Policy analysis of salt reduction in bread in Iran.

Given that average salt intake among Iranians is approximately 10-15 g per day particularly from sodium hidden in bread, cheese, and fast food; lowering this mineral has been followed up seriously in this country for almost 10 years (since 2009). The main objective of the present study was to provide an opportunity to recognize unwanted and unfavorable outcomes of implementing decisions and policies together with associated problems of salt reduction in bread in order to achieve national and global health promotion goals. Thus, this qualitative and retrospective policy analysis was completed to evaluate the policy of salt reduction in bread in Iran. To collect the data, the researchers traveled to six cities in different regions, wherein relevant documents were utilized added to interviews with key actors. Related websites were correspondingly searched to find reports on this policy. Moreover, the researchers referred to some organizations in-person to search documents in this area. Five group discussions were also held to obtain public opinions in this regard. Data analysis was further carried out using framework analysis. The findings revealed that allocation of the highest rates of subsidy to wheat, flour, and bread had led to elimination of competitiveness in wheat, flour, and bread supply chain in Iran. Despite the presence of proper structures as coordinators of other organizations working on public health, there was no intersectoral collaboration in terms of maintaining health of bread products and lowering salt content in this staple food. With regard to changes in priorities of the Iranian Ministry of Health and Medical Education, attempts made to improve bread quality had also failed. In addition, first-line staff (i.e. bakers) had viewed formulation and implementation of the given policy as a top-down one. Given the ambiguities in establishment of new standards, there were similarly contradictions in execution of the policy at various levels. With reference to education provided at a national level, it was concluded that some people had become more sensitive to salt reduction in bread to some extent.

The effect of melatonin supplementation on lipid profile and anthropometric indices: A systematic review and meta-analysis of clinical trials.

BACKGROUND: Epidemiological evidence suggests that melatonin has some effects on the serum lipid. However, these results are controversial. The aim of this systematic review and meta-analysis is to examine the effect of melatonin supplement on dyslipidemia and anthropometric indices. METHODS: We searched electronic databases including Medline, Embase, Scopus, Web of Science and Cochrane Library up to Des 2018 without any language restriction. To compare the effects of melatonin with placebo, differences in standardized means difference (SMD) with 95% confidence intervals (95% CI) were pooled using random effects model. RESULTS: Twelve trials including 641 participants included in meta-analysis finally. The dose of melatonin was reported at 0.8-30 mg. Comparing with the control group, melatonin may improve low density lipoprotein cholesterol (LDL-C) (-0.31 mmol/L, 95% CI (-0.61, 0.01), P = 0.049, I2 = 42%) and triglyceride (TG) level (SMD = -0.45 mmol/L; 95% CI, -0.77, -0.13, P = 0.006, I2 = 47%). No significant effect of melatonin on high density lipoprotein cholesterol (HDL-C) and anthropometric indices was found. CONCLUSIONS: The results of our systematic review and Meta-analyzes showed that supplementation of melatonin could be effective in improving lipid parameters and should be considered in the prevention of cardiovascular disease, although the effect of this supplement on anthropometric indices needs further investigation.

The effect of vitamin D supplementation on blood pressure in patients with elevated blood pressure and vitamin D deficiency: a randomized, double-blind, placebo-controlled trial.

OBJECTIVES: The present evidence indicates a reverse correlation between vitamin D status and blood pressure (BP). The present study determined the effect of oral vitamin D supplementation on BP in patients with elevated BP and vitamin D deficiency. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, 42 outpatients with elevated BP and vitamin D deficiency were assigned randomly to two groups: the vitamin D-supplemented group (VDG), who received one capsule containing 50 000 IU of cholecalciferol weekly, and the placebo group (PG), who received one similar capsule containing oral liquid paraffin as placebo for 8 weeks. The systolic (SBP) and diastolic (DBP) blood pressures, mean arterial blood pressure (MAP), pulse pressure, serum 25-hydroxyvitamin D, parathormone, calcium, phosphorus, magnesium, sodium, and potassium were measured before and after the intervention. RESULTS: In all, 92.7% of the VDG recovered from vitamin D deficiency. At the end of the intervention, the mean SBP and DBP, and the MAP decreased significantly in VDG compared with the PG, whereas at the beginning of the intervention, there was no significant difference between the two groups. The mean changes in SBP (-6.4±5.3 vs. 0.9±3.7 mmHg, P(V)<0.001), DBP (-2.4±3.7 vs. 1.0±2.7 mmHg, P(V)=0.003), and MAP (-3.7±3.6 vs. 0.9±2.5 mmHg, P(V)<0.001) were lower in the VDG than PG. CONCLUSION: The findings of the study showed that the weekly administration of 50 000 IU of oral vitamin D for 8 weeks as an adjunct supplement of antihypertensive drugs in patients with vitamin D deficiency could help prevent vitamin D deficiency and aid control of SBP, DBP, and MAP.