A 30-year trend of dairy consumption and its determinants among income groups in Iranian households

Introduction

Milk and dairy products provide essential nutrients and have the potential to prevent chronic diseases, thus reducing healthcare costs. However, there is a lack of consistent and updated data on dairy consumption trends in Iran. This study aims to analyze the trends in dairy consumption among Iranian households from 1991 to 2021, focusing on household-level determinants across different expense groups.

Methods

The study uses data from the Iranian Household Expenditure and Income Survey conducted annually from 1991 to 2021 to analyze households' dairy consumption. The data includes values and expenses of food and non-food items purchased in the previous month, as well as demographic characteristics of household members. The households were categorized into 10 deciles based on their gross expense. The econometric model used weighted mean per capita milk, yogurt, cheese, and total dairy consumption based on milk equivalent for each decile. The model takes into account changes in income, prices, household composition, education level, occupation, and residency area using panel data. Data preparation and model estimation were performed using RStudio and STATA17 software.

Results

Based on the findings, in 1991, per capita milk, yogurt, and cheese consumption were 26.77 kg, 16.63 kg, and 2.42 kg, respectively. By 2021, these figures changed to 22.68 kg, 11.06 kg, and 3.79 kg, reflecting a decrease in milk and yogurt consumption but an increase in cheese consumption. Family size was positively correlated with yogurt consumption and head of the household spouse's job score were positively correlated with milk, yogurt and cheese consumption. Also, the presence of under five-year-old children and older adults members (over the age of 60) in the household was inversely related with yogurt and cheese consumption. Female-headed households tended to purchase more cheese, while their milk purchase level was significantly lower. Residing in urban areas was negatively related to milk, while cheese and total dairy consumption was higher in urban areas.

Discussion

The findings highlight the importance of targeted dairy subsidy interventions and educational programs to improve dairy consumption in Iranian households, especially among vulnerable groups. This will require urging policymakers and food system stakeholders for effective strategies that address macro-level factors to promote dairy consumption.

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.

An in-depth analysis of hospital food waste in terms of magnitude, nutritional value, and environmental and financial perspectives: A cross-sectional study

Hospital food waste has nutritional, economic and environmental impacts, and halving food waste is a sustainable development goal. This study aimed to quantify hospital food waste and its nutritional, environmental and financial values in medical and surgical wards. In a cross-sectional study in three educational hospitals, nutritional and demographic data of adult inpatients were collected. The food waste was measured at breakfast, lunch and snack times, and a 24-hour food recall was fulfilled for each patient. Also, the nutritional, environmental and financial values of discarded food were calculated. Food waste contributors were determined using linear regression. Totally, 398 meals were evaluated. The average served food was about 1 kg patient-1 day-1, while 539.5 g patient-1 day-1(50.1% of the served food) was discarded. Mean food wastes were 148.9 g (standard deviation (SD): 130.1), 364.3 g (SD: 257.2) and 80.2 g (SD: 101.5) in breakfast, lunch and snacks, equal to 45.7% (SD: 36.9), 51.4% (SD: 36.1) and 62.4% (SD: 53.2) of the served food, respectively. Rice, soup, milk and fruits were mostly discarded. Severely malnourished patients had higher daily food waste. Food preparation and waste were estimated to cost on average US$1.8 and US$0.8 patient-1 day-1, respectively. Each kilogram of food waste resulted in 8.1 m2 of land use, 1.4 kg of CO2-equivalent gas emission, and about 1003 L of water wastage. Half of the hospital food was discarded which means waste of nutrients, environmental resources and money. Current data can help authorities to plan for reducing hospital food waste.

Economic Sanctions Affecting Household Food and Nutrition Security and Policies to Cope With Them: A Systematic Review

BACKGROUND

This review was conducted to identify the impact of economic sanctions on household food and nutrition security and policies to cope with them in countries exposed to sanctions.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020 were used to identify, select, appraise, and synthesize studies. Electronic databases in addition to Persian ones have been systematically searched for all related documents published until March 2022. Exclusion criteria were: lack of data related to food insecurity in countries subject to sanction and very low quality of the article. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal checklists. The results were presented as qualitative and quantitative syntheses.

