Food security and its association with socioeconomic status and dietary diversity in free living older people in Tehran, Iran.

BACKGROUND: Food security is a function of food access and dietary diversity. Older age is a period when adequate and diverse dietary intake is a challenge. This study aimed to investigate the association between food security on the one hand and dietary diversity and socioeconomic factors on the other hand among the free-living older people in the city of Tehran. METHODS: In this cross-sectional study, 583 older people, aged 60-80 years living in Tehran city, were selected through the systematic cluster sampling method. Food security was determined by the United States Household Food Security Survey Module (US-HFSSM (.Socioeconomic status (SES) and two 24-h recalls were obtained. Dietary Diversity Score (DDS) was calculated using the FAO 2010 guideline. Multinomial logistic regression was applied. RESULTS: The average age of participants was 67.87 ± 5.86 years. Based on US-HFSSM, 56.9% of older people were food secure; while 25.7%, 14.2% and 3.2% suffered from food insecurity (FI) without hunger, with moderate hunger, and with severe hunger, respectively. There was no association between FI and DDS, even after controlling for confounders. FI with mild hunger was associated with household income (OR = 2.744, 95% CI = 1.100-6.846), while FI with severe hunger was associated with Fars ethnicity (OR = 0.146, 95% CI = 0.051-0.424). CONCLUSIONS: Overall, socio-economic status and demographic characteristics were the predictors of FI among older people. The findings can have implication in design and targeting of interventions directed at older people.

An in-depth analysis of hospital food waste in terms of magnitude, nutritional value, and environmental and financial perspectives: A cross-sectional study.

Hospital food waste has nutritional, economic and environmental impacts, and halving food waste is a sustainable development goal. This study aimed to quantify hospital food waste and its nutritional, environmental and financial values in medical and surgical wards. In a cross-sectional study in three educational hospitals, nutritional and demographic data of adult inpatients were collected. The food waste was measured at breakfast, lunch and snack times, and a 24-hour food recall was fulfilled for each patient. Also, the nutritional, environmental and financial values of discarded food were calculated. Food waste contributors were determined using linear regression. Totally, 398 meals were evaluated. The average served food was about 1 kg patient-1 day-1, while 539.5 g patient-1 day-1(50.1% of the served food) was discarded. Mean food wastes were 148.9 g (standard deviation (SD): 130.1), 364.3 g (SD: 257.2) and 80.2 g (SD: 101.5) in breakfast, lunch and snacks, equal to 45.7% (SD: 36.9), 51.4% (SD: 36.1) and 62.4% (SD: 53.2) of the served food, respectively. Rice, soup, milk and fruits were mostly discarded. Severely malnourished patients had higher daily food waste. Food preparation and waste were estimated to cost on average US$1.8 and US$0.8 patient-1 day-1, respectively. Each kilogram of food waste resulted in 8.1 m2 of land use, 1.4 kg of CO2-equivalent gas emission, and about 1003 L of water wastage. Half of the hospital food was discarded which means waste of nutrients, environmental resources and money. Current data can help authorities to plan for reducing hospital food waste.

Economic Sanctions Affecting Household Food and Nutrition Security and Policies to Cope With Them: A Systematic Review.

BACKGROUND: This review was conducted to identify the impact of economic sanctions on household food and nutrition security and policies to cope with them in countries exposed to sanctions. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020 were used to identify, select, appraise, and synthesize studies. Electronic databases in addition to Persian ones have been systematically searched for all related documents published until March 2022. Exclusion criteria were: lack of data related to food insecurity in countries subject to sanction and very low quality of the article. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal checklists. The results were presented as qualitative and quantitative syntheses. RESULTS: Of 1428 identified studies, 36 publications remained in the review, which belong to Iran (n=8), Cuba (n=8), Russia (n=7), Iraq (n=7), and Haiti (n=6), respectively. Declining gross domestic product (GDP), devaluation of the national currency, and the quality of food, increase in inflation, unemployment, and consumer prices, infant and under 5 years mortality, energy, and protein deficiency, and the poverty rate were reported as sanction consequences. The most important strategies to improve food security were the humanitarian assistance provided by the international community (Haiti), equity and priority for vulnerable groups mainly by expanding the healthcare system (Cuba), adopting a food ration system in the oil-for-food program, and fixing the price of food baskets (Iraq), import substitution and self-sufficiency (Russia), support domestic production, direct and indirect support and compensation packages for vulnerable households (the approach of resistance economy in Iran). CONCLUSION: Due to the heterogeneity of studies, meta-analysis was not possible. Since inadequate physical and economic food access caused by sanctions affects especially disadvantaged and vulnerable groups, planning to improve food security and providing support packages for these groups seems necessary.

