Association between Malnutrition and Depression in Elderly People in Razavi Khorasan: A Population Based-Study in Iran.

BACKGROUND: To determine the prevalence of malnutrition and depression in free-living elderly people and their relationships (If any) in Razavi Khorasan, Iran 2007. METHODS: To evaluate nutritional status, we used Mini Nutritional Assessment (MNA) method in free-living elderly people (n=1565 using cluster sampling, 720 males and 845 females, aged≥ 60 yr) and their relationship to Socio Economic Conditions (SECs). Based on the final scores, our patients were classified into three groups: score 17-23.5 (at risk for malnutrition), score less than 17 (with malnutrition), and score 24-30 (well nourished). To determine the mood status (here depression), we used Geriatric Depression Score (GDS). According to this score our participants turned out to be in two distinct groups: depressed (score ≥8) and non-depressed (score < 8). RESULTS: From the total subjects entered the study (1495), 22.07% were depressed and 11.5% and 44% were malnourished or at risk of malnutrition respectively. In depressed group, the prevalence of malnutrition was 14.5% (48 out of 330) and the prevalence of "at risk of malnutrition" was 45.8%, whereas the prevalence of malnutrition and at risk of malnutrition in non-depressed population were 10.6% and 43.3% respectively. From the aforementioned information we have concluded that there is a significant statistical difference between the prevalence of malnutrition in depressed and non-depressed individuals (P= 0.047). CONCLUSIONS: With respect to the high rate of vegetative symptoms in elderly depressed individuals, malnutrition would have a higher prevalence in the depressed people.

Prevalence of obesity and its association with socioeconomic factors in elderly Iranians from Razavi-Khorasan province.

There are few data regarding the prevalence of obesity and its socioeconomic determinants among elderly individuals, particularly in Iran. We wished to determine the prevalence of overweight and obesity in free-living elderly people and the relationship to nutritional and socioeconomic factors in the Razavi-Khorasan province of Iran. Free-living elderly persons (917 males/1045 females), aged > or =60 years, were recruited using cluster sampling. Overweight and obesity were evaluated using body mass index (BMI) and subjects were categorized as thin (BMI <18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (> or =30 kg/m2). The association between the prevalence of overweight or obesity with socioeconomic and demographic factors, including gender, place of residence, literacy, type of living, source of income, use of supplements during the past 3 months, and employment status, was examined using regression analysis. The distribution of BMI values indicated that 13, 46.5, 28.9, and 11.7% of the total population were thin, normal, overweight, and obese, respectively. The prevalence of central obesity was higher among Iranian women than men (63.1 vs. 18.6%, respectively). Regression analysis results indicated that gender (p < 0.001), place of residence (p < 0.001), literacy (p = 0.01), and source of income (p < 0.001) were significantly associated with the incidence of overweight or obesity. This study showed that 40.6% of elderly subjects were overweight or obese. Results reinforce the need to plan strategies for primary prevention of this fast-growing public health problem.

Bone mineral density in Iranian adolescents and young adults with beta-thalassemia major.

The authors investigated the prevalence of low bone mass in patients from Tehran, Iran, with beta-thalassemia major (n = 203), aged 10-20 years, and the potential risk factors for osteoporosis in this patient population. Prevalence of osteoporosis was 50.7% in lumbar spine, 10.8% in femur, and 7.9% in both regions with no significant difference between the two genders. The following factors were associated with low BMD: height for age and weight for age below 3rd percentile, delayed puberty or hypogonadism, age when Desferal (for iron chelation) was started, duration of Desferal therapy, and serum zinc. Low serum copper and 25(OH)D were not associated with low BMD.

Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of esophageal cancer.

