Dietary Patterns in 1125 Iranian Women: Adequacy of Energy and Micronutrient Intakes and Weight Statuses.

Background: Women's nutrition status includes significant effects on their children and household health. The purpose of this study was to assess energy and micronutrient intake adequacy in Iranian women. Methods: This study was a part of the Urban HEART Study, which has jointly been developed by the World Health Organization (WHO) Centre for Health Development, Kobe, Japan. In total, anthropometric and dietary intake data were collected from 1125 women in southern Tehran municipality districts. A 24-h recall questionnaire was completed by the expert nutritionists and the participants' anthropometric statuses were assessed. Food intakes were calculated in grams per capita per day. Micronutrients and energy requirements were adapted from WHO/Food and Agriculture Organization (FAO) tables and Iran National Food Consumption Survey, respectively. Results: Nearly 71.5% of the women were overweight or obese [body mass index (BMI) ≥25 kg/m2]. Furthermore, 1.2% of the women were underweight (BMI <18.5 kg/m2), while 27.3% had normal weight (BMI = 18.5--24.9 kg/m2). The mean bread/cereal and vegetable intakes were significantly higher in obese group, compared to that in normal/under/overweight group (375.6 g/day ± 151.4, P = 0.05; and 331.4 g/day ± 227.5, P = 0.02), respectively]. Women in the lean group significantly consumed higher quantities of cakes/pastries and had the lowest calcium and iron adequacy ratios, compared to other groups (p = 0.001, P = 0.03, and P = 0.05, respectively). Conclusions: These findings suggest that Iranian women, especially those who reside in the southern areas of Tehran, need to change their dietary habits to maintain their health. Moreover, being under/normal weight does not necessarily mean following healthy diets.

The Effects of Vitamin D Supplementation on Lipid and Inflammatory Profile of Healthy Adolescent Boys: A Randomized Controlled Trial.

BACKGROUND: Deficiency of vitamin D, an anti-inflammatory micronutrient with some favorable effects on lipid profiles, has been found to be highly prevalent in adolescents. We aimed to investigate the effect of a school-based vitamin D supplementation regimen on the correction of vitamin D deficiency as well as lipid and inflammatory profiles of healthy adolescent boys. METHODS: In this randomized single-blind placebo-controlled trial, seventy-one healthy adolescent boys (age 17 years old) were recruited from one high school in Tehran, Iran, and randomly assigned to two groups. The supplement group received vitamin D pearls at a dose of 50,000 IU monthly for 6 months, this dose is indeed defined by the Ministry of Health in Iran for a potential national school-based vitamin D supplementation program. The other group was given placebo pearls for the same duration. Before and after the treatment, the serum levels of 25-hydroxy vitamin D (25(OH) D), parathyroid hormone (PTH), retinol, lead (Pb), the lipid profile and the inflammatory biomarkers were measured and compared. RESULTS: Between-groups statistical analysis showed that a dose (50,000 IU/month) vitamin D significantly increased the serum levels of 25-hydroxyvitamin D (25 (OH) D) (p < 0.001) and decreased serum levels of PTH (p = 0.003). No significant change was observed in serum levels of retinol and Pb. Between-group analysis revealed that the serum levels of TG (P = 0.001) decreased while an increase in serum levels of HDL (p = 0.021) was observed (p < 0.05). Both the within- and between-group analysis showed that serum tumor necrosis factor receptor 2 (TNFR2) concentration declined while serum interleukin-10 (IL-10) increased in response to vitamin D supplementation (p < 0.05). CONCLUSION: A supplementation regimen of (50,000 IU/month) vitamin D in a context with high rates of vitamin deficiency has shown positive impacts on the serum vitamin D, lipid profile and inflammatory biomarkers in healthy adolescent boys.

The Association of Vitamin D Status with Lipid Profile and Inflammation Biomarkers in Healthy Adolescents.

