Evaluation of the Alternative Healthy Eating Index as a predictor of 10-year cardiovascular disease risk in a group of Iranian employees.

BACKGROUND: Noncommunicable diseases, of which almost half are some form of cardiovascular disease (CVD), have overtaken communicable diseases as the world's major disease burden. There is growing evidence that indices of diet quality could have an association with a decreased risk of CVD in several countries. We aimed to examine the association between diet quality, as measured by the Alternative Healthy Eating Index (AHEI), and 10-year predicted CVD risk based on the Framingham Risk Score (FRS) in a group of Iranian employees. METHODS: A cross-sectional descriptive study was conducted on 296 (232 male, 64 female) employees aged ≥30 years selected by nonrandom sampling. AHEI was calculated according to a food frequency questionnaire with complementary questions on intake of cooking fats and oils among households. The 10-year risk of CVD was calculated based on FRS. Total and high-density lipoprotein-cholesterol, fasting blood sugar and blood pressure were measured to help in the calculation of FRS. RESULTS: AHEI did not have a significant relationship with FRS (r = -0.02, P = 0.67). However, some of its components, such as the intake of nuts and soy groups (r = -0.11, P = 0.04) and fruits (r = -0.14, P = 0.01), had a significant relationship with a reduced risk of CVD. According to stepwise multiple linear regression results, for every single increase in the intake of fruit servings, there would be a 0.14 reduction in the 10-year CVD risk score (ß = -0.14, P = 0.01). CONCLUSIONS: The present study showed no significant relationship between AHEI and the 10-year predicted risk of CVD among Iranian employees.

Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide.

PURPOSE: To evaluate the total fluid intake from drinking water and beverages in adult populations from different countries and assess the percentage of individuals complying with the European Food Safety Agency (EFSA) adequate intake (AI) of water from fluids. METHODS: A total of 16,276 adults (7580 men and 8696 women) aged between 18 and 70 years (mean age 39.8 years) were randomly recruited from 13 different countries from three continents. Information about the total daily fluid intake (sum of drinking water and beverages) was collected using a 24-h fluid-specific record over seven consecutive days. RESULTS: Important differences in total fluid intake between countries were found; however, few differences between men and women were reported in most of the countries. Less than 50 % of the women and approximately 60 % of the men do not comply with the EFSA AI of water from fluids. Women were more than twice as likely as men to meet these AI (OR 2.15; 95 % CI 2.02-2.29). The odds of meeting the AI of water from fluids were lower in individuals over 50 years (OR 0.88; 95 % CI 0.80-0.96). Nine percent of the total population consumed less than half of the AI, 40.5 % between 50 and 100 %, and 50.5 % more than the AI. CONCLUSIONS: There were considerable differences in total fluid intake between countries but not between genders. Only 40 % of men and 60 % of women comply with the EFSA AI of water from fluids. Men and elderly individuals had an increased risk of not complying with this reference value.

Intake of water and different beverages in adults across 13 countries.

PURPOSE: To describe the intake of water and all other fluids and to evaluate the proportion of adults exceeding the World Health Organisation (WHO) recommendations on energy intake from free sugar, solely from fluids. METHODS: A total of 16,276 adults (46 % men, mean age 39.8 years) were recruited in 13 countries from 3 continents. A 24-h fluid-specific record over 7 days was used for fluid assessment. RESULTS: In Spain, France, Turkey, Iran, Indonesia and China, fluid intake was characterised by a high contribution of water (47-78 %) to total fluid intake (TFI), with a mean water intake between 0.76 and 1.78 L/day, and a mean energy intake from fluids from 182 to 428 kcal/day. Between 11 and 49 % of adults exceeded the free sugar WHO recommendations, considering solely fluids. In Germany, UK, Poland and Japan, the largest contributors to TFI were hot beverages (28-50 %) and water (18-32 %). Mean energy intake from fluids ranged from 415 to 817 kcal/day, and 48-62 % of adults exceeded free sugar WHO recommendations. In Mexico, Brazil and Argentina, the contribution of juices and regular sugar beverages (28-41 %) was as important as the water contribution to TFI (17-39 %). Mean energy intake from fluids ranged 565-694 kcal/day, and 60-66 % of the adults exceeded the free sugar WHO recommendation. CONCLUSIONS: The highest volumes recorded in most of the countries were for water, mean energy intake from fluids was up to 694 kcal/day, and 66 % of adults exceeded the free sugar WHO recommendation solely by fluids. Actions to create an environment in favour of water consumption and reduce sugar intake from fluids therefore are warranted.

Intake of water and beverages of children and adolescents in 13 countries.

PURPOSE: To describe the intake of water and all other beverages in children and adolescents in 13 countries of three continents. METHODS: Data of 3611 children (4-9 years) and 8109 adolescents (10-17 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, stratified cluster sampling design was applied to randomly recruit schools classes. A quota method was applied in the other countries to randomly recruit participants. Details on the intake of all fluid types were obtained with a fluid-specific record over 7 consecutive days. RESULTS: In the total sample, the highest mean intakes were observed for water (738 ± 567 mL/day), followed by milk (212 ± 209 mL/day), regular soft beverages (RSB) (168 ± 290 mL/day) and juices (128 ± 228 mL/day). Patterns characterized by a high contribution of water, RSB or hot beverages to total fluid intake were identified among the countries with close geographical location. Adolescents had a significantly lower milk intake and higher intake of RSB and hot beverages than children in most countries. The most consistent gender difference observed was that in both age groups males reported a significantly higher RSB consumption than females. CONCLUSION: On average, water was the fluid consumed in the largest volume by children and adolescents, but the intake of the different fluid types varied substantially between countries. Since the RSB intake was as large, or even larger, than water intake in some countries, undertaking actions to improve fluid intake habits of children and adolescents are warranted.