A comparison of diet quality indices in a nationally representative cross-sectional study of Iranian households

Background: Iranian diet quality has been evaluated using indices that have not been created based on Iranian dietary guidelines. This study aimed to examine the applicability of two diet quality indices by examining their associations with nutrient adequacy, nutrient intakes and sociodemographics. Methods: Dietary data were collected using three 24-h dietary recalls from Iranian households. Nutrient adequacy was assessed using World Health Organization/Food and Agriculture Organization 2002 (WHO/FAO) cut points. Household diet quality was calculated using the Healthy Eating Index (HEI) and Diet Quality Index-International (DQI-I). Sociodemographics of the household members were assessed. Regression analyses were used to examine associations between diet quality and nutrient adequacy, and between sociodemographics and diet quality. Results: A total of 6935 households were included in the analysis. Higher household diet quality was associated with adequate intake of calcium (HEI: OR 1.11, 95% CI: 1.10, 1.13; DQI-I: OR 1.14, 95% CI: 1.13, 1.16), vitamin C (HEI: OR 1.19, 95% CI: 1.17, 1.20; DQI-I: OR 1.12, 95% CI: 1.11, 1.12) and protein (HEI: OR 1.01, 95% CI: 1.00, 1.02; DQI-I: OR 1.09, 95% CI: 1.08, 1.09). Higher household diet quality was associated with household heads who were older (> 56 years old) (HEI: β 2.06, 95% CI: 1.63, 2.50; DQI-I β 2.90, 95% CI: 2.34, 3.45), higher educated (college/university completed) (HEI: β 4.54, 95% CI: 4.02, 5.06; DQI-I: β 2.11, 95% CI: 1.45, 2.77) and living in urban areas (HEI: β 2.85, 95% CI: 2.54, 3.16; DQI-I: β 0.72, 95% CI: 0.32, 1.12). Conclusions: Based on associations with nutrient adequacy and sociodemographics, the applicability of two diet quality indices for assessing the diet quality of Iranian households was demonstrated. Results also indicated DQI-I may be more applicable than HEI for evaluating Iranian nutrient adequacy. Findings have implications for the design and assessment of diet quality in Iranian populations. Future research should examine the link between these diet quality indices and health outcomes

Salty and umami tastes perception in hypertensive patients and its relationship to dietary sodium intake

Background: Reducing the dietary sodium intake is one of the most important factors for controlling blood pressure. The changes that occur in perceiving saltiness and umami tastes in people with hypertension can be associated with the level of sodium intake. The aim of this study was to investigate the gustatory perception of these two tastes in patients with hypertension and its association with the level of dietary sodium consumed by these patients. Materials and methods: In this case control study, 40 patients with hypertension and 40 healthy individuals were chosen. The blood pressure was measured for both groups. The power of perceiving saltiness and umami tastes was investigated using sodium chloride and monosodium glutamate solutions respectively both with concentrations of 200 mmol/lit. The individuals specified the power of each taste along a 10-number criterion. Based on the compounds of foods in Iran, the level of sodium consumed per day was calculated by food frequency questionnaire. The data were analyzed by Mann-Whitney, Pearson, Spearman tests. Results: The mean saltiness perception in the control and case group was 5/8 and 6/6 respectively(p < 0/05) and the mean umami perception the control and case group was 5/5 and 7/6 respectively(p < 0/05).There was an inverse relationship between the level of sodium intake and perceived intensity of saltiness perceptionin case group (p < 0.05).The level of sodium intake had no relationship with perceived intensity of umami taste in none of the groups (p > 0.05). There was also a direct relationship between blood pressure and intensity of perceiving umami taste in case group (p < 0.05).However, no significant relationship was found between blood pressure and the intensity of perceiving saltiness(p > 0.05). Conclusion: Perceived intensity of saltiness perception in case group higher than control group also perceived intensity of umami perception in case group higher than control group. With increase in the blood pressure, the power of perceiving saltiness and umami increases; with increase in sodium intake, saltiness perception diminishes, but umami perception is left unaffected

Is vitamin D status a determining factor for metabolic syndrome? A case-control study

