The relationship between intake of fruits, vegetables and dairy products with overweight and obesity in a large sample in Iran: Findings of STEPS 2016

BackgroundThe present study aimed to investigate the association between fruits and vegetables (FVs) and dairy product intake with body weight based on the data from the nationwide Stepwise approach to surveillance (STEPS) survey in Iran.MethodsSTEPS is a national-based cross-sectional study conducted on 3,0541 people selected by stratified cluster random sampling in Iran from April to November 2016. The outcome of the current study was body mass index (BMI) which was classified as normal weight, underweight, overweight, and obese. Also, as exposure variables, dietary intakes of fruits, vegetables and dairy products were extracted from the STEPS questionnaires. Multinomial logistic regression was used to evaluate the association between dairy products, FVs consumption, and BMI category in the crude and adjusted models.ResultsIn the adjusted model, we observed 41% [odd ratio (OR) = 0.59; 95% confidence intervals (CI): 0.50, 0.68, P < 0.001], 27% (OR = 0.73; 95% CI: 0.62, 0.84, P < 0.001), and 26% (OR = 0.74; 95% CI: 0.63, 0.87, P < 0.001) lower odds of being overweight, and 46% (OR = 0.54; 95% CI: 0.46, 0.64, P < 0.001), 29% (OR = 0.71; 95% CI: 0.60, 0.84, P < 0.001), and 21% (OR = 0.79; 95% CI: 0.65, 0.95, P = 0.014) decrease in obesity odds among the participants who consumed 1, 2, and more than 2 servings of fruits per day in comparison to less than one serving, respectively. Also, we observed participants who consumed 1, 2, and more than 2 servings in comparison to less than one serving of dairy products per day had 31% (OR = 0.69; 95% CI: 0.58, 0.81, P < 0.001), 23% (OR = 0.77; 95 %CI: 0.65, 0.91, P = 0.002), and 21% (OR = 0.79; 95% CI: 0.67, 0.94, P = 0.011) lower odds of being overweight and 47% (OR = 0.53; 95% CI: 0.44, 0.64, P < 0.001), 36% (OR = 0.64; 95% CI: 0.53, 0.77, P < 0.001), and 32% (OR = 0.68; 95% CI: 0.56, 0.83, P < 0.001) lower odds of obesity, respectively. In addition, compared to participants who consumed less than 2 servings of vegetables per day, participants who consumed 2, 3, and more than 3 servings had 40% (OR = 0.60; 95% CI: 0.47, 0.76, P < 0.001), 29% (OR = 0.71; 95% CI: 0.56, 0.90, P = 0.006), and 26% (OR = 0.74; 95% CI: 0.57, 0.96, P = 0.027) lower odds of being overweight, respectively. Furthermore, we observed 36% lower odds of obesity among participants who ate 2 servings of vegetables per day compared to less than 2 serving (OR = 0.64; 95% CI: 0.49, 0.84, P = 0.002).ConclusionOur findings showed that intake of FVs and dairy products is associated with a healthier weight status in adults. Further studies are needed to confirm these findings

Undesirable Knowledge and Practice of Mothers about Under 2 Years Old Children Nutrition are Related to Socio- Economic Factors in Shiraz, Southern Iran

Background: The assessment of mother's knowledge and practice about child nutritional requirement is important in identification of the education needs. This research was conducted to assess the knowledge and practice of mothers about nutrition of children under 2 years of age and its relationship with socioeconomic factors in Shiraz health care centers, southern Iran. Methods: In this descriptive-analytic cross-sectional study, 201 mothers with at list one under 2 years old child were selected by systematic random sampling from health centers in Shiraz, southern Iran. Knowledge and practice of mothers about the type and time of providing supplementary foods for the infants were assessed using a validated questionnaire via face to face interview. Also demographic and socioeconomic information were asked. Pearson correlation coefficient and ANOVA tests were used for data analysis. All analyses were performed using SPSS version 19. Results: According to the findings of this study, 11.4% of mothers had a low level of knowledge and 29.4% of them had a desirable practice. We observed significant relationship between knowledge and job (P=0.002) and level of education ( P<0.001), also between practice and job (P=0.01) and level of education (P=0.046). we observed that mother's knowledge has significant positive correlation with mother's practice (r=0.6, P=0.001) Conclusion: Since the knowledge of high percentage of mothers was moderate, and a high percentage of them had undesirable practice, continuing overall effort to increase mother's nutritional knowledge and practice in order to prevention of infants malnutrition seems to be necessary

Effect of Game-Based Nutrition Education on Nutritional Knowledge of Preschool Children

