Dietary diversity and iron deficiency anemia among a cohort of singleton pregnancies: a cross-sectional study.

BACKGROUND: Iron deficiency anemia (IDA) is considered one of the most common medical disorders observed during pregnancy. In low- and middle-income countries (LMICs), anemia and micronutrients deficiencies among pregnant women are associated with low consumption of animal products, monotonous starchy-diets, and seasonal consumption of vegetables and fruits. METHODS: A cross-sectional study was conducted with 198 pregnant mothers aged between 19-45 years who visited the antenatal care clinics in Northern Jordan to document the prevalence of IDA and to describe the associations between dietary diversity, diet quality scores and oral iron supplementation with the pregnant women iron status. Participants were stratified into three groups by gestational age (n = 66 women per group). Gestational age, blood parameters, minimum dietary diversity score (MDD-W), and prime diet quality score for healthy (PDQSHF) and unhealthy foods (PDQSUF) were assessed using 24- hour dietary recall. RESULTS: Prevalence of mild to moderate anemia was 27.8% among pregnant women. Third-trimester pregnant women were most affected. 52.5% have depleted iron stores (ferritin < 15 ng/ml), of them 30.8% have iron deficiency, and 21.7% have IDA. The (M ± SD) of the MDD-W, PDQSHF, and PDQSUF were 4.8 ± 1.6, 12.8 ± 3.9, and 7.2 ± 2.8 respectively. 52.5% achieved the MDD-W, 68% consumed < 4 servings/week of healthy food groups, and 50% consumed > 4 servings/week of unhealthy food groups. Mothers with higher MDD-W and PDQS had higher Hb and serum concentrations. Those taking iron supplements had significantly (p = 0.001) higher means of Hb, serum ferritin, and gestational weight gain. Significant differences were also found between PDQSHF, PDQSUF and the first and third trimester. CONCLUSIONS: Mild to moderate IDA is prevalent among pregnant mothers, especially in the third trimester. However, the prevalence of IDA among Jordanian pregnant women is lower than the global average. A high-quality, diverse diet, combined with oral iron supplementation and food fortification with iron, will help improve iron status, prevent anemia, and reduce its prevalence.

Dietary Intake Is Not Associated with Body Composition nor with Biochemical Tests but with Psychological Status of Cancer Patients Receiving Chemotherapy.

Chemotherapy can negatively affect cancer patients' eating patterns, psychological status, body composition, and quality of life. In this study, we aimed to investigate the correlations between dietary intake/care and the psychological status of cancer patients treated with chemotherapy. An observational study was conducted on 75 participants during their first cycle of chemotherapy treatment, and they were followed up for three cycles. Each participant completed a reliable validated questionnaire, psychological questionnaire, quality of life questionnaire, and three-day food records. Dietary intake was considered adequate if there was an adherence of participants to dietary recommendations offered by the dietitian and was confirmed by ESHA analysis software (version 10.6.3). Seventy-five percent of participants had inadequate nutrition intake. All anthropometric measurements decreased after 2 months of chemotherapy regardless of patients' dietary intake. Approximately half of the participants reported depression and anxiety. There were significant differences between all nutrient intake levels when compared to the recommended dietary allowance except for fat, unsaturated fatty acids, and iron. Also, there were associations between nutritional intake and life quality and depression. In conclusion, poor dietary intake was associated with depression and insufficient macro- and micronutrient intake. Emotional and nutritional support from healthcare providers and family are highly necessary.

Sex disparities in food consumption patterns, dietary diversity and determinants of self-reported body weight changes before and amid the COVID-19 pandemic in 10 Arab countries.

Background: The COVID-19 pandemic along with its confinement period boosted lifestyle modifications and impacted women and men differently which exacerbated existing gender inequalities. The main objective of this paper is to assess the gender-based differentials in food consumption patterns, dietary diversity and the determinants favoring weight change before and amid the COVID-19 pandemic among Arab men and women from 10 Arab countries. Methods: A cross-sectional study was conducted based on a convenience sample of 12,447 households' family members (mean age: 33.2 ± 12.9; 50.1% females) and information from participants aged 18 years and above was collected about periods before and during the pandemic. Results: Findings showed that, during the COVID-19 period, the dietary diversity, declined by 1.9% among females compared to males (0.4%) (p < 0.001) and by 1.5% among overweight participants (p < 0.001) compared to their counterparts. Conclusions: To conclude, gender-sensitive strategies and policies to address weight gain and dietary diversity during emergent shocks and pandemics are urgently needed in the region.

