Evaluation of the Turkey Nutrition and Health Surveys according to the mediterranean adequacy index and sustainability through water footprints.

OBJECTIVE: Sustainable diet is one of the main factors that support food security, and the Mediterranean diet (MD) one of the sustainable diet models associated with low ecological impact and optimum health results has come to the fore. It was aimed to compare the results of the 2010 and 2017 Turkey Nutrition and Health Studies (TNHS) according to the Mediterranean Adequacy Index (MAI) and in order to evaluate the environmental impact of the current nutritional status in Turkey through water footprints (WF). DESIGN: The MAI score was calculated using the published results of the 2010 and 2017 TNHS, and the WF have been calculated as indicators of environmental impact. SETTING: Turkey. PARTICIPANTS: There are no participants. RESULTS: In the TNHS, there was an increase in the amount of energy provided by foods non-MD in 2017 compared to 2010, with a decrease in the total MAI score. The group with the lowest adherence to the MD in both years was the adult group (MAI20102·74 and MAI20172·31), while the group with the highest adherence was the adolescent group (MAI20103·21 and MAI20172·53). The MAI scores of females were higher than those of males in both years. The males aged 19-64 years had the largest (841 m3/year) WF and the females aged 65+ years had the smallest (483 m3/year). The food group that contributed the most to WF was meat and meat products (21·0-35·0 %). CONCLUSIONS: Adherence to the MD has decreased due to the increase in the consumption of the Western-type diet in Turkey.

Validity and Reliability of the Turkish Version of the Sustainable and Healthy Eating Behaviors Scale.

This study was conducted to determine the validity and reliability of the Turkish version of the Sustainable and Healthy Eating (SHE) Behaviors Scale. The original scale included 8 factors and 34 items related to the SHE behaviors of adults. The research was carried out in three stages with a total of 586 participants aged 19 to 50 years. The Cronbach alpha coefficient was used to evaluate internal consistency reliability and the test-retest method was applied. Exploratory factor analysis (EFA) was performed to determine the factor structure. The model obtained with EFA was evaluated with confirmatory factor analysis (CFA). The Cronbach alpha coefficient of the scale was found to be excellent at 0.912, and the intra-class correlation coefficient was found to be good at 0.832 using the test-retest method. Considering the suitability of the data for factor analysis, the KMO coefficient was 0.859, and the significance level of the Bartlett test of sphericity was less than 0.05 (χ2=3.803,25; p<0.05). As a result of EFA, the items of the scale were found to be distributed in 7 factor dimensions. The factor loadings of the items were between 0.516 and 0.890, and the factors explained 67% of the variance. Considering the fit indices obtained as a result of the analysis of this model with CFA, it was seen that the model had an acceptable fit (χ2/sd=2.593, CFI=0.915, Tucker-Lewis index=0.902, SRMR=0.0754, and RMSEA=0.067). In conclusion, the Turkish version of the SHE Behaviors Scale has credible reliability and construct validity to assess the sustainable and healthy eating behaviors of the Turkish adult population.

Association between ecological footprint awareness and health literacy in adults: a population-based study from Turkey.

This study aimed to determine the relationship between health literacy and ecological footprint which is an indicator of sustainability and environmental impact and to examine the factors that may affect them. It was found that 20.3% of individuals have inadequate, 43.7% problematic, 26.1% sufficient and 10.0% excellent health literacy levels. There were differences in age, education level and BMI classification according to Ecological Footprint Awareness Scale score quartiles and health literacy levels (p < 0.05). It was determined that age and Turkey Health Literacy Scale score had effect on ecological footprint awareness. Individuals with a high level of health literacy have a high awareness of their ecological footprint. The increase in people's health literacy levels and ecological footprint awareness with age can be interpreted as the increase in people's education and knowledge levels and their awareness levels against the protection of nature and the environment.

Effects of Diurnal Ramadan Intermittent Fasting on Cardiometabolic Risk Factors and Sleep Quality in Healthy Turkish Adults.

