A dish-based semi-quantitative food frequency questionnaire for assessment of dietary intakes in epidemiologic studies in Iran: design and development

BACKGROUND: Earlier forms of food frequency questionnaire (FFQ) used in Iran have extensive lists of foods, traditional categories and food-based design, mostly with the interviewer-administered approach. The aim of the current paper is to describe the development of a dish-based, machine-readable, semi-quantitative food frequency questionnaire (DFQ). METHODS: Within the framework of the Study on the Epidemiology of Psychological, Alimentary Health and Nutrition project, we created a novel FFQ using Harvard FFQ as a model. RESULTS: THE FOLLOWING STEPS WERE TAKEN TO DEVELOP THE QUESTIONNAIRE: Construction of a list of commonly consumed Iranian foods, definition of portion sizes, design of response options for consumption frequency of each food item and finally a pilot test of the preliminary DFQ. From a comprehensive list of foods and mixed dishes, we included those that were nutrient-rich, consumed reasonably often or contributed to between-person variations. We focused on mixed dishes, rather than their ingredients, along with foods. To shorten the list, the related food items or mixed dishes were categorized together in one food group. These exclusions resulted in a list of 106 foods or dishes in the questionnaire. The portion sizes used in the FFQ were obtained from our earlier studies that used dietary recalls and food records. The frequency response options for the food list varied from 6-9 choices from "never or less than once a month" to "12 or more times per day". CONCLUSIONS: The DFQ could be a reasonable dietary assessment tool for future epidemiological studies in the country. Validation studies are required to assess the validity and reliability of this newly developed questionnaire.AH Keshteli, Ahmad Esmaillzadeh, Somayeh Rajaie, Gholamreza Askari, Christine Feinle-Bisset and Peyman Adib

Empirically derived dietary patterns in relation to psychological disorders

Objective Psychological disorders are highly prevalent worldwide. The present study aimed to investigate the relationship between major dietary patterns and prevalence of psychological disorders in a large sample of Iranian adults. Design A cross-sectional study was done to identify dietary patterns derived from factor analysis. Dietary data were collected through the use of a validated dish-based semi-quantitative FFQ. Psychological health was examined by use of the Hospital Anxiety and Depression Scale and the General Health Questionnaire. Setting The study was conducted in Isfahan, Iran, within the framework of the Study on Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN). Subjects Iranian adults (n 3846) aged 20-55 years. Results After adjustment for potential confounders, greater adherence to the lacto-vegetarian dietary pattern was protectively associated with depression in women (OR=0·65; 95 CI 0·46, 0·91). Normal-weight participants in the top quintile of this dietary pattern tended to have decreased odds of anxiety compared with those in the bottom quintile (OR=0·61; 95 CI 0·38, 1·00). In addition, the traditional dietary pattern was associated with increased odds of depression (OR=1·42; 95 CI 1·01, 1·99) and anxiety (OR=1·56; 95 CI 1·00, 2·42) in women. Normal-weight participants in the highest quintile of the traditional dietary pattern had greater odds for anxiety (OR=1·89; 95 CI 1·12, 3·08) compared with those in the lowest quintile. The Western dietary pattern was associated with increased odds of depression in men (OR=1·73; 95 CI 1·07, 2·81) and anxiety in normal-weight participants (OR=2·05; 95 CI 1·22, 3·46). There was a significant increasing trend in the odds of psychological distress across increasing quintiles of the fast food dietary pattern in women (P-trend=0·02). Conclusions Recommendation to increase the intake of fruits, citrus fruits, vegetables, tomato and low-fat dairy products and to reduce the intakes of snacks, high-fat dairy products, chocolate, carbonated drinks, sweets and desserts might be associated with lower chance of psychological disorders. © 2015 The Authors

A Longitudinal Dataset of Incidence and Intervention Policy Impacts Regarding the COVID-19 Pandemic in Canadian Provinces