RESULTS

Of 1428 identified studies, 36 publications remained in the review, which belong to Iran (n=8), Cuba (n=8), Russia (n=7), Iraq (n=7), and Haiti (n=6), respectively. Declining gross domestic product (GDP), devaluation of the national currency, and the quality of food, increase in inflation, unemployment, and consumer prices, infant and under 5 years mortality, energy, and protein deficiency, and the poverty rate were reported as sanction consequences. The most important strategies to improve food security were the humanitarian assistance provided by the international community (Haiti), equity and priority for vulnerable groups mainly by expanding the healthcare system (Cuba), adopting a food ration system in the oil-for-food program, and fixing the price of food baskets (Iraq), import substitution and self-sufficiency (Russia), support domestic production, direct and indirect support and compensation packages for vulnerable households (the approach of resistance economy in Iran).

CONCLUSION

Due to the heterogeneity of studies, meta-analysis was not possible. Since inadequate physical and economic food access caused by sanctions affects especially disadvantaged and vulnerable groups, planning to improve food security and providing support packages for these groups seems necessary.

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.

Violation of Food Advertising Regulations in Iran: A Systematic Review

Background

The prevalence of non-communicable diseases (NCDs) and the status of nutritionally high-risk behaviors in the country are not promising. Because of undeniable impact of media advertising on food choices, to combat the problem some regulations on food advertisements are developed in the country. However, the high prevalence of NCDs warns of the possibility that either the laws are not given the necessary attention or they are not implemented properly. Therefore in the present review, all studies on how the country's visual and written mass media comply with regulations related to food product advertisement were systematically reviewed.

Methods

We searched all studies, including Persian and English articles, dissertations, and research projects, published and unpublished reports in eight domestic and international databases and search engines during the years 1996 to December of 2020 (25 years). Then, the content of the eligible studies was extracted, evaluated, and reported.

Results

A total of 18 eligible studies (articles and reports) were included in the review. The results indicated violations of rules and regulations including displaying food products of low nutritional value and obese people, misleading/exaggerating claims, award offers, induction of gluttony, consumerism, and inconsistency with scientific facts. Most of the studies (55%) had, implicitly or explicitly, targeted children and adolescents.

Conclusions

The results of this study indicated a violation of the rules and regulations of health policies, mainly in the field of promoting foods of low nutritional value during the study period. Violations of the ban on advertising for children were also reported in more than half of the studies.

Why Patients Discard Their Food? A Qualitative Study in Iranian Hospitals

Introduction

Food waste reflects inadequate food intake and is of economic and environmental importance. Therefore, understanding the underlying factors is a must to combat food waste.

Methods

A qualitative study was conducted using semi-structured interviews with managers, nurses, nutritionists, food providers, kitchen staff, and inpatients at three hospitals in Tehran. Responses were recorded, coded, and analyzed thematically.

Results

Forty-eight face-to-face interviews led to three core categories: 1. opinions/performance; 2. causes, related factors, and characteristics; and 3. rooting and suggestions. We found that the majority of the hospitalized patients did not consume their entire food. In spite of overall satisfaction with the quantity and quality of food, anorexia, personal taste, and poor quality of raw materials prohibited patients from eating. Also, rice was the most discarded food. Economic barriers were the most important hindrance to elevate the quality, and some strategies, like the supply of high-quality materials and recruiting skillful cooking team, were proposed to improve it.

Conclusions

Our findings delineated a limited budget as the main barrier to improve the quality. Nevertheless, the low quality of hospital foods may actually impose a heavier economic burden due to food waste.

Prediction and analysis of trends in the nutritional status of children under 5 years in Iran: reanalysis of the results of national surveys conducted between 1998 and 2020

Background and aim

Malnutrition is a major public health problem, especially in developing countries. The aim of this study was to analyze the trend in malnutrition among children under 5 years of age in Iran over recent decades and to estimate malnutrition status for 2020.

Methods

This study took the form of a secondary analysis of the reports and data from three cross-sectional national surveys on children's nutritional status conducted between 1998 and 2017. Anthropometric indices, including markers of underweight, wasting, stunting, overweight, and obesity, were used as indicators of the nutritional status of children under 5 years. Malnutrition indicators are reported separately based on regional food security status. Linear mixed-effects modeling was used to predict the status of malnutrition indicators for 2020.

Results

The results of this study indicated a downward trend in the prevalence of stunting, underweight, and wasting, from 15.4 to 4.8%, 10.9 to 4.3%, and 4.9 to 4.3%, respectively, between 1998 and 2017. The proportion of children at risk of overweight and prevalence of childhood overweight/obesity showed a downward trend between 2010 and 2017, from 3.73 to 3.02% and from 12.1 to 10.3%, respectively. However, the trend varied between different provinces. Estimates of the prevalence of malnutrition in 2020 also indicated a decrease in the prevalence of all indicators among children.