This study aimed to evaluate the effect of diurnal Ramadan fasting on cardiometabolic risk factors (blood glucose, lipid profile, inflammatory cytokines) and sleep quality in healthy Turkish adults. This prospective observational study was conducted with a total of 32 individuals (12 males, 20 females) who were aged between 19-32 years and fasted for 25 or more continuous days in Ankara, Turkey between 1 Ramadan 1442 and 30 Ramadan 1442. Individuals applied fasting for 16 hours in the spring season. Blood samples were taken after at least 8 hours of fasting, anthropometric measurements were taken and sleep quality was assessed using The Pittsburgh Sleep Quality Index (PSQI) at the beginning and the end of Ramadan. There was a significant decrease in body mass index (BMI), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) levels during Ramadan fasting (p < .005). There were no changes in lipid profiles and sleep quality. There was a significant increase in fasting blood glucose levels (p < .05); however, this change is within normal limits. There was also a significant relationship between BMI and CRP, IL-6, and TNF-α levels (p < .05). The diurnal Ramadan fasting did not affect lipid profiles and sleep quality in healthy Turkish subjects. However, decreased BMI and inflammatory cytokine levels were observed at the end of Ramadan fasting. More studies are needed to clarify the role of Ramadan fasting in healthy populations.

Turkish version of the 'Three-Factor Eating Questionnaire-51' for obese individuals: a validity and reliability study.

OBJECTIVES: Obesity is a serious public health issue. Investigating the eating behaviour of individuals plays an important role in preventing obesity. Therefore, the purpose of the current study is to adapt the long and first version of the 'Three-Factor Eating Questionnaire' (TFEQ), a scale that examines the eating behaviour of individuals, to Turkish culture and to carry out its validity and reliability study. DESIGN: The data were collected using data collection forms, and anthropometric measurements of the individuals were made by the researchers. The data collection form included several parameters: socio-demographic characteristics, the TFEQ scale, whose validity and reliability analysis is conducted here, and the Dutch Eating Behaviour Questionnaire (DEBQ) which was used as a parallel form. SETTING: The Obesity Clinic at Ege University in Izmir. PARTICIPANTS: The study group consisted of obese adult individuals (n 257). RESULTS: It was seen that constructing the questionnaire with twenty-seven items and four sub-dimensions provides better information about Turkish obese individuals. Factor loadings ranged from 0·421 to 0·846, and item total score correlations ranged from 0·214 to 0·558. Cronbach's α coefficient was found to be 0·639 for the whole scale. A positive, strong and statistically significant correlation was detected between TFEQ and DEBQ, which was used as a parallel form (r = 0·519, P < 0·001). CONCLUSION: In Turkey, the long version of the TFEQ scale was found valid and reliable for obese adult individuals. TFEQ can be used by clinicians or researchers to study the eating behaviour of obese individuals.

Increased Obesity Awareness and Adherence to Healthy Lifestyle-Diet Reduce Metabolic Syndrome Risk in Overweight Children.

Objective: Obesity is a common epidemic issue in all over the world. In order to prevent obesity it is essential to know about obesity and its detrimental consequences. This study aimed to evaluate children's awareness about obesity and to determine the associations between level of awareness, healthy lifestyle, dietary habits and risk factors for metabolic syndrome.Methods: Two hundred and thirty-six overweight children (119 boys and 117 girls) aged 10-14 years were enrolled to the study. Anthropometric and biochemical measurements were taken and metabolic syndrome (MetS) definition were done according to the International Diabetes Federation (IDF) consensus and divided into two groups as MetS (+) and MetS (-). Obesity awareness scale (OBA) and Adapted Healthy Lifestyle-Diet Index for Turkey (HLD-TR) were performed.Results: Among children, the prevalence of having MetS was found as 26.3%. Obesity awareness and HLD-TR index sores were lower in MetS (+) group than MetS (-) group. Metabolic syndrome related biochemical parameters and anthropometric measurements were associated with obesity awareness level of the children. The binary logistic regression model shows that a one-unit increase in the OBA index score increases the odd of not having MetS for 1.12 times after adjustments for age, gender, body mass index, and HLD-TR index score.Conclusions: Increased awareness about obesity among children will help to reduce the risk of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseases in the future.