BACKGROUND: The association between vitamin D status and inflammatory biomarkers and lipid profile is not well known, especially in adolescents. Therefore, the aim of the current study is to investigate the association of vitamin D status with serum lipids and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, in male adolescents. METHODS AND MATERIALS: A sample of seventy-one high school male students, aged 17 years old, from a high school in Tehran were enrolled in the study. They were divided into four groups including group with serum vitamin D below 25 (ng/mL) (SVD < 25; n = 36), 25 and above (ng/mL) (SVD ≥ 25; n = 35), negative-hsCRP (n = 48), and positive-hsCRP (n = 23). Weight, height, body mass index, dietary intake, serum lipids, and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, were measured. RESULTS: In the (SVD < 25) group, the serum level of TNFR-2 was significantly higher compared to that in the (SVD ≥ 25) group. There was a significant negative association between serum TNFR-2 and vitamin D levels in the whole sample. We found significant lower levels of IL-10 in positive-hsCRP group compared to the negative-hsCRP group. In addition, there was a significant negative correlation between the serum vitamin D level and hsCRP in both hsCRP groups. The HDL level was lower in the (SVD < 25) group compared to that in the (SVD ≥ 25) group. Finally, there was a negative correlation between the serum HDL and hsCRP levels in the positive-hsCRP subjects. CONCLUSION: Based on the findings it can be concluded that serum vitamin D affects HDL and inflammation status. Although serum levels of HDL and inflammation status are both predictors of metabolic syndrome and cardiovascular disease, further studies are needed to prove it, especially in adolescents.

The Association between Household Socioeconomic Status, Breastfeeding, and Infants' Anthropometric Indices.

BACKGROUND: The growth, learning, and contribution to active life in the communities are better in well-nourished children, and various factors influence infants' feeding. In this study, we assessed whether household socioeconomic status (SES) affects infants' length-for-age, weight-for-age (indicators of health and nutritional status) and breastfeeding (BF) (a necessity for optimal growth and health) status. METHODS: In this cross-sectional study, 150 households with infants of 1-1.5 years old were interviewed on these variables: family size, dwelling ownership, duration of BF, exclusive BF (EBF) for 6 months, parents' age, parents' ethnicity, birth order, delivery type, and parents' education. Weight and length at 4 and 12 months were obtained from centers' records. To determine SES, we assessed total years of parents' education and household asset ownership by an index of nine owned assets. RESULTS: The average of 4-month length in the low SES group was significantly lower than the two others (P < 0.05). In middle socioeconomic group, duration of BF was significantly higher (19.5 ± 7.3 months vs. 18.0 ± 8.0 months in low and 17.5 ± 7.9 months in high SES groups) (P < 0.05). Comparing illiterate mothers, university degree holders and university students were 73% less likely to not having EBF. Moreover, those with middle SES showed to be about 40% less likely to not having EBF. CONCLUSIONS: Nutritional status, duration of BF, and EBF might be determined by household SES and maternal education. Therefore, these findings can be used to decide how to focus on appropriate target groups in family education planning to improve children's development to its most possible.

Healthy changes in some cardiometabolic risk factors accompany the higher summertime serum 25-hydroxyvitamin D concentrations in Iranian children: National Food and Nutrition Surveillance.

OBJECTIVE: To investigate seasonal variations of vitamin D status at different latitudes and if these changes are accompanied by corresponding variations in certain health parameters in children living in a broad latitudinal range in Iran. DESIGN: Longitudinal study. SUBJECTS: In total, 530 apparently healthy children aged 5-18 years were randomly selected from six regions of Iran with a latitudinal gradient from 29°N to 37·5°N. All anthropometric and biochemical assessments were performed twice during a year (summer, winter). High BMI (Z-score >1), low HDL cholesterol (150 mg/dl) were considered cardiometabolic risk factors. RESULTS: Serum 25-hydroxyvitamin D (25(OH)D) showed between-season variation, with significantly higher concentrations (mean (sd)) in summer v. winter (43 (29) v. 27 (18) nmol/l; P33°N v. <33°N: 4·5; 0·09, 9·0; P=0·04) were predictors of change of serum 25(OH)D between two seasons. CONCLUSIONS: Summertime improvement of vitamin D status was accompanied by certain improved cardiometabolic risk factors, notably serum TAG, total cholesterol and BMI, in children.

Vitamin D status and cardiometabolic risk factors across latitudinal gradient in Iranian adults: National food and nutrition surveillance.

BACKGROUND: This study aimed to evaluate the vitamin D status in an adult population across latitudinal gradient and to investigate its possible associations with certain cardiometabolic risk factors. METHODS: A total of 1406 healthy subjects aged 19-60 years were randomly selected from six regions of Iran across latitudinal gradient from 29° N to 37.5° N. Anthropometric and biochemical assessments were performed. The combination of high body mass index (>25 kg/m2), low high-density lipoprotein cholesterol (< 40 mg/dl in males and < 50 mg/dl in females) and high triglycerides (> 150 mg/dl) was defined as cardiometabolic risk factors. RESULTS: The mean concentration of serum 25-hydroxycalciferol (25(OH)D) was 26.8±17.7 nmol/l. There were no significant differences in the mean serum 25(OH)D levels among different latitudes. Undesirable vitamin D status (deficiency and insufficiency) was found in 90.7% of the subjects. After adjustment for age and gender, the association between weight status and serum 25(OH)D was significant ( p< 0.04, odds ratio:1.49; confidence interval: 1.01-2.19). The prevalence of cardiometabolic risk factors among the subjects with serum 25(OH)D less than 27.5 nmol/l was significantly higher than those with serum calcidiol concentrations above 27.5 nmol/l (13.3% vs. 10.0%, p = 0.033). CONCLUSION: Undesirable vitamin D status is highly prevalent among Iranian adults of both sexes irrespective of latitude and even in sunny regions. The occurrence of cardiometabolic risk factors was significantly higher in those subjects with circulating calcidiol concentrations below 27.5 nmol/l.

