Do lifestyle interventions affect dietary diversity score in the general population?

OBJECTIVE: The dietary diversity score (DDS) is a good indicator of diet quality as well as of diet-disease relationships; therefore, the present study was undertaken to reveal the effect of a lifestyle intervention on this index. DESIGN: A baseline and three evaluation studies were conducted in two intervention districts (Isfahan and Najaf-Abad) and a reference area (Arak), all located in central Iran. The Isfahan Healthy Hearth Programme (IHHP) targeted the entire population of nearly 2 million in urban and rural areas of the intervention communities. One of the main strategies of the lifestyle intervention phase in the IHHP was healthy nutrition. Usual dietary intake was assessed using a forty-nine-item FFQ. A diversity score for each food group was calculated and the DDS was considered the sum of the diversity scores of the food groups. RESULTS: There were significant increases in DDS in both intervention areas (P = 0.0001) after controlling for confounding factors. There was a significant interaction between area and evaluation stage with regard to DDS (P = 0.0001). The effect of the intervention on the diversity scores of all food groups was also significant (P = 0.0001 for all) after adjusting for socio-economic status. CONCLUSION: The community-based lifestyle intervention in the IHHP was successful in improving DDS which might be related to an increase of diet quality of the population that in turn might decrease the risks of chronic diseases.

Effect of a community-based intervention on nutritional behaviour in a developing country setting: the Isfahan Healthy Heart Programme.

OBJECTIVE: The present study was conducted to determine the impact of a community-based intervention on the nutritional behaviour of a representative sample of Iranian adults. DESIGN: The Isfahan Healthy Heart Programme (IHHP), a six-year, action-oriented, integrated community-based study aimed at health promotion through the reduction of CVD risk factors, targeted the whole population living in two intervention cities, and compared outcomes with the population of a non-intervention city considered as reference. Dietary interventions were performed as educational, environmental and/or legislative strategies. A global dietary index (GDI) was calculated representing the general dietary behaviour. In addition, two consumption indices were calculated for specific food groups, i.e. meat products and major sources of fat. Univariate AVOVA was conducted to evaluate the impact of the intervention on dietary behaviours. SETTING: Isfahan and Najaf-Abad (intervention cities) and Arak (reference city), central Iran. SUBJECTS: The baseline survey was conducted among 12514 randomly selected adults aged > or =19 years in both intervention and reference areas. The survey was repeated annually among about 5000 persons (2002-2005) in the intervention and reference communities. RESULTS: According to significant year x group interactions in mean fat consumption index (FCI) and meat consumption index (MCI) in the total population, a significant improvement in FCI and MCI was found in the intervention areas v. the reference area (P < 0.001). In addition, the GDI improved significantly in the intervention areas v. the reference area (P < 0.001). CONCLUSIONS: The IHHP interventions were effective in improving dietary behaviours at the population level. The highest effectiveness was documented in the change in the type of fat consumed. Such simple and integrated interventions can be adopted in other developing countries with limited financial resources.

Fat-modified diets during pregnancy and lactation and serum lipids after birth.

OBJECTIVE: This study investigated the influence of modifying the maternal dietary fat on the serum lipids of infants at birth and at one year of age. METHODS: This single-blind randomized clinical trial was done on 180 4-month-pregnant women. All subjects proved to have a fat-unmodified diet through a 4-day food record dietary questionnaire. They were divided randomly into two groups. The intervention group was kept on a fat-modified diet including saturated fatty acid (SFA) < 10%, monounsaturated fatty acids: (MUFA) 10-5%, polyunsaturated fatty acid (PUFA) upto 10% and cholesterol < 300 mg/day with dietary advice for the pregnancy period. The control group was given only the latter advice. All subjects were followed up monthly. The serum lipids including total cholesterol (T.cho), triglyceride (TG), and HDL cholesterol (HDL-C) were analyzed through enzymatic methods. The level of LDL-cholesterol (LDL-C) was calculated by Friedewald formula. The comparison of mean cord and one-year-old infant serum lipids were done through unpaired T-test in two groups. RESULTS: The mean level of T.cho in the intervention and control group was (70.3+/-15.9, vs 81.4+/-17.2, P< 0.009), TG (85.3 +/- 16.7 vs 97.5 +/- 18.2, P< 0.007), LDL-C (27.8 +/- 15.2 vs 34.8 +/- 17.1, P< 0.04) and non-HDL-C (44.5+/-7.2 vs 54.5 +/- 8.1, P< 0.02) and in one year old infant the comparison of serum lipids were as follows. T.cho (145.7 +/- 51.4 vs 161.4 +/- 56.2, P< 0.003), TG (90.1 +/- 31.8 vs 98.3 +/- 33.1, P< 0.02), LDL-C (85.6 +/- 20.4 vs 92.3 +/- 19.6, P< 0,05) and non-HDL-C (113.6 +/- 30.2 vs 128.8 +/- 34.8, P< 0.04). However, there was no significant difference in HDL-C of both groups. CONCLUSION: There is a significant decrease of T.cho, TG, LDL-C and non-HDL-C levels with no significant increase of HDL-C in the intervention group with the fat-modified diet. Maternal fat-modified diet could be suitable way to prevent cardiovascular disease among infants from the beginning of the life.