Food security and its association with socioeconomic status and dietary diversity in free living older people in Tehran, Iran.

BACKGROUND: Food security is a function of food access and dietary diversity. Older age is a period when adequate and diverse dietary intake is a challenge. This study aimed to investigate the association between food security on the one hand and dietary diversity and socioeconomic factors on the other hand among the free-living older people in the city of Tehran. METHODS: In this cross-sectional study, 583 older people, aged 60-80 years living in Tehran city, were selected through the systematic cluster sampling method. Food security was determined by the United States Household Food Security Survey Module (US-HFSSM (.Socioeconomic status (SES) and two 24-h recalls were obtained. Dietary Diversity Score (DDS) was calculated using the FAO 2010 guideline. Multinomial logistic regression was applied. RESULTS: The average age of participants was 67.87 ± 5.86 years. Based on US-HFSSM, 56.9% of older people were food secure; while 25.7%, 14.2% and 3.2% suffered from food insecurity (FI) without hunger, with moderate hunger, and with severe hunger, respectively. There was no association between FI and DDS, even after controlling for confounders. FI with mild hunger was associated with household income (OR = 2.744, 95% CI = 1.100-6.846), while FI with severe hunger was associated with Fars ethnicity (OR = 0.146, 95% CI = 0.051-0.424). CONCLUSIONS: Overall, socio-economic status and demographic characteristics were the predictors of FI among older people. The findings can have implication in design and targeting of interventions directed at older people.

Real-world practices in reproductive health and counselling for women with epilepsy: A Canadian perspective.

Canadian women of reproductive potential living with epilepsy present unique care challenges due to the complex interplay of hormones, seizures, and medications. This study explores reproductive health practices and counselling for women with epilepsy. Through a questionnaire developed by the Canadian League Against Epilepsy women with epilepsy (WWE) workgroup, we are the first to report demographic and real-world practice characteristics of Canadian healthcare professionals providing care for WWE with specific focus on family planning, birth plans, and postpartum care counselling. Among respondents, 76.9% routinely reviewed contraception with patients and an intrauterine device (IUD) was the most popular recommended method (85.3%). With regards to preconception planning, 50% of respondents routinely had a preconception drug level prior to pregnancy. A significant proportion, 44.9%, reported not communicating a neurology-informed birth plan to obstetrical health practitioners. The majority recommended breastfeeding for WWE on anti-seizure medications (92.3%) and regularly provided safety counselling for women in the postpartum period (84.6%). Overall, our study demonstrates that Canadian practice patterns conform reasonably well to existing evidence and guidelines, although important gaps in care exist.

Real-world practices for the care of women with epilepsy during pregnancy: A Canadian perspective.

OBJECTIVE: Approximately 150,000 Canadian women live with epilepsy, a population that presents with unique challenges. Our objective was to capture demographic and real-world practice characteristics of Canadian healthcare professionals providing care for women with epilepsy (WWE) with specific focus on reproductive considerations to identify potential gaps in knowledge and care. METHODS: A questionnaire developed by the Canadian League Against Epilepsy WWE workgroup was distributed to Canadian healthcare professionals from February 2021 to October 2022 to capture participant demographic characteristics and practice patterns in key areas of the reproductive cycle in WWE. RESULTS: A total of 156 participants completed the questionnaire, most being physicians (81.4%), epilepsy specialists (69.0%), and those who cared for adult patients (86.5%), with a significant proportion based at an academic center (65.4%). The majority of participants counselled on folic acid supplementation (89.7%). Participants selected lamotrigine and levetiracetam most frequently for either focal or generalized epilepsies during pregnancy. Additionally, 85.9% performed therapeutic drug monitoring during pregnancy. Almost all practitioners always or often counseled WWE on valproic acid on the benefits of switching to a less teratogenic medication (96.2%). Some geographic variability in practice patterns was noted with valproic acid being one of the top three medications selected for patients with generalized epilepsies in Western regions, although participants in Eastern regions had brivaracetam more commonly included as one of their top three agents for this population. SIGNIFICANCE: This is the first report of real-world Canadian practices in epilepsy care for women in pregnancy. Overall, our study reports that Canadian practice patterns conform well to current evidence and best-practice guidelines. Important variations in antiseizure medication selection across different regions were identified.