BACKGROUND: A pilot study was carried out to evaluate validity and reproducibility of a food frequency questionnaire (FFQ), which was designed to be used in a prospective cohort study in a population at high risk for esophageal cancer in northern Iran. METHODS: The FFQ was administered four times to 131 subjects, aged 35-65 years, of both sexes. Twelve 24-h dietary recalls for two consecutive days were administered monthly during 1 year and used as a reference method. The excretion of nitrogen was measured on four 24-h urine samples, and plasma levels of beta-carotene, retinol, vitamin C and alpha-tocopherol was measured from two time points. Relative validity of FFQ and 24-h diet recall was assessed by comparing nutrient intake derived from both methods with the urinary nitrogen and plasma levels of beta-carotene, retinol, vitamin C and alpha-tocopherol. RESULTS: Correlation coefficients comparing energy and nutrients intake based on the mean of the four FFQ and the mean of twelve 24-h diet recalls were 0.75 for total energy, 0.75 for carbohydrates, 0.76 for proteins and 0.65 for fat. Correlation coefficients between the FFQ-based intake and serum levels of beta-carotene, retinol, vitamin C and vitamin E/alpha-tocopherol were 0.37, 0.32, 0.35 and 0.06, respectively. Correlation coefficients between urinary nitrogen and FFQ-based protein intake ranged from 0.23 to 0.35. Intraclass correlation coefficients used to measure reproducibility of FFQ ranged from 0.66 to 0.89. CONCLUSION: We found that the FFQ provides valid and reliable measurements of habitual intake for energy and most of the nutrients studied.

Multidisciplinary intervention for reducing malnutrition among children in the Islamic Republic of Iran.

A multidisciplinary intervention to reduce protein-energy malnutrition among children in rural areas was piloted in 3 provinces of the Islamic Republic of Iran. Based on an initial situation analysis, a range of interventions were implemented through local nongovernmental organizations, including nutrition, health and literacy education for mothers, improved growth monitoring and fostering rural cooperatives and income generation schemes. Malnutrition before and after the intervention (in 1996 and 1999) was assessed using anthropometric measurements of random samples of children aged 6-35 months in control and intervention areas. Three years into the intervention, all indicators of malnutrition had consistently decreased in all intervention areas and the prevalence of underweight and stunting was significantly lower. Control areas showed a mixed pattern of small increases and decreases in malnutrition indicators.

Multidisciplinary intervention for reducing malnutrition among children in the Islamic Republic of Iran

A multidisciplinary intervention to reduce protein-energy malnutrition among children in rural areas was piloted in 3 provinces of the Islamic Republic of Iran. Based on an initial situation analysis, a range of interventions were implemented through local nongovernmental organizations, including nutrition, health and literacy education for mothers, improved growth monitoring and fostering rural cooperatives and income generation schemes. Malnutrition before and after the intervention [in 1996 and 1999] was assessed using anthropometric measurements of r and om samples of children aged 6-35 months in control and intervention areas. Three years into the intervention, all indicators of malnutrition had consistently decreased in all intervention areas and the prevalence of underweight and stunting was significantly lower. Control areas showed a mixed pattern of small increases and decreases in malnutrition indicators

Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization.

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg l/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 microg/dl 85.1% had urinary iodine > or =10 microg/dl. Median urinary iodine was above 13 microg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 microg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 microg/dl; urinary iodine of their schoolchildren was <5 microg/dl in 10.8% and <2 microg/dl in 6-9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.

Effect of traditional food supplementation during pregnancy on maternal weight gain and birthweight.

The effects of supplementary traditional food on pregnant women were investigated in a clinical trial in Islamshahr, a suburban area 35 km southwest of Tehran. The study comprised 53 healthy mothers who were neither addicts nor on medication and were free from genetic disorders. The pregnant mothers' health was evaluated by their weight gain, that of lactating mothers by breast milk adequacy, and that of newborns by their weight at birth. The experimental group received traditional food (rice-milk porridge, lentils, pottage, cheese, yogurt, eggs, and milk with bread), supplying an extra 400 kcal energy and 15 g protein from the fourth month of pregnancy until childbirth. All subjects were weighed monthly. To ascertain breast milk sufficiency, the duration of exclusive breastfeeding and the growth trend of infants were surveyed. The study showed the weight gain in the experimental and control groups to be 11.0 +/- 2.9 and 8.5 +/- 3 kg respectively; the difference was 29.4% and statistically significant (p < 0.02). The confounding variables (energy and protein intake, age, height, BMI, age at first pregnancy, parity, last pregnancy spacing, number of children, number of miscarriages, duration of residence in the area, family size, education, housing, occupation of the mother or her husband) did not reveal any significant differences. Maternal weight gain was higher in the experimental compared to the control group. Birth weights in experimental and control groups were 3.33 +/- 0.4 and 3.08 +/- 0.3 kg, respectively. This difference, which amounts to 8.1%, was statistically significant (p < 0.05). While the two groups of newborns had equal breastfeeding duration, heights and weights of newborns were significantly higher in the experimental group. This was also confirmed when compared to the NCHS figures.

