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

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

Association Between Dietary Total Antioxidant Capacity and Diet Quality in Adults

BackgroundDiet quality is a major contributor to human health. In addition, antioxidants have a great contribution to several chronic conditions. The purpose of this study was to evaluate if dietary total antioxidant capacity (TAC) can be considered as a measure of diet quality in a Middle Eastern country. MethodsIn this cross-sectional study on 6,724 Iranian adults, we used a validated food frequency questionnaire (FFQ) to assess dietary intakes. Data derived from the FFQ was used to calculate dietary TAC and well-known diet quality scores including alternate healthy eating index (AHEI) and dietary diversity score (DDS). Dietary TAC was calculated based on the ferric reducing-antioxidant power (FRAP) values reported in earlier publications. AHEI and DDS have also been constructed based on previous publications. Cross-classification was used to examine the agreement between these measures. ResultsMean age and BMI of study participants were 36.89 +/- 8.08 y and 24.97 +/- 3.87 kg/m(2), respectively. We found that individuals in the highest tertile of dietary TAC had higher scores of AHEI (57.53 +/- 0.20 vs. 52.03 +/- 0.20, P < 0.001) and DDS (5.56 +/- 0.03 vs. 4.15 +/- 0.03, P < 0.001) compared with those in the lowest tertile. Participants' distribution on the basis of the cross-classification analysis indicated that the classifications were in exact agreement for 42.6, within an adjacent tertile for 33.05, and in gross misclassification for 20 of individuals. When this was examined between dietary TAC and DDS, we found that exact agreement in the classifications was for 59.2 of participants. Notably, a very low proportion of gross misclassification was seen in this regard such that only 6 of participants were classified in the opposing tertiles, indicating additional support for a good agreement. ConclusionWe found that dietary TAC might be considered as a proper measure for the assessment of diet quality because it was well correlated with well-known measures of diet quality including DDS and AHEI scores

The relation between breakfast consumption and psychological symptoms among adults

Background: Breakfast skipping was related to obesity and obesity has been associated with psychological disorders, but limited data are available linking breakfast consumption to psychological symptoms. Objective: The association between breakfast consumption and psychological disorders, including depression and anxiety, was studied among Iranian adults. Methods: This cross-sectional study was conducted on 4378 healthy adults in Isfahan, Iran. Breakfast consumption was assessed using a validated detailed dietary habits’ questionnaire; and depression and anxiety using an Iranian validated Hospital Anxiety and Depression Scale (HADS) questionnaire. Psychological distress was also examined by means of Iranian validated version of General Health Questionnaire. Findings: Overall, 611 numbers (13.95%) of study participants had anxiety, 1253 numbers (28.62%) depression, and 1015 numbers (23.18%) probable mental disorders symptoms. After controlling for the confounding variables, participants with every day breakfast consumption had lower odds for depression symptoms (OR: 0.49; 95% CI: 0.36-0.66) compared with those with the least frequent intake of breakfast, even after further adjustment for BMI (OR: 0.47; 95% CI: 0.34- 0.63). Frequent breakfast consumption was inversely associated with anxiety before and after controlling for BMI (P<0.001). The same findings were obtained for probable mental disorders (P<0.001). Conclusion: This study showed an inverse relation between breakfast consumption and symptoms of depression, anxiety, and probable mental disorders among Iranian adults. Further prospective studies are needed to confirm these findings

Evaluation of the relationship between major dietary patterns and uninvestigated reflux among Iranian adults

