Validity and Reliability of the Persian Version of Nutrition Screening Tool for Every Preschooler (NutriSTEP®) in Iranian Preschool Children.

BACKGROUNDS: To assess the validity and reliability of the Persian version of Nutrition Screening Tool for Every Preschooler (NutriSTEP®), a community-based nutrition screening tool in preschool children. DESIGN AND METHODS: A cross-cultural validation study was conducted on 192 Iranian preschool children in Mashhad, Iran. Forward and backward translation and face validity was assessed. Criterion validity was confirmed by nutritionist risk score which was determined by an expert physician. Content validity, construct validity and reliability of the Persian version was assessed as well. Receiver operating characteristic (ROC) curve was used to detect the reasonable cut-points for the Persian version. FINDINGS: Content validity index and ratio ranged between 0.9 and 1 and 0.63-1, which both were acceptable. NutriSTEP® scores were significantly different in the three categories of nutritionist risk scores (p = .007). Item-to-scale correlation analysis shows significant correlation between each item and the total score. A significant correlation was seen between test-retest scores of NutriSTEP® (r = 0.68, p < .001). In Persian NutriSTEP®, scores 27 and 31 seems to better reflect the nutrition risk in Iranian preschool children population and are suggested as cut-points; Therefore, scores lower or equal to 27 are determined as mild risk and 28-31 as moderate risk, while scores higher than 31 are categorized as high risk. CONCLUSION: The Persian NutriSTEP® questionnaire is both valid and reliable for the screening of nutrition risk in preschool children of the Iranian population. PRACTICE IMPLICATIONS: Health care professionals may use the NutriSTSP® tool to find nutritionally high risk children as an important step to prevent childhood obesity.

Evidence for the Validity of the Children's Attraction to Physical Activity (CAPA) Scale in Iranian Preschool Children.

PURPOSE: The escalating trend of overweight and obesity is a major global health challenge and needs particular attention. There are a number of reasons for this increase, but the dominant one appears to be the pandemic of physical inactivity. It is now clear that children's attraction to physical activity is an important promising factor in children's physical activity involvement. In this study, we aimed to cross-validate the long version of children's attraction to physical activity (CAPA) scale in Iranian preschool children. DESIGN AND METHODS: Evidence for the validity of the scale was based on face validity, content validity, and internal consistency. The scale was translated into Persian and underwent forward translation, synthesis of the translation and backward translation. Face and content validity were subsequently assessed on individuals and expert panels. A sample of 30 preschool children (5-6 years of age) were randomly selected from three kindergartens. Children were interviewed by their kindergarten teachers. RESULTS: Internal consistency for each of the five subscales of the CAPA scale was evaluated through Cronbach's alpha. The internal consistency was acceptable for most of the subscales when negative statements were excluded from the analyses. CONCLUSIONS: The results supported the use of modified version of Persian-language long CAPA scale for Iranian preschool children, with the deletion of negatively worded items. PRACTICE IMPLICATIONS: Health care professionals may use the CAPA when assessing the attraction of children toward physical activity and its potential involvement in childhood obesity.

Nutritional Requirements in Pregnancy and Lactation.

Optimal nutrition during pregnancy and lactation is vital for the health of the mother and fetus. Nutritional needs should begin in the preconception period, as the fetus depends on the placenta for essential nutrients required for growth and development. A balanced diet rich in nutrient-dense foods-such as whole grains, vegetables, fruits, dairy, legumes, fish, and lean meats-is essential to meet caloric needs during pregnancy. Assessment of maternal health, including dietary history and micronutrient status, is critical to identify potential risks and ensure adequate nutrition. The increased need for micronutrients must be met to prevent complications and fetal growth. Exclusive breastfeeding is recommended for the first six months, and continued breastfeeding is recommended throughout the first year and beyond. During pregnancy and lactation, calorie intake should be increased by focusing on protein and healthy fats. The composition of breast milk is adapted during the breastfeeding period, so that it can provide the necessary nutrients for the growth of the infant. Personalized nutrition plans, developed in consultation with health care professionals, are critical to optimizing maternal and infant health outcomes. This manuscript supports the importance of comprehensive nutritional strategies during pregnancy and lactation to reduce risks and support healthy growth and development of mother and child.

The Effects of Vitamin D Fortified Products on Bone Biomarkers: A Systematic Review and Meta-Analysis.

