Turkish version of the Yale Food Addiction Scale: preliminary results of factorial structure, reliability, and construct validity.

BACKGROUND: Yale Food Addiction Scale (YFAS) was established to identify individuals exhibiting signs of addiction towards certain types of food. This study aimed to develop a Turkish version of the Yale Food Addiction Scale and test its psychometric properties. METHODS: The backward translation techniques were used to develop Turkish versions of the YFAS, and its reproducibility was assessed. Turkish version of the YFAS was administered to a total of 1033 participants (439 men and 594 women), aged 19-65 years. Exploratory factor analysis and confirmatory factor analysis were used to examine the factorial structure of the tool. Construct validity was assessed by principal component factor analysis with varimax rotation. Reliabilities were estimated with Cronbach's alpha coefficient. The criterion-related validity was tested by the administration of Eating Attitude Test-26 (EAT-26) to all participants. RESULTS: The primary factor loadings for seven items were ranged between 0.45 and 0.79, and no items cross-loaded onto other factors. The fit indices showed that eight items of the YFAS were a good representation of the item responses and each item loaded significantly on the specified factor (p < 0.001 for each). YFAS subscales had a high internal consistency and test-retest reliability. The criterion-related validity of the tool showed a positive relationship with scales of the EAT-26. CONCLUSION: Current study suggested that the Turkish version of the YFAS is a reliable, valid, and useful tool for assessing the signs of food addiction in a non-clinical sample.

Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey.

OBJECTIVES: To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry.  Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p less than 0.05), and weight gain during pregnancy was associated with parity and increased infant birth weight (p less than 0.05). However, no correlations were observed between mean pregnancy weight gain and maternal complications (p greater than 0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.

The relation between compliance to the Mediterranean diet and the extensiveness of coronary artery disease.

OBJECTIVE: There are various studies showing the cardiovascular benefits of the Mediterranean diet (MD), but, to the best of our knowledge, this is the first study which aimed to investigate the relation between adherence to the MD and severity of coronary artery disease (CAD). METHODS: The study was a single centre, cross-sectional prospective study which included 200 consecutive patients (131 men [65.5%] and 69 women [34.5%], mean age 57±9) who were diagnosed with CAD by coronary angiography between January 2012 and April 2013. A food frequency questionnaire was administered to the patients. Compliance to the MD was evaluated by the MD score (MDS), which collects prominent diet characteristics under 10 main titles. Each patient's angiographic data was examined by a cardiologist, and Gensini scores (GS) were then calculated to evaluate the extensiveness of coronary atherosclerosis. RESULTS: Forty-four percent of patients were in the third category of body mass index (BMI) (≥30 kg/m2) and 17.5% were in the first category (BMI<25 kg/m2). Education levels were markedly low, with 78% of the patients having fewer than six years in education. Most patients had low physical activity levels (55.5%). Frequency of metabolic syndrome was prominent (79%). The median (25-75 percentiles) of GS was found to be 21.25 (7-44.75) and the MD score was 4 (3-5). A negative correlation was found between compliance to the MD and GS (r=-0.380, p<0.001). CONCLUSION: This study found that in patients with CAD, compliance with the traditional MD is related to decreased severity of coronary atherosclerosis.

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis.

OBJECTIVE/DESIGN: We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. SETTING/POPULATION: Adult population in the Middle East by age, sex, country and time. RESULTS: Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. CONCLUSIONS: Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

Complementary Feeding Practices of Children Aged 12-23 Months in Turkey.

AIM: This study was conducted to determine the breastfeeding and complementary feeding attitudes and practices of women with children aged 12-23 months in three different regions in Turkey. METHODS: From 12 geographical regions (Nomenclature of Territorial Units for Statistics - NUTS 1), 3 regions were selected depending on the Turkish Demographic Health Survey 2003 (TDHS) results of nutritional status of children. Then, a weighted, multistage, stratified cluster sampling was used. In total, 1,486 children aged 12-23 months and mother pairs were enrolled. Mothers were face-to-face interviewed with trained health workers to collect information on breastfeeding practices, amount and types of complementary foods introduced and potentially related factors and demographic data filled in a questionnaire. RESULTS: The percentage of ever breastfeeding was 98.7%, no differences were determined among regions for ever breastfeeding (p>0.05). Duration of exclusive breastfeeding was 5.1±2.4 months. The shortest duration of exclusive breastfeeding was found in the good nutritional status region as 4.8±2.4 months (p<0.05). Yogurt, bread, pasta, fruits and vegetables were the foods introduced to the majority of the children. Red meat, poultry and fish were introduced to children in later ages in the low nutritional status region compared to middle and good nutritional status regions. Complementary feeding is introduced earlier than 6 months of age. CONCLUSIONS: Raising awareness on appropriate infant and young child feeding practices should be a priority. Enhancing of mothers knowledge, attitudes and practices on breastfeeding and complementary feeding is needed.

Testing Two Nutrient Profiling Models of Labelled Foods and Beverages Marketed in Turkey.