Conclusion

Despite the decreasing trend in malnutrition over the past three decades, the prevalence of stunting, underweight, and wasting is still high in food-insecure provinces. Moreover, following the COVID-19 pandemic and its economic consequences, an increase in the prevalence of malnutrition, especially in food-insecure provinces, is plausible.

Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households?

Objective

This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households.

Methods

The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications.

Results

Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated.

Conclusion

The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.

Participatory evaluation of municipal obesity prevention clubs in Tehran city: Strengths, challenges, and future direction

Background and aim

Community-based initiatives are important for obesity prevention. This study aimed to evaluate the activities of municipal obesity prevention clubs (OBCs) in Tehran, Iran, using a participatory approach.

Methods

The evaluation team was formed, and the members identified the OBC's strengths, and challenges and provided suggestions for change through a participatory workshop, observation, focus group discussions, reviewing relevant documents (n = 97), and 35 interviews with involved stakeholders. The MAXQDA software was used for data analysis.

Results

An empowerment training program for volunteers was identified as one of the strengths of OBCs. Despite the obesity prevention efforts of OBCs through public exercise sessions, healthy food festivals, and educational sessions, several challenges were identified that hinder participation in OBCs. These challenges included poor marketing strategies, poor training approaches in participatory planning, insufficient motivational support for volunteers, low perceived recognition of volunteers by the community, volunteers' low food and nutrition literacy, poor educational services in the communities, and limited funding for health promotion activities.

Conclusion

Weaknesses in all stages of community participation, including information, consultation, collaboration, and empowerment, in OBCs were detected. Facilitating a more enabling environment for informing and involving citizens, expanding neighborhood social capital, and involving health volunteers, academia, and all potential governmental sectors to collaborate for obesity prevention is recommended.

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.

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).

Cost-Effectiveness Analysis of Group vs. Weblog Telecommunication (Web Tel) Nutrition Education Program on Glycemic Indices in Patients With Non-Insulin Dependent Diabetes Mellitus Type 2: A Randomized Controlled Trial

This a randomized controlled trial study with a cost-effectiveness analysis that aimed to compare the cost-effectiveness of group nutrition education with that of Web-Tel nutrition education in the glycemic control of patients with non-insulin-dependent type 2 diabetes mellitus (T2DM). The study was conducted on 105 patients with T2DM for 3 months in Quds health centre of Bushehr province, Iran. The participants were classified based on age and disease severity (hemoglobin A1c level); then, they were randomly assigned to one of the three groups: group education, Web-Tel education, and the control group using block randomization method. The clinical (intermediate) outcome was changes in hemoglobin A1c (HbA1c). Patients' perspective was adopted, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainties. The results indicated that the expected effectiveness was 0.46, 0.63, and 0.4; the mean costs was 27,188, 5,335, and 634 purchasing power parity (PPP) dollars for group education, Web-Tel education, and the control group, respectively. The incremental cost-effectiveness ratio (ICER) of Web-Tel education vs. the control group was positive and equal to $21, 613.04 PPP; since it was less than three times of the threshold, the Web-Tel education method was considered as a more cost-effective method than the control group. On the other hand, the ICER of group education vs. control group was $447,067 PPP and above the threshold, so group education was considered as a dominated method compared with the control group. In conclusion, considering the ICER, Web-Tel education is a more cost-effective method than the other two and can be used as the first priority in educating patients with T2DM. The present study was registered in Thailand Clinical Trials Registry (TCTR20210331001).

Household Food Waste Quantification and Cross-Examining the Official Figures: A Study on Household Wheat Bread Waste in Shiraz, Iran

The global consumer food waste (FW) estimates are mainly based on modeling data obtained from governments. However, a major data gap exists in FW at the household level, especially in developing countries. Meanwhile, the reliability of the existing data is questionable. This study aimed to quantify wheat bread waste (HBW) in Shiraz, Iran, and cross-examine the governmental HBW data. Face-to-face waste recall questionnaire interviews were conducted in 419 households from December 2018 to August 2019. A multistage sampling strategy consisting of stratification, clustering, and systematic sampling was employed. Moreover, we carried out a comprehensive document review to extract and analyze the official HBW data. The results revealed that the HBW in Shiraz is 1.80%—the waste amounts for traditional bread and non-traditional bread were 1.70% and 2.50%, respectively. The survey results were compared with the previous official data, revealing a substantial contradiction with the 30% HBW reported between 1991 and 2015. Possible reasons for this disparity are explored in this paper. Although our results cannot be generalized to other food commodities and locations, our findings suggest that considering the substantial likelihood of bias in the official data, policymakers should conduct more FW measurements and re-evaluate the accuracy of the existing data.

