used. RESULTS: The prevalence of FI was 66.7% in cases and 41.5% in controls. According to final analysis model, FI (Odds Ratio [OR] = 1.9, P = 0.016), depression (OR = 2.0, P = 0.018), body mass index (BMI) ≥ 25 kg/m2 (OR = 1.8, P = 0.025), number of children ≥4 (OR = 1.7, P = 0.046), and having children under 18 years. (OR = 2.1, P = 0.011) were significant independent risk factors for T2D. CONCLUSION: The prevalence of FI in patients with T2D was significantly higher compared to the controls. FI was an important risk factor for T2D, even after controlling for the potential confounders. Further studies are suggested.

Revising the Comprehensive Feeding Practices Questionnaire Used in Planning Preventive Overweight, Obesity, and Underweight Programs for 2-5-year-old Children.

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

Second National Integrated Micronutrient Survey in Iran: Study Design and Preliminary Findings.

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

The Association of Household Food Insecurity and the Risk of Calcium Oxalate Stones.

PURPOSE: Food insecurity has been defined as 'limited or uncertain availability of nutritionally adequate and safe foods', which associated with adverse health consequences in human. Another alarming condition, which is related to several comorbidities is kidney stone. This study aimed to determine the association of household food insecurity and developing kidney stones (calcium oxalate) in adults referred to medical centers of Babol. MATERIALS AND METHODS: This case-control study included 200 participants 18-65 years of ages (100 cases, 100 controls). An 18-items food insecurity questionnaire (USDA), a valid and reliable 147-item food frequency questionnaire (FFQ) and demographic characteristics were obtained via interviewing. RESULTS: Sixty eight percent of cases and 40% of controls were food insecure, respectively. Food insecurity was significantly associated with the risk of kidney stone (P < .05). Furthermore, body mass index (BMI) and family history of kidney stone were significantly associated with the risk of kidney stones (P < .05). CONCLUSION: Food insecurity and BMI were significantly associated with the kidney stone, which shows the importance of availability of nutritionally adequate and safe foods in prevention of the kidney stone.

The Relationship between Food Insecurity and Esophageal and Gastric Cancers: A Case-Control Study.

BACKGROUND: Food insecurity is defined as the limited or uncertain availability of enough food for permanent active and healthy life. Upper gastrointestinal (GI) cancers (esophagus and stomach) are one of five most common cancers in Iran. This study aimed to determine the association of food insecurity and upper GI cancers in newly diagnosed patients. STUDY DESIGN: Case-control study. METHODS: Overall, 120 patients with upper GI cancers as cases and 120 patients with orthopedic, ear-nose-throat (ENT), and neurologic diseases as controls were recruited from Imam Khomeini Hospital, Tehran, Iran in 2013. The patients were newly diagnosed using endoscopy or imaging or biopsy methods. They were individually matched for age, sex, and residential area. The general and United States Department of Agriculture (USDA) household food security questionnaires were completed. The univariate and multivariate conditional logistic regression tests were applied using the Stata 11SE statistical software. RESULTS: The food insecurity prevalence was 69.2% and 43.3% in cases and controls, respectively. Food insecurity, low economic level and family history of cancer were significantly associated with cancer (P<0.05). CONCLUSIONS: Food insecurity was one of the important risk factors for upper GI cancers that health care providers should consider it.

Nutritional status of women with gestational hypertension compared with normal pregnant women.

BACKGROUND: Some evidence indicated the role of nutrition in the development of hypertensive disorders of pregnancy. METHODS: This case-control study was conducted on 113 women with gestational hypertension and 150 healthy pregnant women referred to Shahid Akbarabadi Hospital in Tehran. A demographic questionnaire was filled out for all participants. A validated semi-quantitative food frequency questionnaire was used to assess the dietary intakes of the study subjects. All nutrients were adjusted for total energy intake. Logistic regression was used to find the association of energy and nutrient intakes with gestational hypertension. RESULTS: We found that higher intakes of energy (OR, 1.33; 95% CI: 1.17-1.52), monounsaturated fatty acids (OR, 1.34; 95% CI: 1.03-1.74) and polyunsaturated fatty acids (OR, 1.26; 95% CI: 1.00-1.54) were positively associated with the risk of gestational hypertension after adjustment for confounders. We also observed decreased odds of gestational hypertension with increased intakes of vitamin C (OR, 0.87; 95% CI: 0.81-0.94), potassium (OR, 0.45; 95% CI: 0.28-0.71) and magnesium (OR, 0.68; 95% CI: 0.51-0.89). CONCLUSION: This study demonstrates higher intakes of energy, monounsaturated fatty acids and polyunsaturated fatty acids as well as lower intakes of vitamin C, potassium and magnesium are positively correlated with the risk of developing gestational hypertension.

Oxidative stress among non-anemic adults following flour fortification with iron: baseline data.

BACKGROUND: It has been suggested that food fortification might be an inexpensive, simple and effective way to control and prevent iron deficiency and its related anemia in many countries. Despite the advantages of this approach and the fact that it has been implemented in some provinces in Iran for more than 6 years, many scientists in the country worry about the negative aspects of the extra iron distributed among non-anemic persons in the community. OBJECTIVE: This study was designed to assess the effect of the flour fortification program on oxidative stress biomarkers and iron status among non-anemic 40- to 65-year-old adults. STUDY DESIGN: This study had a special design that was implemented in 3 different parts. The main and first part was a field study. We randomized 2 cities in 1 province. In each city, 200 volunteers (100 men and 100 women) were selected using a multi-stage stratified method. Examination and interview (filling out data collection forms) were the methods of data gathering. In each of the 3 phases, demographic, anthropometric, blood pressure, micro- and macronutrient intakes, physical activities, and some oxidative stress biomarkers were the main data that were gathered. The results of this study can help health policy makers in designing future interventions in the country based on food fortification.