School Teachers' Awareness about National Obesity Prevention Programs in Turkey.

Nutritional programs are one of the most important public health policies in order to prevent obesity. School teachers are role models for students and their nutrition knowledge about these policies can affect children's dietary habits. The aim of this observational descriptive study was to evaluate the school teachers' awareness about nutrition programs for the prevention of obesity of the Ministry of Education in Turkey. It was conducted to 87,070 classroom teachers working at state schools from all the cities of Turkey. Data collection was obtained with a plain web-based survey, and national nutrition programs (Nutrition-Friendly School Program, White-Flag Protocol, and circular letter on foods can be sold in school canteens) were questioned. Mean age of teachers was 38.3 ± 9.30 years and 50.4% of them were male. It was determined that only 66.2% of the teachers know whether their school is nutrition-friendly. Frequency of knowing "White-Flag" Protocol was 80.1%. Present study showed that educational programs about nutrition policies are required in order to increase knowledge among school teachers and thus, prevent childhood obesity.

Assessment of the Contribution of Dietary and Beverage Intake Quality to Obesity Development.

OBJECTIVE: Low dietary quality is an important indicator of unhealthy eating patterns that can lead to some consequences such as obesity, so policy is a very powerful tool that can affect the consumption of both healthy and unhealthy foods. Indices that assess whether nutritional policies are applied contribute to the assessment of the quality of the population's diet. This study was conducted to investigate the quality of diets and beverages consumed by Turkish adults, and the factors affecting them. METHOD: This cross-sectional descriptive study was conducted on 352 adults aged between 18 and 58 years. The quality of diet and beverage was measured through the Healthy Eating Index-2010 (HEI) and Healthy Beverage Index (HBI), respectively, using 2-day (weekday and weekend) dietary recall data. RESULTS: The total HBI scores were 79.1 ± 11.8 and 81.0 ± 11.6; total HEI-2010 scores were 45.9 ± 12.3 and 52.3 ± 11.0, of men and women, respectively (p < 0.05). The women had significantly higher scores than that of the men in the HEI-2010 subcomponent of empty calories (p > 0.05). Sugar-sweetened beverage (HBI subcomponent) was significantly correlated with the scores of HEI-2010 and empty calorie (HEI-2010 subcomponent), as expected (p < 0.01). The caloric beverages contributed ∼133.6 kcal/d to the total caloric intake. CONCLUSIONS: The mean contribution of beverages to total daily energy intake of participants was found to be at the suggestion level. This result is rewarding when the relationship of sugar-sweetened beverages scores with the scores of HEI and empty calories is considered.

Relationship between dietary caffeine intake and blood pressure in adults.

The aim of this study was to determine the consumption frequency of caffeinated foods and beverages and daily caffeine consumption amounts, and examine relation between caffeine and blood pressure (BP). A cross sectional door-to-door interview was conducted with 1329 volunteers between the ages of 20 and 60 (mean ages 29.9 ± 10.8 years) and based in Ankara/Turkey. The rate of individuals whose BPs were above 140/90 mmHg was 13.5%. The median caffeine consumption was 150.0 ± 122.06 mg. Although no significant correlation was found between total caffeine intake and diastolic blood pressure (DBP) of individuals, a positive correlation was observed between daily total caffeine and systolic blood pressure (SBP) (p < .05). Also, when analyzed factors that could be associated with DBP and SBP, BMI had effect in the model formed for both types of BP (p < .05). While smoking status associated with SBP (p = .002), gender and waist circumference related to DBP (p < .05) As a result relationship between caffeine intake and BP was affected other factors.