Methodology of the Comprehensive Program on Prevention and Control of Overweight and Obesity in Iranian Children and Adolescents: The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program.

BACKGROUND: The World Health Organization program on Ending Childhood Obesity (WHO-ECHO) has developed a comprehensive and integrated package of recommendations to address childhood obesity. The present study, entitled IRAN-ECHO, was designed and implemented in the framework of the WHO-ECHO program. METHODS: The IRAN-ECHO program is implementing multicomponent interventions by considering life course dimensions. The program has two parts: a population approach and an individual approach. The population approach considers different periods in life, including prenatal, infancy, childhood, and adolescence, as well as family and society. The individual approach targets those children or adolescents with overweight or obesity; this part is conducted as a referral system that is now integrated in the current national health system. As part of the population approach, a quasi-experimental study was conducted in six provinces to compare the status before and after implementing parts of the interventions. By intersectoral collaboration with different organizations, multicomponent interventions are conducted for different age groups. RESULTS: The IRAN-ECHO program is being conducted in six provinces, and will be considered in all provinces in the near future. Its main effects could be assessed in future years. Part of this program that was conducted as a quasi-experimental survey comprised 7149 students and showed that a high percentage of students had acceptable knowledge about adverse health effects of overweight and obesity. However, the knowledge about the low nutritional value of unhealthy snacks such as potato chips, puffs, industrial juices, and carbonated drinks was not appropriate. Many participants had the undesirable attitude of skipping one of the main meals when attempting to lose weight. CONCLUSIONS: The IRAN-ECHO program is presenting the feasibility of conducting the WHO-ECHO recommendations in Iran. The scope of potential policy recommendations to decrease childhood obesity is extensive and includes various elements. This program considers multisectoral interventions through population and individual approaches. The multicomponent interventions of this program address the obesogenic environment by considering the life course dimensions. It is expected that, by its life course interventions, it could help in primordial and primary prevention of noncommunicable diseases.

Vitamin D Status, Latitude and their Associations with Some Health Parameters in Children: National Food and Nutrition Surveillance.

BACKGROUND: Recent data indicate a role for vitamin D in many health aspects including anthropometric measures and blood lipid profiles. Dermal vitamin D synthesis may be influenced by latitude. However, the contribution of latitude in vitamin D status and its association with anthropometric and blood lipid measures in Iranian children have not been studied to date. METHODS: We used data from the National Food and Nutritional Surveillance Program. In total, 667 apparently healthy children aged 5-18 years were randomly selected from six provinces of Iran with different latitudes, from 29 to 37°. Weight, height, circulating 25-hydroxycalciferol; calcidiol [25(OH)D] and blood lipids were measured. RESULTS: In total, 16.7 and 4.1% of children were overweight or obese, respectively. The mean 25(OH)D concentration was 27.3 ± 17.6 nmol/l (95% confidence interval: 26.0-28.7 nmol/l). Over 93% of all children had suboptimal circulating calcidiol concentrations. Undesirable status of vitamin D, serum triglyceride and low-density lipoprotein were all more prevalent in children living in regions >33° latitude than those in <33°, significantly. There was no significant difference in duration of sun exposure between children living in latitudes below and above 33° (p = 0.093). In multivariate regression model, sex, latitude, body mass index for age z-score and sun exposure duration were independently related to 25(OH)D concentrations, but age was not. CONCLUSION: Despite significant association of latitude and vitamin D status, hypovitaminosis D is prevalent across latitude gradient in Iranian children. Our findings warrant immediate sustainable nutritional intervention, including supplementation, to protect children from hypovitaminosis D irrespective of the latitude of their residence.

Validation of Simplified Tools for Assessment of Sodium Intake in Iranian Population: Rationale, Design and Initial Findings.

