A 30-year trend of dairy consumption and its determinants among income groups in Iranian households.

Introduction: Milk and dairy products provide essential nutrients and have the potential to prevent chronic diseases, thus reducing healthcare costs. However, there is a lack of consistent and updated data on dairy consumption trends in Iran. This study aims to analyze the trends in dairy consumption among Iranian households from 1991 to 2021, focusing on household-level determinants across different expense groups. Methods: The study uses data from the Iranian Household Expenditure and Income Survey conducted annually from 1991 to 2021 to analyze households' dairy consumption. The data includes values and expenses of food and non-food items purchased in the previous month, as well as demographic characteristics of household members. The households were categorized into 10 deciles based on their gross expense. The econometric model used weighted mean per capita milk, yogurt, cheese, and total dairy consumption based on milk equivalent for each decile. The model takes into account changes in income, prices, household composition, education level, occupation, and residency area using panel data. Data preparation and model estimation were performed using RStudio and STATA17 software. Results: Based on the findings, in 1991, per capita milk, yogurt, and cheese consumption were 26.77 kg, 16.63 kg, and 2.42 kg, respectively. By 2021, these figures changed to 22.68 kg, 11.06 kg, and 3.79 kg, reflecting a decrease in milk and yogurt consumption but an increase in cheese consumption. Family size was positively correlated with yogurt consumption and head of the household spouse's job score were positively correlated with milk, yogurt and cheese consumption. Also, the presence of under five-year-old children and older adults members (over the age of 60) in the household was inversely related with yogurt and cheese consumption. Female-headed households tended to purchase more cheese, while their milk purchase level was significantly lower. Residing in urban areas was negatively related to milk, while cheese and total dairy consumption was higher in urban areas. Discussion: The findings highlight the importance of targeted dairy subsidy interventions and educational programs to improve dairy consumption in Iranian households, especially among vulnerable groups. This will require urging policymakers and food system stakeholders for effective strategies that address macro-level factors to promote dairy consumption.

Prediction and analysis of trends in the nutritional status of children under 5 years in Iran: reanalysis of the results of national surveys conducted between 1998 and 2020.

Background and aim: Malnutrition is a major public health problem, especially in developing countries. The aim of this study was to analyze the trend in malnutrition among children under 5 years of age in Iran over recent decades and to estimate malnutrition status for 2020. Methods: This study took the form of a secondary analysis of the reports and data from three cross-sectional national surveys on children's nutritional status conducted between 1998 and 2017. Anthropometric indices, including markers of underweight, wasting, stunting, overweight, and obesity, were used as indicators of the nutritional status of children under 5 years. Malnutrition indicators are reported separately based on regional food security status. Linear mixed-effects modeling was used to predict the status of malnutrition indicators for 2020. Results: The results of this study indicated a downward trend in the prevalence of stunting, underweight, and wasting, from 15.4 to 4.8%, 10.9 to 4.3%, and 4.9 to 4.3%, respectively, between 1998 and 2017. The proportion of children at risk of overweight and prevalence of childhood overweight/obesity showed a downward trend between 2010 and 2017, from 3.73 to 3.02% and from 12.1 to 10.3%, respectively. However, the trend varied between different provinces. Estimates of the prevalence of malnutrition in 2020 also indicated a decrease in the prevalence of all indicators among children. Conclusion: Despite the decreasing trend in malnutrition over the past three decades, the prevalence of stunting, underweight, and wasting is still high in food-insecure provinces. Moreover, following the COVID-19 pandemic and its economic consequences, an increase in the prevalence of malnutrition, especially in food-insecure provinces, is plausible.

Effectiveness of Community Nutrition-Specific Interventions on Improving Malnutrition of Children under 5 Years of Age in the Eastern Mediterranean Region: A Systematic Review and Meta-Analysis.

Childhood malnutrition remains an important public health and development problem in low- and middle-income countries. This study aimed to systematically review the community-based nutrition-specific interventions and their effectiveness and/or cost-effectiveness on the nutritional status of children under 5 years of age in the Eastern Mediterranean Region (EMR). A systematic literature search of the English electronic databases, including PubMed, Scopus, ISI Web of Knowledge, Ovid, EMBASE, as well as Persian databases (SID and Magiran) was performed up to May 2019. Studies regarding the effectiveness/cost-effectiveness of the community-based nutrition-specific programs and interventions targeted at under-five-year children in EMR countries were selected. The primary outcomes were mean of Weight-for-age z-score (WAZ), Height-for-Age z-score (HAZ), and Weight-for-Height z-score (WHZ) of children or prevalence of wasting, stunting, and/or underweight among the children. Meta-analysis was also performed on the selected articles and intervention effects (mean differences) were calculated for each outcome for each study and pooled using a weighted random effects model. Risk of bias (ROB) of each included study was assessed based on the Cochrane Handbook for Systematic Reviews. The study protocol was registered in PROSPERO (CRD42020172643). Of 1036 identified studies, eight met the inclusion criteria. Amongst these, seven were from Pakistan and one from Iran. Only one study conducted in Pakistan reported the cost-effectiveness of nutrition-specific interventions in the region. Nutrition education/consultation and cash-based interventions were the most common nutrition-specific strategies used for management of child malnutrition in the EMR countries. Out of these eight studies, four were included in the meta-analysis. When different interventions were pooled, they had resulted in a significant improvement in WHZ of children (MD: 0.26; 95% CI: 0.07 to 0.46, three studies, I2 82.40%). Considering the high prevalence of child malnutrition in a number of countries in the region, capacity building and investigation regarding the implementation of new approaches to improve nutritional status of children and their effect(s) and cost-effectiveness assessment are highly recommended.

