Iodine supplementation for pregnant women: a cross-sectional national interventional study.

BACKGROUND: Although Iran has been considered iodine replete since 2000, the first national survey of iodine intake among Iranian pregnant women in 2014 indicated that despite the adequate intake of iodine by the general population, this vulnerable group has moderate iodine deficiency. Therefore, in this national cross-sectional interventional study, we aimed to assess the iodine intake and thyroid function of Iranian pregnant women 2 years after implementing national iodine supplementation for this vulnerable group. MATERIALS AND METHODS: In this cross-sectional study, we conducted a national interventional survey of pregnant women. A total of 1200 pregnant women (400 women from each trimester) from 12 provinces of Iran were recruited from the antenatal care clinics from October 2018 to March 2019. The median urinary iodine concentration (MUIC), as an indicator of iodine status in three spot urine samples, was measured, along with the serum total T4 (TT4), thyrotropin (TSH), thyroglobulin (Tg), thyroid peroxidase antibody (TPO-Ab), and iodine content of household salt. RESULTS: The mean age of the cohort was 28 ± 6.2 years, with the mean gestational age of 22.7 ± 13.0 weeks. The overall MUIC (IQR) of pregnant women was 188 µg/L (124.2-263 µg/L). Also, the MUICs in the three trimesters of pregnancy were 174 µg/L (110-254), 175 µg/L (116-251), and 165 µg/L (114-235), respectively. The MUICs ≥ 150, 100-149, and < 100 µg/L were found in 63, 19.8, and 16.2% of the subjects, respectively. The mean TT4 level was 12 ± 4.5 µg/dL, and the median (IQR) level of TSH was 2.37 mIU/L (1.66-3.18 mIU/L). According to our local reference range, 118 (10.5%) pregnant women had subclinical hypothyroidism, 6 (0.53%) women had isolated hypothyroxinemia, and 65 (5.7%) women were TPO-Ab positive. Also, the median (IQR) level of Tg was 10.08 µg/dL (5.7-20.4 µg/dL), and the median iodine content of household salt was 29.6 µg/g; the iodine content was ≥ 30 µg/g in 85% of household salt. The results showed that more than 95% of households were under iodized salt coverage. CONCLUSION: The results of this study indicated that iodine supplementation with at least 150 µg of iodine per day improved the iodine intake of pregnant women. Except for subclinical hypothyroidism, the prevalence of clinical hypothyroidism, clinical/subclinical thyrotoxicosis, TPO-Ab positivity, and isolated hypothyroxinemia decreased significantly, which emphasizes the importance of iodine supplementation during pregnancy.

Evaluating the interaction of common FTO genetic variants, added sugar, and trans-fatty acid intakes in altering obesity phenotypes.

BACKGROUND AND AIMS: The results of studies on the effect of trans-fatty acids (TFAs) and added sugars on obesity are not consistent. This study aimed to investigate whether the association of changes in general and central obesity with added sugar and TFA intakes is modified by common fat mass and obesity-associated gene (FTO) polymorphisms, in isolation or in a combined-form genetic risk score (GRS). METHODS AND RESULTS: Subjects of this cohort study were selected from among adult participants of the Tehran Lipid and Glucose Study (n = 4292, 43.2% male). Dietary data were collected using a valid and reliable food frequency questionnaire. The genotypes of selected polymorphisms (rs1421085, rs1121980, and rs8050136) were determined. Genetic risk score (GRS) was calculated using the dominant weighted method. The mean age of participants was 42.6 ± 14 and 40.4 ± 13 years in men and women, respectively. FTO rs8050136 polymorphisms and TFAs have a significant interaction in changing body mass index (BMI) (P interaction = 0.01). There were no changes in waist circumference (WC) and BMI among FTO risk allele carriers, across quartiles of added sugar intake. GRS and TFA intakes significantly interacted in altering the BMI and WC; thus, a higher intake of TFAs was associated with higher changes of BMI and WC in subjects with high GRS (P trend<0.05) compared to individuals with low GRS. CONCLUSION: Our findings suggest that TFA intake can increase the genetic susceptibility of FTO SNPs to BMI or WC change.

