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.

Has iodized salt reduced iodine-deficiency disorders among school-aged children in north-west Iran? A 9-year prospective study.

OBJECTIVE: Low iodine intakes are associated with goitre and other iodine-deficiency disorders (IDD) that have affected billions of people worldwide. We aimed to assess total goitre rate (TGR) and urinary iodine concentration (UIC) in schoolchildren between 2007 and 2015, percentage of iodized salt consumption by households, and salt iodine content at production, distribution and household levels in north-west Iran. Design/Setting/Subjects UIC assessed among schoolchildren in nine consecutive years; 240 schoolchildren aged 8-10 years selected by systematic random sampling each year in the West Azerbaijan Province. RESULTS: Median UIC was >100 µg/l in all years. More than 50 % of children had iodine deficiency (UIC≤99 µg/l) in 2010 and 2011, while this rate was approximately 15-35 % in other years. Proportion with UIC below 50 µg/l was <20 % in all years except 2010 and 2011. Excessive UIC (≥300 µg/l) rate was between 5·4 and 27·5 %. TGR decreased from 44 % in 1996 to 7·6 % and 0·4 % in 2001 and 2007, respectively. Regular surveys from 2002 to 2015 showed that 98 % or more of households consumed iodized salt. Iodine level ≥20 ppm was observed in 87·5, 83 and 73 % of salt at production, distribution and household level, respectively (data from national study in 2007). The last national study in 2014 showed that median iodine level in household salt was 27 ppm. CONCLUSIONS: Our focused data suggest that the universal salt iodization programme is improving the iodine status of schoolchildren in the West Azerbaijan Province of Iran. Reduction of TGR to less than 5 % in schoolchildren indicates successful elimination of IDD as a major public health problem.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran.

OBJECTIVE: To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran. DESIGN: A cross-sectional study. SETTING: All four geographical zones of Urmia city. SUBJECTS: Participants (n 723; 427 women and 296 men), aged 20-64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds). RESULTS: Three major dietary patterns were extracted: 'Traditional High SES' (THS), 'Traditional Low SES' (TLS) and 'Transitional'. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The 'Transitional' pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level. CONCLUSIONS: Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups.

OBJECTIVE: To study the association of weight status with food insecurity (FI) and socio-economic status (SES) in Azeri and Kurd ethnic groups living in Urmia city, North-Western Iran. DESIGN: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20-64 years old, from two ethnic groups (445 Azeri and 278 Kurd), were selected through a combination of cluster, random and systematic sampling methods. Demographic and socio-economic characteristics were assessed by a valid questionnaire, and household food security status was analyzed using an adapted household food insecurity access scale through face-to-face interviews at homes. General and central obesities were measured and evaluated using standard methods. RESULTS: Based on the findings, moderate-to-severe FI, as well as low SES, was more dominant in Kurds, compared to Azeris. After adjusting for confounders, being female (OR = 4.33, CI 95%: 2.35-7.97) and moderate-to-severe FI (OR = 2.00, CI 95%: 1.01-3.97) in Azeris and being female (OR = 5.39, CI 95%: 2.28-12.23) and higher total cost of household/capita (OR = 1.005, CI 95%: 1.002-1.009) in Kurds were related to higher odds of general obesity while low (OR = 0.41, CI 95%: 0.18-0.91) and moderate (OR = 0.13, CI 95%: 0.02-0.60) education levels were linked to lower chance of general obesity. Furthermore, the chance of central obesity was lower in Azeris with high educational levels (OR = 0.64, CI 95%: 0.21-0.94), females (OR = 0.72, CI 95%: 0.34-0.86), home owners (OR = 0.56, CI 95%: 0.31-0.91) and females Kurds (OR = 0.60, CI 95%: 0.37-0.97) with moderate-to-severe FI and higher total income per capita. In contrast, the chance of central obesity increased in Kurds with increased age (OR = 1.06, CI 95%: 1.02-1.10) and total cost of household per capita (OR = 1.004, CI 95%: 1.000-1.008). CONCLUSION: These findings show that the association between moderate-to-severe FI and risk of general/central obesity varies in Azeris, compared to Kurds. However, better SES decreased the chance of general/central obesity in both ethnic groups.