BACKGROUND: The 24-hour urine sodium excretion is considered the gold standard method to estimate salt intake. However, since this method is not easy to perform, this study developed two instruments, including a semi-quantitative food frequency questionnaire (FFQ) and one spot urine sodium excretion, to assess sodium intake. These two methods were then compared with 24-h urine sodium excretion and twelve 24-h recalls during a year. METHODS: This study was performed on 219 healthy subjects aged ≥ 6 years in 2014-2015. The FFQ was completed twice, at baseline and one year thereafter, to examine the reproducibility of the FFQ. The validity of three spot urine sodium excretions in the morning, afternoon, and evening and FFQ for the assessment of sodium intake were compared against the 24-h urine sodium excretion method. Moreover, the validity of FFQ was examined against 24-h dietary recalls for the assessment of total sodium consumption and contribution of food groups to sodium intake. The content validity of the FFQ was estimated by an expert panel including 10 nutritionists. RESULTS: Based on their nutrients, the final food items were categorized into 11 groups including: 1) dairy products, 2) fruits, 3) vegetables, 4) meat and egg, 5) grains and legumes, 6) mixed dishes, prepared foods, and restaurant foods, 8) nuts and seeds, 8) oils and fats, 9) sauces and desserts, 10) drinks, and 11) others. CONCLUSIONS: Spot urine and a specific FFQ comprising 136 items were used to develop a method for the assessment of sodium intake and contribution of foods to its intake among the Iranian population. This method can be used in large-scale population studies at the national level.

A comparison of food pattern, macro- and some micronutrients density of the diet across different socio-economic zones of Tehran.

BACKGROUND: The consumption of low quality foods is common in low socioeconomic areas; and according to epidemiological studies, the density of nutrients often proves the quality of diet. This study aimed to compare the density of macronutrients and micronutrients in various parts of Tehran. METHODS: This was a cross-sectional study performed from September to December 2007 in all the 22 districts of the municipality of Tehran including 1,807 households. Experienced interviewers completed a 24-hour recall questionnaire. To estimate the nutrient densities, nutrient intake (grams or milligrams) was calculated per 1,000 kcal energy intake. To calculate the density of energy intake, energy intake (kcal) was divided by 100 g of foodstuff. The 22 districts of Tehran were divided into five zones of north, center, east, west and south. ANOVA and Tukey tests were used. RESULTS: The highest density of protein and fat intake was observed in the north of Tehran, while carbohydrate density was highest in the west, east and south zones, and energy density was highest in the south zone (p<0.05). Calcium and vitamin C had the highest density in the north of Tehran, and vitamin A and riboflavin had the highest density in the north and center of Tehran, and the lowest level in the south of Tehran (p<0.05). CONCLUSION: Despite the high density of energy in the south of Tehran, a deficiency of micronutrient intake was obvious, reflecting the importance of the impact of socioeconomic factors.

Economic inequality in nutritional knowledge, attitude and practice of Iranian households: The NUTRI-KAP study.

Background: Improper nutritional knowledge is one of the most important causes of nutritional problems, which can affect practice and cause more complications. The aim of this study was to assess the association between nutritional knowledge, attitude and practice (KAP) of Iranian households with socioeconomic status (SES). Methods: The study population was 14,136 households (57 clusters of 8 individuals in each province) who lived in urban and rural regions of 31 provinces of Iran. The sample size of the study was selected using multistage cluster sampling technique. A structured questionnaire and interview with the qualified person in each family was used to collect data. The questionnaire included demographic, SES and nutritional KAP questions. Using principle component analysis, some variables including household assets, occupation and education level of the heads of the families and respondents and the number of family members were used to construct family SES. The SES was categorized as good, moderate and weak. Pearson's Chi-square test was used to analyze categorical variables. Results: The percentage of knowledge about growing up, acquiring energy and being healthy as reasons for eating food was 24.1%, 44.8% and 54.7%, respectively. Only 69.7%, 60.5% and 52.5% of the participants had knowledge of identification of meat and legumes, grain and dairy group, respectively. More than 97% of the participants had a favorable attitude toward importance of nutrition in health. The nutritional knowledge linearly increased with increasing SES. Families with good SES significantly consumed more fruit, vegetable, dairy group, red meat, chicken and poultry, fish and egg while sugar consumption was significantly higher in families with weak SES (p<0.05). Conclusion: SES can influence the rate of nutritional KAP. Some policies should be considered to increase nutritional KAP especially in lower SES group in the society.

Community Interventional Trial (CITFOMIST) of Vitamin D Fortified Versus Non-fortified Milk on Serum Levels of 25(OH) D in the Students of Tehran.