Long-term effects of coffee and caffeine intake on the risk of pre-diabetes and type 2 diabetes: Findings from a population with low coffee consumption.

BACKGROUND AND AIM: Here, we examined the potential effect of coffee consumption and total caffeine intake on the occurrence of pre-diabetes and T2D, in a population with low coffee consumption. METHODS AND RESULTS: Adults men and women, aged 20-70 years, were followed for a median of 5.8 y. Dietary intakes of coffee and caffeine were estimated using a 168-food items validate semi-quantitative food frequency questionnaire, at baseline. Cox proportional hazards regression models, adjusted for potential cofounders, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between coffee and caffeine intakes and incidence of pre-diabetes and T2D. The total population was 1878 adults (844 men, 1034 women) and 2139 adults (971 men, 1168 women) for analysis of pre-diabetes and T2D, respectively. During the follow-up period the incidence of pre-diabetes and T2D was 30.8% and 6.6%, respectively. Forty-three percent of our subjects were no coffee drinker whereas 51.4% consumed 1 cup of coffee/week and 6.0% consumed more than 1 cup of coffee/week. A lower risk of pre-diabetes (HR = 0.73, 95% CI = 0.62-0.86) and T2D (HR = 0.66, 95% CI = 0.44-1.00) was observed in coffee drinkers compared to non-drinkers, in the fully adjusted models. Higher dietary intake of caffeine (≥152 vs. <65 mg/d) was accompanied with a borderline (P = 0.053) reduced risk of pre-diabetes (HR = 0.45, 95% CI = 0.19-1.00). CONCLUSION: Our findings indicated that coffee drinking may have favorable effect in prevention of pre-diabetes and T2D.

Continuously sustained elimination of iodine deficiency: a quarter of a century success in the Islamic Republic of Iran.

BACKGROUND: Iodine deficiency and related disorders were very common in Iran prior to 1996, when universal salt iodization (USI) was implemented and in 2000 Iran was declared iodine deficiency disorders (IDD) free. The aim of this study was to evaluate the adequacy of iodine intake by Iranian households in all 30 provinces of Iran, a quarter of a century after the intervention. METHODS: A total of 18,000 school-aged children (8-10 years with mean 8.7 ± 1 year) were included in this study. Urine samples were collected from all children for measurement of urinary iodine excretion and 1800, 210 and 3000 salt samples were randomly collected from the family kitchen, production site of 73 salt factories and distribution circles of 30 provinces, respectively. RESULTS: The median urinary iodine concentration (UIC) of participants was 161 µg/L. The proportion of children with UIC of, 20-49, 50-99 and ≥ 100 µg/L were 10.3, 15.9 and 73.7%, respectively. The mean (± SD) and median salt iodine values were 28.2 (± 12.6) and 31.7 ppm, at the production site, and 31.5 (± 13.6) and 29.6 ppm at the distribution circles, respectively. About 80% of factory salts had more than 20 ppm iodine. 98% of households consumed iodized salt, 80% had appropriate salt storage, and 83% of the household salts contained ≥ 20 ppm. CONCLUSIONS: Based on the results of this study, Iranian populations are consuming adequate iodine. The well-maintained and monitored USI program has improved the dietary iodine intakes of the population, and the country has achieved all criteria of a well-controlled IDD program.

Dietary approach to stop hypertension diet and cardiovascular risk factors among 10- to 18-year-old individuals.

BACKGROUND: Current evidence available on the association between Dietary Approach to Stop Hypertension (DASH) diet and cardiovascular risk in adolescents is controversial. OBJECTIVE: The aim of the present study was to assess the association between DASH diet and cardiovascular risk factors after 3 years of follow-up among Tehranian adolescents. METHODS: A population-based cohort study was conducted on 628 subjects, aged 10-18 years, selected from among participants of the Tehran Lipid and Glucose Study. The DASH score was determined on the basis of eight components using a valid and reliable food-frequency questionnaire at baseline. Anthropometric and lipid profile data were measured at baseline and after a 3-year follow-up. RESULTS: Mean (SD) age of the study population (46.6% men) was 14.1 (2.5) years. After adjustment for potential confounding variables, including sex, age, physical activity and total calorie intake, the risk of general obesity (OR = 0.26, 95%CI: 0.15-0.76) and central obesity (OR = 0.32, 95%CI: 0.14-0.84) in the highest quintile of DASH score were significantly lower than in subjects in the lowest quintile. However, DASH score was not associated with risk of incident dyslipidaemia in our study (OR = 0.81, 95%CI: 0.30-1.82). The higher DASH score was inversely associated with 3-year changes in body mass index and waist circumference during the study period (P for trend <0.05). However, there was no significant association between the higher score of this diet with 3-year changes in lipid profiles. CONCLUSION: Adherence to the DASH diet was associated with decreased risk of central and general obesity, whereas higher DASH diet score was not associated with risk of dyslipidaemia in adolescents.

