Hassan Eini-Zinab

Methyltetrahydrofolate vs Folic Acid Supplementation in Idiopathic Recurrent Miscarriage with Respect to Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms: A Randomized Controlled Trial.

Purpose To determine whether 5-methylenetetrahydrofolate (MTHF) is more effective than folic acid supplementation in treatment of recurrent abortion in different MTHFR gene C677T and A1298C polymorphisms. Methods A randomized, double blind, placebo-controlled trial conducted April 2011-September 2014 in recurrent abortion clinics in Tehran, Iran. The participants were women with three or more idiopathic recurrent abortion, aged 20 to 45 years. Two hundred and twenty eligible women who consented to participate were randomly assigned to receive either folic acid or 5-MTHF according to the stratified blocked randomization by age and the number of previous abortions. Participants took daily 1 mg 5-methylentetrahydrofolate or 1 mg folic acid from at least 8 weeks before conception to the 20th week of the pregnancy. The primary outcome was ongoing pregnancy rate at 20th week of pregnancy, and the secondary outcomes were serum folate and homocysteine at the baseline, after 8 weeks, and at the gestational age of 4, 8, 12, and 20 weeks, MTHFR gene C677T and A1298C polymorphisms. Results There was no significant difference in abortion rate between two groups. Serum folate increased significantly in both groups over time; these changes were significantly higher in the group receiving 5-MTHF than the group receiving folic acid (value = 2.39, p<00.1) and the result was the same by considering the time (value = 1.24, p<0.01). Plasma tHcys decreased significantly in both groups over time; however these changes were not significantly different between the groups (value = 0.01, p = 0.47). Conclusion The results do not support any beneficial effect of 5-MTHF vs. folate supplementation in women with recurrent abortion with any MTHFR C677T and/or A1298C polymorphism. Trial Registration ClinicalTrials.gov NCT01976676

Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups

ABSTRACT Objective. To study the association of weight status with food insecurity (FI) and socio-economic status (SES) in Azeri and Kurd ethnic groups living in Urmia city, North-Western Iran. Design. In this cross-sectional study, 723 participants (427 women and 296 men) aged 20–64 years old, from two ethnic groups (445 Azeri and 278 Kurd), were selected through a combination of cluster, random and systematic sampling methods. Demographic and socio-economic characteristics were assessed by a valid questionnaire, and household food security status was analyzed using an adapted household food insecurity access scale through face-to-face interviews at homes. General and central obesities were measured and evaluated using standard methods. Results. Based on the findings, moderate-to-severe FI, as well as low SES, was more dominant in Kurds, compared to Azeris. After adjusting for confounders, being female(OR = 4.33, CI 95%: 2.35–7.97) and moderate-to-severe FI (OR = 2.00, CI 95%: 1.01–3.97) in Azeris and being female (OR = 5.39, CI 95%: 2.28–12.23) and higher total cost of household/capita (OR = 1.005, CI 95%: 1.002–1.009) in Kurds were related to higher odds of general obesity while low (OR = 0.41, CI 95%: 0.18–0.91) and moderate(OR = 0.13, CI 95%: 0.02–0.60) education levels were linked to lower chance of general obesity. Furthermore, the chance of central obesity was lower in Azeris with high educational levels (OR = 0.64, CI 95%: 0.21–0.94), females (OR = 0.72, CI 95%: 0.34–0.86), home owners (OR = 0.56, CI 95%: 0.31–0.91) and females Kurds (OR = 0.60, CI 95%: 0.37–0.97) with moderate-to-severe FI and higher total income per capita. In contrast, the chance of central obesity increased in Kurds with increased age (OR = 1.06, CI 95%: 1.02–1.10) and total cost of household per capita (OR = 1.004, CI 95%: 1.000–1.008). Conclusion. These findings show that the association between moderate-to-severe FI and risk of general/central obesity varies in Azeris, compared to Kurds. However, better SES decreased the chance of general/central obesity in both ethnic groups.

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 mothers 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.

Concordance between self-reported body mass index with weight perception, self-rated health and appearance satisfaction in people living in Tehran.

BackgroundObesity is investigated as a health concern due to high prevalence in the world. Nowadays, researchers are looking for an indirect method to measure weight and height. Self-reported Body Mass Index (BMI) is ever more served as an alternative method for direct weight and height measurement. Misreporting is a usual concern in self-reported BMI, thus, this study set explored the association and degree of agreement of self-reported BMI with weight perception, Self-Rated Health (SRH), and appearance satisfaction in people living in Tehran, Iran.Methods722 men and women (268 men and 454 women) aged 30–64 years were selected using Cluster Multi-stage Sampling with the Probability Proportional to Size (PPS) method from each area. The questionnaire included demographic and socioeconomic variables and self-reported weight and height and questions related to weight and health perception, and appearance satisfaction. Independent samples T-test compared the mean of scales and differences in characteristics between BMI categories, analyzed using chi-square test. The Cohen’s kappa coefficient examined the association between self-reported BMI and weight perception, SRH, and appearance satisfaction.ResultsThe mean self-reported weight was 80.79 ± 12.87 in men and 68.33 ± 11.53 in women. The results of the agreement analysis for weight perception were Kappa = 0.38 with p < 0.0001 for women and Kappa = 0.23 with p <0.0001 for men. This measure of agreement, while statistically significant, is fair agreement. SRH and appearance satisfaction were not significantly correlated with self-reported BMI.ConclusionThe measurements of height and weight can cause significant imprecisions in calculation of BMI, which is used as a guide for identifying persons at risk of disease. Direct measurement of height and weight should be performed whenever possible for optimal measurements in clinical practice and clinically oriented researches.