Dietary Acid Load (DAL), Glycated Hemoglobin A1c (HbA1c), and Metabolic Syndrome (MeS) Mediate the Association of the Adherence to the Dietary Approaches to Stopping Hypertension (DASH) and Mediterranean Diet (MeD) With Nonalcoholic Fatty Liver Disease.

The study aimed to investigate the association of adults adhering to Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diet (MeD) with nonalcoholic fatty liver disease (NAFLD) using structural equation modeling (SEM) in Iran. In this population-based cross-sectional study, 3,220 adults (44.65% female) aged ≥18 years were selected from the Amol Cohort Study (AmolCS). The dietary intakes were assessed by a validated 168-item semi-quantitative food-frequency questionnaire (FFQ). Residual method energy adjustment of MeD and DASH scores were calculated. Demographic characteristics and anthropometric and laboratory measurements were collected. NAFLD was diagnosed by an expert radiologist via ultrasound sonography. Based on the primary hypothesis, DASH, MeD, and NAFLD were fitted into models. Metabolic syndrome (MeS) as a potential risk factor directly affected NAFLD risk in all these models. In both genders, the higher adherence to DASH negatively affected NAFLD risk indirectly through the two following paths. (1) Dietary acid load (DAL) and metabolic syndrome (2) DAL and hemoglobin A1c (HbA1c). In addition, the higher DAL positively affected NAFLD risk among male participants indirectly via increasing HbA1c level and MeS (from DAL to HbA1c: ß = 0.07, P < 0.001; from HbA1c to MeS: ß = 0.10, P < 0.001). Similarly, in both genders, the relationship between MeD and NAFLD was mediated through (1) DAL, HbA1c, and MeS and (2) DAL and MeS. Further, among male participants, the MeD and NAFLD risk were also associated via the mediators of HbA1c and MeS. In female participants, the higher MeD score was directly associated with a reduction of NAFLD risk (ß = -0.07, P = 0.008). The present study found three important mediators, including DAL, HbA1c, and MeS, in the association of DASH and MeD scores with NAFLD risk. Preventive and therapeutic interventions should target the mediators, including DAL, HbA1c, MeS, and its components, to reduce NAFLD incidence in the general population.

Association between Dietary Patterns and Major Depression in Adult Females: A Case-Control Study.

BACKGROUND: Depression is one of the most common mental disorders. This study aimed to determine the association between dietary patterns and major depression in adult females. STUDY DESIGN: A case-control study. . METHODS: This study was conducted on adult females suffering from major depression within the age range from 19 to 65 years. The total participants of this study included 170 cases and 340 controls. Dietary intakes were collected using a 168-item validated semi-quantitative food-frequency questionnaire. Household food security was measured using a locally adapted Household Food Insecurity Access Scale. Moreover, the depression status of the adult females was assessed through a validated "Beck" questionnaire. Logistic regression was utilized to assess the association between dietary pattern scores and depression. RESULTS: The mean ±SD ages of the participants were 36.97 ±11.28 and 36.07 ±10.58 years in the case and control groups, respectively (P=0.374), and five major dietary patterns were extracted in this study. The odds ratio (OR) in the last adjusted model was (OR: 0.61; 95% CI: 0.46, 0.81); therefore, the "Healthy pattern" was significantly inversely associated with the odds of depression. Adherence to the "Western pattern" significantly increased depression by 29% (OR: 1.29; 95% CI: 1.06, 1.59). Furthermore, the "Traditional pattern" was positively associated with depression (OR: 1.16; 95% CI: 0.94, 1.43). There was no significant association between "Sugar and fast food" and "red meat and oils" dietary pattern and depression. CONCLUSION: Healthy dietary pattern reduces the risk of depression in adult females; however, the western and traditional dietary patterns increases this risk.