Therapeutic lifestyle change diet enriched in legumes reduces oxidative stress in overweight type 2 diabetic patients: a crossover randomised clinical trial.

The objective of this study was to investigate whether a diet rich in legumes are associated with oxidative stress among type 2 diabetic patients. In a randomized, controlled, crossover clinical trial, 31 type 2 diabetic patients were randomly assigned to receive 2 diets, each for a period of 8 weeks: (1) The legume-free therapeutic lifestyle change (TLC) diet and (2) the legume-based TLC diet. Both diets were similar except that 2 servings of red meat were replaced by different types of legumes 3 days per week in the legume-based TLC diet. Oxidative stress biomarkers were measured at baseline and after 8 weeks. Compared to the legume-free TLC diet, the legume-based TLC diet significantly decreased malondialdehyde (-0.22 versus -0.68 µmol/l; P=0.002), oxidized-LDL (-0.9 versus -2.3 mU/l; P=0.05) and increased nitric oxide (0.40 versus 0.96 mM/l; P=0.03) and catalase activity (1.2 versus 2.1 Iu/ml; P=0.05).

Contribution of dietary amino acids composition to incidence of cardiovascular outcomes: A prospective population-based study.

BACKGROUND AND AIM: Considering the limited data on the cardiovascular effects of dietary amino acid intakes, we assessed possible association of dietary amino acids with the risk of cardiovascular (CVD) events in a prospective population-based study. METHODS: Participants without CVD (n = 2369) were recruited from the Tehran Lipid and Glucose Study and were followed for a mean of 6.7 years. Dietary protein and amino acid intakes were assessed at baseline (2006-2008); demographic, lifestyle and biochemical variables were evaluated at baseline and follow-up examination (2012-2014). Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate risk of CVD across tertiles of dietary amino acids. RESULTS: Mean total protein intake was 76.9 ± 27.5 g/d, and dietary protein had no significant association with the risk of CVD (HR = 1.23, 95% CI = 0.65-2.31, and HR = 0.52, 95% CI = 0.19-1.41, in the second and third tertiles, respectively). After adjustment of potential confounders, the amino acid pattern with higher load of glycine, cysteine, arginine and tryptophan, was negatively associated with CVD (HR = 0.28, 95% CI = 0.09-0.88, P for trend = 0.08). Higher intake of sulfur-containing amino acids (cysteine and methionine), and potentially cardioprotective amino acids (arginine, cysteine, glutamic acid, glycine, histidine, leucine and tyrosine) corresponded to 73% (HR = 0.27, 95% CI = 0.09-0.86) and 74% (HR = 0.26, 95% CI = 0.09-0.78) decreased risk of CVD events. Higher intake of glutamic acid and proline (% of dietary total protein) increased the risk of CVD (HR = 1.30, 95% CI = 1.03-1.64, and HR = 1.33, 95% CI = 1.10-1.60, respectively). CONCLUSION: These novel data provide evidence to suggest that amino acid composition of diet may modify the risk of CVD events.

Nut consumption is associated with lower incidence of type 2 diabetes: The Tehran Lipid and Glucose Study.