AIM: The objective of this study was to evaluate the nutrient profile of labelled foods and also understand the application of two international nutrient profiling models of labelled foods and beverages. METHODS: WXYfm and NRF 9.3 nutrient profiling models were used to evaluate 3,171 labelled foods and beverages of 38 food categories and 500 different brands. RESULTS: According to the WXYfm model, pasta, grains and legumes and frozen foods had the best scores whereas oils had the worst scores. According to the NRF 9.3 model per 100 kcal, the best scores were obtained for frozen foods, grains and legumes and milk products whereas the confectionery foods had the worst scores. According to NRF 9.3 per serving size, grains and legumes had the best scores and flavoured milks had the worst scores. A comparison of WXYfm and NRF 9.3 nutrient profiling models ranked scores showed a high positive correlation (p=0.01). CONCLUSIONS: The two nutrient models evaluated yielded similar results. Further studies are needed to test other category specific nutrient profiling models in order to understand how different models behave.

A community-based iron supplementation program, "Iron-Like Turkey", and the following prevalence of anemia among infants aged 12-23 months.

During the second year of the "Iron-like Turkey" Project, in which all children aged 4-6 months in Turkey receive iron supplementation for 5 months, we aimed to assess the utilization of iron supplementation in the field, as well as the prevalence of anemia in healthy infants aged 12-23 months, while determining a variety of sociodemographic and nutritional factors for anemia in three of the 12 NUTS (Nomenclature of Territorial Units for Statistics) regions (regions with the highest, lowest and middle under-5 malnutrition levels). In a community-based, cross-sectional survey using a multi-staged, weighted, cluster-selected sample, children aged 12-23 months with birthweight ≥2500 g, no chronic illness, no history of blood disease, and from term and singleton pregnancy were enrolled; 1589 children met the criteria. The mean±SD age of children surveyed was 17.8±3.6 months. Of the parents, 72.4% claimed that their physician had recommended iron supplementation, and 68.8% had given supplementation to their children. Overall prevalence of anemia was 7.3%. Multivariate analysis revealed that the frequency of anemia decreased significantly in older infants, when supplementation was recommended by health providers, when an infant was breastfed longer than 6 months, and when the mother received iron supplementation during pregnancy. However, anemia prevalence increased when the infant received iron supplementation at a later age (³9 months), lived in a crowded family (³6 persons), and when the mother had a history of iron deficiency anemia. Anemic infants had significantly lower z scores of weight for age than non-anemic ones. This survey suggests that iron supplementation during pregnancy, initiation of iron supplementation in infants at 4-6 months of age, effective counseling on supplementation, subsequent compliance, support of breastfeeding, and effective training of health care personnel are effective strategies for prevention of anemia in the community.

Application of the BRAFO tiered approach for benefit-risk assessment to case studies on dietary interventions.

The respective examples, described in this paper, illustrate how the BRAFO-tiered approach, on benefit-risk assessment, can be tested on a wide range of case studies. Various results were provided, ranging from a quick stop as the result of non-genuine benefit-risk questions to continuation through the tiers into deterministic/probabilistic calculations. The paper illustrates the assessment of benefits and risks associated with dietary interventions. The BRAFO tiered approach is tested with five case studies. In each instance, the benefit-risk approach is tested on the basis of existing evaluations for the individual effects done by others; no new risk or benefit evaluations were made. The following case studies were thoroughly analysed: an example of food fortification, folic acid fortification of flour, macronutrient replacement/food substitution; the isocaloric replacement of saturated fatty acids with carbohydrates; the replacement of saturated fatty acids with monounsaturated fatty acids; the replacement of sugar-sweetened beverages containing mono- and disaccharides with low calorie sweeteners and an example of addition of specific ingredients to food: chlorination of drinking water.

Association between anthropometric measurements and dental caries in Turkish school children.

AIM: To evaluate the association between anthropometric measurements and dental caries in school children. METHODS: The study was conducted on 245 primary school children (50.2% boys, 49.8% girls,), aged 5 to 9 years. The prevalence and severity of dental caries was measured using the decayed, missing or filled surfaces (dmfs, DMFS) and teeth (dmft, DMFT) indices. RESULTS: Mean dmft indices in children for boys and girls were 5.5 +/- 3.92 and 5.0 +/- 3.64, respectively. The prevalence of children with dental caries (dmft > or = 1) was 84.9%. The prevalence of children with body mass index (BMI) <-1SD and > or = +1SD was 15.9% and 22.9%, respectively. Dental caries were found in 89.7% of children with low body weight (including underweight and at risk for underweight) and in 66.1% of overweight-obese children (p<0.05). Similarly, high indices were detected significantly more often in children with low body weight (p<0.05). Height, weight, BMI and percent of fat mass were found to be negatively correlated with dmft indices (r:-0.141, p: 0.028; r:-0.171, p: 0.007; r:-0.139, p: 0.030; r:-0.158, p: 0.013, respectively). CONCLUSION: Children with low body weight have a higher risk of developing dental caries than overweight-obese children. For these reasons, the evaluation of nutritional status in children should be implemented in control programs for dental caries both on the community and individual levels.

Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults.

OBJECTIVE: To identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults. DESIGN: Cross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score >or=2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 - specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity - 1). SETTING: Turkey, 2003. SUBJECTS: Adults (1121 women and 571 men) aged 18 years and over were examined. RESULTS: Analysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0.55 and 0.60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0.63 and 0.81, the specificities were between 0.42 and 0.71 and the accuracies were between 0.65 and 0.73, for men and women. The cut-off point of 0.59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR >or= 0.59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0.59, except for diabetes in men. CONCLUSIONS: We show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0.59 in Turkish adults.

Anthropometric indices and their relationship with cardiometabolic risk factors in a sample of Turkish adults.

OBJECTIVE: To identify the best anthropometric index that predicts cardiometabolic risk factors.Design and settingCross-sectional study in Turkey, in 2003. SUBJECTS: Turkish men and women aged 18 years and over (n 1692) were examined. Body weight, height, waist and hip circumferences, blood pressure, total cholesterol, HDL cholesterol, TAG, glucose and insulin were measured. Metabolic syndrome score was calculated as the sum of modified National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). RESULTS: BMI, waist:hip ratio (WHpR), waist:height ratio (WHtR), waist circumference (WC) and hip circumference (HC) were significantly correlated with each other. Partial correlation coefficients between systolic blood pressure, HDL cholesterol, TAG levels or HOMA-IR and BMI, WC or WHtR were similar and higher than correlation coefficients of WHpR and HC. The association of anthropometric indices with metabolic syndrome score and Framingham risk score was highest for WHtR. Areas under the receiver-operating characteristic curves showed that WHtR was the best anthropometric index that discriminated between the presence and absence of hypertension, diabetes and metabolic syndrome, whereas WHpR was better for dyslipidaemia. CONCLUSIONS: WHtR was the best anthropometric index for predicting most cardiometabolic risk factors. WC and BMI ranked second for their predictive capability of cardiometabolic risk, followed by WHpR and HC.

Food and nutrition policies: what's being done in Turkey.

OBJECTIVE: The aim of the present paper is to describe the development of the National Plan of Action for Food and Nutrition (NPAFN) for Turkey. DESIGN: Access to a safe and healthy variety of food, a fundamental human right, was stressed by the International Conference on Nutrition and by the World Food Summit. In the International Conference on Nutrition in December 1992, one major commitment was the preparation of NPAFN. The NPAFN for Turkey was designed according to this commitment. SETTING: Turkey. RESULTS: To this end, under the coordination of the State Planning Organization, a Working Committee Report for National Food and Nutrition Strategy of Turkey was prepared and published, with the participation of different sectors. The goal of the prepared National Food and Nutrition Strategy for Turkey is to protect and promote health through and healthy nutrition and reduce the burden of diseases, while contributing to socio-economic development and a sustainable food security. CONCLUSION: In Turkey the NPAFN was developed and implementation has initiated. Nearly for all the actions, related projects are being developed.

Assessment and evaluation of the nutritional status of the elderly using 2 different instruments.

OBJECTIVES: The elderly population continues to increase in most countries and inadequate nutrition is a common problem affecting their functional and physical status. Therefore, we should periodically assess the nutritional status of the elderly using practical methods. Our study objectives are to assess the nutritional status of the elderly using 2 different methods: Mini Nutritional Assessment (MNA) and Nutritional Screening Initiative Checklist (NSIC), and to evaluate the consistency of the methods. METHODS: We carried out a cross-sectional study between February 2003 and March 2004. We included a total of 1,564 elderly volunteers living in Ankara, Turkey, with median (+/- inter quartile range [IQR]) age of 70 +/- 8 (Male: 71 +/- 9; Female: 70 +/- 9 ) years. We utilized 2 frequently used instruments; MNA and NSIC in this study. RESULTS: The MNA results (<17 points) indicated that 6.5% of the male and 8.8% of the female participants had inadequate nutrition. According to NSIC, 34.3% of males and 36.9% of females were classified as having a high risk of nutritional deficiency. We observed a decrease in MNA and an increase in NSIC scores with the increase of age (p<0.01). We determined a negative correlation of MNA and positive correlation of NSIC with body weight, body mass index (BMI), mid-upper arm circumference (MUAC), and calf circumference (CC) (p<0.01). We did not find correlations between MNA and NSIC score to be statistically significant (r:-0.318; p>0.05). We analyzed agreements between MNA and NSIC score by Kappa statistical method (kappa: 0.13, p: 0.285) and determined that neither of these 2 methods can be used in lieu of the other. CONCLUSION: For the assessment of the nutritional status of the elderly, we could use both MNA and NSIC instruments but depending on the facilities and preferences, we cannot use one to replace the other. The MNA includes both anthropometric measurements and various nutritional parameters, and is a practical and most valid method.