Eda Köksal

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis

Objective/design We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. Setting/population Adult population in the Middle East by age, sex, country and time. Results Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. Conclusions Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

Metabolic syndrome (MS) in elderly: A cross sectional survey

This study was conducted to determine the prevalence of metabolic syndrome (MS) in Turkish elderly. All data were collected in a cross-sectional based survey on 266 elderly aged above 65 years living in capital city of Turkey, Ankara. MS was defined according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP ATP III) criteria. In the total sample of participants, the 61.7% (n=164) of the group has been diagnosed as MS. High blood pressure (BP) and waist circumference (WC) and low high density lipoprotein cholesterol (HDL-C) were the criteria of MS with highest prevalence in both gender. In addition female participants have higher systolic blood pressure (93.4%) and WC (79.1%) and lower HDL-C (69.2%) than the men (74.4%, 31.1% and 52.2% respectively). Weight correlated significantly with triglyceride (TG) and MS (p<0.001). WC was the anthropometric variable which had the highest correlation with the MS (r=0.338, p<0.001). Our study indicates that MS is highly prevalent in the elderly people particularly among women. Our findings may be helpful in formulating public health policies and prevention strategies focus on elderly population.

Relationship between dietary mineral intake and blood pressure (BP) in the elderly in Turkey

The aim of this study was to determine the relationship between daily dietary mineral (Na, K, Ca and Mg) intake and BP in the elderly. This study was conducted on 390 elderly volunteers (≥ 65 years). Subjects were randomly selected from the general population of Ankara, Turkey. Anthropometric measurements, lipid profiles, and mean systolic and diastolic BP (SBP and DBP) of all the participants were measured. To determine the mineral intake of the participants, food consumption was measured with a 24-h dietary recall. The 49.3% of participants were found to be hypertensive, 25.1% to be pre-hypertensive and 25.6% were normotensive according to the JNC-7 Guidelines, except for daily Mg and Na intake, the energy, macronutrient and micronutrient intake of groups were not significantly different (p>0.05). A significant inverse correlation between daily Ca intake and SBP was found in the pre-hypertensive group when age and gender adjusted regression analyses were performed (B=-0.006, p<0.05). Na intake and Na/K ratio were directly associated with SBP in the hypertensive group. In conclusion, SBP was found to be most related to dietary Na and Ca intake, and Na-to-K ratio in the elderly population.

Comparison of nutritional status in the elderly according to living situations

AimThis study aimed to evaluate the nutritional status of elderly individuals living alone and with their families.Participants and MethodThe sample of the study included 872 elderly individuals who agreed to participate in the study, were aged 65 or over, and lived in Ankara. The data were gathered from a survey, using face-to-face interviews. The Mini Nutritional Assessment (MNA) was used in evaluating each individual’s nutrition.ResultsThe rate of malnutrition in the study population was 5% while the malnutrition risk was 67%. The rate of malnutrition in the individuals living alone was found to be higher than that of those living with their families. The rates of malnutrition in individuals living alone and with their families were, respectively, 7% and 4%, and the rates of malnutrition risk in individuals living alone and with their families were, respectively, 73% and 66% (p<0.05). In both groups, there were significant relationships between individuals’ ages, BMI values, mid-upper arm circumference (MUAC), and calf circumference measurements and their MNA scores. While there was a negative and significant relationship between age and MNA scores, the relationships between other parameters and MNA scores were positive and significant (p<0.01).ConclusionIn this study, it was revealed that the nutrition of elderly individuals living alone differs from the nutrition of elderly individuals living with their families. Malnutrition rates were higher in individuals living alone. Raising the awareness of elderly people and their families regarding the need to improve and maintain nutrition would be beneficial.

The relationship between diet quality and insulin resistance in obese children: adaptation of the Healthy Lifestyle-Diet Index in Turkey

Abstract Background: Childhood obesity and its complications are serious health problems and diet/lifestyle changes can be beneficial for the prevention of diseases. Adaptation of the Healthy Lifestyle-Diet (HLD) Index in accordance with the dietary guidelines for Turkey (TR) and determination of the relationship between metabolic syndrome risk factors in obese children were the aims of this study. Methods: This study was conducted on 164 overweight or obese children (87 male, 77 female) aged 9–13 years. For all participants, the HLD-TR Index and a 24-h dietary recall were performed and the mean adequacy ratio (MAR) was calculated. Anthropometric measurements and the body composition of the children were taken. Metabolic syndrome risk factors and insulin resistance were assessed. Results: The mean age of the male and female children was 11.2±1.49 and 11.0±1.40 years, respectively. The majority of the children were obese in both genders. There were no statistically significant differences in the HLD-TR scores between the genders. As the index scores increased, a decrease in the energy intake and an increase in the MAR were observed. Negative correlations between the index scores and body mass, waist circumference and body fat mass were observed. Furthermore, a one-unit increase in the index score decreases the insulin resistance risk by 0.91 times after adjustments for age and gender (odds ratio: 0.91 [0.85–0.97]). Conclusions: The HLD-TR Index is a valid tool that can give an idea about the quality of the diet in obese children. Furthermore, with the increase in the compliance with recommendations for diet/lifestyle changes, indicators of obesity and metabolic syndrome were decreased.