Ipsilateral preictal alpha rhythm attenuation (IPARA): An EEG sign of side of seizure onset in temporal lobe epilepsy.

PURPOSE: Identification of the seizure onset zone is critically important for outlining the surgical plan in the treatment of pharmacoresistant focal epilepsy. In patients with temporal lobe epilepsy (TLE), bilateral ictal scalp EEG changes frequently occur and can make lateralization of the seizure onset zone difficult. We investigated the incidence and clinical utility of unilateral preictal alpha rhythm attenuation as a lateralizing sign of seizure onset in TLE. METHODS: Scalp EEG recordings of the seizures acquired during presurgical video-EEG monitoring of 57 consecutive patients with TLE were reviewed retrospectively. Included patients had interictal baseline recordings demonstrating symmetrical posterior alpha rhythm and seizures occurring during wakefulness. RESULTS: We identified a total of 649 seizures in the 57 patients, of which 448 seizures in 53 patients fulfilled the inclusion criteria. Among the 53 included patients, 7 patients (13.2%) exhibited a distinct attenuation of the posterior alpha rhythm prior to the first ictal EEG changes, in 26 of 112 (23.2%) included seizures. Preictal alpha rhythm attenuation in these seizures was ipsilateral to the ultimately determined side of seizure onset (based on video-EEG or intracranial EEG findings) in 22 (84.6%) of these seizures and bilateral in 4 (15.4%), and occurred on average 5.9 ± 2.6 s prior to ictal EEG onsets. CONCLUSION: Our findings suggest that in some patients with TLE lateralized preictal attenuation of the posterior alpha rhythm may be a useful indicator of side of seizure onset, presumably due to early disruption of thalamo-temporo-occipital network function, likely mediated through the thalamus.

Adherence to Mediterranean-Style Dietary Pattern and Risk of Bladder Cancer: A Case-Control Study in Iran.

Few dietary patterns are related to reduce the Bladder Cancer (BC) risk. One of the well-known dietary patterns is the Mediterranean diet (MD). This case-control study investigated the association between MD and the odds of BC among Iranian population. The present case-control study was performed on 103 eligible cases and 200 controls age 45 to 92 years. Diet of participants was assessed by a validated 168-item food frequency questionnaire (FFQ). Adherence to MD was measured by Mediterranean-Style Dietary Pattern Score (MSDPS). Multivariate logistic regression was used to estimate the relationship between MSDPS and risk of BC. After controlling for potential confounders, a negative association was observed between MSDPS and risk of BC (OR = 0.22; 95%CI = 0.09-0.52; p trend = 0.001). Furthermore, significant negative associations were observed for dairy, fish and other seafood, whole-grain, bread intake and risk of BC (p for trend < 0.05). In contrast, the risk of BC increased for high intake of poultry (OR = 1.09; 95%CI = 1.03-1.15; p trend = 0.003), sweets (OR = 1.24; 95%CI = 1.03-1.48; p trend = 0.018) and egg (p for trend = 0.01). Our results suggested that dietary habit in concordance with the principles of the Mediterranean dietary pattern may protect against BC.

Major Dietary Patterns in Association with the Grades of Nonalcoholic Fatty Liver Disease in Newly Diagnosed Patients Living in North of Iran.

Background: Evidence suggests that dietary pattern is related to incidence and grades of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the relationship between major dietary patterns and hepatic histologic features of newly diagnosed patients with NAFLD. Methods: This cross-sectional study included 260 newly diagnosed NAFLD patients. Hepatic fibrosis and steatosis were diagnosed using Fibroscan. Dietary information was obtained using a validated 168-item semiquantitative food frequency questionnaire. The association between dietary patterns and odds ratio of the grade of fibrosis and steatosis was examined by multinomial logistic regression. Results: The mean ± SD age participant was 46.53 ± 11.71 years. Fifty-seven percent of the participants were women. Two major dietary patterns were recognized: "Western dietary pattern" and "Mediterranean dietary pattern." After adjustment for various confounders, adherence to the two extracted dietary patterns was not associated with odds of fibrosis and steatosis (P > 0.05). However, P was not significant. Patients in the second quartile of the Mediterranean dietary pattern had a higher risk for being in the F1 grade compared to those in the reference group in the crude and adjusted model. Conclusions: The major dietary patterns of NAFLD patients living in Gilan were not related to the severity of their disease. More precise study design such as cohort or interventional studies is suggested to reveal the strength of this study findings.

