Razi Journal of Medical Sciences

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For individuals of a population, taking into account varying individual factors such as age, sex, growth stages of puberty, and significant durations such as pregnancy and lactation accompanied by physiologic changes, the importance of appropriate dietary intakes must be emphasized. The food guide pyramid is one of the best daily dietary guidelines that can be used to achieve this purpose. Since dietary assessments have generally focused on evaluating the adequacy of nutrient intakes and little attention has been paid to following the recommendations of the food guide pyramid, this study was performed to assess existing problems in current food habits and to offer solutions required in inhabitants of district 13 of Tehran.This is a cross-sectional study conducted within the framework of the national tehran lipid and glucose study (TLGS) on 920 individuals (472 women and 448 men) aged 10 years and over, who were randomly selected from the TLGS population and evaluated for nutritional status. Trained personnel through the 2-day dietray recall performed dietary assessment. Household values were converted to gram values, which were eventually converted to serving. Statistical analyses were done using the SPSS. Student t-test was used to test differences in means between sex groups and Chi-square test was used to determine the association of meeting the food guide pyramid recommendations with sex. Daily mean intakes of pyramid food groups were: bread and cereals 8.6±3.3 (the recommended number of servings 6-11) vegetables 3.7±2.0 (recommended number of servings 3-5) fruits 3.0±2.5 (recommended number of servings 2-4) dairy products 1.1±0.8 (recommended number of servings 2-3) meat and its alternatives 1.3±0.7 (recommended number of servings 2-3) and fats and sweets 7.1±2.7 (no recommendation). There were significant statistical differences between men and women for intakes of the following groups: grains (P<0.001), dairy products (P<0.01), meats and substitutes (P<0.001) and fats and sweets (P<0.001). In all of the above-mentioned, the mean intakes of the pyramid food groups in men were higher than in women. In about 80% of the population studied, the daily intakes of meat and dairy products were less than those recommended by the food guide pyramid. This study revealed that, as compared to recommendations of the food guide pyramid, daily mean intakes of various food groups were as follows: Bread and cereal servings were close to recommended dietary values, for vegetables the values slightly exceeded minimum recommendations, for fruits these values were the same as those recommended, but the closer we got to the pyramid peak the similarity in servings decreased such that for meat and its alternatives, and dairy groups they were lower than those recommended. For fats and sweets the daily mean intakes were very high. Taking the above results into consideration, the importance of public education aiming at modification of current nutritional habits to fit in with a standard food guide pyramid is strongly recommended.

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Under-and over-reporting of energy intake is one of the well-known problems in dietary intake assessment. This study was conducted to assess the relationship of these factors to body mass index and lifestyle-related factors. Dietary data on 947 pariticipants (415 male and 532 female) of TLGS was collected using two 24-hour recalls by trained interviewers. Weight and height were measured by digital scale and tape meter according to standard protocols and recorded to the nearest 100gr and 1cm, respectively. Basal metabolic rate (BMR) was calculated. Under-normal-and over-reporting of energy intake was defined as EI: BMR<1.35, 1.35-2.39 AND >2.4, respectively. Means (±SD) of age were 37.3(±14.6) and 32.9(±13.6) for men and women, respectively. Men had higher EI: BMR than women (1.72±0.44 VS. 1.27±0.44, P<0.001). EI and EI: BMR were highest in the youngest age groups in both sexes. The prevalence of under-and over-reporting were %31 and %5, respectively. Fewer men than women underreported EI(%40 VS %19, P<0.001). The fraction of over-reporters was significantly higher in men than women (%7 VS. %3, P<0.05). EI: BMR was decreased with age. Under-reporters were older and had higher BMI than normal-reporters but their educational level did not differ significantly. Over-reporters were younger and had lower BMI than normal-reporters but their educational level did not differ significantly. Most of over-reporters had normal BMI. Smoking was more prevalent in over-reporters than normal ones (%28 VS %19 in men and %6 VS. 1% in women, P< 0.01). The results showed a high prevalence of misreporting of energy intake in our country and this phenomenon is related to age, obesity and smoking habits. These findings must be kept in mind in dietary assessments.

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Cardiovascular disease(CVD) is still a health and a social problem in our country. Major risk factors have been identified for CVD in different studies. Other surveys have mentioned some dietary and non-dietary factors related to these risk factors. The aim of this study was to determine the predictors of CVD risk factors in distinct 13 of Tehran. Dietary intake assessment was undertaken with 2-day 24-hour recall in 486 cases older than 20 who participated in Tehran Lipid and Glucose study after excluding the under-and over-reporters. The data about anthropometric, smoking, education level, blood pressure and the level of blood lipids was later obtained. To determine the predictors of CVD, stepwise linear regression was used. Based on the obtained results, BMI and WHR increased with age in women(P<0.01 and P<0.05 respectively). Distribution of people in different age groups was not equal in terms of smoking and education level. Results showed a strong and positive relation between BMI and carbohydrate intake with serum triglyceride(P<0.05, β=0.7, P<0.05, β=2.4) respectively. Furthermore, there was a strong and positive relation between LDL and weight(P<0.05, β=1.1), LDL and age(P<0.05, β=1.6) and LDL and cholestrol(P<0.01, β=0.7). Thus, it can be concluded that there is relation between some dietary and non-dietary factors with CVD risk factors. Considering these relations is important in prevention and reduction of CVD.