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.

The effectiveness of lifestyle training program promoting adolescent health with polycystic ovarian syndrome: A study protocol for a randomized controlled study

BACKGROUND

Lifestyle training is of a key important in adolescent age for better life in the future. Healthy lifestyle in adolescents can management of any disease such as diabetes and polycystic ovarian syndrome (PCOS). Schools can provide an important environment to identify and change the lifestyle of students. The aim of this protocol is designing and evaluating the effectiveness of school-based lifestyle training program improving the PCOS of adolescents.

MATERIALS AND METHODS

A cluster-randomized controlled trial will be conducted to examine the effectiveness of school-based lifestyle training program in 16 to 18 years old adolescent girls. The healthy lifestyle program will be designed by modification of behavioral habit, dietary intake, and physical activity and educated in eight sessions for adolescents and one session for parents in the intervention groups with sixty participants.

RESULTS

Changes in primary and secondary outcomes in PCOS and healthy adolescents before and after intervention in the intervention and control groups will be analyzed for evaluation effectiveness by one-way ANOVA or other nonparametric equivalents.

CONCLUSION

The current study will provide information on the effectiveness of school-based lifestyle training programs for adolescents. With increasing numbers of PCOS at risk for long-term and/or late effects of treatment and other chronic diseases, efforts for promoting the healthy lifestyle of this important group are urgently needed. This lifestyle program may provide valuable information relating to the development of other healthy lifestyle interventions for PCOS and result in appropriate behavior change and self-management strategies.

Exploring health and nutrition stakeholders' expectations and perception toward establishment of the Food and Nutrition Surveillance in Iran

BACKGROUND

Food and Nutrition Surveillance (FNS) is an essential and practical tool for providing timely information at specified times for policy making. This study aimed to explore policymakers' expectations and perception on establishment of the FNS in Iran before its establishment.

MATERIALS AND METHODS

Data in this qualitative study were gathered through documents review (23 relevant documents) and seventeen semi-structured interviews with key informants in the field of food and nutrition at the national and provincial level selected through purposive and snowball sampling. Data were content analysed using MAXQDA (2010).

FINDINGS

Most of the participants defined the FNS as a continuous monitoring system. They expected the FNS to identify and recognize food and nutrition problems; to create a common language and provide an inter-disciplinary cooperation. From the participants' point of view the most important barriers to establishing of the FNS included lack of cooperation and resistance at different levels, lack of support and partnership among the stakeholders, lack of justification and awareness of the stakeholders, mismanagement and misuse of data, inattention to infrastructure.

CONCLUSIONS

Most of the stakeholders believed that the FNS was supposed to monitor food and nutrition status continuously to provide timely and accurate information for policy making.

Food Security and Its Association with Social Support in the Rural Households: A Cross-Sectional Study

Food insecurity is a major and multidimensional global problem, particularly in rural and vulnerable areas. In this cross-sectional study, we aimed to identify the relationship between social support and food insecurity in 404 Iranian rural households. We selected the sample by cluster random sampling and collected data using three questionnaires [demographic, Multidimensional Perceived Social Support Scale (MSPSS), and United States Department of Agriculture food security questionnaires] and analyzed data using chi-square tests and logistic regression (using SPSS version 19.0). Of the 404 Iranian households, 168 (41.6%) were classified as food secure. The logistic regression analysis revealed that education and job status of the household heads and household income were significantly associated with food security status. Additionally, perceived social support was protective against food insecurity after adjusting for confounding factors [compared with the first quartile, second quartile odds ratio (OR)=1.76, 95% confidence interval (CI): 0.94∼3.3 and fourth quartile OR=2.21, 95% CI: 1.13∼4.33]. This study indicated that social support contributes to a reduced chance of food insecurity in rural households. These results suggest that policy makers should focus on strengthening social support in vulnerable communities to help protect against hunger and poverty.

Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. This study aimed to compare the effects of lifestyle interventions on anthropometric, clinical, and biochemical parameters in adolescent girls with PCOS.

