Is vitamin D supplementation program in Iranian schools effective in reducing adolescent depressive symptoms? Cost effectiveness study.

PURPOSE: We aimed to assess the cost-effectiveness of the vitamin D supplementation program in Iranian adolescents reducing adolescent depressive Symptoms. METHODS: In the current cost-effectiveness analysis, the viewpoint of Iran's Ministry of Health was selected. The target population was 1,519,762 Iranian high school students (733,657 girls and 786,105 boys). The total costs of the vitamin D supplementations program were based on the reports of the Nutrition Improvement Office of Iran's Ministry of Health and were adjusted to 2018. The variable of Quality-Adjusted Life Years (QALYs) was considered a suitable variable for estimating the effectiveness of vitamin D supplementation. We chose one year as the time horizon. A decision tree model was constructed in TreeAge Pro. The results of the cost-effectiveness analysis were reported in term of the Incremental Cost-Effectiveness Ratio (ICER). RESULTS: The results of our study showed that the estimated cost per QALY gained of the vitamin D supplementation program is equal to 1528.6676 $, which indicates that vitamin D supplementation in adolescents(11-18Y) is a cost-effective and a dominant strategy in preventing depression through the cost-saving and QALYs increment compared to the no intervention. Sensitivity analysis showed that the possible variations in vitamin D supplement costs could not alter the results, and vitamin D supplementation may be a predominant and cost-effective strategy to prevent adulthood depression with a 100% probability. CONCLUSION: The national program of vitamin D supplementation among Iranian adolescents was a cost-efficient strategy reducing adolescent depressive Symptoms through the cost-saving and QALYs increment compared to the no intervention.

Validation and reproducibility of a semi-qualitative food frequency questionnaire for assessment of sodium intake in Iranian population.

BACKGROUND: Few semi-quantitative food frequency questionnaires (SFFQ)s has yet been developed to assess sodium intake in Middle East region. This study was performed to validate a SFFQ for assessment of sodium consumption and food groups΄ contribution to sodium intake. METHODS: This study was performed on 219 healthy participants including 113 adults aged ≥19 years and 106 children aged 6-18 years in Isfahan, Iran. They were administered two SFFQ at the beginning and after 1 year to evaluate the reproducibility. The validity of SFFQ for assessment of sodium intake was compared with 24-h urine sodium and twelve 24-h dietary recalls which were completed monthly during a year as two standard methods. RESULTS: Correlation coefficient between the contribution of food groups to sodium intake based on SFFQ and 24-h dietary recalls varied from 0.04 for legumes (P = 0.667) to 0.47 for added salt (P < 0.001). There was a significant correlation between the estimated total sodium intake based on SFFQ and both standard methods (P < 0.01). Intraclass correlation coefficient (95% CI) between first and second SFFQ had a diverse range from 0.10 (-0.05, 0.17) for fats and oils to 0.49 (0.28, 0.69) for bread. According to the Bland-Altman plots, we observed an acceptable level of agreement between the two methods for sodium intake. CONCLUSIONS: The SFFQ was a relatively valid and reproducible method for estimating sodium intake. Combination of this SFFQ with a valid prediction of 24-h urinary sodium excretion can be useful in achieving more accurate results.

The cost-effectiveness analysis of a nationwide vitamin D supplementation program among Iranian adolescents for adulthood cardiovascular diseases prevention.

OBJECTIVE: This study aimed to evaluate a national vitamin D supplementation program's cost-effectiveness among Iranian adolescents to prevent cardiovascular diseases (CVDs) in adulthood. STUDY DESIGN: A cost-effectiveness analytical study. METHODS: A decision tree model was adopted to evaluate the cost per quality-adjusted life-year (QALY) of monthly intake of nine pearls of 50,000 IU vitamin D for nine months to prevent CVD a one-year horizon compared to no intervention. The analysis was conducted in Iranian adolescents in first or second high school grades of 47 climatically different Iran regions. RESULTS: Our analytical analysis estimated the 1090$ cost per QALY gained of the monthly intake of 50,000 IU vitamin D for nine months among adolescents over a one-year horizon. Based on the incremental cost-effectiveness ratio (ICER) threshold of 1032-2666, vitamin D supplementation was cost-effective for adolescents to prevent adulthood CVD. It means that vitamin D supplementation costs were substantially less than the costs of CVD treatments compared to the no intervention. CONCLUSIONS: Based on these findings, the national program of vitamin D supplementation in adolescents would be cost effective to prevent CVD development in adulthood. From an economic perspective, vitamin D supplementation, especially in adolescents with vitamin D deficiency, would be administrated.