One year after identifying the first case of the 2019 coronavirus disease (COVID-19) in Canada, federal and provincial governments are still struggling to manage the pandemic. Provincial governments across Canada have experimented with widely varying policies in order to limit the burden of COVID-19. However, to date, the effectiveness of these policies has been difficult to ascertain. This is partly due to the lack of a publicly available, high-quality dataset on COVID-19 interventions and outcomes for Canada. The present paper provides a dataset containing important, Canadian-specific data that is known to affect COVID-19 outcomes, including sociodemographic, climatic, mobility and health system related information for all 10 Canadian provinces and their health regions. This dataset also includes longitudinal data on the daily number of COVID-19 cases, deaths, and the constantly changing intervention policies that have been implemented by each province in an attempt to control the pandemic

Epidemiology and Risk Factors of Tooth Loss among Iranian Adults: Findings from a Large Community-Based Study

Objectives. To investigate the prevalence of tooth loss and different prosthetic rehabilitations among Iranian adults, as well as the potential determinants of tooth loss. Methods. In a cross-sectional community-based study conducted among 8094 Iranian adults living in Isfahan province, a self-administered questionnaire was used to assess epidemiologic features of tooth loss. Results. Thirty-two percent of subjects had all their teeth, 58.6% had lost less than 6, and 7.2% of participants had lost more than 6 teeth. One hundred and sixty-nine individuals (2.2%) were edentulous. Among participants, 2.3% had single jaw removable partial denture, 3.6% had complete removable denture in both jaws, and 4.6% had fixed prosthesis. Others reported no prosthetic rehabilitation (89.5%). In the age subgroup analysis (≤35 and >35 years old) tooth loss was more prevalent among men than women (OR=2.8 and 1.9, resp., P35 years (adjusted OR=1.29, P<0.01). Conclusions. Tooth loss is highly prevalent in Iranian adult population. Community programs promoting oral health for prevention of tooth loss should be considered taking into account its major determinants including lower educational level, male gender, smoking, and metabolic abnormality

Patterns of dietary habits in relation to obesity in Iranian adults

Purpose: Findings from few studies that investigated the relation between dietary behaviors and obesity are inconsistent. We aimed to assess the relation between patterns of dietary habits, identified by latent class analysis (LCA), and obesity in a large sample of Iranian adults. Methods: In a cross-sectional study on 7958 adults, dietary behaviors were assessed in five domains (meal patterns, eating rate, intra-meal fluid intake, meal-to-sleep interval, and fatty foods intake) using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. Anthropometric measures were assessed through the use of a validated self-reported questionnaire. General and abdominal obesity were defined as a body mass index ≥ 30 kg/m², and a waist circumference ≥ 88 cm for women and ≥ 102 cm for men. Results: General and abdominal obesity were prevalent in 9.7 and 27.7 % of the study population, respectively. We identified three distinct classes of eating rates (moderate, moderate to slow, and moderate to fast), two classes of meal patterns (regular and irregular), two classes of intra-meal fluid intake (moderate and more intra-meal drinking), three classes of meal-to-sleep interval (short, moderate, and long meal-to-sleep interval), and three classes of fatty food intake (low to moderate, moderate to high, and low intake of fatty foods). After adjustment for potential confounders, individuals with 'irregular meal pattern' were 21, 24, and 22 % more likely to be overweight/obese, abdominally overweight/obese, and abdominally obese, compared with those who had a 'regular meal pattern.' Individuals with 'more intra-meal drinking' had greater odds of overweight (OR 1.37; 1.19-1.458) and obesity (OR 1.51; 1.16-1.97) than those with 'moderate intra-meal drinking.' Moderate-to-high intake of fatty foods was inversely associated with abdominally overweight/obese (OR 0.85; 0.73-1.00) and abdominally obesity (OR 0.80; 0.68-0.96) compared with 'low-to-moderate intake of fatty foods.' No significant association was observed between eating rate, meal-to-sleep interval, and general or abdominal obesity, after controlling for confounders. Conclusion: Irregular meal pattern and more intra-meal drinking were associated with increased odds of general and abdominal obesity, whereas moderate-to-high intake of fatty foods was related to the decreased odds of central obesity among Iranian adults.Parvane Saneei, Ahmad Esmaillzadeh, Ammar Hassanzadeh Keshteli, Awat Feizi, Christine Feinle-Bisset, Peyman Adib

