Dietary Supplement Use among Iranian Households during COVID-19 Epidemic Lockdown: Less Access in Those Who May Need More National Food and Nutrition Surveillance.

Background: The coronavirus disease 2019 (COVID-19) pandemic elicited the general population to use various dietary supplements (DSs) and nutraceuticals as a protective means against the disease. The present study aimed to evaluate changes and certain determinants of DS intake during the COVID-19 lockdown among Iranian households. Methods: This nationwide cross-sectional study was conducted from April 4 to April 25, 2020, during which Iran was in lockdown. To collect data, a web-based electronic self-administered questionnaire was created. The data were compared among provinces based on their food security situations. Results: A total of 21,290 households were included in the analyses. Approximately 27% of the households were using DSs after the epidemic. The most common DSs used were vitamin D (42%) and vitamin C (20%), followed by multi-vitamin (16%), zinc (9%), omega-3 (6%), vitamin A (4%), and probiotics (3%). Logistic regression analysis revealed that DS intake was directly associated with the household income but inversely with household size and the food security status of the provinces. DS intake was positively associated with the presence of high-risk persons in the households, the education of the households' head, and the presence of a person with a history of COVID-19 within the household. Conclusions: During epidemic lockdown, DS use was remarkably increased among the Iranian households. Apart from the debatable usefulness of DSs against COVID-19, the inverse association of DS use with a household's income and provincial food security well indicates inequity in accessibility to DS. Actions to improve the nutritional status of the under-privileged populations including targeted supplementation are strongly recommended.

Effects of Food Plate Size and Color on Visual Perception of Satiety in Adolescents; a New Strategy toward Weight Management.

Background: Adolescence obesity and its health consequent on adulthood is affected by various environmental factors. Recently, dishware size or color is considered as a probable critical point to manage intake and weight. We investigated visual perception effects of plate size and color on fullness sensation regarding the Body Mass Index (BMI) for age percentiles in Tehran, Iran in 2019. Methods: A cross sectional study conducted on 408 students aged 13-18 year from both sexes with different socioeconomic status through convenience sampling method. Anthropometric characteristics were measured to determine BMI for Age categories based on the WHO protocol. Visual analog scale (VAS) was used to assess participants' perceived satiety when faced to images of different plate's size and color with the same food volume. SPSS 21 was used to statistical analyze. Results: 41.2% of student were on >85th percentile of BMI for age. Mean of score of VAS for medium red plate was significantly lower than medium and large white plates in both sexes (P<0.001), while mean of score of VAS for small white plate was significantly lower than large white plates only in girls (P<0.001). The adolescents who were on >85th percentile of BMI for age, gave higher score to large white plate than medium white plate and to medium white plate than medium red plate, significantly (P<0.001), while the scores given by the adolescent on 5th percentile of BMI, were not significant. Conclusion: Considering dramatic trend of obesity in adolescents in Iran, there is an urgent need to make supportive policies. Manipulating food containers seems to be an effective and simple approach to control feeling satiety. It may be a cost-effective approach to prevent obesity in adolescents before progressing to adulthood.

COVID-19 epidemic lockdown-induced remarkable decrease in dairy products consumption of Iran population: does it really matter? National Food and Nutrition Surveillance.

BACKGROUND: The pandemic of the newly emerged coronavirus infection and its related disease, Covid-19, has influenced various aspects of human life including dietary habits. This study aimed to examine changes in dairy products consumption during Covid-19 lockdown period in a huge sample of Iranian households. METHODS: A cross-sectional descriptive-analytical study using a web-based electronic self-administered questionnaire designed to detect any changes in the consumption frequency of dairy products in the Iranian households during Covid-19 lockdown. RESULTS: A total of 21,290 households were enrolled. During Covid-19 epidemic lockdown, about 29%, 26% and 7% of the households had decreased their consumption frequency of milk, yogurt and cheese, respectively. The female-headed households were 21% more likely to decrease their consumption of milk, compared with male-headed households (OR = 1.21, 95% CI: 1.05-1.4). The households residing in food insecure provinces were 29%, 20% and 45% more likely to decrease their consumption of milk, yogurt and cheese as compared with those living in the food secure provinces. About 37%, 25.3%, 19.4% of those households who reported a decrease in consumption of dairy products had fully omitted them. CONCLUSION: We found considerable decrement of dairy products consumption, especially milk and yogurt, in a high proportion of the studied households. Inadequate intake and, in some households, omission of dairy products can potentially bring about serious health outcomes with heavier economic burden. Further studies to track these changes over time and to evaluate their health consequences are warranted.