Socioeconomic Status and Changes in Iranian Household Food Basket Using National Household Budget and Expenditure Survey Data, 1991-2017.

Background: Socioeconomic factors are major determinants of health and food consumption. The aim of the present study was assessing the changes in energy and different food groups consumption related to the socioeconomic status of Iranian households. Methods: In this repeated cross-sectional study, 717432 households data from the Households Income and Expenditure Survey (HIES) conducted yearly by the Statistical Centre of Iran (SCI) from 1991 to 2017 was used. The food consumption outcome was modeled as a function of household head age, household head age-squared, socioeconomic variables, household size, place of residence, and household's head sex. Principle Component Analysis (PCA) was used to extract a socioeconomic status variable based on the educational, occupational, and income status of households. A cross-classified random effects modeling (CCREM) specifications of Hierarchical Age-Period-Cohort (HAPC) models was used in the present study. Results: In the present study, by moving to the higher quartiles of SES had higher calorie intake increased. There was a positive relationship between "Vegetables", "Fruits", "Dairy", "Meat, Poultry, Fish, Eggs, Legumes, and Nuts" and "Fats, Oils, Sugars, and Sweets" with socioeconomic statues category. In the case of "Bread, Cereal, Rice, and Pasta", there was a reverse relationship, and lower SES quartile consumed a higher amount of this food group. Conclusion: Lower income, education, and occupational status in lower SES quartile groups lead to lower calorie consumption and higher consumption of "Bread, Cereal, Rice, and Pasta" food group, which had lower energy cost compared to the other food groups.

Relationship between diet quality and depression among Iranian older adults in Tehran.

BACKGROUND: Depression is one of the prevalent mental disorders that is common in older ages. Evidence suggests that dietary intake status may potentially be associated with depression. However, this association has not been well studied in older adults, and the nature of the association remains unclear. This study aimed to investigate the association between diet quality and depression in free-living older adults living in Tehran city. METHODS: This cross-sectional study was conducted on 583 older adults (279 men and 304 women) aged 60 to 80 years living in Tehran city, selected by the systematic cluster sampling method. Individuals' dietary intake was determined by two non-consecutive 24-h dietary recalls, and diet quality was assessed calculating score of Healthy Eating Index-2015 (HEI-2015). The validated short form of the Geriatric Depression Scale (GDS-11) was used to assess depression status. A logistic regression model was used to assess the chance of depression across tertiles of HEI-2015 score. RESULTS: The point prevalence of depression was 22.5%, which was significantly higher in women (91 (69.5%) women vs. 40 (30.5%) men). A higher percentage of seniors at the higher tertile of HEI score were women, belonged to Fars ethnicity and had a higher score of activity of daily living (ADL). After adjustment for all potential confounders, the trend of depression chance was significantly decreased in those with higher HEI-2015 scores (p-for trend < 0.05). CONCLUSION: Higher quality of diet was associated with a lower possibility of depression in the studied participants. Further studies are required to investigate the possible causal relationship.

Association of Dietary Approaches to Stop Hypertension diet and risk of bladder cancer: A case-control study.

OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) diet is rich in recommended foods that are inversely associated with bladder cancer (BC) risk. The main objective of this study was to investigate the association between adherence to DASH diet and the risk of BC among Iranian adults. METHOD: This study included 103 BC cases and 200 controls. The controls were patients who were hospitalised for acute non-neoplastic diseases. DASH scores were computed from dietary intake assessed by a previously validated food frequency questionnaire. RESULTS: After controlling for potential confounders, participants in the highest quintile of DASH (compared to the lowest quintile) had 84% lower BC risk (OR = 0.16; 95%CI: 0.05-0.45; p trend = 0.001). Among the DASH components, significant negative associations were observed between low fat dairy and whole grains intake with BC (p value < 0.05). A positive relation was observed for sodium, nuts and legumes, and sweetened beverages (p value < 0.05). CONCLUSION: The results of this study suggested that adherence to DASH might be associated with reduced risk of BC. These findings could be used to develop evidence-based recommendations for the prevention of BC.

Maternal dietary diversity and nutritional adequacy in relation with anthropometric measurements of newborns at birth: a cohort study in Tehran city.

