Iron deficiency anemia status in Iranian pregnant women and children: an umbrella systematic review and meta-analysis.

BACKGROUND: Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available evidence on IDA's prevalence in Iranian pregnant women and children. METHODS: We searched the Web of Science, Science Direct, PubMed, Scopus, and Google Scholar databases for articles published by April 2023. Meta-analyses investigating the status of IDA in Iran were included. The findings of seven meta-analyses comprising 189,627 pregnant women with a mean age of 26 and 5,890 children under six years old were included in this study. The methodological quality of each study was evaluated with the Assessment of Multiple Systematic Reviews (AMSTAR2) instrument. RESULTS: We estimated the prevalence of IDA at 15.71% in pregnant women and 19.91% in young children. According to our subgroup analysis of pregnant women, IDA's prevalence in urban and rural regions was 16.32% and 12.75%; in the eastern, western, central, southern, and northern regions of Iran, it was estimated at 17.8%, 7.97%, 19.97%, 13.45%, and 17.82%, respectively. CONCLUSION: IDA is common in young children and pregnant females and is a significant public health concern in Iran. The present umbrella review results estimated that Iran is in the mild level of IDA prevalence based on WHO classification. However, due to sanctions and high inflation in Iran, the prevalence of anemia is expected to increase in recent years. Multi-sectoral efforts are required to improve the iron status of these populations and reduce the burden of IDA in the country.

Health risk assessment of heavy metal pollutants in Iranian hen eggs: a systematic review and meta-analysis.

Eggs are a high-quality, nutrient-dense source of protein that is available at a relatively low price and the contamination of eggs by heavy metals is an important issue in public health. This review aimed to assess the risk of heavy metal pollutants in Iranian hen eggs. Original full-text available studies in Iran, detecting levels of Pb, Cd, As, and Hg in whole or part of the egg, and published between January 2000 and March 2023 were selected based on the inclusion criteria. The random-effect model was used to estimate the pooled concentrations of Pb, Cd, As, and Hg in Iranian eggs in meta-analysis. The incremental lifetime cancer risk (ILCR) and the target hazard quotient (THQ) were estimated by both calculation and Monte Carlo simulations to determine the carcinogenic and non-carcinogenic risk of egg consumption, respectively. The pooled concentrations of heavy metals in Iranian hen eggs from nine articles (11 datasets: 10 studies on Pb, 7 on Cd, and 5 on As and Hg concentrations) were Pb 0.29 (95% CI 0.20-0.39) mg kg-1, Cd 0.04 (95% CI 0.03-0.06) mg kg-1, As 0.05 (95% CI 0.03-0.07) mg kg-1, and Hg 0.03 (95% CI 0.02-0.04) mg kg-1. THQ did not show the non-carcinogenic risk; however, the ILCR for Pb concentration showed the threshold carcinogenic risk (mean ILCR = 8.94e - 4 and 9.0E - 4 by calculation and Monte Carlo simulations, respectively), with the greater risk for Cd (mean ILCR = 2.02e - 2). The carcinogenic risk of Pb and Cd concentration in Iranian hen eggs shows the urgent need for programs and policies to lower the risk for consumers by providing healthier feeding.

Consumer health risk assessment of Arsenic and Mercury in hen eggs through Monte Carlo simulations.

