The status of clinical nutrition in hospitals of Guilan province, Iran — A mixed-method study / El estado de la nutrición clínica en los hospitales de la provincia de Guilan, Irán: estudio de método mixto

Background: nutritional therapy has an important role in the development of medical care services, and quantitative and qualitative assessments of the status of clinical nutrition in hospitals is crucial. This study aimed to explore the current status of clinical nutrition in hospitals of Guilan province, Iran. Methods: this quantitative-qualitative (mixed method) study was performed on public hospitals in Guilan province, Iran (n = 26). The required information was collected by visiting the hospitals and interviewing with hospital dietitians. The data collection tool had two quantitative and qualitative subscales. The quantitative subscale included a 21-item checklist containing information about the referral system, cooperation of hospital staff in clinical nutrition, clinical nutrition staff status, enteral nutrition, and parenteral nutrition. Results: in more than 55 % of hospitals the patients were not adequately referred to a dietitian. In about 31.2 % of hospitals, cooperation of other departments in the field of clinical nutrition was insufficient. In 37 % of hospitals with intensive care unit (ICU), enteral nutrition was not provided properly. Only 27 % of the hospital properly provided parenteral nutrition for their patients. The most important problems mentioned by hospital dietitians included noncompliance of the food services employers with recommended diets, insufficient number of hospital dietitians, and lack of per case payment method for dietitians. Coverage of diet services by health insurance was the most common suggestion of dietitians to promote diet therapy in public hospitals. (AU)

Antecedentes: la terapia nutricional tiene un papel importante en el desarrollo de los servicios de atención médica, y las evaluaciones cuantitativas y cualitativas del estado de la nutrición clínica en los hospitales son cruciales. Este estudio tuvo como objetivo explorar el estado actual de la nutrición clínica en los hospitales de la provincia de Guilan, Irán. Métodos: este estudio cuantitativo-cualitativo (método mixto) se realizó en hospitales públicos de la provincia de Guilan, Irán (n = 26). La información requerida se recopiló visitando los hospitales y entrevistando a los dietistas de los hospitales. La herramienta de recolección de datos tenía dos subescalas, cuantitativa y cualitativa. La subescala cuantitativa incluía una lista de verificación de 21 ítems que contenía información sobre el sistema de derivación, la cooperación del personal del hospital en nutrición clínica, el estado del personal de nutrición clínica, la nutrición enteral y la nutrición parenteral. Resultados: en más del 40 % de los hospitales, los pacientes no fueron derivados adecuadamente a un dietista. En el 35 % de los hospitales, la cooperación de otros departamentos en el campo de la nutrición clínica fue insuficiente. En el 55 % de los hospitales con unidad de cuidados intensivos (UCI), la nutrición enteral no se brindó adecuadamente. Ninguno de los hospitales proporcionó nutrición parenteral adecuada para los pacientes. Los problemas más importantes mencionados por los dietistas hospitalarios incluyeron el incumplimiento de los programas de alimentos por parte del empleador del sector alimentario, un número insuficiente de dietistas hospitalarios y la falta de pago de honorarios de consulta a los dietistas. La cobertura de los servicios de dietética por parte del seguro de salud fue la sugerencia más común de los dietistas para promover la dietoterapia en los hospitales. (AU)

The status of clinical nutrition in hospitals of Guilan province, Iran - A mixed-method study.

Introduction: Background: nutritional therapy has an important role in the development of medical care services, and quantitative and qualitative assessments of the status of clinical nutrition in hospitals is crucial. This study aimed to explore the current status of clinical nutrition in hospitals of Guilan province, Iran. Methods: this quantitative-qualitative (mixed method) study was performed on public hospitals in Guilan province, Iran (n = 26). The required information was collected by visiting the hospitals and interviewing with hospital dietitians. The data collection tool had two quantitative and qualitative subscales. The quantitative subscale included a 21-item checklist containing information about the referral system, cooperation of hospital staff in clinical nutrition, clinical nutrition staff status, enteral nutrition, and parenteral nutrition. Results: in more than 55 % of hospitals the patients were not adequately referred to a dietitian. In about 31.2 % of hospitals, cooperation of other departments in the field of clinical nutrition was insufficient. In 37 % of hospitals with intensive care unit (ICU), enteral nutrition was not provided properly. Only 27 % of the hospital properly provided parenteral nutrition for their patients. The most important problems mentioned by hospital dietitians included noncompliance of the food services employers with recommended diets, insufficient number of hospital dietitians, and lack of per case payment method for dietitians. Coverage of diet services by health insurance was the most common suggestion of dietitians to promote diet therapy in public hospitals. Conclusion: the situation of providing nutritional services to patients in public hospitals is not favorable in terms of quantity and quality in Guilan province, Iran. Designing the necessary policies and reorient the clinical nutrition system in hospitals to promote patients' health and accelerate patient recovery is warranted.