Dietary diversity and its relationship with nutritional adequacy in 24 to 59 months old children in Iran: study protocol.

BACKGROUND: Nutritional inadequacy, especially micronutrients, is still a serious concern among children in developing countries. Dietary diversity score (DDS) has been recommended as a proxy for nutritional adequacy. The present study aims to develop a questionnaire to assess the dietary diversity among 24-59 months children in Iran; also, the validity of the dietary diversity score as an indicator of nutritional status among the children will be assessed. METHODS: In order to design the questionnaire, the Food and Agriculture Organization Guideline for measuring individual dietary diversity will be applied. According to the guideline, foods are categorized into nine groups, then dietary diversity score will be calculated by summing the number of food groups. In order to evaluate the efficacy of this questionnaire in predicting the nutritional status of the children, the relationship between dietary diversity score calculated by the questionnaire with nutritional adequacy, serum retinol and anthropometric indicators will be compared. DISCUSSION: DDS can be a valuable indicator for predicting the adequacy of macronutrients and micronutrients specially in children. It is also significantly related to the mean probability of adequacy (MPA).

Effects of decaffeinated green coffee extract supplementation on anthropometric indices, blood glucose, leptin, adiponectin and neuropeptide Y (NPY) in breast cancer survivors: a randomized clinical trial.

Objective: This study aimed to evaluate the effects of decaffeinated green coffee extract (DGCE) supplementation on anthropometric indices, blood glucose, leptin, adiponectin, and neuropeptide Y (NPY) in breast cancer survivors with obesity. Method: A total of 44 breast cancer survivors with obesity aged between 18 and 70 years and with a mean body mass index (BMI) of 31.62 ± 4.97 kg m-2 participated in this double-blind randomized clinical trial. Eligible patients were randomized to the intervention (n = 22) and control (n = 22) groups. They received two 400 mg capsules of DGCE or two identical placebos daily for 12 weeks. Serum concentrations of leptin, adiponectin, NPY, fasting blood sugar, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) were measured at the baseline and after completion of the intervention. Also, weight, waist circumference, fat percentage, muscle percentage, and visceral fat were measured. Results: There were no significant differences in terms of changes of anthropometric indices and concentrations of leptin, adiponectin, NPY, and blood sugar between the two studied groups. Conclusion: Supplementation with DGCE in breast cancer survivors with obesity had no significant effect on anthropometric indices and blood glucose, leptin, adiponectin, and NPY levels.

COVID-19 epidemic lockdown-induced changes of cereals and animal protein foods consumption of Iran population: the first nationwide survey.

BACKGROUND: The COVID-19 epidemic has affected diverse issues of life including economy, health and nutrition. This nationwide study was conducted to evaluate the effects of the epidemic lockdown-induced socio-economic changes on animal source proteins and cereals intakes of Iran population for the first time. METHODS: This was a cross-sectional descriptive-analytical study using a web-based electronic self-administered questionnaire. A questionnaire was designed with the aim of detecting any changes in the dietary pattern of the Iranian household following coronavirus epidemic. RESULTS: A total of 21,290 households participated in the study. Approximately 33%, 24%, 14.2% and 7% of the households had decreased the weekly consumption of red meat, white meat, eggs and rice/bread, respectively, following COVID-19 epidemic. The results of ordered logistic regression showed that the female-headed households, as compared with male-headed ones, were 30% more likely to decrease their weekly consumption of white meat (OR = 1.3, 95% CI: 1.1-1.5). About 8.6% of the households had reduced all three major dietary sources of animal protein. Close to half of the households (46.9%) who decreased their intake of the animal protein sources had increased their intake of rice or bread, too. The major reasons for these changes were decrease of income and job loss. CONCLUSION: In conclusion, animal protein food consumption decreased during epidemic lockdown but the amounts of rice and bread, as the major sources of dietary energy, have increased. These changes, if persist long enough, can seriously affect micronutrient status of the whole population. Early nutritional interventions for needy families are warranted.