Dietary intake and lifestyle practices of eastern mediterranean postpartum women before and during COVID-19 pandemic: An internet-based cross-sectional survey.

Background: During the lockdown period, a substantial group of these women reported lifestyle changes. Aim: The aim of the study is to characterize the dietary patterns, intake and the adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Eastern Mediterranean postartum women. Methods: An internet-based cross-sectional survey was used to collect the data. The survey was carried out among 1,939 postpartum women from five countries from the Eastern Mediterranean region. Change in dietary intake from the five food groups and the adherence to USDA's daily recommendations were assessed. Findings: There was a significant increase in the mean (SD) consumption of all the food groups, including bread, rice, and other cereals, fruits, vegetables, milk and milk products, white and red meat, and nuts during the pandemic. Around 84% of participants reported no/low adherence (0-2) to USDA guidelines, whereas only 15% reported moderate or high adherence (3-5) to the guidelines before the pandemic. However, there was an increase in the proportion of subjects reporting moderate/high adherence (22%) during the pandemic. Discussion and conclusions: A substantial proportion of our study participants reported a lower dietary intake than the recommended amounts, and low adherence to the five food groups. Reasonable and applicable actions should be taken to protect postpartum women and their children from the effects of low dietary intake, particularly during pandemics and lockdowns. More researches are needed to identify the modifiable factors which could improve the nutritional status of the postpartum women during the pandemic.

Are STK11 polymorphisms a predictor of the response to metformin in polycystic ovarian syndrome?

The aim of this study was to determine the frequencies of different genetic Serine threonine kinase 11 (STK11) variations in women with PCOS and to evaluate possible associations between the genetic polymorphisms of the STK11 gene and the response to metformin in women with polycystic ovary syndrome (PCOS). A prospective longitudinal cohort study of 57 women with PCOS was conducted. The anthropometric measurements, menstrual history, hirsutism, hair loss, acne, and biochemical parameters, in addition to gene testing for STK11 polymorphisms, were documented. Follow-up was arranged after 6 menstrual cycles whilst on oral metformin therapy, (850 mg, twice daily). Of the 120 women who were interviewed, 88 women fulfilled the inclusion criteria and 57 women completed the study. The mean age, weight, height, and BMI were 23.8 years old, 72.1 kg, 159 cm, and 28.6 kg/m2 respectively. The frequencies of the genotypes of intron 1 of the STK11 gene were 26% CC, 44% CG, and 30% GG, and of intron 6 were 52% CC, 37% CT, and 11% TT genotype. There were statistically significant improvements following metformin therapy in menstrual frequency, blood loss, acne, ultrasound findings, and a decrease in BMI, acne, and hirsutism, but not in alopecia. Fasting insulin decreased significantly, but fasting blood sugar did not. There were no significant statistical differences in relation to the LH/FSH ratio, estradiol, FT, 17 OHP and length of menstruation. In relation to the SKT11 gene polymorphisms and metformin administration, there were variable and mostly insignificant differences in the results regarding menstrual regularity, amount of menstrual blood loss, acne, alopecia, ultrasound findings, and hirsutism score. There was a significant difference in relation to alopecia in the Intron 1 subgroups, and in relation to hirsutism score in the Intron 6 subgroups. It was concluded that polymorphisms in the STK11 gene in either Intron 1 or Intron 6 were not predictive of the response to metformin therapy at a dose of 850 mg twice daily, but may have some effect on alopecia and hirsutism.

Adherence to the United States Department of Agriculture Dietary Recommendations Pre- and During the Coronavirus Disease-19 Pandemic Among Pregnant Women in Arab Countries.