The association between dietary pattern and coronary artery disease: A case-control study.

Introduction: Dietary patterns are an important factors in the progress of cardiovascular disease. This study aimed to assess the association between dietary patterns and coronary artery disease (CAD). Methods: A case-control study was carried on 550 participants. Food expenditure was collected using a validated 168-item food-frequency questionnaire. Dietary patterns were extracted by principal component analysis (PCA). Multiple logistic regressions was used to assess the association between dietary patterns and the risk of CAD. Results: Three major dietary patterns were identified: the "Quasi-Western Pattern" was characterized by higher intakes of sweets and desserts, snacks, legumes, honey or jam, ketchup, mayonnaise, yellow vegetables, potatoes, red meat, refined grains; the "Sugar and Fast foods Pattern" was characterized by higher intakes of sugar, soft drinks, fast foods, high-fat dairy, hydrogenated fats, and the "Quasi-Mediterranean Pattern" was characterized by higher intakes of fruits, cruciferous vegetables, green leafy vegetables, other vegetables, nuts, coffee. In both sexes, the "Quasi-Western Pattern" and the "Sugar and Fast foods Pattern" were positively associated with the risk of CAD. For "Quasi-Western Pattern", adjusted-ORs were (OR: 1.35, 95% CI: 0.99-1.83, P = 0.05) and (OR: 1.38, 95% CI: 1.03-1.83, P = 0.03)for men and women respectively. The ORs were for "Sugar and Fast foods Pattern" (OR: 3.64, 95% CI:2.25-5.89, P < 0.001) and (OR: 3.91, 95% CI: 2.42-6.63, P < 0.001) for men and women respectively.There was a significant inverse relationship among "Quasi-Mediterranean pattern" and CAD in the crude model in women (OR: 0.7, 95% CI: 0.55-0.89, P = 0.0.004). Conclusion: High adherence to the "Quasi-Western Pattern" and "Sugar-Fast foods Pattern" dietary patterns were associated with a higher risk of CAD. The "Quasi-Mediterranean pattern" reduced the risk of CAD.

Seasonal variations of vitamin D and its relation to lipid profile in Iranian children and adults.

BACKGROUND: Vitamin D has a multitude of functional properties and acts like a hormone in the body. Its effect on the lipid profile is one of the proposed mechanisms for its relationship with many disorders during its deficiency. But, this relationship is still conflicting and debatable, so this study was conducted to determine the association between serum level of vitamin D and lipid profiles, including serum concentrations of cholesterol, triglyceride (TG), HDL, and LDL in healthy subjects. METHODS: In this cross-sectional study, 541 volunteers with age of 5-60 years from normal and healthy subjects were selected via random sampling. Demographics and history of daily or weekly sunlight exposures were recorded. Measuring vitamin D was done in two consecutive seasons: winter and summer. Ten milliliters of peripheral venous blood sample was withdrawn after an overnight fasting. Serum levels of 25(OH) D (25, hydroxy vitamin D3) were measured using the enzyme-linked immunosorbent assay (ELISA), and the Confirmatory test was done by high-performance liquid chromatography (HPLC). RESULTS: Mean age in the total mixed population was 30.83 ± 14.02 years. Subjects were 50.5% male and 49.5% female. Mean 25(OH) D in the total population for winter and summer were 45.8 ± 24.26 ng/ml and 55.24 ± 37.47 ng/ml respectively. In the total population, 38.08% were vitamin D deficient. Comparing serum lipid levels in the summer and winter showed a significant difference for cholesterol, LDL, and HDL, but no significant effect was found for TG. Analysis for the comparison of lipid profiles between the two genders in winter showed that there were significant differences in all lipid profiles except for LDL, while such analysis for summer revealed significant difference just for TG. In multivariate analysis, there was a significant mean difference only for LDL in subgroups with vitamin D insufficiency and deficiency. There was no correlation between Vitamin D and lipid profiles. CONCLUSIONS: Vitamin D is different between the two seasons regardless of gender variations. Its status showed some significant relationship with some lipid profiles (cholesterol, LDL, and HDL) during the two seasons. There were different results among winter and summer based on the gender.