Three-year survey of effects of iodized oil injection in schoolchildren with iodine deficiency disorders.

High prevalence of goiter, other IDD such as impaired physical and intellectual growth and hearing deficit have been reported previously in Kiga. In order to evaluate the effect of iodized oil injection, this study was conducted in schoolchildren of Kiga village from 1989 to 1992. One ml of iodized oil solution containing 480 mg of iodine was injected into 198 schoolgirls and boys aged 8-14 years. Serum thyroid hormones, RT 3 U, TSH and thyroglobulin, before and 12, 24 and 36 months after the intra-muscular injection of iodized oil were measured. Assessment of urinary iodine was performed at the same periods by Foss method. Prior to the injection, all schoolchildren had goiters larger than grade 1 A (48% were grade 3); 3 years after intervention 20% had grades zero and 1 A and 8% grade 3 (P < 0.001). Urinary iodine was 11.4 +/- 19.8 before and increased to 113 +/- 63 and 83 +/- 66 microg/g creatinine 2 and 3 years after intervention. Mean serum T 4 was 5.0 +/- 2.1, 10.8 +/- 2.8, 9.8 +/- 2.5 and 9.5 +/- 2.1 microg/dl before and 12, 24 and 36 months after the injection, respectively (P < 0.001). Mean serum TSH was 20.3 +/- 22.8, 1.2 +/- 1.6, 0.8 +/- 1.2 and 2.2 +/- 0.9 mU/L in the same intervals, respectively (P < 0.001). Mean serum thyroglobulin was 132 +/- 107, 10 +/- 12 and 23 +/- 20 ng/ml before and at 2 and 3 years after injection, respectively (P < 0.001). Slight but significant increases in serum TSH and thyroglobulin occurred at 3 years after the injection. Findings show benefits of iodized oil administration in decreasing goiter size and in resuming normal thyroid function up to 3 years after the intervention. An increase in TSH and or thyroglobulin could be considered as the first sign of a fall in effectiveness of iodized oil injection.

Effect of daily and intermittent iron supplementation on iron status of high school girls.

This experimental study was designed to investigate the effects of daily versus intermittent iron supplementation on iron status of high school girls in Zahedan and Rasht cities in 1996-1997. The subjects were selected randomly from among students of grades 1-3 of four high schools in each city. Anemia was determined by measuring hematological indices. 260 anemic and a similar number of non-anemic subjects of 4 high schools were selected and allocated randomly to 4 treatment groups. During a 3-month period, the test groups were given 150 mg ferrous sulfate tablets (50 mg Fe). Subjects in group 1 received a daily dose, groups 2 & 3 received twice or once weekly doses respectively. The control group received no iron supplement. For these subjects, in addition to hematological indices biochemical iron indices were measured in the beginning and at the end of the study. The increases in hemoglobin concentration in anemic subjects were not significantly different among supplemented groups but were different from the control group (p < 0.00001). Among anemic subjects, changes in serum ferritin levels in 3 supplemented groups were significantly different from the control group. Serum ferritin in Group 1 was also increased to a greater extent than groups 2 and 3 (P < 0.00001). It is concluded that over the study period a weekly iron dose was as effective as a daily dose in treating anemia but the daily dose was more effective in improving iron stores than a weekly dose in the short run.

Monitoring iodine following consumption of iodized salt in Tehrani inhabitants.

As the production, distribution and consumption of iodized salt has increased in recent years, this study was carried out to assess iodine status in Tehran in 1996. 1146 families comprising 5140 subjects in the twenty districts of Tehran city from all age groups were randomly selected. Thyroid size was examined by palpation and graded according to the WHO classification. In 163 families selected randomly, thyroid size was determined by ultrasonography and urinary iodine was measured by digestion method. Serum T4, T3 and TSH (IRMA) concentrations were also assayed by kits. Percentage of grades 1 & 2 goiter were 44 & 44% in females and 49 & 33% in males respectively. Median urinary iodine was 17.5 micrograms/dl. Mean serum T4, T3 and TSH were 8.41 +/- 1.4 micrograms/dl, 170 +/- 37 ng/dl and 1.4 +/- 0.8 mu/ml, respectively. In 118 children aged 6-10 years median urinary iodine was 17.5 micrograms/dl. Thyroid volume in children was 4.3 +/- 1.9 ml. No correlation was established between the thyroid volume and goiter grade. This study points to the adequacy of iodine intake in the majority of families residing in Tehran.