METHODS

PubMed, Scopus, and Web of Science was systematically searched to retrieve studies investigating the effects of lifestyle modifications in adolescent girls with PCOS, which were published up to December 2019. The primary outcome was Body Mass Index (BMI) and secondary outcomes were all manifestations of PCOS, including clinical, metabolic, and hormonal parameters. Random effect meta-analysis was applied for significant results. Publication bias was assessed using the Egger test.

RESULTS

This study showed significant improvements in luteinizing hormone (LH) (Pooled SMD = - 0.1.23; 95% CI, - 2.44 to - 0.03), and Free Androgen Index (FAI) levels (Pooled SMD = - 0.78 95% CI, - 0.1.42 to - 0.13) in adolescent girls receiving lifestyle intervention compared to baseline. This study also revealed that diet modifications alone were associated with a significant decrease in Body Mass Index (BMI) (Pooled SMD = - 0.45; 95% CI, - 0.76 to - 0.13), and FG score (Pooled SMD = - 0.81; 95% CI, - 1.33 to - 0.28). Exercise interventions were associated with significant changes in the menstrual cycles (Pooled SMD = 1.16; 95% CI, 0.72 to 1.61), Ferriman-Gallwey (FG) score (Pooled SMD = - 0.57; 95% CI, - 0.99 to - 0.15), LH (Pooled SMD = - 056; 95% CI, - 0.98 to - 0.14), Anti-Müllerian Hormone (AMH) (Pooled SMD = - 0.81; 95% CI, - 0.1.24 to - 0.38), and Triglyceride (TG) levels (Pooled SMD = - 0.32; 95% CI, - 0.62 to - 0.02).

CONCLUSION

This meta-analysis concluded lifestyle interventions, such as diet and exercise, can improve some clinical, metabolic, and hormonal parameters in adolescent girls with PCOS.

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis

BACKGROUND

Nutrition labelling is a strategy to promote healthy eating and combat non-communicable diseases (NCDs). The present study aimed to provide an analysis of the nutrition labelling policy and its opportunities to improve in Iran.

METHODS

Data were collected by 1) reviewing relevant documents and 2) semi-structured interviews with stakeholders through purposive and snowball sampling, continued until data saturation was achieved. A deductive content analysis was used by applying the policy triangulation framework and the Kingdon multiple stream theory. MAXQDA software was used to manage data analysis.

RESULTS

Iran, is the first country in the Eastern Mediterranean region which has accomplished to implement nutrition traffic light labelling. The main contextual factors that affected nutrition labelling policy to become a national included health, political commitment, and international factors. Poor involvement of media for public awareness of nutrition traffic labeling, the inconsistency of nutrition traffic light color ranking using food standard guidelines, lack of consistency between nutrition traffic light colors and the healthy/unhealthy nature of some food products and the absence of a comprehensive evaluation plan were among the policy challenges identified.

CONCLUSIONS

Strengthening the governance for a healthy food environment is recommended to improve the program. Also, establishing national portion sizes for food labelling, initiating public awareness campaigns, evaluation of the policy effect and public perception of the labels and their application are recommended.

Effectiveness of the national food supplementary program on children growth and nutritional status in Iran

This study aimed to evaluate the effectiveness of the national food distribution program on the growth and nutritional status of malnourished or growth-retarded children in 2 provinces of Iran. A quasi-experimental design was used for the effectiveness evaluation. Qualitative data were gathered to explain the results. An intervention group consisted of 362 children aged 6-72 months who were under coverage of the program. These children received monthly food as foodstuff, food vouchers, or cash. A comparison group included 409 children aged 6-72 months who were selected from those covered by the Primary Health Care system. Children anthropometric indices were measured at the baseline and also 6 months later. Twelve focus group discussions were held with mothers who had at least 1 child under the coverage of the program. At the end of the study, the mean weight-for-age Z scores, height-for-age Z scores, and weight-for-height Z scores increased compared with the baselines in both groups (p < .001). The differences between 2 groups in weight-for-age Z scores, height-for-age Z scores, and weight-for-height Z scores were not significant at the end of the study (p = .62, p = .91, and p = .94, respectively). According to the mothers' reports, factors affected the program outcome, that is, children anthropometric indices were low income, intrahousehold food sharing, irregular distribution, quantity and quality of the distributed food, and insufficient training. Providing foods for the malnourished children living in low-income families helped to prevent a worsening of their nutritional status; however, it has not been effective in solving the problem, probably due to the weak implementation and lack of empowerment strategies.