BACKGROUND: As prevention of osteoporosis becomes more imperative with the global ageing of the population, establishing different measures to fight vitamin D deficiency will also become increasingly important. The aim of this study is to help assess the efficacy of vitamin D-fortified milk on circulating concentrations of 25(OH)D (as the primary outcome), a widely accepted indicator of vitamin D status, in Tehran students. Another objective of the protocol is to help assess the compliance with fortified dairy in students of different socioeconomic classes. METHOD: The cluster-randomized trial (CITFOMIST) is conducted on 15- to19-year olds guidance and high school students of both genders from different districts of Tehran, in wintertime. The schools enrolled in this study are randomly assigned to receive one of the three groups of milk (whole milk, milk that contained 600 IU Vit D/1000cc, or milk that contained 1000 IU Vit D /1000cc) for a 30-day period. In order to study the effect of vitamin D-fortified milk on the circulating concentrations of 25(OH) D, a serum vitamin D levels are checked in a subgroup before and after the intervention. CONCLUSION: There are few data on the efficacy of incremental doses of vitamin D from fortified foods among adolescents. This is while developing an optimal model to fight vitamin D deficiency needs further research on bone health outcomes and the safety of vitamin D-fortified products. The modified version of this protocol could be applied in different parts of the country to assess the efficacy of a vitamin-D product.

Nutritional knowledge, attitude and practice toward micronutrients among Iranian households: the NUTRI-KAP survey.

BACKGROUND: Healthy diet for maintaining a healthy weight and prevention of chronic disease is vital at all stages of life. The purpose of this study was to determine the nutritional knowledge, attitude, and practice among urban and rural households in Iran. METHODS: In this nation-wide study, 14,136 subjects were selected using a multistage cluster sampling method from 31 provinces of Iran. This study was on the households in rural and urban areas in Iran. Participants of this study were mothers or other members who were responsible for preparing meals for the whole family. Data were gathered by the questionnaire and the interview with the qualified person in each family. RESULTS: Frequency of knowledge about food source of calcium was between 11.6 and 64.7 %. Knowing of food source of zinc was about 12.8-16.7 %. Knowledge about of meat as source of iron was 50.9 and 46.5 % in regions of urban and rural, respectively. Positive attitude about preferring to use the full-fat dairy was about 25.1 % and negative attitude about this issue was 71.4 %; the positive attitude was slightly lower in rural areas than in urban areas. Respectively, frequency of using red meat in urban households was 10.8, 73.7, and 15.5 % as daily, weekly and rarely. Frequency of using daily of milk, yogurt and cheese was significantly lower in rural than in urban household. CONCLUSION: This national study indicates that in some cases there is a gap between knowledge and behavior among household of Iranian population.

Knowledge, attitude and practice of urban and rural households towards principles of nutrition in Iran: results of NUTRIKAP survey.

BACKGROUND: The aim of this study was to assess knowledge, attitude and practice of urban and rural households toward principles of nutrition in Iran. METHODS: The study population was Iranian households who live in rural and urban areas in all provinces of the country. The sampling method at households' level in each province was single stage cluster sampling with equal size clusters. The incumbent data was collected by a structured questionnaire and through the interview with the eligible subject in each household. RESULTS: A total of 14,136 Iranian households were selected as total sample size, 9,149 urban households, and 4,987 rural households. Around 57.2% of urban and 49.5% of rural households was aware of food groups. Respectively in urban and rural households, about 35.1% and 39.7% had correct knowledge toward roles of food groups. Approximately 41.5% and 39.9% of households had accurate knowledge about reason of food eating in urban and rural areas, respectively. The results showed that 79.6% of them had favorable attitudes. The most of the households consumed red meat and poultry weekly whereas fish was eaten rarely. Fruits, vegetables and dairy were consumed daily in the most of households. Sugar intake was daily in the most of households and cream and butter intake was weekly. CONCLUSION: The most of households had moderate knowledge and good attitudes. Practice of families about food consumption was good. The results of this study can be used for proper intervention for improving of health society.

Nutritional knowledge, attitude and practice of Iranian households and primary health care staff: NUTRIKAP Survey.

The aim of this study is to determine knowledge, attitude and practice of Iranian households and health staff on nutrition at province level. The sampling method in NUTRIKAP survey for households in each province is single-stage cluster sampling and the size of clusters is equal. The sampling method for health staff in each province is stratified random sampling. Samples are selected from physicians, health experts, health technicians, nutritionists and health assistants (Behvarz). Overall, 14136 people in 57 clusters in each province and 480 health staff over the country participate in this survey. The necessary data will be gathered by the structured questionnaire and the interview with the eligible person in each household. Data gathering from health staff will be carried out by self-administered questionnaire. The results of this study can help the bureau of community nutrition to provide the proper interventions to improve nutritional health of households.