The Analysis of Trends of Preschool Child Stunting, Wasting and Overweight in the Eastern Mediterranean Region: Still More Effort Needed to Reach Global Targets 2025.

BACKGROUND: This study was undertaken to analyze and compare Eastern Mediterranean (EM) countries in achievement of WHO nutrition global targets for children growth indicators by 2025. METHODS: A total of 108 national surveys from 20 countries in EM region were analyzed to estimate the prevalence of stunting and wasting and 93 surveys to estimate the prevalence of overweight/obesity in children. These data were obtained from national surveys included in the WHO Global Database on Child Growth and Malnutrition. RESULTS: In EM region, the prevalence of childhood stunting was estimated to have a 38% decline from 2000 (34.7%) to 2025 (21.2%). Only three countries in EM region (Iran and Jordan, Saudi Arabia) were anticipated to achieve the expected WHO target by 2025. From 2000 to 2020, the prevalence of wasting decreased from 6.9 to 5.3. Six countries were presumed to achieve the expected WHO target by 2025. Nine countries will presumably have overweight rates >5% (Djibouti, Egypt, Iraq, Kuwait, Lebanon, Libya, Morocco, Syrian Arab Republic and Tunisia) in 2025 whereas five countries will have overweight rates above 10% (Egypt, Libya, Morocco, Syrian Arab Republic and Tunisia). CONCLUSION: Despite descending trends of child stunting and wasting and a secular trend of child obesity in EM region, it is expected that WHO targets will not be achieved by 2025. A diverse socio-economic condition in EM countries necessitates different action plans. International determination, political commitment and, above all, involvement of the families are needed to achieve 2025 targets for child stunting, wasting and overweight/obesity.

Changes in fast food intake in Iranian households during the lockdown period caused by COVID-19 virus emergency, National Food and Nutrition Surveillance.

Background: Fast foods, though very popular, are commonly known as unhealthy foods. However, coronavirus pandemic may have influenced on food choices of the general population. This study investigated the changes in fast food consumption during epidemic lockdown 2020. Materials and Methods: This study was part of a nationwide survey having been conducted using a web-based electronic self-administered questionnaire. The questionnaire link was extensively distributed among the whole population both through popular social media platforms and by nutrition and health workers of health offices and medical universities of all provinces. The questionnaire included questions about socio-demographic characteristics, changes in frequency of fast food consumption as compared with before pandemic, and the reasons for these changes. Results: A total of 21,290 households took part in the study of whom 89.8% were male-headed, and almost 74% were from urban areas. Decrease in fast food consumption was reported by 74.8%, while increase in fast food consumption was reported by 2% of the households during the COVID-19 quarantine. Among those who decreased their fast food consumption, about 82% had completely omitted them from their food baskets. Fear of contamination of fast foods by coronavirus and increase in the number of people at home were the most and the least frequent reasons for decreasing fast food consumption, respectively. Conclusion: Fast food consumption has dramatically decreased during the lockdown period in Iranian households. Though it may be considered a pleasant offshoot of disastrous COVID-19 epidemic, the foods replaced fast foods in Iranian households and the overall health consequences warrant further studies.

Nutritional Status, Anthropometric Measurements and Physical Activity Level in Adolescents 13-18 Years Old in Tehran, Iran, in 2019.