Food intake and Body Mass Index in the privately institutionalized elderly in Tehran.

Food intake and Body Mass Index (BMI) of privately institutionalized elderly in Tehran was studied using a 5-day food intake survey and anthropometric measurements. Thirty-seven males and sixty-three females in private institutions were selected. The intake of many nutrients including protein, calcium, zinc, vitamins A. riboflavin, folic acid and cobalamin, were deficient. Almost half the subjects were under the 5th percentile of standard BMI for their age and sex, indicating chronic energy malnutrition. More attention needs to be paid to this group of vulnerable people.

The effects of iodized oil injection in eu- and hypothyroid iodine deficient girls.

Iodized oil administration has not been effective in restoration of euthyroidism in adolescents and adults, and only partially effective in children aged 4 to 14 years with endemic myxedematous cretinism. Therefore, we studied the effect of iodized oil injection in euthyroid and hypothyroid school girls in an endemic region. Clinical examination and assessment of serum thyroid hormones and TSH were performed before and at 4, 7 and 12 months after intramuscular injection of 480 mg iodine in 54 school girls. Four months after iodized oil injection, T4 and T3 increased from 58 +/- 24 and 2.6 +/- 0.6 to 127 +/- 28 and 3.1 +/- 0.5 nmol/l, respectively. Serum TSH was above 5 mU/l in 45 girls before and in 4 girls four months after injection. None had increased TSH at 7 and 12 months of study. Older girls had lower T4 and higher TSH than younger ones, however, all responded well to iodized oil administration. Serum T3 was above the normal limit of 3.1 nmol/l in 16 subjects. There was no clinical evidence of hyperthyroidism. Mean serum T3 returned to pre-treatment value by 7 and 12 months. TSH response to TRH was subnormal in 5 girls who had increase in either T3 or T4 or both at the end of one year. Injection of iodized oil reverses thyroid function in children and adolescents with hypothyroidism, when the severity of iodine deficiency is not enough to cause thyroid cell atrophy. Transient elevation in serum T3 and/or T4 occurs in many and may last in some at least one year following injection.

Treatment of goitrous hypothyroidism with iodized oil supplementation in an area of iodine deficiency.

In order to investigate the effect of iodized oil administration on the thyroid status of male hypothyroid children and adolescents residing in an area of iodine deficiency, 32 apparently normal school boys with increased serum TSH, aged 7 to 15 years, were given a single intramuscular injection of 480 mg iodized oil. Four months after injection, serum T4 increased from 60 +/- 23 to 118 +/- 24 nmol/l and serum TSH decreased from 39 +/- 33 to 2.5 +/- 1.2 mU/l. Serum T4 remained unchanged while a further decline in TSH to 1.3 +/- 0.9 and 1.4 +/- 1.3 mU/l was observed 7 and 12 months after injection, respectively. There was a small but significant reduction in serum T3, FT3I as well as in the prevalence and severity of goiter 1 year following iodine treatment. Neither the age of the subject nor the severity of hypothyroidism affected the thyroid response to iodine treatment. It is concluded that iodized oil injection is an effective and convenient treatment for goitrous hypothyroid youngsters in iodine deficient areas.

Physical, neuromotor and intellectual impairment in non-cretinous schoolchildren with iodine deficiency.

Thyroid status and neurologic, psychometric and auditory functions were evaluated in presumably normal schoolchildren aged 6 to 16 years from three areas of iodine deficiency in Iran. The subjects from each area were identified as members of groups A, B or C. In group A there were retarded growth, high prevalence of visible goiter (93%), low T4 (39%) and high TSH (70%). In group B 66% had a visible goiter and 7% had high serum TSH. In group C visible goiter was present in 22% of the subjects but they had normal thyroid function. Urinary iodine excretion was low in all three groups. Head circumference was less in groups A and B, as compared to C. Pyramidal signs occurred in over half of the subjects in Group A (hyperreflexia in 39% and crossed adductor reflex in 29%). The glabellar sign was present in 50% of group A and 20% of group B. Forty-four percent of the subjects in group A and 17% in group B had hearing deficits as shown by audiometry. Psychomotor examination was performed using the Bender Gestalt test. A higher number of errors was evident in groups A and B their psychomotor age was below their chronological age. The results of the Raven test showed mild impairment of IQ in group A, with 55% having an IQ below 91 and 15% less than 70. The subjects in group B had lower IQ than group C, but higher than group A. There was a negative correlation between serum TSH and free thyroid indices and a positive correlation between TSH and the number of pyramidal signs. This study demonstrates that mild to moderate growth retardation and neurological, auditory and psychomotor impairments occur in apparently normal subjects residing in areas of iodine deficiency.

