Fresh Leafy Vegetables and Parasitic Contamination: Practical Solutions.

This study aimed at investigating the parasitic contamination of fresh leafy vegetables in Tehran, Iran, during 2020-2021. A cross-sectional study was conducted and 180 fresh leafy vegetables (including leek, watercress, mint, spring onion, radish, basil, parsley, lettuce, and spinach) were collected randomly in the five regions of Tehran, Iran. Each 200-g sample was soaked with tap water containing detergent, and the obtained sediment was centrifuged and examined for parasitic stages using a light microscope. The overall rate of parasitic contamination was 19.4%, with Trichostrongylus and Toxocara eggs being the most prevalent parasites (3.9%) and the highest rate of parasitic contamination was observed in spinach (40%), whereas no contamination was found in spring onions. Except for radish, other vegetable samples had multiple parasitic infections. Due to the contamination of vegetables, it is necessary to have a suitable method to reduce the parasites. Consequently, policymakers should safeguard public health by consistently monitoring contaminants in food and prioritizing education and research on methods to mitigate their presence in the food chain.

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.

The influence of carboxymethyl cellulose and hydroxypropyl methylcellulose on physicochemical, texture, and sensory characteristics of gluten-free pancake.

In this study, gluten-free pancakes were prepared using rice flour and potato starch at a ratio of 50:50. Due to a lack of gluten networks in these ingredients, the hydrocolloid gums including carboxymethyl cellulose (CMC) at 0.5%, 1%, and 1.5% and hydroxypropyl methylcellulose (HPMC) at 1%, 2%, and 3% were added to improve the quality of the final products. The effects of these hydrocolloid gums on the physicochemical, textural, and sensory properties of the gluten-free pancakes were evaluated. Pancakes prepared with wheat flour were used as a control sample. The results showed that the addition of both gums decreased the hardness and chewiness of the gluten-free pancakes while increasing the springiness and their moisture content. Increasing the concentration of the gums resulted in an L* value (lightness) reduction, which produced a darker crust on the pancakes. Moreover, the gluten-free pancakes containing CMC and HPMC had higher specific volumes than the gluten-free samples made without CMC and HPMC. From a sensory point of view, the samples containing 2%, 3% HPMC and 1% CMC received the highest overall acceptance score. Thus, CMC and HPMC can be used as improvers in gluten-free pancakes.

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.

Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households?

Objective: This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households. Methods: The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications. Results: Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated. Conclusion: The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.

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.

Analysis of fat, fatty acid profile, and salt content of Iranian restaurant foods during the COVID-19 pandemic: Strengths, weaknesses, opportunities, and threats analysis.

This study aimed to analyze the fat, fatty acid profile, and salt content of restaurant foods (RFs) and find out strategies to lower them using the strengths, weaknesses, opportunities, and threats (SWOT). Five types of common foods (n = 70) were collected from restaurants in Tehran, Iran. The fat, fatty acid profile, and salt content of samples were analyzed by acid hydrolysis method, gas chromatography, and Charpentier Volhard methods, respectively. The quantitative data were analyzed by the SPSS using ANOVA and Spearman's correlation test. Then, a SWOT analysis was done. The laboratory results indicated that the highest amount of total fat was in Samosa (16.92% ± 6.27%), whereas saturated fatty acids (SFA) and trans fatty acids (TFA) were significantly higher in Koobideh kebab with rice (44.42% ± 5.07% and 2.86% ± 0.64%, respectively) as compared to other samples. In addition, the highest amount of salt was in the Falafel sandwich (2.87% ± 0.98%). The salt content in the majority of analyzed foods was about two times more than the daily recommendations of the World Health Organization (WHO). The SWOT analysis results showed the lack of standardization of recipes to measure accurate fat and salt content was the main weakness and food labeling in the menus was detected as an important opportunity. TFA and salt in RFs were alarmingly high and it is necessary to find strategies for reformulation of RFs to reduce their fat and salt content. Policymakers can use the SWOT analysis results of this study to offer directions for potential future strengthening actions of healthy foods in restaurants for public health.

A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic.

The restaurant business has turned into a dynamic and ever-growing industry. So, food safety must be a priority for these establishments, especially during the COVID-19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self-reported practice (KAP) of restaurant food handlers during the COVID-19 pandemic. This quasi-experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher's exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self-reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA. Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID-19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.