Background: Nutrition education during childhood plays a substantial role in promotion of healthy eating habits throughout the life. We aimed to assess the effect of a newly designed game-based nutrition education program on nutritional knowledge of preschool children. Methods: An experimental study was conducted at eight kindergartens from various socioeconomic levels in Shiraz, Iran. Forty-eight children aged 5 to 6 years old were recruited to the study. We developed a computer-game containing health improving nutritional messages, based on snake and ladder game. The intervention period of game playing was 20 minutes per day for a week. All children were asked to complete a questionnaire, including 9 questions designed for their age group, before and after playing the game. Also, we assessed the acceptance of the game among the experimental group. Results: Forty-seven children including 27 boys and 20 girls completed the study (23 in the experiment and 24 in the control groups). The mean age of participants was 5.71±0.41 years. Baseline scores of nutritional knowledge were significantly more in high socioeconomic regions. The mean score of nutritional knowledge in experimental and control groups improved significantly (0.73±1.62 and 0.52±1.78, respectively). Considering the baseline mean score as covariate, the mean score of nutritional knowledge significantly increased in the experiment group. The results showed that all children preferred to select more healthy foods after playing game. Moreover, the experimental group was interested in playing the game in 3 levels; low (8.7%), high (52.2%), and very high (39.1%). Conclusion: This new game-based educational approach may simplify the education in preschool children and enhance their nutritional knowledge

The Relationship between Nutritional Knowledge and Food Habits and Some Cardiometabolic Risk Factors in Patients with Diabetes in Shiraz, Iran

Background: Diabetes is an increasing health problem. Diet and nutritional knowledge are the most important factors in diabetes. This study was done to investigate the association between nutritional knowledge and food habits in relation to cardiometabolic risk factors in the patients with diabetes. Methods: This cross-sectional study was conducted on 260 subjects with diabetes in Motahhari Diabetes Clinic in Shiraz, southern Iran. Dietary intakes were evaluated using a 147-item food frequency questionnaire (FFQ). Also socio-economic, demographic and nutritional knowledge questionnaires were completed. Weight, height and waist circumference were measured. Fasting blood glucose (FBG), low density lipoprotein cholesterol (LDL), high density lipoproteincholesterol (HDL) and triglyceride TG were extracted from patients’ medical records. Results: Of 73 male and 187 female patients, 39.2% were overweight and 33.5% were obese. There was a significant correlation between nutritional knowledge and vegetables intake. Also, getting more dairies and fats were significantly correlated to the levels of FBS. A positive significant correlation was seen between serum HDL and beans and cereals intake. Conclusion: Nutritional awareness cannot lead to a healthy diet alone because socioeconomic status, motivation, and other factors also affect dietary intake. Dietary habits can affect blood lipids and FBG. Therefore, improving the diet of diabetic patients is essential

Higher Glycemic Index and Load Could Increase Risk of Dyslipidemia

Background: To quantify carbohydrates, various indicators such as glycemic load (GL) and glycemic index (GI) were introduced. In order to address the effect of dietary carbohydrate content on lipid profile, we investigated the relationship between dietary GI and GL with lipid profile in adults living in Shiraz, Iran.Methods: In a cross-sectional study, 236 participants aged between 20 and 50 years were selected using cluster random sampling in Shiraz, Iran. For assessing the food intake, a 168-item food frequency questionnaire (FFQ) was utilized. Dietary GI and GL were calculated based on food items intake.Results: Higher GI was associated with increased odds ratio (OR) of lowdensity lipoprotein-cholesterol (LDL-C, OR: 2.51; p-trend=0.008), nonhigh-density lipoprotein-cholesterol (HDL, OR: 2.34; p-trend=0.01) and LDL to HDL ratio (OR: 2.13; p-trend=0.02) in crude model. In adjusted model, direct association was observed between GI and total cholesterol (TC, OR: 2.40; p-trend=0.01), LDL-C (OR: 2.50; p-trend=0.01) and non-HDL-C (OR: 2.48; p-trend=0.01). Association was noted between higher GL with TC (OR: 2.50; p-trend=0.01), LDL-C (OR: 2.22; p-trend=0.02), non-HDL-C (OR: 2.49; p-trend=0.005) and LDL-C to HDL-C ratio (OR: 2.29; p-trend=0.01) in crude model. After adjusting for potential cofounder, association remained for TC (OR: 3.97; p-trend=0.01), LDL-C (OR: 4.39; p-trend=0.005) and non-HDL-C (OR: 3.72; p-trend=0.008).Conclusion: Dietary GI and GL may have an association with higher odds of abnormal lipid profile. It seems that a diet with a low GI and GL (which full of whole grains, fruits, vegetables, nuts and legumes) can play an effective role in favorable lipid profile

Nutritional Status and Its Related Factors among 6-24 Month-Old Children Referring to Health Care Centers in Arsanjan City, Southern Iran

Background: Considering that children are major part of most populations and also considering the fact that childhood nutrition affects the health status in adulthood, we aimed to assess the nutritional status and its related factors among 6-24-month-old children referring to health care centers in Arsanjan city, southern Iran, in 2011. Methods: This cross-sectional study was done on 310 children aged 6-24 months. Weight and height were measured and data regarding demographic status, type of feeding, and birth order, were gathered by face to face interview with mothers of the children. Exact age of the children was recorded according to their birth certificate. Z-scores of weight and height were calculated using Epi-info software. SPSS version 16 was used for data analysis. Results: 27.2% of the studied children were mildly underweight, 2-6% were moderately underweight, and 0.3% were severely underweight. Also 15.6%, 1.6%, and 0.3% had mild, moderate, and severe stunting, respectively. According to weight for age index 7.4% were mildly overweight and 1.6% were moderately overweight. The prevalence of underweight was significantly more among 6-month-old children compared with the older children (P=0.019). There were no correlations between underweight and stunting and parents’ education or breast feeding. Conclusion: Our results indicated that although the prevalence of malnutrition is less than previous decade, it is still substantial. On the other hand it seems that the prevalence of overweight among children younger than 2 years is increasing. As childhood obesity is a risk factor for adulthood obesity and its related diseases such as diabetes and cardiovascular diseases, prevention of obesity among children is of importance