Description of the healthy eating indices-based diet quality in Turkish adults: a cross-sectional study.

OBJECTIVES: This study aims to describe the dietary status of Turkish adults using two different versions of the Healthy Eating Index (HEI). METHODS: In this cross sectional study, 494 healthy participants (311 females) with randomly selected and living in Ankara were included between September 2013 and March 2014. A questionnaire was completed and anthropometric measurements (weight and height) were performed. The 24-h dietary recall of individuals was collected. Diet quality was measured through HEI-2005 and HEI-2010 scores. RESULTS: The mean age, body mass index (BMI), HEI-2005 and HEI-2010 scores of individuals were 32.9 ± 10.8 years; 25.0 ± 4.8 kg/m2; 56.1 ± 13.9 and 41.5 ± 13.7 points, respectively. Significant differences were found between mean HEI-2005 and HEI-2010 scores (p < 0.05). The individual's whose diet quality needs to be improved according to mean HEI-2005 score, had poorer diet based on mean HEI-2010 scores. The highest mean HEI-2005 and HEI-2010 scores were stated in female, in subjects had low education levels, aged 51 years or older and in overweight groups (p <0.05). Both versions of healthy eating indices were correlated positively with BMI and age CONCLUSION: Diet qualities of the individuals are associated with age, gender, education and BMI. Although the components and scores in HEI-2010 version were changed from the version of HEI-2005, the changes may encourage healthy choices of some food group. HEI-2010 gives more attention to food quality than HEI-2005. Thus, in the present study it was concluded that HEI-2010 provided more precise results about diet quality.

Complementary Feeding Practices of Children Aged 12-23 Months in Turkey.

AIM: This study was conducted to determine the breastfeeding and complementary feeding attitudes and practices of women with children aged 12-23 months in three different regions in Turkey. METHODS: From 12 geographical regions (Nomenclature of Territorial Units for Statistics - NUTS 1), 3 regions were selected depending on the Turkish Demographic Health Survey 2003 (TDHS) results of nutritional status of children. Then, a weighted, multistage, stratified cluster sampling was used. In total, 1,486 children aged 12-23 months and mother pairs were enrolled. Mothers were face-to-face interviewed with trained health workers to collect information on breastfeeding practices, amount and types of complementary foods introduced and potentially related factors and demographic data filled in a questionnaire. RESULTS: The percentage of ever breastfeeding was 98.7%, no differences were determined among regions for ever breastfeeding (p>0.05). Duration of exclusive breastfeeding was 5.1±2.4 months. The shortest duration of exclusive breastfeeding was found in the good nutritional status region as 4.8±2.4 months (p<0.05). Yogurt, bread, pasta, fruits and vegetables were the foods introduced to the majority of the children. Red meat, poultry and fish were introduced to children in later ages in the low nutritional status region compared to middle and good nutritional status regions. Complementary feeding is introduced earlier than 6 months of age. CONCLUSIONS: Raising awareness on appropriate infant and young child feeding practices should be a priority. Enhancing of mothers knowledge, attitudes and practices on breastfeeding and complementary feeding is needed.

Comparison of energy balance-related behaviours and measures of body composition between Turkish adolescents in Turkey and Turkish immigrant adolescents in the Netherlands.

OBJECTIVE: To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL). DESIGN: Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study. SETTING: Primary and secondary schools. SUBJECTS: A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses. RESULTS: Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents. CONCLUSIONS: Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

Validity and Reliability of the Turkish Version of the Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF).