Home Food Safety Practice and Household Food Insecurity: A Structural Equation Modeling Approach.

BACKGROUND: Food safety and food security are interrelated concepts with a profound impact on the quality of human life. The current study, for the first time, was set to identify associations between home food safety practice and household food insecurity a structural equation modeling approach. METHODS: In this cross-sectional study, urban households were selected from among 10 health centers of five districts of Tehran, Iran (2015). The following questionnaires were completed: socioeconomic status (SES), food security and food safety. Structural Equation Modeling (SEM) was applied for predicting the relationships between SES, food insecurity, and food safety in households. RESULTS: Food security was observed in 56% of households. Mild, moderate and severe food-insecure households were determined to be 29%, 12%, and 3%, respectively. In addition, the scores of home food safety practice in 37.5%, 33% and 29.5% of the households were classified as desirable, acceptable and weak, respectively. Low-educated mothers having husbands with low educational and occupational level had a weaker food safety practice compared to high-educated ones. Based on the SEM results, an inverse association between food safety practice and food insecurity score was observed (t= -2.89, ɣ = 0.16). CONCLUSION: Food insecurity and undesirable food safety practice were relatively prevalent among households. In addition, the economic and social factors could inversely affect both food insecurity and food safety practices.

Development of a Home Food Safety Questionnaire Based on the PRECEDE Model: Targeting Iranian Women.

Food safety is an essential public health issue for all countries. This study was the first attempt to design and develop a home food safety questionnaire (HFSQ), in the conceptual framework of the PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) model, and to assess its validity and reliability. The HFSQ was developed by reviewing electronic databases and 12 focus group discussions with 96 women volunteers. Ten panel members reviewed the questionnaire, and the content validity ratio and content validity index were computed. Twenty women completed the HFSQ, and face validity was assessed. Women who were responsible for food handling in their households (n =320) were selected randomly from 10 health centers and completed the HFSQ based on the PRECEDE model. To examine the construct validity, a principal components factor analysis with varimax rotation was used. Internal consistency was determined with Cronbach's α. Reproducibility was checked by Kendall's τ after 4 weeks with 30 women. The developed HSFQ was considered acceptable with a content validity index of 0.88. Face validity revealed that 95% of the participants understood the questions and found them easy to answer, and 90% confirmed the appearance of the HFSQ and declared the layout acceptable. Principal component factor analysis revealed that the HFSQ could explain 33.7, 55.3, 34.8, and 60.0% of the total variance of the predisposing, reinforcing, practice, and enabling components, respectively. Cronbach's α was acceptable at 0.73. For Kendall's τc, r = 0.89, with a 95% confidence interval of 0.85 to 0.93. The HFSQ developed based on the PRECEDE model met the standards of acceptable reliability and validity, which can be generalized to a wider population. These results can provide information for the development of effective communication strategies to promote home food safety.

Schools' Cafeteria Status: Does it Affect Snack Patterns? A Qualitative Study.

BACKGROUND: The aim of this study was to evaluate patterns of students' snacks habits regarding to their schools' cafeteria status in Tehran by focus group discussion (FGD) technique. METHODS: Participants were 240 students (12-15 years old), selected from12 middle-schools in Tehran. The field study consisted of 24 FGDs sessions; involving 8-10 participants. Collected data were coded, categorized and analyzed using constant comparative method. RESULTS: Over half of the students believed that snack consumption is necessary. Although, majority of students believed that their schools' cafeterias are not acceptable, they noted them as one of the necessary parts of school. Nearly half of the children were complaining of unvaried and expensive food items. The most purchased items were: Cookies, sandwiches with mayonnaise and ketchup, soft drinks and chocolate milk. Most of the students were interested in having roles in their cafeterias. CONCLUSIONS: Schools' cafeteria are significant sources of supplying adolescents' snacks, so developing hygienic stores containing healthy and nutritious food items is a key element to affect their snack selection positively. Reaching this goal requires a multi disciplinary approach through participation of students, school staff, parents, and the support of community and media.

Major dietary patterns in relation to stunting among children in Tehran, Iran.