BACKGROUND: This study was conducted to assess the concentration of heavy metals (arsenic and mercury) and estimate the probability that consumption of hen egg products collected in Iran has carcinogenic or non-carcinogenic consequences. METHODS: A total of eighty-four hen eggs from 21 major brands were randomly selected from among thirty local supermarkets in two seasons (winter (January) and summer (August) 2022). Arsenic (As) and Mercury (Hg) was determined by using ICP-MS. The human health risk assessment refers to the formulation of the USEPA standard focused on Estimated Daily Intake (EDI), International Lifetime Cancer Risk (ILCR), Target Hazard Quotient (THQ), and Monte Carlo simulation (MCS) as a probabilistic method. Data analysis was carried out using the statistical software SPSS. Differences in mean concentrations of As and Hg in two seasons were tested by paired t-test. RESULTS: Over two seasons, the average As and Hg concentrations in hen eggs were 0.79 and 0.18 µg.kg-1, respectively. Seasonal difference in As concentration (p = 0.451) was not significant, whereas that of Hg concentration (p < 0.001) was significant. The calculated value of EDI was 0.29 µg As/day and 0.06 µg Hg/day. The EWI in the maximum scenario of as level in hen eggs was estimated to be 8.71 µg As and 1.89 µg Hg/month for Iranian adults. THQ's mean for As and Hg in adults was determined to be 0.00385 and 0.00066, respectively. In addition, ILCRs by MCS for As were 4.35E-4. CONCLUSION: In total, the result indicates that there was not a significant risk of developing cancer; the calculation of THQ was still below the accepted level of 1, indicating that there was no risk while, according to most regulatory programs (ILCR > 10- 4) shows a threshold carcinogenic risk of arsenic through consuming in hen eggs. Therefore, policymakers need to be aware that it is prohibited to establish chicken farms in heavily polluted urban areas. It is essential to regularly conduct examinations to measure the presence of heavy metals in both ground waters used for agriculture and the feed provided to chickens. Additionally, it is advisable to focus on raising public awareness about the importance of maintaining a healthy diet.

Risk assessment of lead and cadmium concentrations in hen's eggs using Monte Carlo simulations.

The hen egg is one of the main sources of cheap, great quality, and nutritious food. This study aimed at determining the level of lead (Pb) and cadmium (Cd) in hen eggs and at assessing the carcinogenic and non-carcinogenic risks caused by the consumption of hen eggs collected in Iran. A total of 42 hen eggs from 17 major brands were randomly sampled from supermarkets. Lead and cadmium concentrations were determined by using inductively coupled plasma mass spectrometry (ICP-MS). Additionally, using the Monte Carlo simulation (MCS) method to calculate dietary exposure, target hazard quotient (THQ), and incremental lifetime cancer risk (ILCR), the related human health risk associated with ingesting these hazardous metals for adults was evaluated. The average Pb and Cd concentrations in whole eggs were 7.16 ± 0.248, and 2.83 ± 0.151 µg kg-1, respectively, which were less than the maximum permitted levels, established by FAO/WHO and the Institute of Standards and Industrial Research of Iran (ISIRI). Pb and Cd concentrations were significantly correlated at the 0.05 level (r = 0.350). Regarding the levels of Pb and Cd in eggs, overall, the estimated weekly intake (EWI) of these metals for adults by egg consumption was determined 0.014 and 0.007 mg/week, respectively, which were lower than the risk values suggested. The carcinogenic and non-carcinogenic indexes of Cd and Pb indicated that the adult population in Iran was safe (THQ Pb and Cd <1, ILCR <10-6 Pb). It should be emphasized that this research primarily focuses on egg consumption, which may account for a relatively small portion of Iranian consumers' overall exposure to Pb and Cd. Therefore, a comprehensive study on the risk assessment of these metals through whole-diet foods is recommended. The findings showed that lead and cadmium levels in all evaluated eggs were suitable for human consumption. Adults' Pb and Cd exposure from eating eggs was significantly lower than the risk levels established by Joint FAO/WHO Expert Committee on Food Additives (JECFA), per the exposure assessment. According to the THQ values of these dangerous metals, which were below one value, egg eating by Iranian consumers does not present a non-carcinogenic risk. In addition, this finding provides accurate and reliable information for policymakers to improve food safety status to reduce public health hazards.

Iron, Copper, and Magnesium Concentration in Hair and Risk of Esophageal Cancer: A Nested Case-Control Study.