Bioactive Carboxymethyl Starch-Based Hydrogels Decorated with CuO Nanoparticles: Antioxidant and Antimicrobial Properties and Accelerated Wound Healing In Vivo.

In this study, nanocomposite hydrogels composed of sodium carboxymethylated starch (CMS)-containing CuO nanoparticles (CMS@CuO) were synthesized and used as experimental wound healing materials. The hydrogels were fabricated by a solution-casting technique using citric acid as a crosslinking agent. They were characterized by Fourier-transform infrared spectroscopy (FTIR), energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and thermogravimetric analysis (TGA) to evaluate their physicochemical properties. In addition, swelling, antibacterial activities, antioxidant activities, cytotoxicity, and in vivo wound healing were investigated to evaluate the wound healing potential of the CMS@CuO nanocomposite hydrogels. Growth inhibition of the Gram-positive and Gram-negative pathogens, antioxidant activity, and swelling were observed in the CMS@CuO nanocomposite hydrogels containing 2 wt.% and 4 wt.% CuO nanoparticles. The hydrogel containing 2 wt.% CuO nanoparticles displayed low toxicity to human fibroblasts and exhibited good biocompatibility. Wounds created in rats and treated with the CMS@2%CuO nanocomposite hydrogel healed within 13 days, whereas wounds were still present when treated for the same time-period with CMS only. The impact of antibacterial and antioxidant activities on accelerating wound healing could be ascribed to the antibacterial and antioxidant activities of the nanocomposite hydrogel. Incorporation of CuO nanoparticles in the hydrogel improved its antibacterial properties, antioxidant activity, and degree of swelling. The present nanocomposite hydrogel has the potential to be used clinically as a novel wound healing material.

Can methods based on spot urine samples be used to estimate average population 24 h sodium excretion? Results from the Isfahan Salt Study.

OBJECTIVE: To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples. DESIGN: A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics. SETTING: Iranian adults recruited in 2014-2015. PARTICIPANTS: Healthy volunteer adults aged ≥18 years. RESULTS: With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (-469 to -708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (-151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50). CONCLUSIONS: In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.

What is the best solution to manage vitamin D deficiency?

Nowadays, vitamin D deficiency is the most common nutritional deficiency worldwide. In addition to the skeletal effects, it is now recognized that vitamin D deficiency is associated with higher morbidity and mortality. Currently, optimizing serum concentration of 25-hydroxy vitamin D with targeted strategies is becoming one the most interesting topics of public health nutrition. It is not possible for everyone to obtain sufficient serum concentrations of vitamin D by effective solar ultraviolet B exposure or usual dietary intake. Nutritional supplements and fortified foods as an available and cost-effective way to provide the recommended amount of vitamin D. Although, vitamin D supplementation is considered a good and simple short-term solution for vitamin D deficiency treatment; however, it seems that at a population level, food fortification, using staple foods, is the best method to increase vitamin D consumption and long-term treatment of vitamin D deficiency. © 2019 IUBMB Life, 71(9):1190-1191, 2019.

Trend of salt intake measured by 24-hour urine collection samples among Iranian adults population between 1998 and 2013: The Isfahan salt study.