The global consumption of highly (ultra) processed foods (HPFs) is increasing, and it is associated with non-communicable diseases. This study aimed to assess the validity and reliability of the Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF). This study included 94 adults. Sociodemographic data were collected, and anthropometric and blood pressure measurements were performed. The sQ-HPF was translated into Turkish and culturally adapted. Dietary intake was assessed using three-day dietary records. Factor analysis and Cronbach's alpha were used to evaluate the validity and consistency of the sQ-HPF. Test-retest reliability was assessed with the intraclass correlation coefficient (ICC). Three items from the original sQ-HPF were excluded due to low factor loadings. The Kaiser-Meyer Olkin (KMO) coefficient for the measure of sample adequacy was found to be 0.642 and Bartlett's test of sphericity was found to be significant (p < 0.001). A significant correlation was found between the sQ-HPF score and HPF consumption derived from the 3-day dietary records (p < 0.05). Cronbach's alpha was found to be 0.65. Individuals with higher sQ-HPF scores consumed a significantly greater percentage of energy from HPFs (kcal/day) (p < 0.001). The sQ-HPF demonstrated good test-retest reliability (ICC = 0.76). The Turkish version of the sQ-HPF is a valid and reliable tool for assessing HPF consumption patterns and can be used in epidemiological and clinical studies.

A community-based iron supplementation program, "Iron-Like Turkey", and the following prevalence of anemia among infants aged 12-23 months.

During the second year of the "Iron-like Turkey" Project, in which all children aged 4-6 months in Turkey receive iron supplementation for 5 months, we aimed to assess the utilization of iron supplementation in the field, as well as the prevalence of anemia in healthy infants aged 12-23 months, while determining a variety of sociodemographic and nutritional factors for anemia in three of the 12 NUTS (Nomenclature of Territorial Units for Statistics) regions (regions with the highest, lowest and middle under-5 malnutrition levels). In a community-based, cross-sectional survey using a multi-staged, weighted, cluster-selected sample, children aged 12-23 months with birthweight ≥2500 g, no chronic illness, no history of blood disease, and from term and singleton pregnancy were enrolled; 1589 children met the criteria. The mean±SD age of children surveyed was 17.8±3.6 months. Of the parents, 72.4% claimed that their physician had recommended iron supplementation, and 68.8% had given supplementation to their children. Overall prevalence of anemia was 7.3%. Multivariate analysis revealed that the frequency of anemia decreased significantly in older infants, when supplementation was recommended by health providers, when an infant was breastfed longer than 6 months, and when the mother received iron supplementation during pregnancy. However, anemia prevalence increased when the infant received iron supplementation at a later age (³9 months), lived in a crowded family (³6 persons), and when the mother had a history of iron deficiency anemia. Anemic infants had significantly lower z scores of weight for age than non-anemic ones. This survey suggests that iron supplementation during pregnancy, initiation of iron supplementation in infants at 4-6 months of age, effective counseling on supplementation, subsequent compliance, support of breastfeeding, and effective training of health care personnel are effective strategies for prevention of anemia in the community.

Validity and reliability of food frequency questionnaire used in age-related eye disease studies in Turkish adults.

The present study aimed to perform the validity and reliability study of the Food Frequency Questionnaire (FFQ) on the frequency of foods rich in antioxidant nutrients and used in Age-Related Eye Diseases (AREDs). In the first interview of the study, the first application of FFQ was carried out, and blank forms of Dietary Records (DRs) were given. For the validity of the FFQ, a total of 12 d (3 days * 4 weeks) of DR were taken. For the reliability of the FFQ, a test-retest application was made with an interval of 4 weeks. The daily intake means of antioxidant nutrients, omega 3 and total antioxidant capacity data obtained from both the FFQ and DR were calculated, and the concordance between the two methods was evaluated with the Pearson Correlation Coefficient (PCC) and Bland-Altman graphs. The present study was carried out at Ege University Izmir/Turkey, Department of Ophthalmology, Retina Unit. The study was conducted with individuals aged ≥50 years who suffered from Age-Related Macular Degeneration (n 100, 72⋅0 ± 8⋅03 years). The values obtained from the test-retest applications for FFQ reliability were the same. The nutrient intake means obtained from the FFQ were similar or significantly higher than DR (P < 0⋅05). In the Bland-Altman graphical approach, the nutrient data were within the limits of agreement, and the PCCs between the two methods were moderately related. Considered together, this FFQ is a suitable tool for determining the dietary intakes of antioxidant nutrients in the Turkish population.

