Adherence to low-carbohydrate diet in relation to gastric cancer : Findings from a case-control study in Iran

This study examined the association between adherence to low carbohydrate diet (LCD) and risk of gastric cancer (GC). This hospital-based case-control study was conducted in Iran Cancer Institute, Tehran, Iran between 2010 and 2012. Totally, 178 patients with GC and 276 apparently healthy controls participated in this study. Cases were histo-pathologically confirmed GC patients aged ≥40 years diagnosed with GC in the last year. Dietary intakes were assessed using a validated 146-item Diet History Questionnaire. We computed the LCD score trough the protocol explained by Halton. Patients with GC were older (60.8 vs. 53.2 years, P < 0.001) and more likely to be male (74.2 vs. 63.8%, P = 0.02), married (97.8 vs. 86.6%, P < 0.001) and illiterate (62.4% vs. 26.1%, P < 0.001) than controls. Before adjusting for covariates, adherence to LCD-diet was not associated with risk of GC [odds ratio (OR) 1.31; 95% confidence interval (CI) 0.82-2.09 for highest vs. lowest tertile; Ptrend< 0.26]. Adjustments for several potential confounders including H-pylori infection and BMI, participants in the highest tertile of LCD score were 7% more likely to have GC than those in the lowest tertile; however, it was not statistically significant (OR 1.07; 95% CI 0.59-1.95 for highest vs. lowest tertile; Ptrend< 0.79). No significant association was also seen between adherence to animal- or vegetable-based LCD diet and risk of GC. In conclusion, we failed to find any evidence on the association between consumption of LCD and odds of GC. Further studies, in particular of prospective design, are required to confirm these findings.acceptedVersionPeer reviewe

Association between gastric cancer and the intake of different types of iron and meats

Background: Heme and non-heme irons are two forms of iron in the diet. Few studies have evaluated the association between heme iron intake and the risk of gastric cancer (GC). We aimed to investigate the association between heme, non-heme and total iron intake and risk of GC in Iran. Methods: In a hospital-based case–control study, nutritionists interviewed 178 pathologically confirmed GC patients and 276 controls using a valid Diet History Questionnaire. Multiple logistic regression model was used to estimate Odds Ratios (OR) and 95% Confidence Intervals (CIs) for iron intake and risk of GC. Results: Subjects in the highest tertile of total iron intake were 46% less likely to get GC than those in the lowest (OR = 0.54, 95% CI: 0.32–0.92), however, the associations were not significant for intake of heme and non-heme iron. The risk of GC in the highest tertile of total meat intake was 2.51 times higher than the lowest. We found significant associations between GC and chicken (OR = 2.95; 95% CI: 1.66–5.22) and fish intake (OR = 1.89; 95% CI: 1.09–3.27), However, we found no associations between the risk of GC and intake of red meat, salted fish, and liver. Conclusion: Total iron intake was associated with a lower risk of GC which could be partly due to the high prevalence of anemia in Iran. Although, we could not find any significant association between the risk of GC and the intake of heme and non-hem iron among the Iranian population.publishedVersionPeer reviewe

Patterns of Nutrient Intake in Relation to Gastric Cancer : A Case Control Study

Gastric Cancer (GC) is the most common cancer among Iranian men. We conducted a case-control study to investigate the association between patterns of nutrient intake and the risk of GC in Iran. We enrolled 178 GC patients and 271 controls matched for age and sex. We collected dietary intakes using a validated diet history questionnaire. We performed factor analysis on 28 nutrients using multivariate logistic regression models on tertiles of factor scores and estimated odds ratios (OR) and 95% confidence intervals (95% CI). We identified three nutrient patterns. The first pattern included pantothenic acid, riboflavin, zinc, animal protein, and calcium. Selenium, thiamin, carbohydrate, vegetable protein, niacin and low intake of vitamin E loaded the second pattern, and the third pattern was abundant in fiber, carotene, vitamin C and A. We found no significant association between GC and any of the dietary patterns. However, in the first patterns, men in the highest tertile had significantly higher odds of GC than the lowest (OR = 2.15, 95% CI: 1.13–4.09, p trend = 0.02). A dietary pattern loaded by animal products may increase the risk of GC among Iranian men. Larger studies are required to approve these findings in overall and in different subgroups. Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1931697.acceptedVersionPeer reviewe