BACKGROUND: Maternal dietary intake during pregnancy plays an important role in fetal development and birth outcomes. The aim of the present study was to determine maternal dietary diversity and Nutritional adequacy in relation with anthropometric measurements of newborn at birth as a cohort study in Tehran city. METHODS: This prospective cohort study, was conducted by participation of 585 pregnant women referred to public health centers and hospitals covered by Shahid Beheshti, Tehran and Iran Universities in Tehran City. Using face-to-face interviews, general characteristics were obtained by questionnaire. Pre-pregnancy dietary intake was measured by a 168-item semi-quantitative food frequency questionnaire at the first visit, and dietary intake during pregnancy was measured by 2 non-consecutive 24-h food recall (one holiday and one regular day) at 31-34 weeks. Maternal height and weight were measured using standard tools and protocol at the first visit, and maternal weight at the end of pregnancy and data related to neonatal anthropometric indices were collected from mothers and neonates health records in the Sib electrical system. By applying SPSS software (version 23) the association was analyzed by linear regression with adjusting for confounding factors. P-value< 0.05 was considered as significant. RESULTS: Mean ± standard deviation of body mass index (BMI) of pre-pregnancy, pregnancy weight gain, BMI for age z-score (BAZ) at birth of infants were 24.52 ± 4.12, 12.16 ± 6.85 kg and - 0.61 ± 1.48, respectively. Mean ± SD of the Dietary Diversity Score (DDS) and Mean Adequacy Ratio (MAR) before and during pregnancy were 5.31 ± 1.11, vs.5.23 ± 1.42 and 289.85 ± 113.12 vs. 371.07 ± 197.28, respectively. After adjusting for confounding factors DDS in the third trimester of pregnancy was inversely correlated with WAZ (B = -0.16, 95% CI = - 0.23_0.30) and BAZ (B = - 0.24, 95% CI = - 0.06_0. 42) at birth, MAR of pre-pregnancy (B = - 0.001, 95% CI = - 0.002_0.00) and in the third trimester of pregnancy (B = - 0.18, 95% CI = - 0.35_0.004) were negatively associated with WAZ at birth. CONCLUSION: The findings showed that maternal nutritional status (dietary diversity and nutritional adequacy) before and during pregnancy were correlated with neonatal anthropometric indices at birth.

Association of Recommended and Non-Recommended Food Score and Risk of Bladder Cancer: A Case-Control Study.

Bladder cancer (BC) is the ninth most common cancer in the world. Dietary patterns and diet quality could reduce exposure to carcinogenic factors postulated to increase the risk of BC. The main objective of this study was to investigate the associations of Recommended Food Score (RFS) and Non-Recommended Food Score (n-RFS) with the risk of BC among Iranian adults.This is a hospital-based case-control study, conducted at three referral hospitals in Tehran, the capital of Iran. Cases consisted of 103 histologically confirmed BC patients, aged greater than 45 years. Age-matched controls (n = 200) were selected from the same hospital where cases were recruited. Controls were patients with non-neoplastic diseases that are not related to smoking, or long-term diet modification. Dietary intake was assessed by a 168-item Food Frequency Questionnaire (FFQ), which was validated in Iran. Logistic regression tests were used to estimate the relationship between RFS and n-RFS with BC.The risk of BC decreased by 69% (OR = 0.31; 95% CI:0.13-0.71) among participants belonging to the highest compared with the lowest quartile of RFS. After adjusting for age, sex, smoking, and total energy, a significant inverse trend was observed between the risk of BC and quartile of RFS. Regarding the n-RFS, also expressed as quartiles, subjects in the fourth quartile were at 2.7 times higher risk of having BC compared to participants in the first quartile (OR = 2.7; 95%CI: 1.07-6.78).The findings of this study suggested that, adherence to RFS decreased the risk of BC. Additionally, a higher score of n-RFS may lead to an increased risk of BC. These findings could be used to develop evidence-based recommendations for the prevention of BC in Iran.

Association of the Healthy Nordic Food Index with risk of bladder cancer: a case-control study.