Policy challenges of food advertisements from the viewpoints of Stakeholders: A qualitative study.

This study aims to explore the stakeholders' views and suggestions about the policy challenges of food advertisements. Sixteen semistructured interviews were held with media and the food industry experts. Directed content analysis and constant comparison methods were used to obtained categories until subthemes were extracted, and the results were shared as member checking with the stakeholders. Two categories in two themes and seven subthemes were investigated based on the perspectives of the stakeholders: (a) Creating food advertisements and (b) Regulations and rules of food advertising. Few strict guidelines and rules are governing food advertising in Iran. Some factors influencing the general approach in nutrition policy and particularly the choice of policy options and instruments that can be placed in this area, including economic factors, political leadership, lack of political, and systematic monitoring of food advertising status, will were perceived as powerful constraints in advertising policy. Strong links must be established between all sectors that have a bearing on healthy food (the media, public health community, food industry, and consumers). The research findings seek to offer policy options for both the government and the stakeholders for challenging future policies of food advertising.

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.

A Mixed-Method Study on COVID-19 Prevention in Iranian Restaurants.

Background: In the face of the COVID-19, as a public health emergency, the restaurant industry is struggling to organize itself. The aim of this study is to determine the knowledge, attitude, and practice and also the perceptions of restaurants' customers and managers toward COVID-19 prevention. Methods: This cross-sectional study was conducted using the mixed-method approach. Two online questionnaires were undertaken through WhatsApp Messenger among the 210 customers and 50 managers of restaurants. Multivariate linear regression analysis was conducted to identify the predictors of knowledge, attitude, and practice toward COVID-19 prevention. Then semi-structured, in-depth phone interviews were conducted with 45 subjects to identify their perceptions about the restaurant industry during the COVID-19 pandemic. Results: The majority of customers had moderate knowledge (72.4%), positive attitude (90.5%), and desirable practice (38.6%); whereas the majority of managers had sufficient knowledge (50%), negative attitude (82%), and acceptable practice (58%) toward the prevention of COVID-19 in restaurants. Multiple linear regression analysis showed with increasing each 10 years in the age of the customers, the practice score significantly decreased (Beta = -0.155, p < 0.05). Moreover, qualitative results revealed three categories (1. restaurant industry, 2. social media, and 3. government) in 9 themes with 32 sub-themes which were explored based on the perception of the participants toward COVID-19 prevention in restaurants. Conclusion: The majority of restaurant customers and managers have sufficient knowledge and acceptable practice, but a positive attitude among customers and a negative attitude among managers about the prevention of COVID-19 were shown. There is an urgent need to understand public awareness about preventing COVID-19 in restaurants at these critical moments. The results seek to provide strategies for the policymakers and restaurant industry to plan the specific educational intervention about how to manage future crises and public health improvement.

Home Food Safety Practice and Household Food Insecurity: A Structural Equation Modeling Approach.

BACKGROUND: Food safety and food security are interrelated concepts with a profound impact on the quality of human life. The current study, for the first time, was set to identify associations between home food safety practice and household food insecurity a structural equation modeling approach. METHODS: In this cross-sectional study, urban households were selected from among 10 health centers of five districts of Tehran, Iran (2015). The following questionnaires were completed: socioeconomic status (SES), food security and food safety. Structural Equation Modeling (SEM) was applied for predicting the relationships between SES, food insecurity, and food safety in households. RESULTS: Food security was observed in 56% of households. Mild, moderate and severe food-insecure households were determined to be 29%, 12%, and 3%, respectively. In addition, the scores of home food safety practice in 37.5%, 33% and 29.5% of the households were classified as desirable, acceptable and weak, respectively. Low-educated mothers having husbands with low educational and occupational level had a weaker food safety practice compared to high-educated ones. Based on the SEM results, an inverse association between food safety practice and food insecurity score was observed (t= -2.89, ɣ = 0.16). CONCLUSION: Food insecurity and undesirable food safety practice were relatively prevalent among households. In addition, the economic and social factors could inversely affect both food insecurity and food safety practices.

Evaluating the rancidity and quality of discarded oils in fast food restaurants.