Key Informants' Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran

INTRODUCTION

Childhood malnutrition is a major public health issue. Multidisciplinary approach for Improvement of Nutritional Status of Children in Iran was implemented in order to reduce malnutrition among children.

OBJECTIVE

This study aimed to evaluate the implementation aspect of the program and to explore key informants' perceptions and experience regarding the factors affected its implementation.

METHODS

Data were collected through the review of secondary data and semistructured interviews at national, province, and local levels. Four layers of key informants were selected purposefully for interviewing, including policymakers, senior nutrition officers, head of Hygiene, Remedy and Insurance Affairs in Imam Khomeini Relief Foundation, and community health workers. Qualitative content analysis was carried out based on Supporting the Use of Research Evidence framework and Tailored Implementation for Chronic Diseases' checklist to interpret the viewpoints of the study participants.

RESULTS

Results showed that the program had successes in improving mother's knowledge on health, nutrition, and child care through health system and increased families' access to food, but there were some aspects that affected program's implementation. Some of these factors are the lack of clarity in the program's protocol and indicators, human shortage and inadequate financial resources, poor facilities, inattention to staff motivation, insufficient commitment among different sections, poor communication and supervision among different executive sections, and program protocols designing regardless of practical condition.

CONCLUSION

Based on the results, top-down approach in policymaking and inadequate financial and human resources were responsible for most of the challenges encountered in the implementation.

Impact of the National Food Supplementary Program for Children on Household Food Security and Maternal Weight Status in Iran

Background:

Food aid programs are strategies that aim to improve nutritional status and to tackle food insecurity. This study aimed to evaluate the effect of a National Food Supplementary Program for Children on households’ food security.

Methods:

The study sample included 359 mothers of children aged 6–72 months under the coverage of the program in two provinces of Iran. Demographic and socioeconomic characteristics of the households and percentage of supplementary food items consumed by target child were assessed by a questionnaire and checklist. Data on household food security were collected by locally adapted Household Food Insecurity Access Scale at the baseline of the study and 6 months thereafter.

Results:

At the baseline, only 4.7% of families were food secure, while 43.5% were severely food insecure, and these proportions were changed to 7.9% and 38%, respectively (P < 0.001), at the end of the study. Odds of having worse food insecurity in households with medium and high wealth index was 65% and 87% lower than those with low wealth index, respectively (odds ratio [OR] = 0.35, 95% confidence interval [CI]: 0.2–0.61, and OR = 0.23, 95% CI: 0.12–0.43). Food sharing was common among more than 95% of the studied households. Mean maternal body mass index (BMI) increased significantly after 6 months (P < 0.001). However, there was no significant association between mother's BMI and household food security in the baseline and at the end of the study (P > 0.05).

Conclusions:

Findings show that the food supplementary program for children can also improve the household food security status. Further research is needed to assess other factors that affect the effectiveness of this kind of programs.

A comparison of the effects of reboxetine and placebo on reaction time in adults with Attention Deficit-Hyperactivity Disorder (ADHD)

OBJECTIVE

Some studies have demonstrated that Reaction Time (RT) is longer in patients with ADHD which in turn may be associated with educational and occupational impairment and increased driving risks. Any alteration on RT which is induced by the treatment in this population may have great consequences positively or negatively. This study was designed to examine the effects of reboxetine on RT in adults with Attention Deficit-Hyperactivity Disorder (ADHD).

METHODS

A total of 30 adult patients with ADHD who did not suffer from any other major psychiatric disorder were eligible to participate in this double blind, placebo controlled study. Patients were randomly assigned to receive either reboxetine (4 mg/day for one week, then 8 mg/day) or placebo for 4 weeks. RT was assessed at baseline and after 4 weeks by validated software which collects and analyses the data for auditory and visual stimulants. Numbers of correct responses, omission and substitution errors for each stimulus were calculated.

RESULTS

Regarding visual tasks and in comparison with baseline scores, the number of correct responses increased significantly and the number of omission errors decreased significantly after 4 weeks of treatment (P<0.05) in both groups. However, with regard to auditory tasks scores, no significant differences were found at the end of the study compared to the baseline in each of the two groups. Additionally, no significant differences were noted between the two groups when both visual and auditory tasks were considered.

CONCLUSION

Results of this study showed that reboxetine did not affect the RT of the patients when both visual and auditory tasks were assessed. Further studies with larger number of patients and for a longer period of time are required to confirm the result of this study.