BACKGROUND: Bladder cancer (BC) is the ninth recurrent neoplasm in the world. In Iran, incidence of BC is the third most common among men. Few dietary patterns are related to reduced carcinogenesis and consequently are amenable to modification in order to reduce the BC risk. Adherence to the traditional Nordic diet, as measured by the Healthy Nordic Food Index (HNFI), have shown a beneficial effect on chronic disease prevention, including cancer. The principal objective of this study was to investigate the association between HNFI and the odds of BC in a case-control study, in Iran. METHOD: The present case-control study was performed on 100 eligible cases and 200 controls of patients ≥45 years old referred to three referral hospitals in Tehran. Dietary intakes are assessed by a valid 168-item food frequency questionnaire (FFQ). The relationship between HNFI and BC is estimated using the logistic regression tests. RESULTS: The average age of cases and control were 65.41 and 61.31 years, respectively. After controlling for potential confounders (age, smoke, total energy, and sex), participants in the highest tertile of HNFI (compared to the lowest tertile) have 83% lower BC risk (OR = 0.17; 95%CI = 0.07-0.42). Based on an independent assessment of HNFI component and BC risk, a significant negative association was observed for fish intake (OR = 0.30; 95%CI = 0.15- 0.60) and whole-grain bread intake (OR = 0.33; 95%CI = 0.17-0.63). CONCLUSION: The findings of this study suggested that adherence to traditional Nordic diet could decrease the risk of BC. Of the elements of this diet, fish and whole-grain bread consumption seemed to decrease the odds of BC. Such findings ought to be considered in the development of evidence-base intervention for BC prevention in the country.

Dietary supplements consumption and its association with socioeconomic factors, obesity and main non-communicable chronic diseases in the north of Iran: the PERSIAN Guilan Cohort Study (PGCS).

BACKGROUND: Dietary supplements (DSs) use have become a growing trend worldwide, and it may be affected by demographic and sociocultural factors. Some people use supplements with the thought that they can improve their health, reduce symptoms and prevent disease. The aim of the present study was to define the frequency of DS use and its association with socioeconomic factors among participants with selected main non-communicable chronic diseases (NCDs) (diabetes, cardiovascular disease (CVD), hypertension (HTN), cancers, and obesity in the north of Iran. METHODS: This large cross-sectional study was conducted as a part of the PERSIAN Guilan cohort study. Supplement use during last year and its type, demographic factors, socioeconomic status, lifestyle habits were asked by face-to-face interview. The history of chronic disease was defined by a trained team. Data were analyzed using SPSS. The chance of supplement use according to demographic, socioeconomic, and lifestyle variables and history of chronic disease was analyzed by logistic regression. RESULTS: 10,520 men and women aged 35-70 years in Some'e Sara County (including urban regions and 39 villages) were studied. About 25% of participants consumed DSs. The highest consumption of DS was calcium/vitamin D (11.1%), ferrous sulfate (8.8%), and vitamin D pearl or ampoule (7.7%). The highest percent of the history of chronic disease was central obesity (62.7%), HTN (43.2%), and general obesity (32.7), respectively. After adjustment for confounders, those with female gender, the highest age ranges (55-65 and > 65 years), high academic education, living in urban regions, and good economic status were more likely to be DSs consumers; however, married and smoker subjects were more likely to consume DS. Participants who had a history of diabetes, HTN, CVD, Obesity, and Central Obesity were more likely to intake DS in comparison with healthy subjects. CONCLUSION: This study showed that a quarter of the participants were DS users. Female sex, older age groups, and higher educated participants, and among chronic disease, patients with HTN, CVD, and diabetes were more likely to be users of any DS.

Assessing the Changes in Iranian Household Food Basket Using National Household Budget and Expenditure Survey Data, 1991-2017.