This cross-sectional study attempts to determine the rancidity and quality of discarded oils in fast food restaurants. Samples of the discarded frying oils were collected randomly from 50 fast food restaurants in Tehran, Iran. Their physicochemical properties were assessed and compared to the standard values. The means (±SD) of the physicochemical indicators of the rancidity in the discarded oils were as follows: peroxide value, 3.06 (0.51) (mEq/kg); free fatty acids content, 1.52 (2.26) (%); p-anisidine value, 57.63 (4.02) (mEq/kg); total oxidation value, 64.53 (4.15); total polar compounds (TPC), 20.19 (1.02) (%); viscosity, 107.87 (2.35) (cp); and red color, 9.64 (0.84). Positive correlations were found between the TPC, viscosity, and red color (p ≤ 0.01) of the oil samples. The majority of discarded oil from fast food restaurants were overdegraded containing hazardous secondary oxidative products, and also, the consumption of nonstandard frying oil has increased in fast food restaurants. Policymakers should develop guidelines to determine whether and when frying oils should be discarded and consider the consumption of overdegraded oils as a public health hazard.

Challenges of Edible Oils From Farm to Industry: Views of Stakeholders.

OBJECTIVE: The purpose of this study is to explore stakeholders' views about quality and safety of edible oils from farm to industry and propose policy options to address these challenges. METHODS: Semistructured, face-to-face interviews were conducted with 11 experts in the edible oil industry. Participants were selected through purposive and snowball sampling. Open-ended interview questions were used to identify the edible oils' challenges from farm to industry. All interviews were recorded and final transcripts were re-read to obtain categories until themes were developed using directed content analysis and constant comparison methods. RESULTS: Six categories in 14 themes with 49 sub themes were explored based on the perspectives of the stakeholders who were responsible for edible oil industry: (1) safety, (2) imports, (3) factory, (4) edible oils' monitoring, (5) edible oil industry, and (6) building consumer trust. The participants' views showed that to increase the quality and safety of edible oils, the following approaches are required: updating food safety regulations, effective inspection, monitoring and surveillance systems, updating laboratory equipment, and controlling the media advertising. CONCLUSIONS: In order to build and maintain effective edible oil safety systems, strong links must be established between all sectors responsible. The key players need to have access to reliable and up-to-date information so that timely collective action can be taken. It is recommended that governments face up to this task and lead the way. The research findings seek to offer policy options for government and the stakeholders for challenging future strategies for edible oil industry.

Development of a Home Food Safety Questionnaire Based on the PRECEDE Model: Targeting Iranian Women.

Food safety is an essential public health issue for all countries. This study was the first attempt to design and develop a home food safety questionnaire (HFSQ), in the conceptual framework of the PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) model, and to assess its validity and reliability. The HFSQ was developed by reviewing electronic databases and 12 focus group discussions with 96 women volunteers. Ten panel members reviewed the questionnaire, and the content validity ratio and content validity index were computed. Twenty women completed the HFSQ, and face validity was assessed. Women who were responsible for food handling in their households (n =320) were selected randomly from 10 health centers and completed the HFSQ based on the PRECEDE model. To examine the construct validity, a principal components factor analysis with varimax rotation was used. Internal consistency was determined with Cronbach's α. Reproducibility was checked by Kendall's τ after 4 weeks with 30 women. The developed HSFQ was considered acceptable with a content validity index of 0.88. Face validity revealed that 95% of the participants understood the questions and found them easy to answer, and 90% confirmed the appearance of the HFSQ and declared the layout acceptable. Principal component factor analysis revealed that the HFSQ could explain 33.7, 55.3, 34.8, and 60.0% of the total variance of the predisposing, reinforcing, practice, and enabling components, respectively. Cronbach's α was acceptable at 0.73. For Kendall's τc, r = 0.89, with a 95% confidence interval of 0.85 to 0.93. The HFSQ developed based on the PRECEDE model met the standards of acceptable reliability and validity, which can be generalized to a wider population. These results can provide information for the development of effective communication strategies to promote home food safety.

Schools' Cafeteria Status: Does it Affect Snack Patterns? A Qualitative Study.