Food intake, plate waste and its association with malnutrition in hospitalized patients.

BACKGROUND: Hospital malnutrition is a worldwide dilemma and challenge. High levels of plate waste contribute to malnutrition-related complications in hospital. We investigated the association between the levels of plate waste, food intake and patient satisfaction with nutritional risk and malnutrition prevalence in three hospital settings. METHODS: The sample population of 120 patients, aged 18-65 year, admitted consecutively over a 12 month period to 3 different educational university hospitals was included. For all the patients, diet history, anthropometric measurements, body mass index and patient satisfaction with the hospital food service was evaluated. Weight plate waste for all daily meals was done and actual intakes computed individually for each day. Nutrition risk screening (NRS)-2002 (≥ 3) tool was used for estimating the nutritionally at-risk population. Results: From one hundred twenty non-critically ill patients with a mean 8.9 ± 3.5 day length of hospital stay, 40.8% (49) were men and 59.2% (71) were female. Mean energy and protein requirements were 2,030.3 ± 409.03 kcal/day and 76.13 ± 15.33 g/day respectively. Mean intakes were 1,326 ± 681.44 kcal/day and 66.81 ± 31.66 g/day respectively. The mean percent of plate waste for lunch and dinner were 37.7 ± 29.88 and 30.4 ± 23.61 respectively. In the total population, 25% of patients were satisfied and 75% patients were unsatisfied with hospital foods. Based on BMI (< 20), unintentional weight loss (> 10%), malnutrition prevalence was 12.5% and 14.2% respectively during hospitalization. The prevalence of nutritionally at-risk population was 30% at admission time and reached 33.3% at discharge. CONCLUSION: Plate waste and hospital malnutrition were highly prevalent in accompanying with increasing nutritionally risk progression. So it should be addressed as an important health issue and appropriate strategies for stimulating governmental policies should be adopted.

Changes of Overweight and Obesity Prevalence Among School Children in North West of Iran After 3 Years Follow-up (2009-2011): A Longitudinal Study.

BACKGROUND: Obesity and overweight among children is a major public health problem in developed and developing countries and has important health and economic implications. This longitudinal study aimed to assessing the prevalence trend of overweight and obesity in West Azerbaijan in North West of Iran. METHODS: This study was a longitudinal follow-up study and was conducted in school children at 2009-2011 year. The subjects were all school children (12 years of age) that were recruited from rural and urban schools in West Azerbaijan. Overall, 22,820 girls and 28,763 boys were enrolled in 2009 and were followed for 3 years. A body mass index (BMI) 85(th)-95(th) percentile was classified as overweight and a BMI >95(th) percentile was classified as obese. All statistical analyses were performed using the Excel Software. Descriptive statistics were used to characterize the sample in different time periods. The prevalence was calculated as the ratio of number of present cases to a given population number in a given subgroup at a given time. RESULTS: In urban schools, the prevalence of overweight among girls and boys was 118.26 and 103.9 per 1000 persons in 2009 year, respectively, and this trend was increased in both girls (152.90 per 1000 persons) and boys (125.72 per 1000 persons) in 2011. The obesity trend was increased among both girls and boys (22.26 and 26.52 among girls and boys in 2009 to 24.66 and 28.65 per 1000 persons in 2011), respectively. In rural schools, the prevalence of overweight among girls was increased from 84.5 in 2009 to 108.89 per 1000 persons in 2011, but this trend was decreased among boys (from 95.49 in 2009 to 43.9 per 1000 persons in 2011), and the prevalence of obesity among boys was increased at the end of follow-up, but this trend was decreased among girls. CONCLUSIONS: Overweight and obesity in children has increased. Further studies are necessary to evaluate the relationship between obesity and overweight and risk factors such as dietary pattern and physical inactivity.