During pregnancy, woman's diet is one of the most preeminent factors affecting mother and child's health. Prior to the coronavirus disease-19 (COVID-19) pandemic, inadequate maternal diet and low adherence to dietary guidelines was reported among pregnant women in the Arab countries. Nowadays, COVID-19 infection during pregnancy is widely discussed among literature. However, there is limited data on the health impacts of the COVID-19 pandemic on non-infected pregnant women. This substantially larger group also suffered significant lifestyle changes during the lockdown period. The aim of the study is to characterize dietary patterns, intake and adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Arab pregnant women. Using a specially designed questionnaire and using the snowball sampling method, the survey was carried out among a convenient sample of 1,939 pregnant women from five Arab countries. Our study found an increment in the consumption of cereals, fruits, vegetables, dairy products, meats, and nuts that occurred during the pandemic compared to the preceding period. Despite this noticeable increase during the pandemic, the Arab pregnant women in this study had significantly lower adherence to the USDA pregnancy guidelines. The daily consumption of almost all food groups was lower than the USDA's daily recommendations, except for fruits intake, which was higher than the daily standard. Demonstrated poor adherence to prenatal USDA dietary guidelines by Arab pregnant women can lead to numerous deficiencies and health risks among their offspring. In conclusion, our study showed that before and during the COVID-19 pandemic, poor adherence to dietary recommendations occurred in a considerable number of Arab pregnant women. The findings emphasize the need for nutritional education and intervention during prenatal visits.

Protein Intake Among Patients with Insulin-Treated Diabetes is Linked to Poor Glycemic Control: Findings of NHANES Data.

Background: Nutrition therapy is considered a key component of diabetes management. Recently, high-protein diets have gained in popularity. Understanding the glycemic effect of dietary protein among patients with diabetes has been of particular interest. Methods: This study is based on NHANES data of 990 participants aged 40 years and older from the NHANES cohorts of 2011-2012 and 2013-2014 surveys. Glycosylated hemoglobin (HbA1c level) was used as indicator of glycemic control. Patients were categorized into quartiles for daily protein intake. Average protein intakes for patients in quartile 1 to quartile 4 were 35.5 g, 58.7 g, 79.9 g, and 131.6 g, respectively. Covariates included in the analysis were gender, age, race, caloric intake, muscle strength, education, income, smoking, sedentary lifestyle, alcohol consumption, and BMI. Results: After controlling for covariates, patients in quartile 4 of protein intake had 261% increased risk of poor glycemic control compared with those in quartile 1 (95% CI: 1.29-5.30). The association was not attenuated after further control for insulin use (OR = 1.94; 95% CI: 0.89-4.24). In conclusion, higher protein intake seems related to a worse glycemic control in diabetic subjects.

Health-Risk Behaviors and Dietary Patterns Among Jordanian College Students: A Pilot Study.

Background/Aims: Health promotion and the incorporation of health-protective behaviors in people's lifestyles have a great role in enhancing individuals' overall health and well-being. College students are at increased risk of developing unhealthy dietary and lifestyle behaviors. A cross-sectional pilot study was conducted to assess the health-risk behaviors among undergraduate college students at Jordan University of Science and Technology. Methods: The final sample included 136 students, with a mean age of 21.1 ± 2.37 years, mostly females (69%). A self-reported questionnaire was used for data collection about dietary and lifestyle behaviors among college students. The questionnaire consisted of four parts: sociodemographic characteristics, body weight classifications, lifestyle behaviors, and dietary patterns and intake, and eating behaviors. Results: Most of the students did not meet the daily recommendations for fruit (76%) and vegetable (82%) intake. Males were significantly consuming fast food more frequently (p = 0.019), and smoked cigarettes (p < 0.001) or hookah (p = 0.015) more frequently than did females. Further, the majority met the recommendations for physical activity (81%), but exceeded recommendations for sedentary behavior. Females were more likely to have normal weight or be underweight (OR = 4.865), to have a fear of weight gain (OR = 3.387), and to have the recommended sleeping hours (OR = 7.685) than were males. Conclusion: The results indicate the health-risk behaviors and the gender-related differences among college students.

Androgens and hirsutism score of overweight women with polycystic ovary syndrome improved after vitamin D treatment: A randomized placebo controlled clinical trial.