Impairment of neuromotor and cognitive development in iodine-deficient schoolchildren with normal physical growth.

In order to detect somatic and psychomotor disturbances in children and adolescents residing in areas of iodine deficiency, schoolchildren from three areas with different degrees of iodine deficiency were studied. In Randan, the prevalence of severe endemic goiter was accompanied by alteration in thyroid function, increased thyrotropin levels and retardation of both bone and psychomotor age and decreased intellectual quotient. In Tehran, where iodine deficiency is mild, visible goiter was present in 15% of schoolchildren but no alterations in thyroid function, serum thyrotropin, somatic or psychomotor development could be detected. In Zagoon, where the prevalence and severity of goiter was less than Randan but more than Tehran, thyroid function was normal but slightly decreased as compared to Tehran; somatic development was unaltered, but retardation in psychomotor development was evident and the mean intellectual quotient was less than that of Tehranian schoolchildren. These findings indicate the occurrence of physical and psychomotor disturbances in apparently normal schoolchildren from areas of iodine deficiency. Alteration in psychomotor development may occur in children with normal physical growth, due to iodine deficiency.

Survey of iodine deficiency in a rural area near Tehran: association of food intake and endemic goitre.

Goitre is endemic in many parts of Iran. This study was undertaken first to obtain the base line data and identify the nature of the problem and then to take measures to ameliorate it. Shahryar, an endemic area near the capital city, was selected as the pilot field. The sample size was 368 families. Sixty-six per cent of females and 54 per cent of males were goitrous. A food consumption survey revealed that 38 per cent and 62 per cent of the families had failed to receive at least 80 per cent of their requirement for energy and vitamin A, respectively. Free T4 index was normal but significantly lower in grade 2 goitre than the non-goitrous subjects (P less than 0.01). Significant reverse correlations were found between goitre prevalence and vitamin A and protein intakes (P less than 0.05). Supplementation with 40 micrograms iodine/g salt raised urinary iodine excretion significantly (P less than 0.001). We conclude that although iodine deficiency plays the key role in goitre, the association of other dietary factors observed in this study needs further consideration.

Thyroidal radioactive iodine uptake in Iran.

The thyroidal uptake of iodine in 356 goitrous patients in Tehran and Mashad (two major cities in Iran) was studied. 131I was orally administered at the doses 10 to 50 microCi and the uptake was measured 2 and 24 hours following administration. The results demonstrate that the iodine deficiency is the main cause of goitre in these two cities and that the deficiency in Mashad is more severe than in Tehran.

Vitamin A status and endemic goiter.

Serum vitamin A levels were determined in two groups of subjects living in an endemic goiter area in Iran. The first group consisted of 242 non-goitrous subjects, and the second, contained 603 subjects with different grades of goiter. Serum vitamin A concentrations were correlated with goiter, sex, and age. Serum retinol values were not statistically different between goitrous and non-goitrous females, but goitrous male subjects especially those under 13 years of age, had lower serum retinol values than non-goitrous male subjects. The prevalence of low vitamin A levels was higher in goitrous boys. In both groups the prevalence of low serum vitamin A decreased with the increase in age. The prevalence of goiter was not statistically different between boys and girls under 18 years, but was more prevalent in women over 18 years, than men in the same age group (P less than 0.001). This difference was in accordance with serum vitamin A status between women and men after the age of 18 (P less than 0.001). Serum vitamin A increased with age up to 18 years, in both sexes and remained unchanged afterwards. The increase was gradual in girls under 18 years but was sharper in boys during puberty years. Although the values for serum vitamin A in each sex covered wide overlapping ranges, but a general superiority of male serum vitamin A levels over the females was observed.