BACKGROUND: Considering the importance of adolescent obesity on adulthood health, this cross-sectional study aimed 408 students aged 13-18 years from different socioeconomic districts through convenience sampling to investigate nutritional status and physical activity (PA) level focusing on sex and socioeconomic differences. METHODS: Weight and height were measured to investigate prevalence of obesity and underweight based on percentile of body mass index (BMI) for age. Information on dietary intake were collected via 3-day food recalls. PA level was investigated using a valid and reliable questionnaire. RESULTS: The prevalence of underweight, overweight, and obesity were 4.9%, 15.9% and 23%, respectively. Weight and height were higher in boys than girls significantly (P-value < 0.001). Calorie intake in prosperous districts was higher than semi-prosperous districts (P = 0.01). Intake of zinc and calcium in prosperous districts was higher than semi-prosperous and disadvantaged districts (P-value < 0.001 and 0.02, respectively). Intake of calcium and zinc in both sexes and iron in girls, was lower than recommended dietary allowances (RDA) in all districts (P-value < 0.001). CONCLUSIONS: High prevalence of obesity and low micronutrients intake, especially in disadvantaged districts, suggest an urgent need to plan many efficient programs to prevent serious problems in future.

Is the hedonic hunger score associated with obesity in women? A brief communication.

OBJECTIVE: Food intake for its hedonic properties can result in excess caloric intake. It may play a role in increasing trend of obesity in the world. Hedonic hunger may effect on dietary patterns. We assessed the association between dietary patterns and the hedonic score in obese and non-obese women. In this case-control study 140 women aged 17-44 years from an obesity club at district 4 of Tehran participated. Dietary patterns were assessed through food frequency questionnaire by factor analysis method. The hedonic score was determined using a 21-item valid questionnaire. ANOVA and Logistic regression were used to statistical analysis. RESULTS: Factor analysis method showed that there were 2 dietary patterns named healthy and unhealthy, in order to their food items. There was not any significant trend for obesity among tertiles of healthy and unhealthy dietary patterns. The mean hedonic score was significantly higher in obese than non-obese women, (p < 0.05). The second and the third tertiles of hedonic score significantly increase the odds of obesity referring the first tertile (2.8 and 10.8, respectively). Hedonic hunger had a positive association with obesity; but there was no difference in dietary patterns of obese and non-obese women, unexpectedly.

The Effects of Synbiotic Supplementation on Body Mass Index, Metabolic and Inflammatory Biomarkers, and Appetite in Patients with Metabolic Syndrome: A Triple-Blind Randomized Controlled Trial.

It has been shown recently that metabolic syndrome is associated with gut dysbiosis. The gut microbiota may be the main target for prevention or treatment of metabolic syndrome. We investigated the effects of synbiotic supplementation on metabolic syndrome. In this triple-blinded clinical trial, 46 Iranian patients with metabolic syndrome, from both sexes, aged 25-70 years, who fulfilled inclusion criteria were randomly categorized to receive either the synbiotic or a placebo capsule, twice a day for three months, plus a weight-loss diet using stratified random sampling based on body mass index (BMI). Each synbiotic capsule consisted of seven strains probiotic bacteria (2× 108) plus fructooligosaccharide as a prebiotic. Anthropometric measurements and biochemical tests were assessed at baseline and at the end of week 12 for fasting blood sugar (FBS), insulin, lipid profile, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), peptide YY (PYY), and glucagon-like peptide-1 (GLP-1). The mean changes of weight, BMI, FBS, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), and GLP-1 between the two groups was statistically significant (p < .001). Furthermore, peptide YY (PYY) increased significantly in the synbiotic group (p ≤ .05). The trend of weight loss in the synbiotic group was significant until the end of the study (p < .001) while it stopped at week 6 in the placebo group. Synbiotic treatment may improve the status of BMI, FBS, insulin resistance, HOMA-IR, GLP-1, and PYY in patients with metabolic syndrome.

The effects of symbiotic therapy on anthropometric measures, body composition and blood pressure in patient with metabolic syndrome: a triple blind RCT.