Vitamins and Stomach Cancer : A Hospital Based Case-Control Study in Iran

Background: This study investigated the association between vitamins intakes and risk of gastric cancer (GC) among Iranian population. Methods: In this hospital-based case-control study, 178 pathologically confirmed GC patients and 276 healthy controls were interviewed to answer a valid diet history questionnaire. Unconditional logistic regression, in which potential confounders were taken into account, was applied to determine the association of vitamin intakes and odds of GC in total population and in stratums of body mass index (BMI), helicobacter pylori (H-pylori) infection, and smoking. Results: GC was directly associated with vitamin D (OR 1.59; CI 95% 1.07, 2.36) and cobalamin (OR 1.25; CI 95% 1.08, 1.44). Thiamin (OR 0.50; 95%CI 0.30, 0.83), pantothenic acid (OR 0.71; 95%CI 0.58, 0.87), folate (OR 0.99; 95%CI 0.99, 0.99) and vitamin E (OR 0.98; 95%CI 0.96, 0.99) were inversely associated with GC. In 231 H-pylori infected participants, consumption of thiamin (OR 0.3; 95% CI 0.59, 0.86), pyridoxine (OR 0.52; 95%CI 0.31, 0.85), and folate (OR 0.99; 95%CI 0.99, 0.99) reduced GC risk. In H-pylori negative participants, only vitamin E (OR 0.96; 95%CI 0.93, 0.99) reduced the risk and vitamin D (OR 1.99; 95%CI 1.18, 3.36), riboflavin (OR 1.91; 95%CI 1.37, 2.66), pantothenic acid (OR 1.34; 95%CI 1.13, 1.64), biotin (OR 1.03; 95%CI 1.01, 1.05), and cobalamin (OR 1.36; 95%CI 1.13, 1.64) increased the risk. In BMI stratums, only vitamin D (OR 1.81; 95%CI 1.07, 3.08) was associated with the risk of GC among normal weight participants. Vitamin E was associated with lower risk of GC in ever smokers (OR 0.97; 95%CI 0.95, 0.99) and thiamin (OR 0.41; 95%CI 0.19, 0.86) and niacin (OR 0.93; 95%CI 0.87, 0.99) were associated with lower risk in never smokers. Positive associations were observed by increasing vitamin D (OR 2.08; 95%CI 1.12, 3.85) and cobalamin (OR 1.33; 95%CI 1.08, 1.65) in never smokers. Conclusion: This study provided support for a possible protective effect of vitamin E, thiamin, pantothenic acid, and folate on GC risk. Vitamin D and cobalamin intake increased the risk.publishedVersionPeer reviewe

Dietary total antioxidant capacity and head and neck cancer: a large case-control study in Iran

BackgroundData on the association between head and neck cancer (HNC) and dietary factors are inconclusive. No study has so far investigated the association between dietary total antioxidant capacity (dTAC) and HNC concerning interactions with other risk factors.MethodPathologically confirmed new diagnosed HNC patients were included in this study. The control group was healthy hospital visitors who were frequently matched with patients on age (5 years interval), gender, and province of residence. Trained interviewers administered a validated Food Frequency Questionnaire (FFQ) to assess the participants’ food intake 1 year before the cancer diagnosis. Data on TAC scores of foods was collected by Ferric Reducing Antioxidant Power (FRAP) and Total Radical-trapping Antioxidant Parameters (TRAP) from published data. We applied logistic regression adjusted for age, sex, energy intake, socioeconomic status, province, opium use, alcohol use, physical activity, and dental health. We also studied the interaction of dTAC with tobacco smoking status, and opium use on the risk of HNC.ResultsWe recruited 876 HNC patients and 3,409 healthy controls. We observed a significant decrease in the odds of HNC with increasing dTAC scores. The OR of HNC for the third vs. the first tertile was 0.49 (95%CI 0.39–0.61) for FRAP and 0.49 (95%CI 0.39–0.62) for TRAP. Both dTAC scores were inversely associated with lip and oral (T3 ver. T1 OR = 0.51; 95%CI 0.36–0.71 for FRAP and OR = 0.59; 95% CI 0.44–0.82 for TRAP) and larynx (T3 ver. T1 OR = 0.43; 95%CI 0.31–0.61 for FRAP and OR = 0.38; 95% CI 0.26–0.55 for TRAP) cancers. There was no interaction between tobacco smoking, opium use; and TRAP or FRAP on the risk of HNC.ConclusionAn antioxidant-rich diet in terms of FRAP or TRAP could decrease the risk of HNC and its subtypes