BACKGROUND: An association has already been hypothesized between iron, copper, and magnesium status assessed through food frequency questionnaires (FFQs) and the risk of esophageal squamous cell carcinoma (ESCC). However, self-reported dietary assessment methods are prone to measurement errors. We studied the association between iron, copper, and magnesium status and ESCC risk, using hair samples as a long exposure biomarker. METHODS: We designed a nested case-control study within the Golestan Cohort Study, that recruited about 50000 participants in 2004-2008, and collected biospecimens at baseline. We identified 96 incident cases of ESCC with available hair samples. They were age-matched with cancer-free controls from the cohort. We used inductively coupled plasma mass spectrometry (ICP-MS) to measure iron, copper, and magnesium concentrations in hair samples. We used multiple logistic regression models to determine odds ratios and 95% confidence intervals. RESULTS: Median concentrations of iron, copper, and magnesium were 35.4, 19.3, and 41.7 ppm in cases and 25.8, 18.3, and 50.0 ppm in controls, respectively. Iron was significantly associated with the risk of ESCC in continuous analysis (OR=1.41, 95% CI=1.03-1.92), but not in the tertiles analyses (ORT3 vs. T1=1.81, 95% CI=0.77-4.28). No associations were observed between copper and magnesium and ESCC risk, in either the tertiles models or the continuous estimate (copper: ORT3 vs. T1=2.56, 95% CI=1.00-6.54; magnesium: ORT3 vs. T1=0.75, 95% CI=0.32-1.78). CONCLUSION: Higher iron status may be related to a higher risk of ESCC in this population.

A systematic review and meta-analysis of lead and cadmium concentrations in cow milk in Iran and human health risk assessment.

The aim of the current research was to systematically review and summarize the studies that evaluated the concentration of lead (Pb) and cadmium (Cd) in cow milk in different regions of Iran and to perform a meta-analysis of the findings. Moreover, the non-carcinogenic and carcinogenic risks of Pb and Cd through milk consumption in adult and child consumers were assessed. As a result of a systematic search in the international and national databases between January 2008 and October 2018, 17 reports involving 1874 samples were incorporated in our study for meta-analysis. The pooled concentrations of Pb and Cd were estimated to be 13.95 µg mL-1 (95% CI 9.72-18.11 µg mL-1) and 3.55 µg mL-1 (95% CI - 2.38-9.48 µg mL-1), respectively, which were lower than the WHO/FAO and national standard limits. The estimated weekly intake (EWI) of Pb and Cd through consuming milk was 16.65 and 7 µg day-1 for adults of 70 kg and 45 and 34 µg day-1 for children of 26 kg, respectively, which was well below the risk values set by Joint FAO/WHO Expert Committee on Food Additives (JECFA). The maximum target hazard quotient values (THQs) of Pb and Cd were 5.55E-5 and 5.55E-5 for adults and 5.55E-5 and 5.55E-5 for children, respectively, which were lower than 1 value, suggesting that Iranian consumers are not exposed to non-carcinogenic risk through consuming milk. Moreover, the incremental lifetime cancer risk (ILCR) of Pb estimated to be 2.96E-04 in adults and 1.0E-03 in children, indicating that consumers in Iran are at threshold carcinogenic risk of Pb through consuming milk (ILCR > 10-4). Therefore, planning and policy making for the sustainable reduction of these toxic metals in milk, particularly in industrial regions of Iran, are crucial.