BACKGROUND: Increase in prevalence of obesity and type 2 diabetes which are of the main risk factors of metabolic syndrome, is not only the result of changes in genetic, diet or physical activity, but also an imbalance of micro flora may play an important role. Therefore, alteration of micro flora using pre/probiotic is considered as a new strategy for treatment of metabolic disorders. METHODS: The current study is a triple blind randomized controlled trial. 46 patients from both sexes, who fulfilled inclusion criteria, randomly categorized into intervention or placebo group. The intervention and placebo groups consumed 2 probiotic capsules or 2 placebo capsules during 3 months, respectively. Both groups received a weight loss diet, according to their adjusted ideal body weight. Anthropometric, body composition, blood pressure and nutritional measurements were done in the beginning, at 6th week, and at the end of the study. T-test and paired-t test were used for statistical analysis. RESULTS: 40 patients completed the study. BMI, WC, HC, fat mass, lean mass and blood pressure were reduced in all participants (p< 0.05). Systolic blood pressure in symbiotic group was less than placebo group, significantly (p< 0.05). The trend of weight loss in symbiotic group continued at least for 12 weeks while it was stopped at week 6 in placebo group. CONCLUSION: Symbiotic supplement with the weight loss diet had synergistic effects on improvement in systolic blood pressure and anthropometric measurements. Based on our findings, symbiotic can postpone plateau phase of weight loss and it may prevent resistance to further weight loss.

Accuracy of energy intake reporting: comparison of energy intake and resting metabolic rate and their relation to anthropometric and sociodemographic factors among Iranian women.

BACKGROUND: This study assesses the accuracy of energy intake (EI) reporting and its relation to anthropometric characteristics and sociodemographic factors. In addition, we attempt to identify foods for which under- or over-reporting is more prevalent. METHODS: EI was assessed for 187 women using a semi-quantitative 168-item food frequency questionnaire (FFQ). Resting metabolic rate (RMR) was measured with an indirect calorimeter. We calculated the EI/RMR ratio to assess the accuracy of EI reporting. This study defined under-reporters as those with an EI/RMR of ≤ 1.34 and over-reporters as those with an EI/RMR of ≥ 2.4. We measured anthropometric characteristics and collected sociodemographic information. The chi-square test, ANOVA and multiple linear regressions were used for statistical analyses. RESULTS: Among participants, the under-reporting rate was 35.5% and the over-reporting rate was 7.5%. The EI/RMR ratio was significantly higher for younger women compared to older women (P < 0.04). Under-reporters had higher weight, waist circumference (WC), body mass index (BMI) and resting metabolism compared to accurate reporters (P < 0.05). Resting metabolism was significantly lower among over-reporters than accurate reporters. After adjusting for energy, the consumption of fish, high-fat dairy products, hydrogenated oil, sweets and coffee was lower, whereas consumption of unsaturated oils, tea, salt and yellow vegetables was higher among under-reporters compared to accurate reporters. CONCLUSION: Under-reporting of EI is more frequent than over-reporting among Iranian women. Among various factors that may affect the accuracy of EI reporting, age and anthropometric characteristics might have a significant effect.

Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies.

OBJECTIVE: To investigate if there is a reduced risk of type 1 diabetes in children breastfed or exclusively breastfed by performing a pooled analysis with adjustment for recognized confounders. RESEARCH DESIGN AND METHODS: Relevant studies were identified from literature searches using MEDLINE, Web of Science, and EMBASE. Authors of relevant studies were asked to provide individual participant data or conduct prespecified analyses. Meta-analysis techniques were used to combine odds ratios (ORs) and investigate heterogeneity between studies. RESULTS: Data were available from 43 studies including 9,874 patients with type 1 diabetes. Overall, there was a reduction in the risk of diabetes after exclusive breast-feeding for >2 weeks (20 studies; OR = 0.75, 95% CI 0.64-0.88), the association after exclusive breast-feeding for >3 months was weaker (30 studies; OR = 0.87, 95% CI 0.75-1.00), and no association was observed after (nonexclusive) breast-feeding for >2 weeks (28 studies; OR = 0.93, 95% CI 0.81-1.07) or >3 months (29 studies; OR = 0.88, 95% CI 0.78-1.00). These associations were all subject to marked heterogeneity (I(2) = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for >2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75-0.99), and heterogeneity was reduced (I(2) = 0%). Adjustments for potential confounders altered these estimates very little. CONCLUSIONS: The pooled analysis suggests weak protective associations between exclusive breast-feeding and type 1 diabetes risk. However, these findings are difficult to interpret because of the marked variation in effect and possible biases (particularly recall bias) inherent in the included studies.