Relationships between serum and dietary magnesium, calcium, and metabolic parameters in women with type 2 diabetes mellitus.

BACKGROUND & AIMS: Magnesium and calcium are essential minerals in several enzymatic activities that modulate essential biological functions. Hypomagnesemia occurs in patients with type 2 diabetes mellitus (T2DM), especially those with poor metabolic control. Dietary magnesium and calcium intake play a protective role in the development of T2DM. This research aimed to investigate the association of dietary and serum magnesium and calcium with metabolic control parameters in diabetic women. METHODS: This case-control study was conducted on 80 women, including 40 patients diagnosed with T2DM and 40 healthy controls aged 35-60 years. Some anthropometric measurements of the individuals were taken, and their body mass index was calculated. In addition, some biochemical parameters, serum magnesium, and calcium were analyzed. A validated 96-item quantitative food frequency questionnaire was used to obtain dietary magnesium and calcium intake data. RESULTS: Serum magnesium levels were lower in subjects with diabetes than in controls, and there was a similar incidence of hypomagnesemia in T2DM patients and controls, but not statistically significant (p > 0.05). In T2DM patients, there was a statistically significant inverse association between HbA1c and serum magnesium (p < 0.05). Dietary magnesium intake was inversely associated with HOMA-IR scores (p < 0.05) but had a positive association with serum magnesium levels in patients with T2DM (p < 0.05). There were no significant differences in the calcium/magnesium ratio between T2DM patients and healthy controls (p > 0.05). In a multiple linear regression analysis, dietary magnesium intake and HbA1c were found to be significantly related to altered serum magnesium in T2DM patients. CONCLUSION: The present findings suggest that lower serum magnesium levels were associated with higher HbA1c levels in subjects with T2DM. Increased dietary magnesium intake in T2DM may enhance HOMA-IR scores and serum magnesium levels.

Time-restricted eating (16/8) and energy-restricted diet: effects on diet quality, body composition and biochemical parameters in healthy overweight females.

BACKGROUND: Time-restricted eating (TRE) is a current popular dietary strategy for noncommunicable diseases. However, studies demonstrated contradictory results for it and in all dietary strategies, diet quality is an the important part of the well-being. Our study aimed to investigate the effect of TRE and energy-restricted diet (ERD) on the nutritional status and diet quality of individuals. METHODS: This pilot study was completed 23 healthy overweight female. Anthropometric and body composition measurements of individuals were taken. The energy expenditure was measured using indirect calorimetry. Blood pressure and heart rate measurements were made. Biochemical parameters were evaluated and food consumption were taken. The quality of dietary intake was assessed using the Healthy Eating Index (HEI) -2015. The physical activity levels of the individuals were estimated using the physical activity record. The Statistical Package for the Social Sciences (version 22.0) software was used for all analyses. A p-value of less than 0.05 was considered to be statistically significant. RESULTS: After 8 weeks of intervention, while no change was observed in the diet quality of the individuals in the TRE group (p > 0.05), a significant increase was found in the diet quality score of the individuals in the ERD group (p < 0.05). There was a 3.2% and 5.5% decrease in body weight of individuals in the TRE and ERD groups, respectively (p < 0.05). While no significant change was observed in the body fat percentage of individuals in the TRE group (p > 0.05), a 7.1% decrease was observed in the ERD group (p < 0.05). A statistically significant decrease was found in the total cholesterol (3.7%) in the ERD group, and in the total cholesterol (6.7%) and low density lipoprotein cholesterol (LDL-C) (6.5%) in the TRE group. In addition, a statistically significant increase was found in adiponectin (77.3%) and total antioxidant status (TAS) (13.2%) in the ERD group. CONCLUSION: Energy-restricted diet yielded better results in weight loss and improvement of body composition and diet quality compared to TRE. Also, a decrease in total cholesterol level was found in the ERD group. However, more studies should be done with longer follow-ups and high sample sizes are very important in terms of creating public health-based recommendations.