BACKGROUND AND AIM: Few population-based studies conducted in the Eastern Mediterranean region assessed salt intake by the measurement of 24-h sodium urine excretion (24-hUNa). The current study aimed to assess the trend of mean salt intake in Iranian adults between 1998 and 2013. METHODS AND RESULTS: These cross-sectional studies were performed on 564, 157, 509 and 837 randomly selected healthy adults aged >18 years from Isfahan city, Iran, in 1998, 2001, 2007 and 2013, respectively. BP was measured using a mercury sphygmomanometer according to a standard protocol. Single 24-h urine was collected to assess 24-hUNa as a surrogate of salt intake, and 24-h urinary K (24-hUK). The estimated trend of salt intake was 9.5, 9.7, 9.6 and 10.2 g/day in total population (P < 0.001). The increase in salt intake between 1998 and 2013 was significant only in men, (P < 0.001). The risk of pre-hypertension was 21% and 18% significantly greater in the highest quartiles of UNa/UK after adjustment for potential confounders in 2001 and 2013, respectively, [OR (95% CI): 1.21 (1.03-1.64) and 1.18 (1.02-1.38), respectively]. CONCLUSIONS: This population-based study indicated that mean salt intake was about two times of recommendation in Isfahan city, Iran, and suggest that it would be essential to implement a salt reduction strategy program in Iranian population. Longitudinal national studies with larger samples examining the trend of salt intake are warranted.

Implementation evaluation of an iron supplementation programme in high-school students: the crosswise model.

OBJECTIVE: To evaluate the implementation of the national health promotion programme (through nutritional education and Fe supplementation) among female high-school students in Iran and to assess the application of the crosswise model (CM) for evaluating the programme's implementation. DESIGN: Two cross-sectional surveys in female high-school students, one using the direct questioning (DQ) method and the other using the CM, were conducted. Two survey questionnaires used to collect the data contained questions about three aspects of the programme: delivering the Fe supplements, consuming them and holding nutritional training sessions. SETTING: Female high schools, West Azerbaijan Province, Iran. PARTICIPANTS: A sample of 2180 students, of whom 1740 were surveyed by the CM and 440 were interviewed by DQ. RESULTS: The CM resulted in estimates that were consistently lower than the estimates of the DQ. The proportion of students in the DQ and CM who reported receiving the pills weekly and on a regular basis was 73·2 and 22·5 %, respectively. About 43 and 31 % of students in the DQ and CM surveys reported consuming all pills delivered to them. In the DQ method, only 12 % of students who reported the number of pills consumed had taken the complete dose (sixteen pills). CONCLUSIONS: Implementation of the Fe supplementation programme in female high schools was poor and insufficient, so that it seems unsuccessful in reducing Fe-deficiency anaemia in adolescent girls. The CM might be considered for evaluating the health programme's implementation at high schools.

Low correlation between morning spot and 24-hour urine samples for estimating sodium intake in an Iranian population: Isfahan Salt Study.

Introduction: Although difficult, the 24-hour urine sodium excretion is still considered as the gold standard method to estimate salt intake. The current study aimed to assess the validity of using spot urine samples in comparison with the standard 24-hour urine collection to estimate sodium and potassium intake in healthy Iranian adults. Methods and subjects: This cross-sectional study was performed on 1099 healthy Iranians aged 18-69 years. Samples of 24-hour and fasting morning spot urine were collected to measure sodium and potassium excretions. Tanaka's formula was utilized to predict the 24-hour sodium and potassium urinary excretions based on the spot values. Results: The difference between measured and estimated sodium excretion values was 4265 mg/day (95% CI: 4106-4424; P < 0.001) and 2242 mg/day in case of potassium excretion (95% CI: 2140-2344; P < 0.001). There was a weak significant correlation between the 24-hour urine sodium and potassium excretion and the predicted values (intraclass correlations: 0.22 and 0.28, respectively; both P < 0.001). Conclusion: The weak association between the predicted and measured values of sodium and potassium along with the marked overestimation of daily sodium and potassium excretions based on the spot urine and using Tanaka formula indicates that Tanaka formula is not practical for the prediction of sodium and potassium or salt intake in Iranian adults. Using other spot urine sampling times and/or adopting a formula designed based on the characteristics of the Iranian population may increase the validity of spot urine tests.

Healthy changes in some cardiometabolic risk factors accompany the higher summertime serum 25-hydroxyvitamin D concentrations in Iranian children: National Food and Nutrition Surveillance.