Introducción: Antecedentes: la terapia nutricional tiene un papel importante en el desarrollo de los servicios de atención médica, y las evaluaciones cuantitativas y cualitativas del estado de la nutrición clínica en los hospitales son cruciales. Este estudio tuvo como objetivo explorar el estado actual de la nutrición clínica en los hospitales de la provincia de Guilan, Irán. Métodos: este estudio cuantitativo-cualitativo (método mixto) se realizó en hospitales públicos de la provincia de Guilan, Irán (n = 26). La información requerida se recopiló visitando los hospitales y entrevistando a los dietistas de los hospitales. La herramienta de recolección de datos tenía dos subescalas, cuantitativa y cualitativa. La subescala cuantitativa incluía una lista de verificación de 21 ítems que contenía información sobre el sistema de derivación, la cooperación del personal del hospital en nutrición clínica, el estado del personal de nutrición clínica, la nutrición enteral y la nutrición parenteral. Resultados: en más del 40 % de los hospitales, los pacientes no fueron derivados adecuadamente a un dietista. En el 35 % de los hospitales, la cooperación de otros departamentos en el campo de la nutrición clínica fue insuficiente. En el 55 % de los hospitales con unidad de cuidados intensivos (UCI), la nutrición enteral no se brindó adecuadamente. Ninguno de los hospitales proporcionó nutrición parenteral adecuada para los pacientes. Los problemas más importantes mencionados por los dietistas hospitalarios incluyeron el incumplimiento de los programas de alimentos por parte del empleador del sector alimentario, un número insuficiente de dietistas hospitalarios y la falta de pago de honorarios de consulta a los dietistas. La cobertura de los servicios de dietética por parte del seguro de salud fue la sugerencia más común de los dietistas para promover la dietoterapia en los hospitales. Conclusión: la situación de la prestación de servicios nutricionales a pacientes en hospitales públicos no es favorable en términos de cantidad y calidad en la provincia de Guilan, Irán. Se justifica diseñar las políticas necesarias para reorientar el sistema de nutrición clínica en los hospitales y, en definitiva, promover la salud y acelerar la recuperación de los pacientes.

The effect of FTO rs9939609 polymorphism on the association between colorectal cancer and dietary fiber.

Background: Gene polymorphisms may explain the controversy on the association between colorectal cancer (CRC) and dietary fibers. The purpose of this study was to investigate the effect of fat mass and obesity-associated (FTO) rs9939609 polymorphism on the association between colorectal cancer and dietary fiber. Methods: This case-control study was conducted on 160 CRC cases and 320 healthy controls in Tehran, Iran. The participants' food intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). The frequency of rs9939609 FTO polymorphism in the case and control groups was determined using the tetra-primer amplification refractory mutation (tetra-ARMS) method. Results: In the participants with the TT genotype of the FTO rs9939609, the cases had higher BMI and lower intake of dietary fiber compared to the controls (P = 0.01). Among A allele carriers of FTO rs9939609 polymorphism, the cases had higher BMI (P = 0.04) and lower intake of total fiber (P = 0.02) and soluble fiber (P = 0.02). An inverse association was found between CRC and dietary fiber intake among those with the AA/AT FTO rs9939609 genotype after adjusting for age, sex, smoking, alcohol consumption, physical activity, BMI, and calorie intake (OR = 0.9, CI 95%:0.84-0.92, P < 0.05). Conclusion: This study found a link between higher dietary fiber consumption and a lower risk of CRC in A-allele carriers of FTO rs9939609 polymorphism. Future studies are needed to identify the underlying mechanisms of the association between CRC and dietary fibers in people with different FTO genotypes.

Association between dietary intake of fatty acids and colorectal cancer, a case-control study.