Evaluation of sustainable and healthy eating behaviors and adherence to the planetary health diet index in Turkish adults: a cross-sectional study.

Aim: The Planetary Health Diet Index (PHDI) is a relatively new index, and studies about its relationship with eating behaviors, nutritional status, and obesity in adults are very limited. For this reason, in this study, sustainable healthy eating behaviors of individuals and compliance of their diets with PHDI were evaluated. Methods: This cross-sectional study was conducted with 1,112 adults (70.1% women and 29.9% men with mean age = 28.7 years, SE = 9.47). Study data were obtained with the face-to-face interview method via a questionnaire including sociodemographic characteristics, anthropometric measurements, the Sustainable and Healthy Eating (SHE) Behaviors Scale, and 24-h dietary recall. PHDI was evaluated for adherence to EAT-Lancet Commission recommendations. Results: The average PHDI total score was 41.5 points. Higher SHE Behaviors Scale and PHDI scores were observed in participants with a duration of education above 8 years (p < 0.05). Those with lower SHE Behaviors Scale and PHDI scores were more likely to be obese (p < 0.001). The total PHDI score was positively associated with fiber, vitamin E, potassium, and folate, and negatively associated with pyridoxine and calcium (p < 0.05). The total SHE Behaviors Scale score was positively associated with carbohydrates, fiber, and potassium and negatively associated with pyridoxine, calcium, and energy (p < 0.05). A one-unit increase in SHE Behaviors Scale total score resulted in a 5,530 unit (95%CI: 4.652; 6.407) increase in PHDI total score and a one-unit increase in duration of education (years) resulted in a 0.660 unit (95%CI: 0.403; 0.918) increase in PHDI total score. Furthermore, a one-unit increase in Body Mass Index (BMI) (kg/m2) resulted in a - 0.218 unit (95%CI: -0.424; -0.013) decrease in PHDI total score. Conclusion: The participants' PHDI index scores were low; therefore, the adherence to the EAT-Lancet recommendation was low which might be associated with obesity. Clinical studies evaluating the effects of adherence to sustainable diets on adequate and balanced nutrition and health outcomes are recommended.

Children's eating attitudes test (ChEAT): validation and reliability in Turkish children.

OBJECTIVES: This study aims to examine the validity and reliability of the children's eating attitudes test (ChEAT) in Turkish children. METHODS: The participants were 331 children (137 boys and 194 girls, ages 8-15). Data was collected through face-to-face interviews using a questionnaire containing socio-demographic characteristics, the ChEAT, and the children's eating behaviour questionnaire (CEBQ). Exploratory factor analysis (EFA) was performed to determine the factor structure of the Turkish version of the ChEAT. Additionally, the reliability was examined in terms of internal consistency and test-retest reliability. All statistical analyses were performed using Mplus Trial Version and SPSS 11.5 (SPSS, Chicago, IL, USA). RESULTS: According to the goodness-of-fit statistic, a three-factor solution was appropriate and compatible with clinical considerations. The three factors explained 50.1% of the variance. Cronbach's alpha coefficient was 0.75 for ChEAT-26, 0.67 for "Preoccupation with thinness and food", 0.63 for "Social pressure to eat", and 0.71 for "Dieting". Furthermore, the test-retest reliability was 0.72, 0.62, 0.59, and 0.59 respectively. Statistically significant correlations between the ChEAT and CEBQ were found (p < 0.05). "Preoccupation with thinness and food" was significantly higher in obese children (p < 0.05), while "Social pressure to eat" was lower (p < 0.001). Sex, grade, BMI, parental education in addition to working status affected the ChEAT-26 scores. CONCLUSIONS: The present study has provided preliminary evidence for the validity and reliability of a Turkish version of the ChEAT.