OBJECTIVE: To investigate seasonal variations of vitamin D status at different latitudes and if these changes are accompanied by corresponding variations in certain health parameters in children living in a broad latitudinal range in Iran. DESIGN: Longitudinal study. SUBJECTS: In total, 530 apparently healthy children aged 5-18 years were randomly selected from six regions of Iran with a latitudinal gradient from 29°N to 37·5°N. All anthropometric and biochemical assessments were performed twice during a year (summer, winter). High BMI (Z-score >1), low HDL cholesterol (150 mg/dl) were considered cardiometabolic risk factors. RESULTS: Serum 25-hydroxyvitamin D (25(OH)D) showed between-season variation, with significantly higher concentrations (mean (sd)) in summer v. winter (43 (29) v. 27 (18) nmol/l; P33°N v. <33°N: 4·5; 0·09, 9·0; P=0·04) were predictors of change of serum 25(OH)D between two seasons. CONCLUSIONS: Summertime improvement of vitamin D status was accompanied by certain improved cardiometabolic risk factors, notably serum TAG, total cholesterol and BMI, in children.

Nutrition and food security policy in the Islamic Republic of Iran: situation analysis and roadmap towards 2021.

BACKGROUND: All government policies and programmes for food and nutrition security should include providing healthy food, as well as providing economic and social availability for all people. AIM: This study aimed to analyse the current situation of Iranian food and nutrition security and establish a road map towards 2021. METHODS: The applied methods were situation analysis and a mixed qualitative-quantitative method. The conceptual method used for developing this national document encompassed three areas: sustainable food supply, food safety and nutrition. RESULTS: The outcomes of the Iranian food and nutrition security system in the past three decades include development of management infrastructure and improvement in food and nutrition security status. However, analysis of current programmes showed that there were some overlapping, intertwining and parallel works in the responsibilities of related organizations in the field of supervision of food safety (from production to supply). The national document produced as the outcome of this paper was communicated by the Iranian Ministry of Health in 2012 and has been running for 2 years. Selected ministries are responsible for implementation of 20 national programmes by the end of the 5th Economic, Social and Cultural Development Programme (2016-2011). The consensus of stakeholders by the end of the 6th Development Programme (2021) is to put all of the provinces in a safe or very safe situation in terms of food and nutrition security. CONCLUSION: The most important challenge in establishing national documents is to make them operational. This aim was achieved by an intersectoral nutrition and food security working group, which produced a general memorandum of understanding with the main organizations, the media, universities and private sector.

Vitamin D Status, Latitude and their Associations with Some Health Parameters in Children: National Food and Nutrition Surveillance.

BACKGROUND: Recent data indicate a role for vitamin D in many health aspects including anthropometric measures and blood lipid profiles. Dermal vitamin D synthesis may be influenced by latitude. However, the contribution of latitude in vitamin D status and its association with anthropometric and blood lipid measures in Iranian children have not been studied to date. METHODS: We used data from the National Food and Nutritional Surveillance Program. In total, 667 apparently healthy children aged 5-18 years were randomly selected from six provinces of Iran with different latitudes, from 29 to 37°. Weight, height, circulating 25-hydroxycalciferol; calcidiol [25(OH)D] and blood lipids were measured. RESULTS: In total, 16.7 and 4.1% of children were overweight or obese, respectively. The mean 25(OH)D concentration was 27.3 ± 17.6 nmol/l (95% confidence interval: 26.0-28.7 nmol/l). Over 93% of all children had suboptimal circulating calcidiol concentrations. Undesirable status of vitamin D, serum triglyceride and low-density lipoprotein were all more prevalent in children living in regions >33° latitude than those in <33°, significantly. There was no significant difference in duration of sun exposure between children living in latitudes below and above 33° (p = 0.093). In multivariate regression model, sex, latitude, body mass index for age z-score and sun exposure duration were independently related to 25(OH)D concentrations, but age was not. CONCLUSION: Despite significant association of latitude and vitamin D status, hypovitaminosis D is prevalent across latitude gradient in Iranian children. Our findings warrant immediate sustainable nutritional intervention, including supplementation, to protect children from hypovitaminosis D irrespective of the latitude of their residence.