BACKGROUND: The aim of this study was to evaluate patterns of students' snacks habits regarding to their schools' cafeteria status in Tehran by focus group discussion (FGD) technique. METHODS: Participants were 240 students (12-15 years old), selected from12 middle-schools in Tehran. The field study consisted of 24 FGDs sessions; involving 8-10 participants. Collected data were coded, categorized and analyzed using constant comparative method. RESULTS: Over half of the students believed that snack consumption is necessary. Although, majority of students believed that their schools' cafeterias are not acceptable, they noted them as one of the necessary parts of school. Nearly half of the children were complaining of unvaried and expensive food items. The most purchased items were: Cookies, sandwiches with mayonnaise and ketchup, soft drinks and chocolate milk. Most of the students were interested in having roles in their cafeterias. CONCLUSIONS: Schools' cafeteria are significant sources of supplying adolescents' snacks, so developing hygienic stores containing healthy and nutritious food items is a key element to affect their snack selection positively. Reaching this goal requires a multi disciplinary approach through participation of students, school staff, parents, and the support of community and media.

Major dietary patterns in relation to stunting among children in Tehran, Iran.

To the best of our knowledge, no information is available to link major dietary patterns to stunting during childhood, although dietary patterns are associated with chronic diseases. This study was conducted to determine the relationship between major dietary patterns and stunting in the first grade pupils of Tehran in 2009. In this case-control study, 86 stunted children (defined as height-for-age of less than the 5th percentile of CDC2000 cutoff points) were enrolled from among 3,147 first grade pupils of Tehran, selected using a multistage cluster random-sampling method. Participants for the control group (n=308) were selected randomly from non-stunted children (height-for-age more than the 5th percentile of CDC2000 cutoff points), after matching for age, sex, and area of residence. Dietary data were collected using two 24-hour dietary recalls through face-to-face interview with mothers. Factor analysis was used for identifying major dietary patterns. Mean consumption of dairy products (308 +/- 167 vs 382 +/- 232 g/day, p < 0.05), dried fruits and nuts (2.5819 vs 7.15 +/- 26 g/day, p < 0.05) were significantly lower among stunted children than those in the control group. Three major dietary patterns were identified: 'traditional dietary pattern' that was dominated by bread, potato, fats, eggs, flavours, vegetables other than leafy ones, sugar, drinks, and fast food; 'mixed dietary pattern' that was dominated by leafy vegetables, fast foods, nuts, fats, cereals other than bread, fruits, legumes, visceral meats, sugars, eggs, and vegetables other than leafy vegetables; and 'carbohydrate-protein pattern' that was dominated by sweets and desserts, poultry, dairy, fruits, legumes, and visceral meats. No significant relationships were found between traditional and mixed dietary patterns and stunting. Individuals in the third quartile of carbohydrate-protein dietary pattern were less likely to be stunted compared to those in the bottom quartile (OR: 0.31, 95% CI 0.13-0.78, p < 0.05). Adherence to dietary patterns high in protein (e.g. dairy, legumes, and meat products) and carbohydrates (e.g. fruits, sweets, and desserts) might be associated with reduced odds of being stunted among children.

Determinants of stunting in school-aged children of tehran, iran.

BACKGROUND: Limited data are available indicating associates of stunting among Iranian children. This study was conducted to investigate determinants of stunting in first grade primary school children of Tehran in 2007. METHOD: In this case-control study, 3147 school children were selected by multistage cluster random sampling method from 5 districts of Tehran. Anthropometric measurements were done and stunting was defined as height for age less than the 5(th) percentile of CDC2000 cut-off points. Eighty six stunted children were identified and considered as case group. After matching for age, sex and residence area, 308 non-stunted children were randomly selected as control group. Required data were collected by trained nutritionists using questionnaires. RESULTS: Stunting was prevalent among 3.7% of the study population (girls 4.4% vs. boys 2.8%, P < 0.05). Mean age of the studied children was 82.3 month. Children with a birth weight of >3000 g were less likely to be stunted (OR: 0.25: 95% CI: 0.11-0.54) compared with those with a birth weight of <3000 g. Being born to older mothers (>35 years) was associated with greater odds of being stunted (3.01; 1.19-7.60) compared with being born to younger mothers (<35 years). Those with fathers' height of >160 cm were less likely to be stunted (0.04; 0.005-0.37) than those whose fathers' height was less than 160 cm. CONCLUSIONS: We found that birth weight, maternal age and fathers' height are the major contributing factors to stunting in this group of Iranian children. Taking into account the determinants of stunting might help policy makers designing appropriate interventions.