AIM: Nuts are rich in unsaturated fatty acids as well as other bioactive constituents. The present study investigated the association between nut consumption and the incidence of type 2 diabetes mellitus (T2DM) in a Middle Eastern population. METHODS: The study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS), in which 1984 participants (920 men and 1064 women) free of DM, aged≥20 years, were followed from phase III (2005-2008) to phase V (2011-2014). Dietary data were obtained from valid and reliable food-frequency questionnaires at baseline. Using multiple logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, with adjustments for age, gender, BMI, serum cholesterol and triglycerides, smoking and energy intake. RESULTS: Study participants' means±SD of age and of BMI were 40.1±13.1 years and 27.0±4.8kg/m2, respectively. The median±SE of their total daily consumption of nuts was 1.19±0.11 servings. After 6.2±0.7 years of follow-up, 150 cases of T2DM were confirmed. On comparing those who consumed ≥4 servings/week with those who consumed <1 serving/week, the age-/energy-adjusted OR of incident T2DM for total nut consumption was 0.64 (95% CI: 0.36-1.12; P for trend = 0.03). In a fully adjusted model, nut consumption was associated with a lower risk of T2DM, and the ORs (95% CIs) of risk for those consuming 2-3.99 and ≥4 servings/week of nuts were 0.51 (0.26-0.97) and 0.47 (0.25-0.90), respectively, compared with those consuming <1 serving/week (P<0.001 for trend). CONCLUSION: Our findings suggest that consuming ≥4 servings/week of nuts reduced the risk of T2DM compared with <1 serving/week.

Effect of interactions of polymorphisms in the Melanocortin-4 receptor gene with dietary factors on the risk of obesity and Type 2 diabetes: a systematic review.

AIM: To perform a systematic review of the effect of interaction between Melanocortin-4 receptor (MC4R) single nucleotide polymorphisms and diet on the development of obesity and Type 2 diabetes. BACKGROUND: Environmental factors, such as nutrient intakes or feeding behaviours, can modulate the association of polymorphism in the MC4R gene with obesity and Type 2 diabetes mellitus. METHODS: A systematic literature search was conducted in the PubMed, Scopus and Google Scholar databases, with a combination of the following keywords: Diet*, nutr*, melanocortin receptor, melanocortin 4 receptor and MC4R. To assess the quality of observational studies, we used a 12-item quality checklist, derived from the STREGA statement. RESULTS: A total of 14 articles were selected based on the inclusion and exclusion criteria. Consumption of highly salty foods and adherence to a Mediterranean dietary pattern can modulate the association between MC4R polymorphisms and the risk of obesity or Type 2 diabetes. Despite the highly contradictory results of intervention studies, after short-term lifestyle interventions, children with variant alleles of MC4R single nucleotide polymorphisms can lose more body weight, compared with non-carriers, although they may have difficulty in maintaining this weight loss in the long-term. To interpret the results of studies on adults, we need further studies. CONCLUSIONS: The interaction between MC4R genes with dietary factors plays a significant role in the development of obesity or Type 2 diabetes phenotypes. Early detection of MC4R risk alleles in individuals and modification of their diet based on these results could be an efficient strategy to prevent obesity or diabetes in these subgroups.

Colors of fruits and vegetables and 3-year changes of cardiometabolic risk factors in adults: Tehran lipid and glucose study.

BACKGROUND/OBJECTIVES: We aimed to investigate the associations of colors of fruit and vegetable (FV) subgroups, with 3-year changes of cardiometabolic risk factors. SUBJECTS/METHODS: This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study, between 2006-2008 and 2009-2011, on 1272 adults. Total intake of FV and their subgroups have been assessed by a validated semi-quantitative food frequency questionnaire at baseline (2006-2008) and again at the second examination (2009-2011). Demographics, anthropometrics and biochemical measures were evaluated at baseline and 3 years later. The associations of anthropometric and lipid profile changes with FV subgroups were estimated. RESULTS: The mean age of men and women at baseline was 39.8±12.7 and 37.3±12.1 years, respectively. Mean total intake of FV, red/purple, yellow, green, orange and white FV was 706±337, 185±95, 141±91, 152±77, 141±87 and 22±18 g/day, respectively. In men, 3-year changes of weight (ß=-0.13, P=0.01) and waist circumference (ß=-0.14, P=0.01) were related to intake of red/purple FV; the yellow group was inversely associated with 3-year changes of total cholesterol (ß=-0.09, P=0.03) and High-density lipoprotein cholesterol (ß=-0.11, P=0.03). Consumption of green and white FV was inversely related to abdominal fat gain, and atherogenic lipid parameters in men (P<0.05). In women, higher intake of red/purple FV was associated to lower weight and abdominal fat gain, fasting serum glucose and total cholesterol (P<0.05); yellow FV was also related to 3-year weight gain (ß=-0.11, P=0.01). CONCLUSIONS: Various colors of FV subgroups had different effects on cardiometabolic risk factors; higher intake of red/purple FV may be related to lower weight and abdominal fat gain, and yellow, green and white FV may be related to lipid parameters.

Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial.

BACKGROUND/OBJECTIVE: The objective of this study was to determine the effects of substitution of red meat with legumes in the Therapeutic Lifestyle Change (TLC) diet on cardiometabolic risk factors in type 2 diabetes patients based on dietary education. SUBJECTS/METHODS: This study was a randomized, controlled, cross-over trial. Thirty-one participants (24 women and 7 men; age: 58.1 ± 6.0 years) with type 2 diabetes were randomly assigned to consume a control diet (legume-free TLC diet) and legume-based TLC diet for 8 weeks. Legume-based TLC diet was the same as the control diet, but the legume-based TLC group was advised to replace two servings of red meat with legumes, 3 days per week. After the interventional period, a washout period was conducted for 4 weeks. The groups were then advised to follow the alternate treatment for 8 weeks. Cardiometabolic risk factors were measured. RESULTS: Compared with the legume-free TLC diet, the legume-based TLC diet significantly decreased fasting blood glucose (P=0.04), fasting insulin (P=0.04), triglyceride concentrations (P=0.04) and low-density lipoprotein cholesterol (P=0.02). Total cholesterol concentrations decreased after consumption of both TLC diet and legume TLC diet; however, the data did not differ significantly between the two diets. body mass index (BMI), waist circumference, systolic and diastolic blood pressures did not change significantly after consumption of either the legume-free TLC diet or the legume-based TLC diet. CONCLUSIONS: Dietary advice given for substitution of red meat with legume intakes within a TLC diet-improved lipid profiles and glycemic control among diabetes patients, which were independent from BMI change. This trial was registered in the Iranian Registry of Clinical Trials (http://www.irct.ir) as IRCT201202251640N7.

Dietary phytochemical index is inversely associated with the occurrence of hypertension in adults: a 3-year follow-up (the Tehran Lipid and Glucose Study).

BACKGROUND/OBJECTIVE: The epidemiological association of phytochemical-rich foods with the risk of hypertension is unclear. This study aimed to determine the association of dietary phytochemical index (PI) with the occurrence of hypertension (HTN) after 3 years of follow-up in Tehranian adults. SUBJECTS/METHODS: This prospective study was conducted on 1546 nonhypertensive subjects, aged 20-70 years. Dietary intake was collected by validated semiquantitative food frequency questionnaire (FFQ). Dietary PI was calculated as (dietary energy derived from phytochemical-rich foods (kcal)/total daily energy intake (kcal)) × 100. Blood pressure was measured at baseline and after 3 years of follow-up and HTN was defined by Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. The odds of HTN after 3 years in each quartile category of dietary PI were estimated by logistic regression model and adjusted for potential variables. RESULTS: The mean age of participants was 38.0±12.0 years and 43% were male. The mean dietary PI was 29.1±11.8. After 3 years of follow-up, 265 (17.1%) new cases of HTN were identified. No significant changes were observed in the systolic and diastolic blood pressure across quartile categories of dietary PI. After adjustment for confounders, the odds (95% confidence interval) of HTN across quartiles of dietary PI were 1.00, 0.97 (0.62-1.38), 0.69 (0.45-1.07) and 0.52 (0.32-0.84) (P for trend=0.004). CONCLUSIONS: Consumption of phytochemical-rich foods may prevent the development of HTN. Further investigations are, however, recommended.

Cereal, fruit and vegetable fibre intake and the risk of the metabolic syndrome: a prospective study in the Tehran Lipid and Glucose Study.