Vitamin D status and cardiometabolic risk factors across latitudinal gradient in Iranian adults: National food and nutrition surveillance.

BACKGROUND: This study aimed to evaluate the vitamin D status in an adult population across latitudinal gradient and to investigate its possible associations with certain cardiometabolic risk factors. METHODS: A total of 1406 healthy subjects aged 19-60 years were randomly selected from six regions of Iran across latitudinal gradient from 29° N to 37.5° N. Anthropometric and biochemical assessments were performed. The combination of high body mass index (>25 kg/m2), low high-density lipoprotein cholesterol (< 40 mg/dl in males and < 50 mg/dl in females) and high triglycerides (> 150 mg/dl) was defined as cardiometabolic risk factors. RESULTS: The mean concentration of serum 25-hydroxycalciferol (25(OH)D) was 26.8±17.7 nmol/l. There were no significant differences in the mean serum 25(OH)D levels among different latitudes. Undesirable vitamin D status (deficiency and insufficiency) was found in 90.7% of the subjects. After adjustment for age and gender, the association between weight status and serum 25(OH)D was significant ( p< 0.04, odds ratio:1.49; confidence interval: 1.01-2.19). The prevalence of cardiometabolic risk factors among the subjects with serum 25(OH)D less than 27.5 nmol/l was significantly higher than those with serum calcidiol concentrations above 27.5 nmol/l (13.3% vs. 10.0%, p = 0.033). CONCLUSION: Undesirable vitamin D status is highly prevalent among Iranian adults of both sexes irrespective of latitude and even in sunny regions. The occurrence of cardiometabolic risk factors was significantly higher in those subjects with circulating calcidiol concentrations below 27.5 nmol/l.

Economic inequality in nutritional knowledge, attitude and practice of Iranian households: The NUTRI-KAP study.

Background: Improper nutritional knowledge is one of the most important causes of nutritional problems, which can affect practice and cause more complications. The aim of this study was to assess the association between nutritional knowledge, attitude and practice (KAP) of Iranian households with socioeconomic status (SES). Methods: The study population was 14,136 households (57 clusters of 8 individuals in each province) who lived in urban and rural regions of 31 provinces of Iran. The sample size of the study was selected using multistage cluster sampling technique. A structured questionnaire and interview with the qualified person in each family was used to collect data. The questionnaire included demographic, SES and nutritional KAP questions. Using principle component analysis, some variables including household assets, occupation and education level of the heads of the families and respondents and the number of family members were used to construct family SES. The SES was categorized as good, moderate and weak. Pearson's Chi-square test was used to analyze categorical variables. Results: The percentage of knowledge about growing up, acquiring energy and being healthy as reasons for eating food was 24.1%, 44.8% and 54.7%, respectively. Only 69.7%, 60.5% and 52.5% of the participants had knowledge of identification of meat and legumes, grain and dairy group, respectively. More than 97% of the participants had a favorable attitude toward importance of nutrition in health. The nutritional knowledge linearly increased with increasing SES. Families with good SES significantly consumed more fruit, vegetable, dairy group, red meat, chicken and poultry, fish and egg while sugar consumption was significantly higher in families with weak SES (p<0.05). Conclusion: SES can influence the rate of nutritional KAP. Some policies should be considered to increase nutritional KAP especially in lower SES group in the society.

High occurrence of food insecurity among urban Afghan refugees in Pakdasht, Iran 2008: a cross-sectional study.

This research aimed to evaluate food security and its association with anthropometric measures among Afghan refugees living in Pakdasht, one of the main harbors of Afghan refugees in the neighborhood of Tehran. A total of 414 registered Afghan refugee households were recruited in a cross-sectional study. About 88% of households were food insecure. Unemployment and socioeconomic status were the major determinants of food insecurity among the refugee households. While about 58% of women were overweight/obese, the prevalence of underweight and wasting were remarkable in children (11.0% and 12.7%, respectively), indicating a recent malnutrition. Government and organizations working for refugees must focus their activities on empowering Afghan refugees.