Pesticide Residue in Iranian Fruits and Vegetables: A Systematic Review

There is a growing concern about the health-threatening effects of pesticide residues in fruits and vegetables worldwide. This study systematically reviewed the published data on pesticide residues in Iranian fruits and vegetables to clarify the gap in this issue. Method: The authors systematically searched PubMed, Google Scholar, Scopus, SID, and Iran Medex to find published studies on pesticide residues in Iranian foods without time and language restrictions. The title and abstract of all articles were evaluated after removing duplicate articles (2289 articles) by two independent reviewers. Finally, 25 articles were found that reported pesticide residues in fruits and vegetables. There was a great variation in measurement methods and pesticides reported across studies, which precluded meta-analysis. Therefore, a summary of the included studies was only reported. Results: Twenty-four studies reporting pesticide residues in Iranian fruits and vegetables were included. The percentage of Iranian fruits and vegetables contaminated with pesticides exceeding the maximum residue limit (MRL) was less than 10% in most studies. Contaminated samples were collected mainly from cultivated areas such as fields, orchards, or greenhouses. Conclusion: Pesticide residues in food have not been systematically reported in Iran. It was found that only limited articles were published by academic societies on this issue. Considering the current scenario, there is an urgent need to facilitate reliable and continuous measurements of toxic residues in Iranian food

Data_Sheet_1_Worse becomes the worst: obesity inequality, its determinants and policy options in Iran.docx

BackgroundThis tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities.MethodsThis study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran’s policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study.ResultsInequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary.ConclusionObesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.</p

Table_3_Worse becomes the worst: obesity inequality, its determinants and policy options in Iran.pdf

BackgroundThis tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities.MethodsThis study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran’s policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study.ResultsInequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary.ConclusionObesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.</p

Macronutrients intake and stomach cancer risk in Iran : A hospital-based case-control study

Background: Stomach cancer (SC) is one of the most common cancers in the world. Dietary risk factors of SC are not fully understood. This study aimed to investigate the association between macronutrient intakes and the risk of SC. Study design: A hospital-based case-control study. Methods: The data were obtained from a hospital-based case-control study conducted at the Cancer Institute of Iran from 2010 to 2012. Patients were 40 years or older and were diagnosed with SC in less than one year with no history of any cancers. On the other hand, the controls were healthy subjects who were caregivers or visitors of the patients. Demographic characteristics were collected using a structured questionnaire through face to face interviews by trained interviewers. Dietary data were obtained using a validated Diet History Questionnaire. The age and gender-adjusted odds ratios (ORs), as well as the adjusted ORs of age, gender, energy, education, smoking, and body mass index, were reported for continuous and tertiles of intakes. Results: Totally, 207 SC patients and 217 controls participated in this study. In the full adjusted model, after comparing the highest tertiles to the lowest ones, the intake of sucrose (OR: 2.94; 95% CI: 1.66-5.19; P-trend<0.001), protein (OR: 2.04; 95% CI: 1.17-3.55; P-trend=0.011), cholesterol (OR: 2.22; 95% CI: 1.28-3.85; P-trend=0.005), and percent of calories from protein (OR: 3.09; 95% CI: 1.69-5.61; P-trend<1.001) showed a positive significant association with SC. Moreover, a significantly negative association was found between the percent of calories obtained from carbohydrates and SC (OR: 0. 57; 95% CI: 0.33-0.98; P-trend=0.015). Conclusion: The findings in this study showed that macronutrient intakes might be associated with the etiology of SC in Iran.publishedVersionPeer reviewe