BACKGROUND: The present study aimed to determine whether total fibre or specific fibre food sources are associated with the incidence of the metabolic syndrome (MetS) after 3 years of follow-up in the Tehran Lipid and Glucose Study. METHODS: This population-based prospective study, conducted within the framework of the Tehran Lipid and Glucose Study, included 1582 adults, who were aged 19-84 years and free of MetS at baseline. Usual dietary fibre intake was assessed at baseline using a 168-item food frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipid profiles were measured at baseline and 3 years later. The MetS was defined according to the definition of the revised Adult treatment Panel III. RESULTS: During the 3-year follow-up, there was 15.2% incidence of MetS. Among sources of dietary fibre, fruit fibre was significantly and inversely associated with the occurrence of MetS, after adjustment for confounding factors, with a 21% lower risk [odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.60-0.97] in the highest tertile of intake compared to the lowest tertile. Subjects in the highest tertile of cereal fibre intake had lower odds of MetS compared to those in the lowest tertile (OR = 0.73, 95% CI = 0.52- 0.97) and this association disappeared after adjustment for confounders. No significant association was found between intakes of vegetables, legumes and nut fibre with the incidence of MetS. CONCLUSIONS: Among specific fibre food sources, fruit fibre had a protective effect against the risk of MetS.

Metabolic syndrome profiles, obesity measures and intake of dietary fatty acids in adults: Tehran Lipid and Glucose Study.

BACKGROUND: To determine the association between fatty acid intake and the prevalence of risk factors for the metabolic syndrome. METHODS: In this population-based cross-sectional study, a sample of 2750 Tehranian subjects (44% men and 56% women) aged 20-74 years, who completed a validated food frequency questionnaire, was studied. The metabolic syndrome (MetS) was defined in accordance with the modified guidelines of the National Cholesterol Education Program Adults Treatment Panel III, and waist circumference was coded according to the newly-introduced cut-off points for Iranian adults (≥95 cm for both sexes). Metabolic risk factors across quartile categories of each type of dietary fat [total fat intake, total poly-unsaturated fatty acid (PUFA) intake, total MUFA intake, total saturated fatty acid (SFA) intake expressed as percentage of energy and quartiles of the ratio of polyunsaturated fat to saturated fat (P : S)] were compared. RESULTS: The mean (SD) ages of participants were 40.8 (14.6) and 38.6 (12.9) years, respectively, for men and women. The mean contribution of fat to energy intake was approximately 26% in men and women. A positive trend over successive quartiles of SFA intake with low-density lipoprotein-cholesterol (LDL-C) and triglyceride, as well as P/S ratio intake with high-density lipoprotein-cholesterol (HDL-C), was found. An inverse association between HDL-C with SFA and PUFA intake and a positive association with MUFA and the P/S ratio was found. A significant association of fatty acid consumption and risk of the MetS in this population was observed, except for total PUFA intake. CONCLUSIONS: Special dietary fatty acids are associated with metabolic risk factors among the Iranian population. Because of the high prevalence of cardiovascular disease and MetS, national nutrition policies must be developed accordingly for the modification of dietary fatty acid intake with respect to causation and prevention.

Fast food consumption and the risk of metabolic syndrome after 3-years of follow-up: Tehran Lipid and Glucose Study.

BACKGROUND: There are growing concern globally regarding fast food consumption and its related cardiometabolic outcomes. In this study we investigated whether fast food consumption could affect the occurrence of metabolic syndrome (MetS) after 3-years of follow-up in adults. METHODS: This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study on 1476 adults, aged 19-70 y. The usual intakes of participants were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline (2006-2008) and 3 years later (2009-2011). Multiple logistic regression models were used to estimate the occurrence of the MetS in each quartile of fast food consumption. RESULTS: The mean age of participants was 37.8±12.3 y, and mean BMI was 26.0±4.5 kg/m(2) at baseline. Participants in the highest quartile of fast food consumption were younger (33.7 vs 43.4 years, P<0.01). Higher consumption of fast food was accompanied with more increase in serum triglyceride levels and triglyceride to HDL-C ratio after the 3-year follow-up. After adjustment for all potential confounding variables, the risk of metabolic syndrome, in the highest quartile of fast foods compared with the lowest, was 1.85 (95% CI=1.17-2.95). The effects of fast food consumption on the occurrence of MetS were more pronounced in younger adults (<30 years), and participants who had greater wait to hip ratio, consumed less phytochemical-rich foods or had low-fiber diet (P<0.05). CONCLUSION: We demonstrated that higher consumption of fast foods had undesirable effects on metabolic syndrome after 3-years of follow-up in Iranian adults.