Structural equation modeling analysis of Iranian womens food consumption: influence of socio-demographic characteristics and the information, motivation, and behavioral skills model / Análise de modelagem de equações estruturais do consumo alimentar de mulheres iranianas: influência das características sociodemográficas e do modelo de Informação, motivação e habilidades comportamentais

ABSTRACT Objective This study aimed at examining whether food consumption varies in accordance with socio-demographic and behavioral factors in the conceptual model, analyzing adult women in Tehran, Iran, for that purpose. Methods This cross-sectional study was conducted with 247 women in childbearing age, who were selected through systematic cluster sampling from five regions in Tehran. Dietary assessment was done through a Food Frequency Questionnaire, and the anthropometric indices were measured. Data on socio-economic status and information-motivation-behavioral skills model were obtained through a questionnaire. Then, subjects were stratified according to the socio-economic status and model components. Statistical analysis was done using analysis of variance and structural equation modeling. Results Consumption of food groups among the participating women differed based on their living region, education, occupation, household expenditure, and model components (p<0.05). Intake of red and processed meat (p<0.05) was at the lowest level in illiterate or low educated women. Those with lower total expenditure had higher consumption of fats and oils (p<0.05). Women with higher perceived social support consumed more milk and dairy products (p<0.05), fats and oils (p<0.05), and less bread and cereals (p<0.05). Model components including information, attitude, social support, self-efficacy, and self-regulation were the most important factors negatively affecting the consumption of unhealthy foods (red and processed meat, fats and oils, sugar, and salty foods). Conclusion Considering the impact of model components on women's eating behaviors, the specific integration strategies delineated for each construct of the model can be utilized to design model-based interventions targeting the promotion of healthy nutritional behavior.

RESUMO Objetivo Este estudo buscou examinar se o consumo de alimentos varia de acordo com fatores sociodemográficos e comportamentais no modelo conceitual entre mulheres adultas em Teerã, Irã. Métodos Este estudo transversal foi conduzido em 247 mulheres em idade reprodutiva, selecionadas por amostragem sistemática por conglomerados de cinco regiões de Teerã. A avaliação da dieta foi realizada por meio de um questionário de frequência alimentar, e os índices antropométricos foram medidos. Os dados sobre o status socioeconômico e o modelo de habilidades de informação-motivação-comportamento foram obtidos através de um questionário. Em seguida, os sujeitos foram estratificados conforme o status socioeconômico e os componentes do modelo. A análise estatística utilizou análise de variância e modelagem de equações estruturais. Resultados O consumo de grupos de alimentos entre as mulheres participantes diferiu de acordo com a região onde vivem, educação, ocupação, gasto familiar e componentes do modelo (p<0,05). A ingestão de carne vermelha e processada (p<0,05) foi mais baixa entre mulheres analfabetas ou com baixa escolaridade. Aquelas com menor gasto total apresentaram maior consumo de gorduras e óleos (p<0,05). Mulheres com maior apoio social percebido consumiram mais leite e derivados (p<0,05), gorduras e óleos (p<0,05) e menos pão e cereais (p<0,05). Os componentes do modelo, incluindo informação, atitude, apoio social, autoeficácia e autorregulação, foram os fatores mais importantes que afetaram negativamente o consumo de alimentos não saudáveis (carne vermelha e processada, gorduras e óleos, açúcar e alimentos salgados). Conclusão Considerando o impacto dos componentes do modelo nos comportamentos alimentares das mulheres, as estratégias de integração específicas delineadas para cada construto do modelo podem ser utilizadas para projetar intervenções baseadas em modelos visando promover um comportamento nutricional saudável.

Prevalence and associated factors of cardio-metabolic risk factors in Iranian seafarers.

BACKGROUND: Since Iran's economy is based on the sale of petroleum products, seafaring is considered a crucial job. Little research has been done on issues related to seafarers' health in Iranian maritime industry. The present study investigated the prevalence and associated factors of cardio-metabolic risk factors in seafarers of National Iranian Tanker Company (NITC). MATERIALS AND METHODS: A cross-sectional study was performed on 234 Iranian male seafarers of NITC in 2015. Metabolic syndrome (MetS) was diagnosed according to the reports of National Committee of Obesity. Three main blood parameters (of elevated total cholesterol, elevated low-density lipoprotein cholesterol, and elevated very low-density lipoprotein cholesterol) and general obesity were included as additional cardio-metabolic risk factors. RESULTS: The mean age of the participants was 36.0 ± 10.3 years. The prevalence of MetS was 14.9%. The common cardio-metabolic risk factors were excess weight (51.1%), abdominal obesity (38.5%), and smoking (27.8%) among Iranian seafarers. In multivariate analysis, age (OR: 1.05, 95% CI: 1.01-1.09) and body mass index (OR: 1.14, 95% CI: 1.01-1.27) were associated with the increase in hypertension risk. CONCLUSIONS: Our finding showed that the current prevalence of MetS among Iranian male seafarers working on tankers can affect negatively their health and career at sea.