Background: The association of dietary fat and colorectal cancer (CRC) was frequently reported. However, few studies assessed the effects of different types of dietary fats on CRC. This study aimed to investigate the association between intakes of different types of dietary fatty acids with colorectal cancer risk. Methods: This case-control study was conducted on 480 participants including 160 CRC cases and 320 healthy controls in Firoozgar Hospital, Tehran, Iran. The intake of dietary fatty acids of the participants was assessed using a semi quantitative food frequency questionnaire (FFQ). Results: The mean intake of cholesterol (273.07 ± 53.63 vs. 254.17 ± 61.12, P = 0.001), polyunsaturated fatty acids (PUFA) (16.54 ± 4.20 vs. 15.41 ± 4.44, P = 0.012), and calorie (2,568.76 ± 404.48 vs. 2,493.38 ± 176.03, P = 0.006) was higher and the mean intake of oleic acid (5.59 ± 3.17 vs. 8.21 ± 5.46) and linoleic acid (6.03 ± 3.44 vs. 7.02 ± 4.08, P = 0.01) was lower in the case group compared to the control group. An inverse association was found between colorectal cancer (CRC) and dietary intake of oleic acid (OR: 0.85, CI 95% 0.80-0.90, P = 0.001), linoleic acid (OR: 0.85, CI 95% 0.78-0.93, P = 0.001), and α-linolenic acid (OR: 0.75, CI 95% 0.57-0.98, P = 0.04). The association remained significant after adjusting for age and sex, sleep, smoking, and alcohol consumption, and BMI. Conclusions: The results of this study support a protective effect of oleic acid, linoleic acid, and α-linolenic acid against CRC. Further longitudinal studies are warranted to confirm these results.

Relationship between breast cancer and dietary inflammatory index; a case-control study.

INTRODUCTION: Breast cancer is the leading cause of cancer-related mortality among women around the world. The relationship between the inflammatory potential of diet and breast cancer has been studied extensively, but results remain inconsistent. This study aimed to investigate the association between the dietary inflammatory index (DII) and odds of breast cancer. METHODS: This case-control study includes 180 women with breast cancer and 360 healthy women randomly selected from those referred to Shohadaye Tajrish hospital in Tehran, Iran. The DII scores were computed based on a 168-item food frequency questionnaire (FFQ) assessed based on dietary intake. After adjusting the potential confounders, logistic regression models were used to estimate multivariable odds ratios (ORs). RESULTS: The positive association was found between DII and breast cancer risk. A higher level of DII was associated with a higher risk of developing breast cancer after being adjusted for age (OR: 2.11, 95% CI: 1.01-4.46, P = 0.04). Additional adjustments for BMI, alcohol consumption, smoking, pregnancy number, abortion number, breastfeeding duration, menopause age, and total calorie intake did not change the results (OR: 5.02, 95% CI: 1.43-17.58, P = 0.01). CONCLUSIONS: Following a pro-inflammatory diet was associated with an increased risk of BC. Further longitudinal studies are warranted.

Efficacy of the omega-3 fatty acids supplementation on inflammatory biomarkers: An umbrella meta-analysis.

BACKGROUND: Existing meta-analyses on omega-3 polyunsaturated fatty acids and their anti-inflammatory effects have reported uncertain findings. The current umbrella meta-analysis aimed to assess the findings of multiple meta-analyses on the efficacy of n-3 PUFAs on inflammatory biomarkers in adults with different health conditions. METHODS: Using suitable keywords, articles published until December 2021 were searched in PubMed/Medline, Web of Science, Scopus, EMBASE, and Google Scholar. Meta-analyses investigating the impact of supplementation of n-3 PUFAs on inflammatory biomarkers in adults were included. We performed this meta-analysis using a random-effects model. RESULTS: Overall, 32 meta-analyses were qualified in this umbrella meta-analysis. Our findings demonstrated that the n-3 PUFA supplementation significantly reduced serum C-reactive protein (CRP) (ES = -0.40; 95 % CI: -0.56, -0.24, p < 0.001; I2 = 89.5 %, p < 0.001), Tumour necrosis factor α (TNFα) (ES = -0.23; 95 % CI: -0.37, -0.08, p = 0.002; I2 = 60.1 %, p < 0.001), and interleukin 6 (IL-6) concentrations (ES = -0.22; 95 % CI: -0.39, -0.05, p = 0.010; I2 = 66.2 %, p < 0.001). CONCLUSION: The current umbrella meta-analysis found that supplementation of n-3 PUFAs in adults can improve CRP, TNF-α, and IL-6 concentrations under various health conditions. n-3 PUFAs can be recommended as adjuvant anti-inflammatory agents.

The Association Between Different Types of Dietary Carbohydrates and Colorectal Cancer: A Case-Control Study.