Relationship between dietary caffeine intake and blood pressure in adults

Abstract The aim of this study was to determine the consumption frequency of caffeinated foods and beverages and daily caffeine consumption amounts, and examine relation between caffeine and blood pressure (BP). A cross sectional door-to-door interview was conducted with 1329 volunteers between the ages of 20 and 60 (mean ages 29.9 ± 10.8 years) and based in Ankara/Turkey. The rate of individuals whose BPs were above 140/90 mmHg was 13.5%. The median caffeine consumption was 150.0 ± 122.06 mg. Although no significant correlation was found between total caffeine intake and diastolic blood pressure (DBP) of individuals, a positive correlation was observed between daily total caffeine and systolic blood pressure (SBP) (p < .05). Also, when analyzed factors that could be associated with DBP and SBP, BMI had effect in the model formed for both types of BP (p < .05). While smoking status associated with SBP (p = .002), gender and waist circumference related to DBP (p < .05) As a result relationship between caffeine intake and BP was affected other factors.

Validity and reliability of beverage intake questionnaire: evaluating hydration status

OBJECTIVE The purpose of this investigation is to test the validity and reliability the assessment methods for the true beverage consumption of adults. METHODS This cross-sectional study was carried out 291 healthy volunteers. The beverage intake questionnaire (BIQ) was prepared in combination with a new one which is developed based on basic principles and the existing one developed for the beverages consumed the most with respect to frequency and amount by Turkish populations. During the initial visit the participants completed BIQ1 and then provided a urine sample to determine urinary specific gravity(USG). For validity, participants recorded the type and quantity of foods and beverages consumed on the same day and previous two days. Two weeks later, for reliability, participants completed the same beverage intake questionnaire (BIQ2). RESULTS Mean daily total fluid intake was estimated at 1,773 ± 49.4mL using the dietary intake record (DIR), 2,120 ± 49.5 mL with BIQ1 and 1,990 ± 46.3 mL for BIQ2. The largest contribution to total fluid intake was plain water. The response on the two assessment tools (DIR and BIQ1) all beverage intakes were significantly correlated (p < 0.01) except for alcoholic beverage intake. One could see a significant correlation between BIQ1 and BIQ2 in relation to total fluid intakes (r = 0.838,p < 0.01). The USG measurement was negatively correlated with three assessment tools (DIR, BIQ1 and BIQ2), the amount of plain water and the amount of total fluid intake. CONCLUSIONS The self-administered instrument described in this study may be useful for researchers interested in assessing habitual beverage consumption patterns or evaluating hydration status for adults.

Comparison of energy balance-related behaviours and measures of body composition between Turkish adolescents in Turkey and Turkish immigrant adolescents in the Netherlands

OBJECTIVE To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL). DESIGN Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study. SETTING Primary and secondary schools. SUBJECTS A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses. RESULTS Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents. CONCLUSIONS Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

Assessment of the Contribution of Dietary and Beverage Intake Quality to Obesity Development

ABSTRACT Objective: Low dietary quality is an important indicator of unhealthy eating patterns that can lead to some consequences such as obesity, so policy is a very powerful tool that can affect the consumption of both healthy and unhealthy foods. Indices that assess whether nutritional policies are applied contribute to the assessment of the quality of the populations diet. This study was conducted to investigate the quality of diets and beverages consumed by Turkish adults, and the factors affecting them. Method: This cross-sectional descriptive study was conducted on 352 adults aged between 18 and 58 years. The quality of diet and beverage was measured through the Healthy Eating Index-2010 (HEI) and Healthy Beverage Index (HBI), respectively, using 2-day (weekday and weekend) dietary recall data. Results: The total HBI scores were 79.1 ± 11.8 and 81.0 ± 11.6; total HEI-2010 scores were 45.9 ± 12.3 and 52.3 ± 11.0, of men and women, respectively (p < 0.05). The women had significantly higher scores than that of the men in the HEI-2010 subcomponent of empty calories (p > 0.05). Sugar-sweetened beverage (HBI subcomponent) was significantly correlated with the scores of HEI-2010 and empty calorie (HEI-2010 subcomponent), as expected (p < 0.01). The caloric beverages contributed ∼133.6 kcal/d to the total caloric intake. Conclusions: The mean contribution of beverages to total daily energy intake of participants was found to be at the suggestion level. This result is rewarding when the relationship of sugar-sweetened beverages scores with the scores of HEI and empty calories is considered.

Are breast milk adipokines affected by maternal dietary factors

Abstract Background Maternal diet and gestational age of infant may affect the composition of breast milk. The aim of this study was to evaluate the relationship between breast milk adiponectin and leptin levels of mothers delivering preterm and term infants and maternal diet. Methods Sixty-five mothers (31 preterm, 34 term) were included in the study. General information about parents and infants and food consumption of mothers were determined through a questionnaire. Milk samples were taken from mothers during the period between the 15th and 30th day after birth (mature milk). For the evaluation of maternal diet, the nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were used. Results According to MAR, 71.0% of preterm mothers’ and 79.4% of term mothers’ dietary adequacy was categorized as “good”, and none of the mothers fell into the “insufficient” category (p>0.05). The median (interquartile range [IQR]) level of adipokines was found to be higher in preterm than in term mothers (24.6 [14.3] ng/mL; 22.9 [9.7] ng/mL for adiponectin and 2.0 [2.5] ng/mL; 0.0 [2.3] ng/mL for leptin, respectively) (p>0.05). A negative correlation was found between the leptin level and intake of unsaturated fatty acids, protein NAR and meat, poultry and fish consumption in preterm mothers (p<0.05). A positive correlation was found between leptin concentration and MAR, protein, calcium, potassium NAR and consumption of dairy products in term mothers (p<0.05). In the regression model, gestational age and MAR are important predictors of leptin. Conclusions These results show that maternal diet is related to the leptin content in breast milk.