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Healthy eating index(HEI) has been developed to track the quality of diet in different societies. The aim of this study was to determine the HEI score and its relation with nutrients intake and the number of servings from each food group in adolescents residing in district 13 of Tehran. The present study, which was conducted within the framework of Tehran lipid and glucose study(TLGS) and was part of a dietary intake assessment, was carried out according to the food guide pyramid of individuals residing in district 13 of Tehran. In this study 465 adolescents, aged 10-18 years old, were chosen. Dietary intake assessment was undertaken with 2-day 24-hour recalls. HEI was calculated based on 9 components (food guide pyramid groups: components 1 to 5, the precent of fat and saturated fatty acid intake, cholesterol consumption: components 6 to 8 and dietary variety score: component 9). The score range of each component was 0 to 10 and therefore, the sum score of this index was 90. Also, HEI score was modified with regard to HEI of previous studies. Dietary variety score was determined according to the number of consumed foods in the sample size of this study. The HEI score was categorized into three groups: less than 45(poor diet), 45-72(needs improvement) and more than 72 (good diet). Partial correlation was used to show the relation between HEI score and nutrients intake and the number of servings from each food group. The score of each component was calculated and grouped into three categories: <5, 5-8 and >8. The percentage of people according to each component of HEI was determined. The mean score of HEI was 64.9±9.6 in boys and 64.8±9.4 in girls. The results showed that the serving number of food groups in those with good diet was significantly higher than two other groups(P<0.001). On the contrary, the percent of saturated fat intake and cholesterol consumption in those with HEI>72 was lower than other groups(P<0.001). Approximately all nutrients intake and number of food items in adolescents with HEI score>72 was significantly more than others(P<0.001). There was a significant positive correlation between the serving number of grain group(r=0.2, P<0.001), vegetable(r=0.3, P<0.001), fruit(r=0.2, P<0.001), dairy(r=0.3, P<0.001), meat(r=0.1, P<0.001) and HEI. There was a significant negative correlation between fat intake score(r=-0.2, P<0.001), percent of saturated fatty acids(r=-0.1, P<0.05) and cholesterol consumption(r=-0.1, P<0.05) and HEI score. The number of food items had a strong significant positive correlation with HEI(r=0.5, P<0.001). There was a significant positive correlation between HEI and nutrients intake. The results showed that 74% of adolescent’s diet needed improvement, 23% was good and 3% was poor. In conclusion, HEI is an appropriate tool for assessment of diet quality in adolescents and since the diets of most adolescents need improvement, nutrition education is necessary in this age group.

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    Background & Objective: This study was carried out to examine the relationship between the scores of various food groups and the adequacy of specific nutrients in Tehrani women.

Method: In this cross-sectional study, 286 females aged 18 and over from district 13 in Tehran — chosen as representatives for Tehrani female population — participated. We assessed their food intake through a validated semi-quantitative food frequency and two 24-hour recall questionnaire. Two different dietary diversity indices named dietary diversity score (DDS) and food variety score were used. Mean adequacy ratio(MAR), i.e. the mean ratio of intake to recommended amount of 12 nutrients and their calories, was calculated as an indicator of nutrient adequacy.

Results: The mean ± SD of age and body mass index was 41±13 years and 27±4 kg/m² respectively. The mean of DDS was measured to be 6.11± 1.02. DDS correlated with MAR(r=0.4, p<0.05), the NAR (Nutrient Adequacy Ratio) of Thiamine(r=0.3, p<0.05), vitamin A(r=0.4, p<0.05), Calcium(r=0.4, p<0.05), Phosphorus(r=0.4, p<0.05) and total intake of fat(r=0.3, p<0.05). Variety of whole grains correlated mostly with the NAR of protein(r=0.3, p<0.05). Variety of vegetables and fruits had the highest correlation with the NAR of vitamin C(r=0.3, p<0.05) as well as vitamin A(r=0.3, p<0.05). In the forth quartile of variety score of food groups, the intake of most macro-and micro-nutrients made the highest amount. Variety score of meat and milk was the most important predictor of MAR.

Conclusion: Variety of different food groups is a useful indicator of specific nutrients adequacy. Hence to determine the adequacy of a specific nutrient, the variety score of specific food groups can be considered.