BACKGROUND: The aim of the present study was assessing the changes in Iranian household food basket. The Households Income and Expenditure Survey (HIES) data of 717,432 of Iranian households from 1991 to 2017 were used in this repeated cross-sectional study. METHODS: A cross-classified random-effects modeling (CCREM) specifications of hierarchical age-period-cohort (HAPC) in two models, one without controlling for the effects of key individual characteristics, namely socioeconomic status; household size; place; and household head sex, and another one with controlling for the effect of mentioned variables, was used in the present study. RESULTS: The present study showed that the equivalent to an adult male daily consumption of "total calorie" (P value = 0.0001) and "fats, oils, sugars, and sweets" (P value = 0.0002) had an increasing trend from 1991 to 2004 and a decreasing trend from 2005 to 2017 among Iranian households. The daily consumption of "bread, cereal, rice, and pasta" (P value = 0.0001) had a decreasing and "fruits" (P value = 0.0002) had a rising trend during periods. After an increasing trend for the "meat, poultry, fish, eggs, legumes, and nuts" (P value = 0.0002) and "vegetable" (P value=<0.0001) by 2004, there was a decreasing trend from 2004 to 2017, but the share of them in the total calorie consumption increased. The "dairy" (P value = 0.0002) consumption had a decreasing trend in recent years. CONCLUSIONS: Iranian household food basket, during these years, had significant changes that some of them (increase in the share of the vegetables and fruits in the total calorie intake) are positive and some of them are negative (decrease in the consumption of dairy).

Comparison of anthropometric indices as predictors of the risk factors for cardiovascular disease in Iran: The PERSIAN Guilan Cohort Study.

OBJECTIVE: This study was conducted to assess the prevalence of central and general obesity and compare nine anthropometric indices as predictors of the risk factors for cardiovascular disease (CVD) in Iranian adults. METHODS: A total of 10,520 adults between ages 35 and 70 years old who were referred to the PERSIAN Guilan Cohort Study were included in this study. Anthropometric indices, including body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), conicity index, hip circumference (HC), waist to hip to height ratio (WHHR), body adiposity index, and a body shape index (ABSI), were measured using the standard methods. The risk factors for CVD (diabetes mellitus, hypertension, and out of range lipid profiles) were defined by laboratory tests and medical history. The odds ratio of the risk factors based on a unit increase in anthropometric indices was examined by an adjusted logistic model. RESULTS: The mean of all anthropometric indices was higher in women than in men (p<0.01). After adjusting for confounders, the risk of diabetes mellitus, hypertension, and hypertriglyceridemia increased with an increase in all anthropometric indices. The highest risk of diabetes mellitus and hypertriglyceridemia was found in higher WHHR. The highest risk of low high density lipoprotein cholesterol (HDL C) and high low density lipoprotein cholesterol (LDL C) was found in an increase in the WHR and ABSI, respectively. CONCLUSION: Our findings emphasize higher levels of general and central obesity in adults in the north of Iran. The WHHR and WHtR seem to be more valuable indices than BMI and WC for predicting distinct risk factors for CVD. However, the WHR was the strongest index for the prediction of high LDL C/HDL C ratio.

Recommended Food Score and Healthy Nordic Food Index in Cancer: A Systematic Review.

Aim: Cancer is the second leading cause of death in the world. About one third of deaths from cancer are due to the five behavioral and dietary risk factors e.g., high body mass index, low fruit and vegetable consumption, lack of physical activity, tobacco use, and alcohol use. The aim of this study is to review systematically the association of Recommended Food Score (RFS) and the Healthy Nordic Food Index (HNFI) with cancer.Method: Literature search conducted using electronic database PubMed, Google scholar, Science direct for the period of 2011 until January 2020 also reference list of the included studies.Results: Nine studies were met inclusion criteria. Two studies that investigated about RFS showed no significant association between RFS and breast cancer and colorectal cancer survival. Two out of three studies aboutthe HNFI and colorectal cancer observed that adherence to the HNFI might decrease colorectal cancer incidence and improve colorectal cancer survival. In addition, two out of three studies showed adherence to the HNFI could decrease cancer mortality.Conclusion: Adherence to the HNFI might decrease the risk of colorectal cancer incidence. It is suggested more studies about between RFS and THE HNFI with other kind of cancers.

Designing a healthy, low-cost and environmentally sustainable food basket: an optimisation study.