Objectives: The etiology of uninvestigated reflux is largely unknown. Although diet has been associated with uninvestigated reflux, the role of dietary patterns is not clear yet. The aim of this study was to investigate dietary patterns in relation to uninvestigated reflux among Iranian adults. Methods: This cross-sectional study was carried out within the framework of SEPAHAN (Study on the Epidemiology of Psychological, Alimentary Health and Nutrition) among Iranian adults. Dietary data were collected using a self-administered, 106-item, dish-based, semiquantitative food frequency questionnaire. Uninvestigated reflux was considered to be present when an individual reported to be suffering from heartburn sometimes or frequently in the preceding 3 mo. Specific dietary patterns were identified using factor analysis. Results: Complete information from 3846 individuals was available for statistical analysis. We identified four major dietary patterns: fast food, traditional, vegetarian, and Western. After controlling for potential confounders, no overall significant associations were found between these dietary patterns and uninvestigated reflux. However, participants in the third quintile of the traditional dietary pattern had greater odds of uninvestigated reflux, either in the crude (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.09-1.74) or the adjusted (OR, 1.52; 95% CI, 1.16-2.00) model taking into account different confounders. After controlling for age, men in the second (OR, 1.64; 95% CI, 1.10-2.45) and women in the fourth (OR, 1.47; 95% CI, 1.02-2.11) quintiles of the fast food dietary pattern were more likely to have uninvestigated reflux. Moreover, in the age-adjusted model, men in the second (OR, 1.72; 95% CI, 1.14-2.59) and fourth (OR, 1.56; 95% CI, 1.03-2.35) quintiles, and women in the second (OR, 1.48; 95% CI, 1.08-2.04) quintile of the traditional dietary pattern were at higher risk for being diagnosed with uninvestigated reflux. Conclusion: Although the present study showed no statistically significant associations between major dietary patterns and the risk for uninvestigated reflux, relative positive associations were found between uninvestigated reflux and adherence to either fast food or traditional dietary patterns, suggesting that these contribute to the risk for developing reflux.Mahdieh Khodarahmi, Leila Azadbakht, Hamed Daghaghzadeh, Christine Feinle-Bisset, Ammar Hassanzadeh Keshteli, Hamid Afshar, Awat Feizi, Ahmad Esmaillzadeh, Peyman Adib

Empirically derived dietary habits are associated with irritable bowel syndrome

Background/Objectives: The associations between empirically derived dietary habits and irritable bowel syndrome (IBS) have not been investigated. This study aimed to assess the relationship between empirically derived dietary habits and IBS in a large population of Iranian adults. Subjects/Methods: In a cross-sectional study, dietary habits of 4763 adults were assessed in three domains, "meal pattern", "eating rate" and "intra-meal fluid intake". We used latent class analysis to identify classes of dietary habits. IBS was defined based on ROME III criteria. Results: IBS was prevalent in 20.3% (n = 966) of the study population. Two distinct classes of meal patterns: "regular" and "irregular", three classes of eating rates: "moderate", "moderate-to-slow" and "moderate-to-fast" and two classes of fluid ingestion with meals: "moderate" and "heavy intra-meal drinking" were identified. After adjustment for confounders, "heavy intra-meal fluid intake" was protectively associated with IBS (OR = 0.79; 95% CI:0.64-0.96). When potential confounders were considered, "meal pattern" and "eating rate" were not significantly associated with IBS in the whole population. After adjustment for confounders, women with "irregular meal pattern" had a 30% greater risk of having IBS, compared with those with "regular meal pattern" (OR = 1.30; 95% CI:1.02-1.67). Overweight participants with "fast eating rate" were 70% more likely to have IBS, compared to those with "moderate eating rate" (OR = 1.70; 95% CI:1.13-2.55). "Irregular meal pattern" was related to frequency and severity of abdominal pain. Conclusions: We found a significant association between heavy intra-meal fluid intake" and IBS. More large-scale prospective studies are needed to affirm this association.Fatemeh Zaribaf, Ammar Hassanzadeh Keshteli, Ahmad Esmaillzadeh, Parvane Saneei, Awat Feizi, Hamed Daghaghzadeh, Christine Feinle-Bisset, Peyman Adib

Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the SEPAHAN study

Little is known about the effects of carbohydrate, particularly any association between dietary glycaemic index or glycaemic load and uninvestigated heartburn or uninvestigated chronic dyspepsia in the community. The present study aimed to determine associations between dietary glycaemic index or glycaemic load and uninvestigated heartburn or uninvestigated chronic dyspepsia.This cross-sectional study was conducted in 2987 adults. Dietary glycaemic index and glycaemic load were estimated using a validated food-frequency questionnaire. Uninvestigated heartburn and uninvestigated chronic dyspepsia were determined using a modified and validated version of the Rome III questionnaire.After controlling for various confounders, high glycaemic load was associated with an increased risk of uninvestigated heartburn [odds ration (OR) = 1.75; 95% confidence interval CI = 1.03, 2.97; P = 0.04] and uninvestigated chronic dyspepsia (OR = 2.14; 95% CI: 1.04, 4.37; P = 0.04) in men but not in women. In normal-weight individuals, high glycaemic index was related to an increased risk of uninvestigated heartburn (OR = 1.52; 95% CI: 1.07, 2.15; P = 0.02) and high glycaemic load to an increased risk of uninvestigated chronic dyspepsia (OR=1.78; 95% CI: 1.05, 3.01; P = 0.03). No significant associations were observed in subjects with excess body weight.Our data suggest that there are body mass index- and sex-specific associations between dietary carbohydrate quality with uninvestigated heartburn and uninvestigated chronic dyspepsia.A.H. Keshteli, F. Haghighatdoost, L. Azadbakht, H. Daghaghzadeh, C. Feinle‐Bisset, H. Afshar, A. Feizi, A. Esmaillzadeh, P. Adib