The association of dietary phytochemical index and cardiometabolic risk factors in adults: Tehran Lipid and Glucose Study.

BACKGROUND: Phytochemicals are natural non-nutritive bioactive compounds found in fruits, vegetables, whole grains, nuts and legumes, as well as other plant foods. In the present study, we assessed the dietary phytochemical index (PI) in relation to cardiometabolic risk factors among Iranian adults. METHODS: This cross-sectional study was conducted within the framework of third phase of Tehran Lipid and Glucose Study 2006-2008. For the present study, 2567 subjects aged 19-70 years (1129 men and 1438 women) were selected randomly. Dietary data were collected using a validated semi-quantitative food frequency questionnaire with 168 food items. The PI was calculated based on daily energy derived from phytochemical-rich foods. The odds ratios of abdominal obesity, impaired fasting glucose, hypertriglyceridaemia, low high-density lipoprotein-cholesterol and hypertension were assessed across PI quartile categories. RESULTS: The mean (SD) age of participants was 39.4 (13.2) years. Participants in the upper quartile of PI were older, and had a lower weight and waist circumference. The mean (SD) of the PI was 17.3 (5.6), 25.5 (6.4), 32.7 (8.3) and 42.8 (10.5) in the first, second, third and fourth quartiles, respectively. Compared with those in the lower quartile of PI, participants in the upper quartiles had a 66% lower risk of abdominal obesity [95% confidence interval (CI) = 0.23-0.51] and a 36% lower risk of hypertriglyceridaemia (95% CI, 0.47-0.86), after adjustment for potential confounders. CONCLUSIONS: Higher intakes of phytochemical-rich foods are associated with a lower risk of abdominal obesity and hypertriglyceridaemia as the main cardiometabolic risk factors.

The association of anthropometric indices in adolescence with the occurrence of the metabolic syndrome in early adulthood: Tehran Lipid and Glucose Study (TLGS).

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Little is known about the predictive ability of anthropometric indices in adolescence for prediction of early adulthood metabolic syndrome (MetS). There are controversies about the predictive power of body mass index (BMI) vs. waist circumference (WC) for prediction of MetS in late adolescence; some of the studies did not support the need to measure WC in mid-adolescence, in addition to BMI; on the other hand, some other studies proposed either similar predictability or superiority of WC to identify MetS in late adolescence. WHAT THIS STUDY ADDS: This is the first study to evaluate the adolescent anthropometric indices in relation to early adulthood MetS incidence one decade later in the Middle East region. There is an important sex difference regarding the incidence of MetS in Tehranian adolescents. It is interesting to know that all anthropometric indices in the pubertal age group (11-14 years) had better predictive ability compared to late-pubertal (15-18 years) adolescents. In addition, adolescent abdominal obesity surrogates, including WC and waist-to-height ratio, predicted adulthood MetS better than BMI in boys. It seems that WC had an independent role beyond BMI in identification of adulthood MetS in Tehranian boys (11-18 years old). BACKGROUND: Little is known about the predictive ability of anthropometric indices in adolescence for prediction of early adulthood metabolic syndrome (MetS). OBJECTIVE: Our purpose was to explore incidence of MetS and the optimal anthropometric indicator to predict early adulthood MetS in Tehranian adolescents. METHODS: Using data from the population-based, prospective, Tehran Lipid and Glucose Study, the utility of four anthropometric indices of adolescents in predicting early adulthood MetS (2009 Joint Scientific Statement definition) was examined among 1100 participants, aged 11-18 years, who were free of MetS at baseline, during a mean of 10.2 years of follow-up. RESULTS: The cumulative incidence of MetS was 25.5% (95% confidence interval [CI]: 21.8-29.2%) for young men and 1.8% (95% CI: 0.6-3%) for young women. In boys, waist circumference (WC) had the highest odds ratio (OR) for the MetS risk, followed by waist-to-height ratio (WHtR). Adjusting body mass index (BMI) in addition to WC did not change the results in the 11-14-year age group (OR for WC: 2.28 [1.64-3.16] without BMI adjustment vs. 1.98 [1.05-3.73] with BMI adjustment), suggesting that WC may predict MetS risk beyond BMI. None of the anthropometric indices were found to have significant associations with subsequent MetS risk in girls. CONCLUSIONS: Measures of abdominal obesity including WHtR and WC predicted early adulthood MetS better than BMI in Tehranian male adolescents (11-18 years old).