The therapeutic value of thiazole and thiazolidine derivatives in Alzheimer's disease: a systematic literature review.

Background and purpose: Alzheimer's disease (AD) is a common neurodegenerative disease and the fifth leading cause of death among the elderly. The development of drugs for AD treatment is based on inhibiting cholinesterase (ChE) activity and inhibiting amyloid-beta peptide and tau protein aggregations. Many in vitro findings have demonstrated that thiazole-and thiazolidine-based compounds have a good inhibitory effect on ChE and other elements involved in the AD pathogenicity cascade. Experimental approach: In the present review, we collected available documents to verify whether these synthetic compounds can be a step forward in developing new medications for AD. A systematic literature search was performed in major electronic databases in April 2021. Twenty-eight relevant in vitro and in vivo studies were found and used for data extraction. Findings/Results: Findings demonstrated that thiazole-and thiazolidine-based compounds could ameliorate AD's pathologic condition by affecting various targets, including inhibition of ChE activity, amyloid-beta, and tau aggregation in addition to cyclin-dependent kinase 5/p25, beta-secretase-1, cyclooxygenase, and glycogen synthase kinase-3ß. Conclusion and implications: Due to multitarget effects at micromolar concentration, this review demonstrated that these synthetic compounds could be considered promising candidates for developing anti-Alzheimer drugs.

IL-18 and CD14 variants in chronic HBV predisposition: a case-control study with in silico analyses focused on transcription and splicing.

Hepatitis B virus (HBV), a vaccine-avoidable infection, is a health concern worldwide, leading to liver disorders such as acute self-constraint and chronic hepatitis, liver failure, hepatic cirrhosis, and even hepatocellular carcinoma if untreated. 'Immunogeneticprofiling', genetic variations of the pro- and anti-inflammatory cytokines responsible for regulating the immune responses, cause person-to-person differences and impact the clinical manifestation of the disease. The current experimental-bioinformatics research was conducted to examine whether promoteric IL-18-rs187238 C > G and -rs1946518 T > G and intronic CD14-rs2569190 A > G variations are associated with chronic HBV. A total of 400 individuals (200 in each case and control group) participated in the study and were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The data was also assessed bioinformatics-wise for conservation, genomic transcription and splicing, and protein interactions. Findings proposed that unlike the IL-18-rs1946518 T > G and CD14-rs2569190 A > G, the IL-18-rs187238 C > G is a protector against chronic HBV (odds ratio [OR] = 0.62, 95% confidence intervals [CI]: 0.46-0.83, and p = 0.002). The TG/CC/AA, TG/CC/AG, TT/CC/AG, and GG/CC/AA combined genotypes significantly increased chronic HBV risk (p < 0.05), while the IL-18 G/T and G/G haplotypes lessened it (p < 0.05). Moreover, IL-18-rs1946518 T > G is in the protected genomic regions across mammalian species. In contrast to the IL-18-rs1946518 T > G, IL-18-rs187238 C > G is likely to create novel binding sites for transcription factors, and the CD14-rs2569190 A > G presumably changed the ribonucleic acid splicing pattern. More research on larger populations and other ethnicities is required to authenticate these results.

Household food insecurity and associated factors in the Northeast of Iran: a cross-sectional study : Household food security in Northern Iran.

BACKGROUND: Food Insecurity (FI) is a global health concern. For the first time, this study evaluated households' food insecurity and factors related to it in Golestan province, North of Iran. METHODS: This cross-sectional study was conducted on 5129 randomly selected households in the Golestan Province in 2016. Sociodemographic characteristics, including age, ethnicity, household size, education level, and occupation status, were collected via interview. The prevalence and severity of food insecurity were identified by the Household Food Insecurity Access Scale (HFIAS), whose scores are between 0 and 27, with larger values indicating more severe food insecurity. The prevalence of food insecurity based on the geographical area was presented using GIS. RESULTS: Out of 5129 households, 2216 (43.21%) had food security, and 2913 (56.79%) households had food insecurity, with a Mean ± SD HFIAS score of 4.86 ± 5.95. Out of 2913 households with FI, 1526 (52.39%), 956 (32.82%), and 431 (14.79%) had mild, moderate, and severe food insecurity, respectively. Among 14 regions of the province, three regions had the most cases of food insecurity. Food insecurity (moderate or severe) was significantly associated with mothers as the household head (adjusted OR = 1.67, 95% CI: 1.03-2.70) and lower education level of the household head. CONCLUSION: The prevalence of household food insecurity in the Golestan Province is higher than the national average. Factors such as literacy, employment status, and gender of the household head can be significantly associated with food insecurity.