Iron and vitamin C co-supplementation increased serum vitamin C without adverse effect on zinc level in iron deficient female youth.

BACKGROUND: Iron supplementation can decrease the absorption of zinc and influence other antioxidants levels such as vitamin C. This study aimed to investigate the effect of iron supplements alone and in combination with vitamin C on zinc and vitamin C status in iron deficient female students. METHODS: In a double-blind randomized clinical trail, 60 iron deficient students were selected from 289 volunteers residing in dormitory. After matching, subjects were randomly assigned into two groups: Group I (50 mg elemental iron supplements) and Group II (50 mg elemental iron + 500 mg ascorbic acid). Serum ferritin, iron, serum zinc, and plasma vitamin C concentrations were measured by using enzyme-linked immunosorbent assay, spectrophotometer, atomic absorption spectrometer, and colorimeter, respectively after 6 and 12 weeks supplementation. Student's t-test and repeated measures analysis of variance were applied to analyze the data using SPSS software. RESULTS: Serum zinc levels had no significant differences between 2 groups at the baseline; however, its concentration decreased from 80.9 ± 4.2-68.9 ± 2.7 µg/dl to 81.2 ± 4.5-66.1 ± 2.9 µg/dl (P < 0.001) in Groups I and II, respectively after 6 weeks of supplementation. Continuous supplementation increased serum zinc concentration to baseline levels (79.0 ± 2.9 µg/dl; P < 0.01) in Group I and 70.5 ± 3.1 µg/dl in Group II following 12 weeks of supplementation. Plasma vitamin C increased from 3 ± 0/1-3.3 ± 0.2 mg/dl to 2.7 ± 0. 1-4.2 ± 0.2 mg/dl (P < 0.01) in Groups I and II, respectively. At the end of study, plasma vitamin C significantly increased from 3.3 ± 0.3-4.7 ± 0.3 (P < 0.01) to 4.2 ± 0.2-7.1 ± 0.2 (P < 0.001) in Groups I and II, respectively. CONCLUSIONS: Iron supplementation with and without vitamin C led to reduction in serum Zn in iron-deficient female students after 6 weeks. However, the decreasing trend stops after repletion of iron stores and Zn levels returned to the approximately baseline values after 12 weeks.

Systematic review of zinc biomarkers and esophageal cancer risk.

BACKGROUND It is hypothesized that poor zinc nutritional status is associated with an increased risk of esophageal cancer (EC), but current evidence is contradictory. Since some factors may influence zinc absorption, its status may be better evaluated thorough biomarkers. The objectives of this study were to perform a systematic review on the association of zinc biomarkers with EC in observational studies and to evaluate the efficacy of zinc supplements in preventing EC in randomized trials. METHODS The MEDLINE database was searched in December 2013 for studies written in English with relevant keywords. Articles which met inclusion criteria were included in this study. RESULTS Eleven observational studies that measured zinc biomarkers and eight randomized trials which evaluated supplements containing zinc, met our inclusion criteria. The majority of studies suggested that higher zinc status was inversely associated with EC risk. CONCLUSION Most of the evidence for this hypothesis comes from case-control studies, which may introduce bias. Cohort studies are needed to establish whether poor zinc status is associated with increased risk for EC. Findings from trials are inconclusive as there is no data from single agent trials. However, the evidence is not still strong enough to conclude a protective role of zinc in EC.