Diet Quality of Adolescents in Shiraz, Southern Iran Needs Moderate to Severe Improvement

Background: The importance of healthy eating habits increases in adolescence therefore, healthy eating index (HEI) and diet diversity score (DDS) are embedded in order to evaluate them. This study was undertaken to assess the diet quality of high school students in Shiraz,southern Iran. Methods: This cross-sectional study enrolled 696, fourteen to twenty years old teenage boys and girls in Shiraz, southern Iran. Anthropometric indices including weight, height and waist circumference (WC) were measured. A 168-item food frequency questionnaire (FFQ) was used to estimate usual dietary intakes, then HEI and DDS were calculated. Two physical activity questionnaires, one related to sitting activities and another about other activities were completed by participants. Results: Among 341 boys and 355 girls, 51.4%, 31.2% and 17.4% had were normal, underweight, and overweight or obese, respectively. Mean WC of participants was 71.7±10.71 cm. The mean of HEI score was 57.6±6.8. Only 0.2% of students had a good diet. The mean of DD Score was 6.4±1.3. About 23.5% of participants had highly diverse diet. A statistically significant higher HEI score (girls: 58.8±7.0, boys: 56.4±6.4) and lower DDS score (6.7±1.3 vs 6.1±1.2) were noticed in girls compared to boys. A positive association was seen between fruits and vegetables diversity score and negative relation between breads/grains, meat and dairies diversity scores with HEI. Conclusion: Dietary habits of most of junior and senior high school students in Shiraz needed moderate to severe improvements. So it is necessary to promote adolescents’ nutritional knowledge and attitudes

Dehydration among the Elderly: A Comparison between Nine Different Clinical and Metabolic Criteria

Background: Dehydration, as a common problem in older adults, plays a significant role in morbidity and mortality. The elderly are more susceptible to dehydration and fluid deficiency due to age-related factors. There is not much literature concerning fluid intake in older adults. This study aims to investigate fluid intake and dehydration prevalence in older people and compare the accuracy of potential markers in the detection of dehydration. Methods: This cross-sectional study was done on 127 old people (48 males and 79 females) selected from a nursing home in Shiraz, Iran. Socioeconomic status was assessed via interview. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), urine specific gravity (USG), urine color (UC) and bioelectrical impedance analysis (BIA), extracellular water (ECW), intracellular water (ICW), and total body water (TBW) were measured. The fluid intakes were recorded using a beverage and fluid intake questionnaire. Total fluid intakes were compared using two fluid intake guidelines (European guidelines and US guidelines) as well. Furthermore, anthropometric indices were measured. Results: The mean age of participants was 73.01± 5.70 year. Fluid intake was 2.32 ± 0.48 liter/day.  Based on urine specific gravity (USG) (˃1.020) and SBP (SBP ˂ 100 mmHg), 9.4% and 14.2% of the participants were dehydrated respectively. Among all hydration criteria, ECW had the highest potential for detection which identified 72.4% of participants as dehydrated. Among fluid intake guidelines, US guidelines were the best in dehydration diagnosis (112 individuals out of 127). Conclusions: Although urinary markers and physical indexes (SBP and HR) could not be used to determine hydration status, BIA measurements, especially ECW, have the potential to detect dehydration. In addition, daily fluid intakes are still practical for assessment of hydration status

The relationship between the intake of fruits, vegetables, and dairy products with hypertension: findings from the STEPS study

Abstract Background The current research aimed to evaluate the relationship between fruit, vegetable (FV), and dairy consumption with the odds of developing hypertension based on nationwide Stepwise approach to surveillance (STEPS) data in Iran. Methods This cross-sectional study was accomplished by the research center of non-communicable diseases (NCDs) in Tehran. In total, 29,378 individuals’ data were analyzed. Participants were classified into normal, elevated BP, stage I, and stage II hypertension according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) examinations. Based on the STEPS questionnaire, the consumption of FVs and dairy products was evaluated. Multinomial logistic regression was applied to assess the relationship between the consumption of FVs and dairy products with hypertension. Results The findings revealed that only fruit consumption (≥ 2 servings/day) was negatively related to stage I hypertension (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.69–0.95) in two servings per day and OR = 0.81; 95% CI: 0.68–0.96 in > two servings per day) in the adjusted model. There was no significant relationship between consuming vegetables and dairy products with elevated BP and hypertension. Conclusion Our study showed that increasing fruit consumption was related to reducing hypertension odds. Regarding the consumption of dairy products and vegetables, no significant relationship was found with the odds of hypertension. More studies, especially cohorts, are needed to evaluate the impacts of FV and dairy products on the risk of hypertension