OBJECTIVE: Sustainable diets are diets with low environmental impacts and high affordability which contribute to food and nutrition security. The present study aimed to develop a healthy, low-cost and environmental-friendly food basket for Iran based on current consumption. DESIGN: The Households Income and Expenditure Survey data were used. Linear Programming was utilised to obtain the optimal diets, separately, for each goal of the sustainable food basket: (1) Diet with maximum Nutrient Rich Food (NRF) index, (2) Diet with minimum cost, (3) Diet with the minimum water footprint and (4) Diet with the minimum carbon footprint. Goal Programming techniques were used to optimise the sustainable food basket by considering all goals simultaneously. SETTING: Iran. PARTICIPANTS: Households (n 100 500) in urban and rural areas of Iran, nationally representative. RESULTS: In the 'optimal model', compared with the usual consumption, the amount of the 'bread, cereal, rice, and pasta', 'meat, poultry, fish, eggs, legumes, and nuts' and 'fats, oils, sugars, and sweets' groups was decreased. Inside those food groups, cereals, poultry and vegetable oil subgroups were increased. Also, dairy, fruits and vegetable groups were increased. In this model, there was a 14 % reduction in the total water footprint, a 14 % decrease in the total carbon footprint, a 23 % decrease in the cost and a 7 % increase in NRF of diet compared with the usual consumption. CONCLUSIONS: Increasing the consumption of dairy, fruits and vegetables and reducing the consumption of bread, rice, pasta, meat, fish, eggs, legumes, nuts, hydrogenated fats and sugars are required to achieve a sustainable food basket.

Dietary Approaches to Stop Hypertension (DASH) diets and breast cancer among women: a case control study.

BACKGROUND: Studying entire dietary patterns is a promising alternative approach to overcome limitations of the single food or nutrient approach. We evaluated the relationship between the scores of 4 established Dietary Approaches to Stop Hypertension (DASH) diet indexes and breast cancer risk among Iranian women. METHODS: This case-control study was carried out on 408 eligible women (136 cases and 272 hospital-based controls). A validated 168 item semi-quantitative food frequency questionnaire was used for assessing usual dietary intakes. DASH index scores were generated based on predefined algorithms for each of the 4 previously described indexes (Dixon's, Mellen's, Fung's and Günther's DASH diet index). Unconditional logistic regression analysis was performed to estimate odds ratio (OR) and 95% confidence intervals (CIs) for score categories or quintiles of DASH diet indexes and breast cancer risk in multivariate adjusted models. RESULTS: Women in the highest categories of the Mellen's and Günther's scores had lower odds of breast cancer than those in the lowest quintiles (Mellen's OR:0.50; 95% CI:0.62-0.97; P-trend:0.02; Günther's OR:0.48; 95% CI:0.25-0.93; P-trend:0.05). However, no significant associations were found between Dixon's and Fung's DASH score and breast cancer risk. Modification by menopausal status revealed that breast cancer risk was only reduced in postmenopausal women with higher scores on Mellen's index (OR:0.24; 95% CI:0.08-0.68; P-trend:0.04). CONCLUSION: A greater adherence to 2 of the 4 DASH indexes (Mellen's and Günther's indexes) was associated with decreased risk of breast cancer.

Food frequency questionnaires developed and validated in Iran: a systematic review.

OBJECTIVES: To systematically review and identify food frequency questionnaires (FFQs) developed for the Iranian population and their validation and reproducibility in order to determine possible research gaps and needs. METHODS: Studies were selected by searching for relevant keywords in the PubMed, Scopus, Science Direct, Google Scholar, SID, and Iranmedex databases, unpublished data, and theses in November 2016 (updated in September 2019). All English-language and Persian-language papers were included. Duplicates, articles with unrelated content, and articles only containing a protocol were excluded. The FFQs were categorized based on: (1) number of food items in to short (≤80 items) and long (>80 items) and; (2) the aim of the FFQ to explore total consumption pattern/nutrients (general) or to detect specific nutrient(s)/food group(s) (specialized). RESULTS: Sixteen reasonably validated questionnaires were identified. However, only 13 presented a reproducibility assessment. Ten FFQs were categorized as general (7 long, 3 short) and 6 as specialized (3 long, 3 short). The correlation coefficients for nutrient intake between dietary records or recalls and FFQs were 0.07-0.82 for long (general: 0.07-0.82 and specialized: 0.26-0.67) and 0.20-0.67 for short (general: 0.24-0.54 and specialized: 0.20-0.42) FFQs. Long FFQs showed higher validity and reproducibility than short FFQs. Reproducibility of FFQs was acceptable (0.32-0.89). The strongest correlations were reported by studies with shorter intervals between FFQs. CONCLUSIONS: FFQs designed for the Iranian population appear to be appropriate tools for dietary assessment. Despite their acceptable reproducibility, their validity for assessing specific nutrients and their applicability for populations other than those they were developed for may be questionable.