Background: Vitamin D plays an essential role in the regulation of bone metabolism. The current meta-analysis aimed to assess the effectiveness of vitamin D fortification on special bone biomarkers. Methods: Five main databases (PubMed/Medline, ISI Web of Knowledge, Science Direct, Scopus, Cochrane Library as well as Science Direct, and Scopus) were considered for this systematic review, until Jan 2020. All randomized controlled trials were included to evaluate the probable relationship between consumption of vitamin D fortification products and bone biomarkers profile in this review. Results: Among serum bone biomarkers (osteocalcin and telopeptides of type-1 collagen) investigated, only the level of telopeptides of type-1 collagen significantly decreased after fortification of vitamin D in the intervention group. A significant increase in vitamin D was seen in those older than 18 yr old, while the increase in younger children was not statistically significant between intervention and control groups. Conclusion: Vitamin D fortification was not associated with a significant improvement in bone mass density (BMD), while it resulted in decreased PTH levels. Vitamin D fortified foods have some benefits on bone health due to increase in the level of vitamin D and IGF-1; and decreasing PTH and CTx levels.

Impact of Parent Engagement in Childhood Obesity Prevention Interventions on Anthropometric Indices among Preschool Children: A Systematic Review.

Background: Home environment, modeling of weight-related behaviors, and general parenting style are very important predictors of obesity in children. The effect of parent engagement in prevention of obesity in children is not clear. The main objective of this systematic review was to address the effects of parent engagement in obesity prevention interventions on anthropometric changes among preschool children. Methods: PubMed/Medline, Cochrane Library, ISI Web of Knowledge, Scopus, Science Direct, and Google Scholar were searched. Eligible studies were randomized controlled trials in last 10 years (from 2008 until February 14, 2018), which had a parent engagement in obesity prevention interventions (as an intervention) and children's anthropometric indices (as an outcome). Results: Twenty-six studies were included. Half of studies targeted both parents and children, and the rest targeted only parents. Types of interventions ranged from a simple motivational interviewing to professional skill training approaches. Studies that targeted overweight or obese children in their intervention containing training sessions followed by maintenance for parents and those that focused on individual support for overweight children and their parents, resulted in higher improvement in BMI and other outcomes. Conclusions: Anthropometric indices and BMI are not appropriate for reflecting the effectiveness of parent engagement in obesity prevention interventions. Having an individual component in the intervention and focusing more on parents vs. children in the intervention may result in improvement in anthropometric outcomes. Focusing on weight-related behaviors as the main outcome in both, children and parents, rather than anthropometric indices, is highly recommended for future reviews.

A Customized Intervention Program Aiming to Improve Healthy Eating and Physical Activity Among Preschool Children: Protocol for a Randomized Controlled Trial (Iran Healthy Start Study).

BACKGROUND: Prevention of childhood obesity is a key approach to the primary prevention of noncommunicable diseases. Several models, based on the population health approach and aligned with ecological models, are used to design childhood obesity prevention programs around the world. OBJECTIVE: This study aims to introduce the design and evaluation plan of "Iran Healthy Start (IHS)/Aghazi Salem, Koodake Irani"-the customized Iranian version of Canadian Healthy Start/Départ Santé health promotion program-which is now being developed in Mashhad University of Medical Sciences (Mashhad, Iran) and focuses on improving physical activity and healthy eating among preschool children. METHODS: We will evaluate the intervention using a pilot randomized controlled design. The components of intervention include customized Decoda Web-based resources for children, an implementation guide for educators and managers, training and monitoring, communication and knowledge exchange, building partnership, and parent engagement. Outcomes include changes in anthropometry, physical activity level, nutritional risk status and dietary intake, and quality of life. RESULTS: The project is funded by Mashhad University of Medical Sciences. The intervention was completed by the end of March 2018, and the analysis is currently under way. The first results of the IHS intervention program are expected to be submitted for publication in December 2018. CONCLUSIONS: The double burden of malnutrition in early years children is a major health concern in developing countries. This justifies the need for health promotion programs that are specifically designed to target both overnutrition and undernutrition prevention. If the efficacy approved, the IHS could potentially be a comprehensive health promotion program for young children whose lifestyle behaviors can be improved toward a healthy future life in a nutrition transition setting. TRIAL REGISTRATION: International Clinical Trials Registry Platform IRCT2016041927475N1; https://en.irct.ir/trial/22497. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11329.