BACKGROUND & AIM: The objective of this study was to investigate the effect of vitamin D treatment on androgen levels and hirsutism scores in overweight women with PCOS. METHODS: A prospective, randomized, double-blind, placebo-controlled clinical study was conducted at King Abdullah University Hospital in Irbid, Jordan. Overweight Jordanian females aged 18-49 years with vitamin D deficiency and PCOS (n = 60) were assigned to two groups: the treatment group (n = 30) who received 50,000 IU per week of vitamin D3 and the control group (n = 30) who received a placebo. RESULTS: After receiving the treatment for 12 consecutive weeks, the levels of total testosterone, parathyroid hormone, free androgen index, and hirsutism score were significantly decreased (P < 0.001), and the levels of 25-hydroxyvitamin D (25(OH)D), sex hormone binding globulin, and phosphorus were significantly increased (P < 0.05). Furthermore, significant changes were observed in ovarian volume and follicle numbers and size ultrasonography, and in the regularity of the menstrual cycle (P < 0.001). In the placebo group, no significant changes were observed in either androgen levels, hirsutism score, or menstrual regularity. CONCLUSION: Vitamin D3 at a treatment dose of 50,000 IU per week improved 25(OH)D levels and decreased the hirsutism scores and androgen levels of overweight women with PCOS. These results could mean increased fertility and better reproductive health for overweight women with PCOS; the use of vitamin D3 as a treatment for these patients should be further investigated. CLINICALTRIALS. GOV REGESTRATION NUMBER: NCT02328404.

Incidence and impact on prognosis of impaired kidney function in Middle Eastern patients undergoing percutaneous coronary intervention: results from the first Jordanian PCI Registry.

Aims: The aim of this study was to evaluate the impact on prognosis of renal impairment (RI) in Middle Eastern patients after percutaneous coronary intervention (PCI). Methods and results: PCI patients (N=2,426) were divided into three groups according to the estimated glomerular filtration rate (eGFR, ml/min/1.73 m2): normal renal function (eGFR ≥90), mild RI (eGFR 60-89), or moderate to severe RI (eGFR <60). Mean age of participants was 56±11 years. Normal renal function was present in 41.6%, mild RI in 44.2%, and moderate to severe RI in 14.2%. Patients with moderate to severe RI were older and had higher prevalence of hypertension and diabetes mellitus compared with other patients (p≤0.002). At one year, patients with moderate to severe RI had a higher incidence of cardiac mortality (3.78%) compared with patients with mild (1.77%) or no RI (1.49%), p=0.03. In multivariate analysis, moderate to severe RI was associated with higher one-year cardiac mortality compared to mild or no RI (odds ratio=3.7; 95% CI: 2.8-5.0, p=0.001). Conclusions: Impaired renal function was present in about six out of 10 Middle Eastern patients undergoing PCI. Moderate to severe RI carries a higher risk of cardiac mortality at one year compared with mild or no RI.

Vitamin D3 prevents cardiovascular diseases by lowering serum total homocysteine concentrations in overweight reproductive women: A randomized, placebo-controlled clinical trial.

Obesity and overweight are associated with vitamin D deficiency and hyperhomocysteinemia, all of which are contributing factors for developing cardiovascular disease (CVD). Therefore, we hypothesized that improving serum 25-hydroxyvitamin D [25(OH)D] levels may decrease the body weight and total homocysteine concentrations among overweight reproductive women. To test our hypothesis, a randomized, double-blind placebo-controlled clinical trial, registered under ClinicalTrials.gov Identifier No. NCT03310307, was conducted on 100 overweight reproductive women that were allocated into two groups, namely, the treatment group (n = 50), which received 50 000 IU vitamin D3 per week, and the placebo group (n = 50), and followed for 2 months. Participants' 25(OH)D, homocysteine, parathyroid hormone, calcium, phosphorus, body weight and body mass index (BMI) were measured and compared before and after treatment. The results showed that there was a significant decrease in homocysteine levels after the first and second months of vitamin D3 intervention in the treatment group, and no significant changes were seen in the placebo group throughout the period of follow up. Statistically significant (P ≤ .05) reductions in homocysteine concentration, body weight, BMI, and parathyroid hormone levels were noticed in the treatment group compared to the placebo. Meanwhile, 25(OH)D, calcium and phosphorus levels were statistically significantly (P ≤ .05) increased in the treatment group. In conclusion, vitamin D3 intervention with a treatment dose of 50 000 IU per week for at least 2 months can help decrease BMI and homocysteine levels, which in turn will help prevent or minimize the risk of CVD among overweight women of reproductive age.