This study was undertaken to assess vitamin D status in nonmenopausal women with metabolic syndrome (MeS) and to evaluate its possible role in inflammation and other components of MeS. A case-control study was conducted during late fall and winter 2009–10. A total of 375 women with waist circumference (WC) ≥88 cm were examined to find 100 who met MeS criteria according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel (ATP) III criteria (NCEP/ATP III). Of those without MeS, 100 age- and residence area-matched women were selected as a control group. Anthropometric and laboratory evaluations were performed. Waist-to-hip ratio (WHR), body mass index (BMI), homeostatic model of insulin resistance (HOMA-IR) and body fat mass (FM) were also evaluated. Women with MeS had significantly higher BMI, waist circumference (WC) and FM but lower serum osteocalcin than controls. There was no significant difference in serum 25 hydroxyvitamin D (25[OH]D), intact parathyroid hormone (iPTH) or vitamin D status between the two groups. Serum highly sensitive C-reactive protein (hsCRP) concentration was significantly higher in the MeS group, compared to the controls (3.4 ± 3.3 vs 2.0 ± 1.9 mg/L, P < 0.001). The difference remained significant even after controlling for BMI (P = 0.011), WC (P = 0.014) and FM (P = 0.005). When comparison was made only in those subjects with insulin resistance (HOMA-IR > 2.4), hsCRP was still higher in the MeS group (n = 79) than in the control group (n = 61) (P < 0.001). When data were categorized according to vitamin D status, in the MeS group significantly higher plasma glucose concentrations were observed in subjects with vitamin D deficiency compared to those with insufficiency or sufficiency (104.0 ± 11.7, 83.0 ± 11.3 and 83.2 ± 9.9 mg/dL, respectively, P < 0.001). Interestingly, their WC or WHR did not show any significant difference. In stepwise regression analysis, 25(OH)D was the main predictor of both hsCRP and plasma glucose. Vitamin D status may, at least in part, be a determining factor of systemic inflammation and the related metabolic derangements of MeS

The nutrition knowledge level of physicians, nurses and nutritionists in some educational hospitals

Nutritional care is an important part of medical care of patients and plays a key role in improvement, prevention and control of malnutrition in hospitals. The current study aimed to determine the nutrition knowledge level of doctors, nurses and nutritionists in some teaching hospitals in Tehran in 2008. In a cross-sectional study a total of 198 samples including 28 nutritionists, 81 nurses and 89 physicians were selected using simple random sampling. The current study was conducted in 9 hospitals affiliated with the Shahid Beheshti University of Medical Sciences (SBMU) in Tehran. A self-administered multiple choice questionnaire about different aspects of basic and clinical nutrition was completed. Then nutrition knowledge levels of each individual was determined by calculating correct knowledge, perceived knowledge and accuracy of knowledge scores. The median knowledge score of the nutritionists, physicians, and nurses was 85%,77%, and 75%, respectively. The median perceived knowledge of all the groups was above 90%. The mean accuracy score in the 3 groups of nutritionists, physicians and nurses was 87%,79%, and 76%, respectively. The results indicated that all groups have a poor knowledge, especially in clinical nutrition topics. Based on the current results, knowledge level of clinical staff is an effective factor in not paying attention to the importance of nutritional care as a part of medical care of the patients. Enhancing awareness level of all groups especially physicians and nutritionists in clinical division plays an important role in enhancing clinical nutrition care and treatment regime

Dietary patterns derived using principal component analysis and associations with sociodemographic characteristics and overweight and obesity: A cross-sectional analysis of Iranian adults

IntroductionThis study examined the cross-sectional association between household dietary patterns and sociodemographic characteristics and BMI in a nationally representative sample of Iranian adults.MethodsData on 6,833 households (n = 17,824 adults) from the National Comprehensive Study on Household Food Consumption Pattern and Nutritional Status 2001–2003 were used. Principal component analysis (PCA) was used to extract dietary patterns from three household 24-h dietary recalls. Linear regression analyses were used to examine associations between dietary patterns and sociodemographic characteristics and BMI.ResultsThree dietary patterns were identified: the first was characterized by high citrus fruit intake, the second by high hydrogenated fats intake and the third by high non-leafy vegetables intake. The first and third patterns were associated with household heads with higher education and living in urban areas, while the second was associated with household heads with lower education and living in rural areas. All dietary patterns were positively associated with BMI. The strongest association was found with the first dietary pattern (β: 0.49, 95% CI: 0.43, 0.55).DiscussionWhile all three dietary patterns were positively associated with BMI, the sociodemographic characteristics of Iranian adults who consumed them differed. These findings inform the design of population-level dietary interventions to address rising obesity rates in Iran