Cost-Effectiveness Analysis of Group vs. Weblog Telecommunication (Web Tel) Nutrition Education Program on Glycemic Indices in Patients With Non-Insulin Dependent Diabetes Mellitus Type 2: A Randomized Controlled Trial.

This a randomized controlled trial study with a cost-effectiveness analysis that aimed to compare the cost-effectiveness of group nutrition education with that of Web-Tel nutrition education in the glycemic control of patients with non-insulin-dependent type 2 diabetes mellitus (T2DM). The study was conducted on 105 patients with T2DM for 3 months in Quds health centre of Bushehr province, Iran. The participants were classified based on age and disease severity (hemoglobin A1c level); then, they were randomly assigned to one of the three groups: group education, Web-Tel education, and the control group using block randomization method. The clinical (intermediate) outcome was changes in hemoglobin A1c (HbA1c). Patients' perspective was adopted, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainties. The results indicated that the expected effectiveness was 0.46, 0.63, and 0.4; the mean costs was 27,188, 5,335, and 634 purchasing power parity (PPP) dollars for group education, Web-Tel education, and the control group, respectively. The incremental cost-effectiveness ratio (ICER) of Web-Tel education vs. the control group was positive and equal to $21, 613.04 PPP; since it was less than three times of the threshold, the Web-Tel education method was considered as a more cost-effective method than the control group. On the other hand, the ICER of group education vs. control group was $447,067 PPP and above the threshold, so group education was considered as a dominated method compared with the control group. In conclusion, considering the ICER, Web-Tel education is a more cost-effective method than the other two and can be used as the first priority in educating patients with T2DM. The present study was registered in Thailand Clinical Trials Registry (TCTR20210331001).

Exploring health and nutrition stakeholders' expectations and perception toward establishment of the Food and Nutrition Surveillance in Iran.

BACKGROUND: Food and Nutrition Surveillance (FNS) is an essential and practical tool for providing timely information at specified times for policy making. This study aimed to explore policymakers' expectations and perception on establishment of the FNS in Iran before its establishment. MATERIALS AND METHODS: Data in this qualitative study were gathered through documents review (23 relevant documents) and seventeen semi-structured interviews with key informants in the field of food and nutrition at the national and provincial level selected through purposive and snowball sampling. Data were content analysed using MAXQDA (2010). FINDINGS: Most of the participants defined the FNS as a continuous monitoring system. They expected the FNS to identify and recognize food and nutrition problems; to create a common language and provide an inter-disciplinary cooperation. From the participants' point of view the most important barriers to establishing of the FNS included lack of cooperation and resistance at different levels, lack of support and partnership among the stakeholders, lack of justification and awareness of the stakeholders, mismanagement and misuse of data, inattention to infrastructure. CONCLUSIONS: Most of the stakeholders believed that the FNS was supposed to monitor food and nutrition status continuously to provide timely and accurate information for policy making.

Process evaluation of a national, community-based, food supplementary programme for improving the nutritional status of children in Iran.

OBJECTIVE: To evaluate the process of implementation of a national nutritional programme for improving the nutritional status of children in Iran. DESIGN: A cross-sectional process evaluation was carried out using field observations, document reviews, semi-structured interviews and focus group discussions. SETTING: Data were collected across urban and rural areas of Qazvin and Semnan provinces of Iran, March-September 2014. SUBJECTS: Mothers (n 362) of children under programme coverage were chosen for the survey. Senior nutrition officers, the head of Hygiene, Remedy and Insurance Affairs at Imam Khomeini Relief Foundation and community health workers were selected purposively for interviews. Mothers with at least one child under 6 years of age covered by the programme were selected to participate in focus group discussions. RESULTS: Five steps of programme implementation were identified: supplementary food basket content, food basket distribution methods, selection of eligible children, distributed food consumption, and child growth monitoring and nutrition training sessions for mothers. The distributed food baskets did not have enough milk/dairy products, vegetables and fruits. Nearly 50 % of children consumed 75-100 % of the distributed milk and cake/biscuit, while staple foods were shared with other family members. When electronic cards were offered instead of food baskets, attendance for child growth monitoring and the food items participants chose with the cards tended to differ from what was originally designed. CONCLUSIONS: Focusing on food items that are mostly being used for child feeding (e.g. eggs or milk in food baskets) may be beneficial to assure the target child is receiving the distributed foods.