Background: Several factors such as genetics and dietary intake are involved in the development of colorectal cancer (CRC). Higher intake of dietary carbohydrates may be associated with an increased risk of CRC. This study aimed to investigate the association between different types of dietary carbohydrates and CRC. Methods: This hospital-based case-control study was carried out from June 2020 to May 2021 on 480 randomly selected participants including 160 CRC patients and 320 healthy controls aged 35-70 years in Firoozgar hospital, Tehran, Iran. Dietary intake was assessed using Food Frequency Questionnaire (FFQ). Nutritionist IV software was used to determine the intake of calorie and various forms of dietary carbohydrates including total carbohydrate, simple sugar, glucose, fructose, galactose, sucrose, lactose, and maltose. Results: The average daily intake of calorie, carbohydrates, sugar, glucose, fructose, sucrose, and maltose were significantly higher among CRC cases compared to the controls (All P < 0.05). The logistic regression found significant associations between CRC with dietary intake of carbohydrates (OR = 1.009, CI 95%: 1.003-1.01, P = 0.002), sugar (OR = 1.02, CI 95%: 1.01-1.03, P < 0.001), glucose (OR = 1.06, CI 95%: 1.01-1.11, P = 0.009), fructose (OR = 1.31, CI 95%: 1.19-1.43, P < 0.001), sucrose (OR = 1.19, CI 95%: 1.12.-1.25, P < 0.001), maltose (OR = 9.03, CI 95%: 3.93-20.78, P < 0.001), galactose (OR = 1.31, CI 95%: 1.07-1.6, P = 0.008), and lactose (OR = 1.009, CI 95%: 1.01-1.18, P = 0.02). This association remained significant after adjustment for sex and age (except for galactose and lactose), and additional adjustment for sleep, tobacco, and alcohol level, and further adjustment for calorie intake and body mass index (BMI) (except for glucose). Conclusions: A positive association was found between CRC and dietary intake of carbohydrates, sugar, fructose, sucrose, and maltose. Following a low-carbohydrate, low-sugar diet may help prevent CRC. Future longitudinal studies are warranted to confirm these findings.

Association between the index of nutritional quality and lipid profile in adult women.

BACKGROUND: Dyslipidaemia is a group of abnormalities that predispose people to heart disease. The index of nutritional quality (INQ) is a tool for qualitative and quantitative nutritional assessment, which has special significance in assessing clinical nutritional problems. The objective of this study was to determine the association between the INQ and lipid profile in adult women. METHODS: This was a cross-sectional study on 360 healthy women referring to the nutrition clinic of Shohadaye Tajrish hospital, Tehran, Iran. Calorie and nutrient intake were assessed using a validated food frequency questionnaire. The amount of physical activity was estimated using a validated International Physical Activity Questionnaire. To measure serum lipid levels, 5 ml of venous blood samples was taken from the participants. RESULTS: The results showed a negative association between total cholesterol and the INQ of niacin (B = -0.110, p = .02) and between high-density lipoprotein cholesterol with the INQ of biotin (B = -0.119, p = .01). Also, a positive association was found between triglyceride and the INQ of B6 (B = 0.096, p = .04). The results remained significant after adjusting for body mass index, waist circumference and total energy intake (except for niacin). CONCLUSIONS: Findings of the present study suggest that a diet rich in niacin and low in vitamin B6 and biotin may be associated with an improved lipid profile that reduces lipid-related diseases such as fatty liver, metabolic syndrome and cardiovascular disease. Further studies are needed to confirm these findings and to identify the underlying mechanisms.

FTO genotype was associated with breast cancer in HER2 negative patients.

BACKGROUND: The fat mass and obesity-associated (FTO) gene may influence the risk of breast cancer (BC). The single nucleotide polymorphisms (SNPs) of FTO gene may exert different impacts on different types of BC. In this study, we investigated the association between FTO SNP rs9939609 and the status of estrogen receptor (ER), progesterone receptor (PR), P53, and human epidermal growth factor receptor-2 (HER-2) in BC patients. METHODS: Our case-control study was included 540 Iranian participants aged 35 to 70 (180 women with BC as the case group and 360 healthy controls). After genotyping for risk allele rs9939609 of the FTO gene, a logistic regression was applied to elucidate the association between FTO SNP rs9939609 and BC risk based on the receptor status. RESULTS: The number of HER-2 negative patients was significantly higher in FTO rs9939609 risk allele carrier group (61.5% vs. 41.4%, P < 0.05). A significant association was found between BC and rs9939609 FTO gene polymorphism only in HER2 negative BC patients (OR = 1.79, CI95%: 1.2-3.56, P = 0.03). No association was identified between FTO rs9939609 polymorphism and the status of ER, PR, and P53. CONCLUSION: We indicated that FTO SNP rs9939609 can be a potential therapeutic target particularly in HER-2 negative BC cases. The importance of this risk allele in BC pathogenesis needs to be further highlighted.