To the best of our knowledge, no information is available to link major dietary patterns to stunting during childhood, although dietary patterns are associated with chronic diseases. This study was conducted to determine the relationship between major dietary patterns and stunting in the first grade pupils of Tehran in 2009. In this case-control study, 86 stunted children (defined as height-for-age of less than the 5th percentile of CDC2000 cutoff points) were enrolled from among 3,147 first grade pupils of Tehran, selected using a multistage cluster random-sampling method. Participants for the control group (n=308) were selected randomly from non-stunted children (height-for-age more than the 5th percentile of CDC2000 cutoff points), after matching for age, sex, and area of residence. Dietary data were collected using two 24-hour dietary recalls through face-to-face interview with mothers. Factor analysis was used for identifying major dietary patterns. Mean consumption of dairy products (308 +/- 167 vs 382 +/- 232 g/day, p < 0.05), dried fruits and nuts (2.5819 vs 7.15 +/- 26 g/day, p < 0.05) were significantly lower among stunted children than those in the control group. Three major dietary patterns were identified: 'traditional dietary pattern' that was dominated by bread, potato, fats, eggs, flavours, vegetables other than leafy ones, sugar, drinks, and fast food; 'mixed dietary pattern' that was dominated by leafy vegetables, fast foods, nuts, fats, cereals other than bread, fruits, legumes, visceral meats, sugars, eggs, and vegetables other than leafy vegetables; and 'carbohydrate-protein pattern' that was dominated by sweets and desserts, poultry, dairy, fruits, legumes, and visceral meats. No significant relationships were found between traditional and mixed dietary patterns and stunting. Individuals in the third quartile of carbohydrate-protein dietary pattern were less likely to be stunted compared to those in the bottom quartile (OR: 0.31, 95% CI 0.13-0.78, p < 0.05). Adherence to dietary patterns high in protein (e.g. dairy, legumes, and meat products) and carbohydrates (e.g. fruits, sweets, and desserts) might be associated with reduced odds of being stunted among children.

Family-based intervention for controlling childhood obesity: an experience among Iranian children.

BACKGROUND: Treatment of childhood obesity is difficult, and successful management may differ in various areas with different cultural backgrounds. The present study was conducted to assess the effect of lifestyle modification family-based intervention in young Iranian children. METHODS: This field trial study was conducted in 2011 among 156 obese children in Tehran, Iran. They were randomly assigned to intervention and control groups. At baseline, anthropometric measurements and biochemical analysis were performed. The second and third phases consisted of training sessions for parents of the intervention group. At the fourth phase, there was no training program. In all four phases, questionnaires on demographic characteristics, lifestyle and food frequency were completed by interviewing with mothers, and biochemical analysis was repeated at the end of the study. RESULTS: During the second and third phases of the study, weight and height increased significantly in both groups, although weight increased more slowly, and waist and hip circumferences was decreased in the intervention group. Serum triglycerides and cholesterol decreased significantly in the intervention group (P < 0.05). Analysis of food group consumption showed that in the intervention group, not only consumption of milk, dairy and nuts group increased significantly but also the corresponding figure decreased for bread and cereals, sugar and confectionery ingredients; moreover, the family's oil and fat consumption decreased significantly (P < 0.05). Watching TV and playing on the computer decreased significantly in the intervention group; however, walking time increased significantly in both groups (P < 0.05). CONCLUSIONS: The family-based lifestyle program had limited but desirable effects on anthropometric and metabolic outcomes of the obese children. We suggest that a longer period of intervention may have more favorable results.

Determinants of stunting in school-aged children of tehran, iran.

BACKGROUND: Limited data are available indicating associates of stunting among Iranian children. This study was conducted to investigate determinants of stunting in first grade primary school children of Tehran in 2007. METHOD: In this case-control study, 3147 school children were selected by multistage cluster random sampling method from 5 districts of Tehran. Anthropometric measurements were done and stunting was defined as height for age less than the 5(th) percentile of CDC2000 cut-off points. Eighty six stunted children were identified and considered as case group. After matching for age, sex and residence area, 308 non-stunted children were randomly selected as control group. Required data were collected by trained nutritionists using questionnaires. RESULTS: Stunting was prevalent among 3.7% of the study population (girls 4.4% vs. boys 2.8%, P < 0.05). Mean age of the studied children was 82.3 month. Children with a birth weight of >3000 g were less likely to be stunted (OR: 0.25: 95% CI: 0.11-0.54) compared with those with a birth weight of <3000 g. Being born to older mothers (>35 years) was associated with greater odds of being stunted (3.01; 1.19-7.60) compared with being born to younger mothers (<35 years). Those with fathers' height of >160 cm were less likely to be stunted (0.04; 0.005-0.37) than those whose fathers' height was less than 160 cm. CONCLUSIONS: We found that birth weight, maternal age and fathers' height are the major contributing factors to stunting in this group of Iranian children. Taking into account the determinants of stunting might help policy makers designing appropriate interventions.