 

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    Background & Aim: There are so far few comparisons of the prevalence of obesity according to the type of definitions and, therefore, more reports are required to show the diversity of obesity patterns across countries with different economic development and cultural background. The objective of the present study was to assess the prevalence and trends in overweight among Iranian children and adolescents using three different definitions. Patients & Methods: Anthropometric measurements were assessed in two population-based cross-sectional studies of children and adolescents aged 3-19y in 1998(n=4528) and 2001-2002(n=2037) within the framework of Tehran Lipid and Glucose Study. Overweight was defined as ≥95th percentile of BMI for age and sex based on: 1) standardized percentile curves of body mass index(BMI) suggested for Iranian children and adolescents, and 2) 2000 centers for disease control and prevention growth charts. The prevalence of overweight using age-and sex-specific cut-points suggested by International Obesity Task Force(IOTF) was also estimated. Results: Using Iranian cut-points, the prevalence of overweight was approximately 3% for 3-5y and 12% for 6-11y and 12-19y in 1998. These estimates rose to 4, 19 and 16%, respectively, in 2001-2002. Using CDC2000 cut-points, the prevalence of overweight among age categories of 3-5, 6-11 and 12-19y were approximately 3.5, 6 and 7%, respectively, in 1998, which rose to 6, 10 and 9%, respectively, in 2001-2002. Overweight, as defined by IOTF cut-points, was prevalent among 2% of 3-5y, 4% of 6-11y and 5% of 12-19y in 1998, which increased to 4%(P=0.20), 6%(P=0.02) and 7%(P=0.01), respectively, in 2001-2002. In the age categories of 6-11 and 12-19y, estimates obtained from Iranian cut-points were higher than those obtained by using CDC2000 or IOTF, whereas in the 3-5 age category, there was no significant difference between the estimates obtained from Iranian cut-points and those estimated by CDC2000 or IOTF. Conclusion: The prevalence of overweight among Iranian children is increasing. Our findings also reflect the difference in prevalence estimates based on different definitions.

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    Background & Aim: There are many articles on the association between β3-adrenoreceptor gene polymorphisms and obesity. The aim of this study was to investigate the association between β3-adrenoreceptor gene polymorphism and serum concentration of Leptin with body mass index(BMI). Materials and Methods: The study was cross-sectional. Participants of Tehran Lipid and Glucose Study were divided on the basis of BMI in four groups: BMI<20, 20≤BMI<25, 25≤BMI<30, BMI≥30. Totally 401 subjects(mean age 44±14 years)[197 men(46±14 years), 204 women(42±13 years)] were selected randomly each group including 97, 98, 104 and 102 subjects, respectively. Leptin level was determined by Enzyme immuno assay(EIA) method and FBS, HDL-C, Triglyceride and Total Cholesterol levels were determined by Enzyme colorimetric method. Factors including Body mass index and blood pressure were measured too. A 210 bp fragment of mentioned gene was amplified using PCR and subject's genotyping in Tehran Lipid and Glucose Study population was determined by RFLP(MvaI, restriction enzyme) method. Data were analyzed using the T-test. We used one-way ANOVA test followed by post hoc multiple comparison(Tukey) between four BMI groups and also between two groups, of AA/TA(arg Carrier) and TT(Arg non Carrier). All data were analyzed using SPSS 11.5. Results: The A(Arg) allele frequency was 0.08 among the population and satisfied Hardy-Weinberg equilibrium. Presence of A(Arg) allele was significantly associated with increase of the BMI(AA/TA, 27±6kg/m2 TT, 25±5 kg/m2 P=0.043) and increase serum Leptin level(AA/TA, 30±25mg/dl TT, 23±21 mg/dl P=0.009). Conclusion: These data showed the association between Trp64Arg polymorphism of β3-adrenoreceptor gene with increasing BMI and Leptin level.

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    Background & Aim: In epidemiologic studies, food frequency questionnaire (FFQ) is usually the most suitable dietary assessment tool on a long-term basis. Hence assessing its validity and reproducibility  is conceptually important to determine the accurate relationship between diet and diseases. The current study was done to examine the relative validity and reproducibility of food groups of the semi-quantitative FFQ, developed for the Tehran Lipid and Glucose Study (TLGS).

Patients and Method: This study investigated 132 subjects (61 men and 71 women), aged ≥ 20 years who completed a 168-item FFQ twice (FFQ1-FFQ2), with a 14-month interval. Dietary data were collected monthly by means of twelve 24-hour dietary recalls. The

Results: Means (SD) for age and body mass index of subjects were 35.5 (±16.8) years and 25.5 (±5.2) kg/m² respectively. In order to assess validity of the FFQ, age-adjusted and deattenuated Spearman correlation coefficients were performed. Coefficients ranged between 0.10 (solid fat) and 0.77 (refined sugar) in men (mean=0.44), and between 0.12 (snacks) and 0.79 (refined sugar) in women (mean= 0.42). Mean age-and energy-adjusted intraclass correlation coefficients, assessing reproducibility of the FFQ, were 0.51 in men, highest for tea (0.91), and 0.59 in women, highest for refined sugar (0.74). Mean percentages of disagreement were 7.3 in men and 9.3 in women, the highest percentage being observed for snacks and desserts in men and for tea and coffee in women.

Conclusion: The FFQ designed for TLGS was found to be reliable and valid for several food groups.

first DR

was collected one month after FFQ1 and the

last DR

was collected one month before FFQ2. Food items were categorized into 17 food groups based on the previous studies. The residual method was used to calculate energy and age-adjusted food group intakes. Spearman and deattenuated correlation coefficients and Chi-square test based on tertiles of food group intakes were used to determine the relative validity between the second FFQ and 24-hour DRs, and intraclass correlation coefficients were calculated between FFQ1 and FFQ2 to assess the reproducibility of the FFQ.