Glycemic index, glycemic load, and common psychological disorders

First published November 25, 2015Background: Potential associations between dietary glycemic index (GI) and glycemic load (GL) with psychological disorders remain uncertain. Objective: We investigated the relations of dietary GI and GL with psychological distress, anxiety, and depression. Design: A total of 3363 nonacademic members of the staff of Isfahan University of Medical Sciences were included in this cross-sectional study. GI and GL were assessed by using a validated, self-administered, dish-based, semiquantitative food-frequency questionnaire. Validated Iranian versions of the Hospital Anxiety and Depression Scale and General Health Questionnaire-12 were used to assess anxiety, depression, and psychological distress. Results: After control for potential confounders, individuals in the top tertile of GI had greater odds of depression (OR: 1.44; 95% CI: 1.03, 2.02; P-trend = 0.03) and a trend for greater odds of anxiety (OR: 1.52; 95% CI: 0.97, 2.38; P trend = 0.06) compared with those in the first tertile. Higher GL values were linked to lower odds for mental disorders (OR: 0.66; 95% CI: 0.49, 0.90; P-trend = 0.009), depression (OR: 0.69; 95% CI: 0.51, 0.93; P-trend = 0.02), and psychological distress (OR: 0.67; 95% CI: 0.48, 0.92; P-trend = 0.01). Significant interactions were observed between GI and sex for depression (P = 0.01) and psychological distress (P = 0.046) in the crude model. In stratified analyses by sex, after control for potential confounders, a greater GI was linked to a higher odds of depression (OR: 1.52; 95% CI: 1.20, 1.94; P-trend = 0.001) and psychological distress (OR: 1.66; 95% CI: 1.28, 2.14; P-trend = 0.001) in women but not in men. Conclusion: Our findings support a direct link between the odds of depression and dietary GI but inverse associations between GL and mental disorders, depression, and psychological distress. This trial was registered at clinicaltrials.gov as NCT02362113.Fahimeh Haghighatdoost, Leila Azadbakht, Ammar Hassanzadeh Keshteli, Christine Feinle-Bisset, Hamed Daghaghzadeh, Hamid Afshar, Awat Feizi, Ahmad Esmaillzadeh, and Peyman Adib

Association between healthy lifestyle score and upper gastrointestinal disorders in Iranian adults

Background and Objective: Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders (FGIDs), there is no epidemiologic data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia (FD), its symptoms and gastro-esophageal reflux disease (GERD) in a large group of Iranian adults. Methods: This descriptive -analytic study was conducted on 3363 Iranian adults (19-70 yr), whom were working in 50 health centers across Isfahan province in Iran during 2012. We used easy non-random sampling to select participants. The “healthy lifestyle score” for each participant was calculated by summing up the binary score given for five lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. A validated Persian version of ROME III questionnaire was used, to assess functional gastrointestinal disorders. Results: The prevalence of FD and GERD among study participants was 14.5 and 23.6%, respectively. After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD (95% CI: 0.05-0.92, OR: 0.21, P=0.03) and GERD (95% CI: 0.09-0.69, OR: 0.26, P=0.01), respectively, compared with those with the lowest score. They were also less likely to have early satiation (95% CI: 0.11-0.73, OR: 0.28, P=0.001), postprandial fullness (95% CI: 0.09-0.50, OR: 0.22, P<0.001) and epigastric pain (95% CI: 0.21-0.92, OR: 0.44, P=0.03). In addition to the combined healthy lifestyle score, low levels of psychological distress, a healthy diet, healthy dietary habits and non-smoking were separately associated with FGIDs (P<0.05). Conclusion: This study showed that adherence to a healthy lifestyle was associated with lower odds of GERD, FD and its symptoms in this group of Iranian adults. Individual lifestyle-related factors were also associated with these conditions