General and Central Obesity in Two Iranian Ethnic Groups Living in Urmia, West Azerbaijan, Iran: Effect of the Neighborhood Environment.

BACKGROUND: Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight status of the residents. OBJECTIVES: To assess the relationship between general and central obesity and the neighborhood environment in two ethnic groups (Azeri Turks and Kurds) living in Urmia city, Northwestern Iran. PATIENTS AND METHODS: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and a health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with general and central obesity was analyzed by a logistic regression model. RESULTS: Three common neighborhood environments were identified: 1) modern-affluent, 2) central-high access and 3) marginal. These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results. However, after adjustment for educational level, the association was not significant. CONCLUSIONS: The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity.

Malnutrition, overweight, and obesity among urban and rural children in north of west Azerbijan, Iran.

INTRODUCTION: Malnutrition is one of the most important causes for improper physical and mental development of children. Childhood obesity is a worldwide public health problem. The increasing prevalence of childhood obesity has become a growing matter of public health concern worldwide. The aim of the current study was to determine the prevalence of malnutrition and obesity in children under 5 years old in Salmas district. METHODS: The current study is a cross-sectional study conducted on 902 of children under 5 years old to assess the nutritional status in Salmas district and performed from 16 until 30 October, 2011, with the cooperation of the Office of Community Nutrition Improvement and the United Nations Children's Fund. ENA (Emergency Nutrition Assessment) and Spss software were used for data analysis. RESULTS: 49.6% of children were boys and 50.4% were girls. The prevalence of malnutrition based on underweight, stunting, and wasting was estimated to be 2.3%, 7.3%, and 1.4% among children, respectively. Stunting was more common in rural areas and this difference was significant (P < 0.001). CONCLUSION: In this area stunting, overweight and obesity were the most important priorities that health officials must pay more attention to. ENA software has a special ability to determine the samples and clusters and is a simple, rapid, and accurate method, especially in epidemiological studies in the country, and can be a convenient tool and its use is suggested for the same studies.

Children malnutrition in northwestern, central and southern regions of Iran: does geographic location matter?

INTRODUCTION: Malnutrition is one of the most important morbidity and mortality causes in children. In comparison with healthy children malnourished children are at higher risk of illness and death as 60 percent of more than 7 million deaths in children aged less than five years are attributed to the malnutrition. The present study is intended to determine the prevalence of malnutrition in West Azerbaijan and compare with Kermanshah and Isfahan provinces. MATERIALS & METHODS: The current survey is a cross-sectional study which is conducted with the aim of determining the nutritional status of children aged less than five years in three West Azerbaijan, Kermanshah and Isfahan provinces using ENA software and has been performed since 16th until 30th October, 2011 with the cooperation of the Office of Community Nutrition Improvement and the United Nations Children's Fund (UNICEF). Research data are collected by questionnaire and according WHO index, percentage of children with malnutrition (underweight, wasting, stunting) were calculated. Chi-square test was used to assess the relationship between variables and malnutrition. RESULTS: The rate of underweight, stunting, and wasting in West Azerbaijan was 2.3%, 7.3% and 1.4%, respectively. Wasting rate in boys was higher than in girls while stunting and underweight were more common in girls but differences were not significant. Results showed that the percentage prevalence of stunting in rural areas was higher than in urban areas, and this difference was significant. (p < 0.03) prevalence of overweight in West Azarbijan, Kermanshah and Isfahan was 5.1%, 4.5% and 3.7%, respectively. Also, Prevalence of obesity in West Azarbijan, Kermanshah and Isfahan was 1.3%, 0.7% and 0.1%, respectively. CONCLUSION: Given the differences between various provinces and regions of the country which are as a result of the differences between the levels of development in these areas, the necessity of designing and implementing targeted strategies are required for different areas.