Patterns of diet-related practices and prevalence of gastro-esophageal reflux disease

BackgroundNo studies have evaluated associations between patterns of diet-related practices as determined by latent class analysis (LCA) and gastro-esophageal reflux disease (GERD). We aimed to assess this relationship in a large sample of Iranian adults.MethodsIn a cross-sectional study in 4763 adults, diet-related practices were assessed in four domains, 'meal pattern', 'eating rate', 'intra-meal fluid intake', and 'meal-to-sleep interval', using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. We defined GERD as the presence of heartburn sometimes, often or always.Key resultsThe prevalence of GERD in the study population was 23.5% (n = 1120). We identified two distinct classes of meal patterns: 'regular' and 'irregular', three classes of eating rates: 'moderate', 'moderate-to-slow', and 'moderate-to-fast', two major classes of fluid ingestion with meals: 'moderate' and 'much intra-meal drinking', and two classes regarding the interval between meals and sleeping: 'short' and 'long meal-to-sleep' interval. After adjustment for potential confounders, subjects with 'irregular meal pattern' had higher odds of GERD compared with subjects with 'regular meal pattern' (OR: 1.21; 1.00-1.46). However, when taking into account BMI, the association disappeared. 'Long meal-to-sleep interval' was inversely associated with GERD compared with 'short meal-to-sleep interval' (OR: 0.73; 95% CI: 0.57-0.95). 'Eating rate' and 'intra-meal fluid intake' were not significantly associated with GERD.Conclusions & inferencesOur data suggest certain associations between dietary patterns and GERD. These findings warrant evaluation in prospective studies to establish the potential value of modifications in dietary behaviors for the management of GERD.A. Esmaillzadeh, A. H. Keshteli, A. Feizi, F. Zaribaf, C. Feinle-Bisset & P. Adib

Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia

To our knowledge, no study has assessed the relationships between patterns of dietary behaviours, identified by latent class analysis (LCA), and chronic uninvestigated dyspepsia (CUD). The present study was conducted to determine the association between the patterns of dietary behaviours, identified by LCA, and CUD in a large sample of adults. In a cross-sectional study conducted on 4763 Iranian adults, we assessed the patterns of dietary behaviours in four domains, including 'meal patterns', 'eating rate', 'intra-meal fluid intake' and 'meal-to-sleep interval', as identified by LCA, using a pre-tested comprehensive questionnaire. Patients with CUD were identified using the Rome III diagnostic criteria. CUD was prevalent in 15.2 % (95% CI 14:4, 16.2 %; n 723) of patients. Early satiation occurred in 6.3% (n 302) of patients, bothersome postprandial fullness in 8.0% (n 384) of patients and epigastric pain in 7.8% (n 371) of patients. We defined two distinct classes of meal patterns: 'regular' and 'irregular'. For eating rates, three classes were defined: 'moderate', 'moderate-to-slow' and 'moderate-to-fast'. Participants were identified as ingesting fluid with meals in two major classes: 'moderate intra-meal drinking' and 'high intra-meal drinking'. In terms of the interval between meals and sleeping, two distinct classes were identified: 'short meal-to-sleep interval' and 'long meal-to-sleep interval'. After controlling for potential confounders, the 'irregular meal pattern' was significantly associated with a greater odds of CUD (OR 1:42, 95% CI 1:12, 1:78) compared with a 'regular meal pattern'. Individuals with a 'moderate-to-fast eating rate' were more likely to have CUD compared with those who had a 'moderate eating rate' (OR 1:42, 95% CI 1:15, 1:75). Patterns of the 'meal-to-sleep interval' and 'intra-meal fluid intake' were not significantly associated with CUD. In conclusion, the 'irregular meal pattern' and the 'moderate-to-fast eating rate' were significantly associated with a greater odds of CUD. Further prospective investigations are warranted to confirm this association..Ammar Hassanzadeh Keshteli, Awat Feizi, Ahmad Esmaillzadeh, Fatemeh Zaribaf, Christine Feinle-Bisset, Nicholas J. Talley, and Peyman Adib