Regular consumption of vitamin D-fortified yogurt drink (Doogh) improved endothelial biomarkers in subjects with type 2 diabetes: a randomized double-blind clinical trial

<p>Abstract</p> <p>Background</p> <p>Endothelial dysfunction has been proposed as the underlying cause of diabetic angiopathy that eventually leads to cardiovascular disease, the major cause of death in diabetes. We recently demonstrated the ameliorating effect of regular vitamin D intake on the glycemic status of patients with type 2 diabetes (T2D). In this study, the effects of improvement of vitamin D status on glycemic status, lipid profile and endothelial biomarkers in T2D subjects were investigated.</p> <p>Methods</p> <p>Subjects with T2D were randomly allocated to one of the two groups to receive either plain yogurt drink (PYD; containing 170 mg calcium and no vitamin D/250 mL, n₁= 50) or vitamin D3-fortified yogurt drink (FYD; containing 170 mg calcium and 500 IU/250 mL, n₂= 50) twice a day for 12 weeks. Anthropometric measures, glycemic status, lipid profile, body fat mass (FM) and endothelial biomarkers including serum endothelin-1, E-selectin and matrix metalloproteinase (MMP)-9 were evaluated at the beginning and after the 12-week intervention period.</p> <p>Results</p> <p>The intervention resulted in a significant improvement in fasting glucose, the Quantitative Insulin Check Index (QUICKI), glycated hemoglobin (HbA1c), triacylglycerols, high-density lipoprotein cholesterol (HDL-C), endothelin-1, E-selectin and MMP-9 in FYD compared to PYD (<it>P </it>< 0.05, for all). Interestingly, difference in changes of endothelin-1, E-selectin and MMP-9 concentrations in FYD compared to PYD (-0.35 ± 0.63 versus -0.03 ± 0.55, <it>P </it>= 0.028; -3.8 ± 7.3 versus 0.95 ± 8.3, <it>P </it>= 0.003 and -2.3 ± 3.7 versus 0.44 ± 7.1 ng/mL, respectively, <it>P </it>< 0.05 for all), even after controlling for changes of QUICKI, FM and waist circumference, remained significant for endothelin-1 and MMP-9 (<it>P </it>= 0.009 and <it>P </it>= 0.005, respectively) but disappeared for E-selectin (<it>P </it>= 0.092). On the contrary, after controlling for serum 25(OH)D, the differences disappeared for endothelin-1(<it>P </it>= 0.066) and MMP-9 (<it>P </it>= 0.277) but still remained significant for E-selectin (<it>P </it>= 0.011).</p> <p>Conclusions</p> <p>Ameliorated vitamin D status was accompanied by improved glycemic status, lipid profile and endothelial biomarkers in T2D subjects. Our findings suggest both direct and indirect ameliorating effects of vitamin D on the endothelial biomarkers.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01236846">NCT01236846</a></p

Parental Determinants of Overweight and Obesity in Iranian Adolescents: A National Study

Objective: Overweight among adolescents is not only an important public health problem but also a problem affecting economic growth in developing countries. The aim of this study was to investigate the parental determinants of overweight and obesity in Iranian adolescents at national level. Methods: This cross sectional study was conducted within the framework of the Comprehensive Study on Household Food Consumption Patterns and Nutritional Status of IR Iran during 2001-2003. In adolescents, anthropometric indices were defined based on the CDC 2000 cut-off points for age and gender-specific body mass index (BMI). Parental characteristics were collected by questionnaire. Among the 7158 participating households, data on 7908 adolescents aged 11-19 years (3750 girls and 4158 boys) was analyzed. Findings: The prevalence of overweight (85–94th percentile) in boys and girls was 6.2%, and 8.7%, respectively. The prevalence of obesity (≥95th percentile) among boys and girls was similar (3.3%). Parents’ weight status, father’s job and parents’ education showed significant association with weight status in adolescents. Logistic regression analysis showed that parental overweight and obesity, parental education and father’s job were the main parental determinants of overweight and obesity in Iranian adolescents. Conclusion: Parental overweight and obesity, parental education and father’s job seem to be the major parental determinants of overweight in Iranian adolescents. Future prevention programs must take these risk factors into account

Validity of Telephone versus Face-to-Face Interviews in the Assessment of Bread Consumption Pattern