Early diagnosis and intervention of abnormal eating attitudes are crucial to minimizing adverse physical as well as psychological health outcomes such as obesity or being underweight for children with eating disorders. Since eating disorders occur early, screening for nutritional attitudes along with behaviors is crucial. The Children's Eating Attitudes Test (ChEAT) was developed by Maloney et al. to evaluate eating attitudes and behaviors in children. This study aimed to adapt the ChEAT-26 to Turkish and evaluate its validity and reliability. The present study has provided preliminary evidence for the validity and reliability of a Turkish version of the ChEAT. High scores on ChEAT-26 indicate the severity of the eating disorder.

Association between adherence to the Mediterranean diet with anthropometric measurements and nutritional status in adolescents.

Introduction: Background: adolescence is a critical period for developing healthy eating habits. It is crucial to evaluate and encourage adherence to the Mediterranean diet, a sustainable and healthy diet model in this age group. Objective: this study aimed to evaluate the relationship between adherence to the Mediterranean diet and anthropometric measurements and nutritional status in Turkish adolescents. Material and methods: the demographic characteristics, health information, nutritional habits, physical activity status, and 24-hour dietary recall of the adolescents were obtained with a questionnaire. Adherence to Mediterranean diet was evaluated with the Mediterranean-Style Dietary Pattern Score (MSDPS). Results: a total of 1,137 adolescents (mean age 14.0 ± 1.37 years) were included; 30.2 % of the boys and 39.5 % of the girls were overweight/obese. The median (interquartile range) value of the MSDPS was 10.7 (7.7), and this value was 11.0 (7.6) for the boys and 10.6 (7.4) for the girls (p > 0.05). The levels of protein, fiber, vitamin A, vitamin C, folate, vitamin B12, iron, magnesium, zinc, and potassium intake increased with adherence to Mediterranean diet (p < 0.001). Age, parental education level, body mass index (BMI), waist circumference, and skipping meals affected MSDPS. Conclusion: adolescents' adherence to the Mediterranean diet was low and correlated with some anthropometric measures. Increasing adherence to the Mediterranean diet may contribute to preventing obesity and adequate and balanced nutrition in adolescents.

Introducción: Introducción: la adolescencia es un periodo crítico para el desarrollo de hábitos alimentarios saludables. Es fundamental evaluar y fomentar la adherencia a la dieta mediterránea, un modelo de alimentación sostenible y saludable en este grupo de edad. Objetivo: este estudio tuvo como objetivo evaluar la relación entre la adherencia a la dieta mediterránea y las medidas antropométricas y el estado nutricional en adolescentes turcos. Material y métodos: las características demográficas, la información de salud, los hábitos nutricionales, el estado de actividad física y el recuerdo dietético de 24 horas de los adolescentes se obtuvieron mediante un cuestionario. La adherencia a la dieta mediterránea se evaluó con el Mediterranean-Style Dietary Pattern Score (MSDPS). Resultados: se incluyó un total de 1.137 adolescentes (edad media 14,0 ± 1,37 años). El 30,2 % de los niños y el 39,5 % de las niñas tenían sobrepeso/obesidad. El valor de la mediana (rango intercuartílico) del MSDPS fue de 10,7 (7,7), siendo este valor de 11,0 (7,6) para los niños y de 10,6 (7,4) para las niñas (p > 0,05). Los niveles de ingesta de proteína, fibra, vitamina A, vitamina C, folato, vitamina B12, hierro, magnesio, zinc y potasio aumentaron con la adherencia a la dieta mediterránea (p < 0,001). La edad, el nivel de educación de los padres, el índice de masa corporal (IMC), la circunferencia de la cintura y la omisión de comidas afectaron al MSDPS. Conclusión: la adherencia a la dieta mediterránea de los adolescentes fue baja y se correlacionó con algunas medidas antropométricas. El aumento de la adherencia a la dieta mediterránea puede contribuir a la prevención de la obesidad y a una nutrición adecuada y equilibrada en los adolescentes.