Iron, iodine and vitamin a in the middle East; a systematic review of deficiency and food fortification.

BACKGROUND: Micronutrient deficiency is one of the major public health problems in the Middle East affecting economic, political and social development of countries. The three commonest micronutrient deficiencies belong to iron, iodine and vitamin A. METHODS: we conducted a systematic review of published English articles in the Middle East countries using databases from PubMed, World Health Organization and Food and Agriculture Organization from 1985 onward. A total of 6050 articles were identified and after evaluation based on eligibility criteria, 81 articles included in this systematic review. RESULTS: Despite implementation of flour fortification other control strategies, the prevalence of iron deficiency is moderate to severe in the Middle Eastern countries, because of ineffective iron fortification program, food interaction and hemoglobin application as anemia indictors in these countries. Mild to severe iodine deficiency disorders exist in many countries of the Middle East, due to lack of effective iodine supplementation program. The prevalence of vitamin A deficiency is mild to severe and there is lack of vitamin A fortification program in many countries in this region. CONCLUSION: Despite unharmonized efforts to control malnutrition of micronutrients, iron, iodine and vitamin A deficiencies are still exist in some countries of the Middle East. Effective, well controlled and harmonized programs for elimination of micronutrient deficiencies need to be initiated for governments and supported by international organizations in this region.

Differences between subjects with sufficient and deficient urinary iodine in an area of iodine sufficiency.

BACKGROUND: Iran has long been recognized as a country of iodine sufficiency; however, recent studies show that the proportion of subjects with insufficient urinary iodine is gradually increasing in Tehran capital city. AIM: The aim of this study was to evaluate differences between individuals with sufficient and deficient urinary iodine in Tehran. MATERIAL AND METHODS: In this cross-sectional study, 639 Tehranian adult subjects, aged ≥ 19 yr (242 males, 397 females), were enrolled through randomized cluster sampling. A 24-h urine sample was collected for measurement of urinary iodine, sodium and creatinine concentrations using the digestion method, flame photometry and autoanalyzer assay, respectively. Salt intake was estimated and iodine content of household salt was measured by titration. RESULTS: Medians (interquartile range) of 24-h urinary iodine concentrations in subjects with sufficient and deficient urinary iodine were 163.0 (126.0-235.0) and 44.0 (26.0-67.0) µg/l, p<0.001, respectively. Salt with iodine content of >20 parts per million was consumed by 77.4 and 38.3% of subjects with sufficient and deficient urinary iodine, respectively (p<0.001). Median daily salt intake in subjects with sufficient urinary iodine was significantly higher than in those with deficient urinary iodine (8.1 vs 7.3 g, p<0.001). No significant differences in the mentioned variables were observed between males and females. Fifty and 30% of subjects with insufficient and sufficient urinary iodine had <7 yr education, respectively (p<0.001). CONCLUSIONS: Iodine content of salt, the amount of salt intake and education levels differ greatly between subjects with sufficient and deficient urinary iodine in Tehran.

Effect of nutritional intervention on the prevalence of metabolic syndrome and heart disease risk factors in urban Tehran (Tehran lipid and glucose study).

In a case-control study a nutritional intervention consisting of an educational program based on the Therapeutic Lifestyle Change diet (TLC) guidelines was implemented in one area of Tehran. Data were collected from subjects in the intervention area (n =133) and controls from another area (n = 183), before and 3.8 years after the intervention. Mean energy and macronutrient intakes and prevalence of risk factors including metabolic syndrome were compared between and within cases and controls. Baseline and follow-up evaluations showed improvement in hypercholesterolemia and high LDL cholesterol levels in cases versus controls. Central obesity and low HDL cholesterol levels increased significantly in controls but not in cases. As there were no significant differences between the 2 groups in energy and macronutrient intakes, it is difficult to claim that nutritional interventions played an important role.