Background and Objective: There are different methods to assess dietary intake in the community. Accurate and appropriate methods, rather than costly and time-consuming ones, are good alternatives to assess dietary intake. The aim of this study was to analyze the validity of telephone and face-to-face interviews, in determination of bread-consumption pattern. Material and Methods: A randomized and stratified multi-stage sampling method was used to select 2312 participating households within the Tehran metropolitan area. The study (research) was carried out in two individual and household levels, using 24 hours recall and purchase frequency questionnaire. The same 24 hour recall and purchase frequency questionnaires were used at both individual and household level.Results: At household and individual level, the correlation coefficients between the two methods were 0.64 and 0.60, respectively (p&lt;0.001). Mean difference of intake of bread between the methods at individual level was 16-21 g/day and at household level was 3-4 g/person/day, statistically not significant.Conclusion: Our findings suggest that a telephone survey can provide a reliable estimation of actual bread intake at both individual and household level. This method is important considering its cost and needed time.Keywords: face to face interview, telephone interview, bread consumption patter

Validity and reproducibility of a food frequency questionnaire for assessment of fruit and vegetable intake in Iranian adults

Background: This study′s aim was to design and validate a semi-quantitative food frequency questionnaire (FFQ) for assessment of fruits and vegetables (FV) consumption in adults of Isfahan by comparing the FFQ with dietary reference method and blood plasma levels of beta-carotene, vitamin C, and retinol. Methods: This validation study was performed on 123 healthy adults of Isfahan. FV intake was assessed using a 110-item FFQ. Data collection was performed during two different time periods to control for seasonal effects, fall/winter (cold season) and spring/summer (warm season). In each phase a FFQ and 1 day recall, and 2 days of food records as the dietary reference method were completed and plasma vitamin C, beta-carotene and retinol were measured. Data was analyzed by Pearson or Spearman and intraclass correlations. Results: Serum Lipids, sex, age, body mass index (BMI) and educational level adjusted Pearson correlation coefficient of FV with plasma vitamin C, beta-carotene and retinol were 0.55, 0.47 and 0.28 in the cold season (p < 0.05) and 0.52, 0.45 and 0.35 in the warm season (p < 0.001), respectively. Energy and fat intake, sex, age, BMI and educational level adjusted Pearson correlation coefficient for FV with dietary reference method in the cold and warm seasons were 0.62 and 0.60, respectively (p < 0.001). Intraclass correlation for reproducibility of FFQ in FV was 0.65 (p<0.001). Conclusions: The designed FFQ had a good criterion validity and reproducibility for assessment of FV intake. Thus, it can serve as a valid tool in epidemiological studies to assess fruit and vegetable intake

Development and Validation of a Food Frequency Questionnaire for Assessing Dietary Calcium in Children

Background and Objectives: This study aimed to develop and validate a food frequency questionnaire (FFQ) for measuring calcium intake in 9-13 years old children in Tehran, Iran. Materials and Methods: A 56-item FFQ containing main contributors of calcium in Iranian diet was designed. Criterion validity of the calcium specific FFQ was evaluated through comparing its result with five 24-h recalls as the reference method. Reproducibility was measured by twice administration of FFQ, one month apart. The study was performed in the selected primary and middle schools of Tehran city. Subjects included 184 children aged 9-13 years (90 girls and 94 boys), who were recruited through two-stage systematic cluster sampling from 20 primary and middle schools. Results: Mean calcium intake was 922.8±322.3 and 876.0±491.8 mg/d for the 24-h recalls and FFQ, respectively, indicating a mean difference of 46.7±458.7 mg/d (P<0.001). Corrected Pearson’s correlation was 0.57. Cross-classification analysis of the FFQ and 24-h recalls classified 80% of the subjects in the same or adjacent category, and 6% in the extreme quartiles. The FFQ correctly identified 85% of the children consuming less calcium than the age-specific Recommended Dietary Allowance (RDA) (1300 mg/d). Pearson’s correlation for repeated administrations was 0.65. Cross-classification analysis of the repeated administration of FFQ classified 81% of the subjects in the same or adjacent quartiles, and 3.3% in the extreme categories. Conclusions: The FFQ underestimates mean calcium intake of a group, and has limited use to estimate calcium intake for individuals. However, it has acceptable validity and reproducibility for epidemiologic studies to assess a group’s mean calcium intake. Keywords: Validation, Food frequency questionnaire, Calcium intake, Childre