Assessment of body weight, maternal dietary knowledge and lifestyle practices among children and adolescents in north Jordan.

OBJECTIVE: To estimate the prevalence of overweight and obesity among children and adolescents in north Jordan and to evaluate the dietary knowledge of their mothers. DESIGN: Cross-sectional study.SettingsSchools, Irbid, Jordan. SUBJECTS: Male and female participants (n 516) aged 6-18 years. RESULTS: Thirty per cent of our sample population was overweight or obese, and about 11 % was underweight. Males tend to have a higher BMI and waist circumference than females except in the age group ≥15 years. Children who ate in front of the television tended to have higher BMI and waist circumference. Forty per cent of the mothers answered four or more questions correctly out of six, which indicated a sufficient level of nutritional knowledge. CONCLUSIONS: The study revealed that obesity is a growing health problem in children and adolescents in north Jordan. This finding is considered a serious concern for public health and calls for the creation of new prevention programmes at the individual, family and community level.

Total homocysteine is positively correlated with body mass index, waist-to-hip ratio, and fat mass among overweight reproductive women: A cross-sectional study.

Conflicting associations between total homocysteine (tHcy), body mass index (BMI) lean body mass, and fat mass in the general population have been reported. We investigated the hypothesis that elevated tHcy levels are associated with increased BMI, waist-to-hip ratio (WHR), and body fat mass percent. In Jordan, obesity and overweight are prevalent among reproductive women and hyperhomocysteinemia, along with obesity and overweight, are independent risk factors for cardiovascular diseases. The participants used in this cross-sectional study were 325 overweight Jordanian women aged between 18 and 49 years old. The main outcome measures were tHcy, BMI, WHR, fat mass, fat-free mass, and total body water. Serum tHcy was analyzed using a liquid chromatography tandem mass spectrophotometry (LC-MS/MS) complete kit. The body compositions were measured using a bioelectrical impedance analyzer. Study participants were stratified according to their tHcy level into two groups, ≤10 µmol/L and >10 µmol/L, and the difference between mean values of body compositions was evaluated. The tHcy was significantly and negatively correlated with age, fat-free mass, and total body water, and significantly and positively correlated with BMI, hip circumference, WHR, fat mass, and dry lean weight. The chi-square and the independent sample t-tests showed statistically significant (P ≤ .05) differences between tHcy and BMI, WHR, fat and fat-free mass, and total body water percentages. In conclusion, BMI, WHR and body fat mass were found to be associated with elevated tHcy levels among overweight reproductive women, and they might be used as independent predictors of the tHcy level.

Fetal weight normograms for singleton pregnancies in a Jordanian population.

BACKGROUND AND OBJECTIVES: Estimated intrauterine fetal weight (EIUFW) is important for reducing prenatal mortality and morbidity through early detection of faltering growth. Our objectives were to develop patterns of ultrasonically determined EIUFW by gestational age, for normal singleton pregnancies, and to assess the effect of a number of variables on EIUFW. METHODS: Ultrasonically, EIUFW was obtained from 600 pregnant women who were at 20 to 42 weeks of gestation (WG). EIUFW was categorized into low weight and normal weight using the tenth and twentieth percentile as the cut-off points. Logistic regression was used to calculate the odds ratio and their 95% confidence limits for a number of risk factors hypothesized to be associated with low fetal weight. EIUFW percentiles (twenty-fifth, fiftieth, and seventy-fifth), by gestational age and sex, were calculated for singleton pregnancies. RESULTS: Up to 32 WG there was no statistically significant difference between male and female fetuses in EIUFW. Between 32 and 39 WG males had significantly (P< .05) higher fetal weight than females. Charts of ultrasonically determined EIUFW by gestational age and sex for singleton pregnancies were created. A number of variables were significantly associated with EIUFW, such as pregnancy weight gain, maternal hemoglobin level, frequency of antenatal visits, smoking status, and fetal sex. CONCLUSION: Weight gain during pregnancy should be encouraged for pregnant mothers who gain less than one kilogram per month in the second and third trimester. A prospective study on a national representative sample in Jordan is needed to generate our own standards for fetal growth.