Dietary Supplement Use among Iranian Households during COVID-19 Epidemic Lockdown: Less Access in Those Who May Need More National Food and Nutrition Surveillance.

Background: The coronavirus disease 2019 (COVID-19) pandemic elicited the general population to use various dietary supplements (DSs) and nutraceuticals as a protective means against the disease. The present study aimed to evaluate changes and certain determinants of DS intake during the COVID-19 lockdown among Iranian households. Methods: This nationwide cross-sectional study was conducted from April 4 to April 25, 2020, during which Iran was in lockdown. To collect data, a web-based electronic self-administered questionnaire was created. The data were compared among provinces based on their food security situations. Results: A total of 21,290 households were included in the analyses. Approximately 27% of the households were using DSs after the epidemic. The most common DSs used were vitamin D (42%) and vitamin C (20%), followed by multi-vitamin (16%), zinc (9%), omega-3 (6%), vitamin A (4%), and probiotics (3%). Logistic regression analysis revealed that DS intake was directly associated with the household income but inversely with household size and the food security status of the provinces. DS intake was positively associated with the presence of high-risk persons in the households, the education of the households' head, and the presence of a person with a history of COVID-19 within the household. Conclusions: During epidemic lockdown, DS use was remarkably increased among the Iranian households. Apart from the debatable usefulness of DSs against COVID-19, the inverse association of DS use with a household's income and provincial food security well indicates inequity in accessibility to DS. Actions to improve the nutritional status of the under-privileged populations including targeted supplementation are strongly recommended.

The national health program for vitamin D supplementation in a developing country.

BACKGROUND: Previous studies have reported a high frequency of vitamin D deficiency (VDD) among different age groups in Iran. AIMS: In this study, the current coverage, status of vitamin D supplement taking, and program efficacy have been evaluated by the Office of Nutrition Department Society in Iran since 2014. METHODS: This study was conducted in collaboration with the International UNESCO center for Health-Related Basic Sciences and Human Nutrition and the Office of Nutrition Department Society. Sixty three medical universities were included in the current study to calculate the availability, accessibility and acceptability coverages. Furthermore, 3 medical universities including Mashhad (MUMS), Qom (QUMS) and Zahedan (ZAUMS) University of Medical Sciences were selected based on the results of the National Integrated Micronutrient Survey 2012 (NIMS-II study), in order to assess the status of vitamin D supplement intake in all age ranges. RESULTS: Quantitative analysis showed that availability coverage was 74.96% and 77.56% and accessibility was 80.70% and 83.26% in elderly and middle-aged subjects, respectively in 2018. The acceptability was approximately 43.7% and 43.9% among elderly and middle-aged participants, respectively. The availability and acceptability coverage was 80.99% and 85.0% among students in high schools. The mean vitamin D supplement uptake frequency was 27.0% (n = 387); 20.7% and 29.2% in rural and urban area, respectively (P = 0.001). The results showed that there was no significant difference in serum vitamin D levels between urban (20.41 ± 6.43 ng/ml) and rural areas, (P = 0.887). There was no significant difference in the serum vitamin D concentrations between men and women (P = 0.461). CONCLUSIONS: The frequency of taking vitamin D supplements was 27.0% in Iran in 2018. The frequency of taking of vitamin D supplements among vitamin D deficient group (serum vitamin D levels <19.99 ng/ml) was 43.6%. Lack of knowledge was the most important reason for not taking vitamin D supplement. Moreover, the serum vitamin D levels have increased in subjects aged 18-30 years old after the implementation of the vitamin D supplementary program.