Applying social marketing mix to identify consumers’ preferences towards functional dairy products in Iran

Purpose During the past few decades, production and marketing of functional foods has increased in many countries including Iran. Considering the fact that consumers’ preferences play an important role in the success of marketing a product to increase consumption, this study aims to fill the knowledge gap in this regard in Iran. Design/methodology/approach The theory of social marketing served as the framework of this study. Qualitative data were collected via eight semi-structured focus group discussions, between May and September 2014. Participants were 65 women (44 housewives and 21 employed women), aged 23-68 years, selected by purposeful sampling technique, considering maximum diversity. All focus group discussions were audio recorded and transcribed verbatim. Analysis of the qualitative content of the data was conducted using MAXQDA® software. Findings The findings showed that there were quite diverse preferences among studied women in regards to different aspects of a product and its social marketing strategies. The preferences toward functional dairy products were categorized in four main groups: characteristics of products including sensory and non-sensory characteristics; price; place of the product supply; and promotion strategies of products categorized in three subgroups of informing and educating, advertising and recommending. Originality/value This study is the first study in this regard in Iran. Given the novelty of functional dairy products in the market, the diversity of preferences should be considered both in production of dairy foods and their promotion plans. This understanding can contribute to success of interventions to increase consumption of these products among consumers.

Developing and validating a scale to measure Food and Nutrition Literacy (FNLIT) in elementary school children in Iran

Background Food and nutrition literacy is an emerging term which is increasingly used in policy and research. Though research in this area is growing, progression is limited by the lack of an accepted method to measure food and nutrition literacy. The aim of this study is to develop a valid and reliable questionnaire to assess food and nutrition literacy in elementary school children in the city of Tehran. Methods The study was conducted in three phases. To develop Food and Nutrition Literacy (FNLIT) questionnaire, a comprehensive literature review and a qualitative study were initially performed to identify food and nutrition literacy dimensions and its components. Content and face validity of the questionnaire were evaluated by an expert panel as well as students. In the second phase, construct validity of the scale was evaluated using Explanatory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA). In the last phase (confirmatory phase), the final version of the questionnaire was evaluated on 400 students. Results Findings show Content Validity Ratio (CVR) and Content Validity Index (CVI) of the 62-item questionnaire at acceptable levels of 0.87 and 0.92, respectively. EFA suggested a six-factor construct, namely, understanding food and nutrition information, knowledge, functional, interactive, food choice, and critical. The results of CFA indicated acceptable fit indices for the proposed models. All subscales demonstrated satisfactory internal consistency (Cronbach’s alpha≥0.70), except for critical skill subscale (0.48). The intraclass correlation coefficient (ICC = 0.90, CI: 0.83–0.94) indicated that Food and Nutrition Literacy (FNLIT) scale had satisfactory stability. Each phase of development progressively improved the questionnaire, which resulted in a 46-item (42 likert-type items and 4 true-false items) Food and Nutrition Literacy (FNLIT) scale. The questionnaire measured two domains with 6 subscales, including: 1) cognitive domain: understanding and knowledge; 2) skill domain: functional, food choice, interactive, and critical skills. Conclusion The developed food and nutrition literacy scale is a valid and reliable instrument to measure food and nutrition literacy in children. This measure lays a solid empirical and theoretical foundation for future research and tailored interventions to promote food and nutrition literacy in this age group.

A haplotype of three SNPs in FTO had a strong association with body composition and BMI in Iranian male adolescents

Background Single-nucleotide polymorphisms (SNPs), which are located in the first intron of the FTO gene, are reported to be associated with body weight and the body mass index (BMI). However, their effects on anthropometric measurements in adolescents are poorly understood. Objective This study aimed to investigate the association of three adjacent polymorphisms (rs9930506, rs9930501, & rs9932754) in the FTO gene with anthropometric indices in Iranian adolescent males. Design The participants comprised a total of 237 adolescent males who were recruited randomly from two high schools in Tehran, Iran. The DNA samples were genotyped for the FTO gene polymorphisms by DNA sequencing. BMI, body fat percentage (BF%), and body muscle percentage (BM%) were determined using a validated bioelectrical impedance analysis scale. The association of the FTO polymorphisms with weight, height, BMI, BF%, and BM% was investigated. Results A haplotype of rs9930506, rs9930501, and rs9932754 (GGT) in the first intron of the FTO with complete linkage disequilibrium (LD) was found to be significantly associated with higher weight (OR = 1.32), BMI (OR = 5.36) and BF% (OR = 1.46), and lower BM% (OR = 3.59) (all P<0.001). None of the students with GGC genotypes were underweight, while all of the students with AAT genotypes had high muscle mass. Conclusions A haplotype in the first intron of the FTO gene had a strong association with obesity indices in Iranian adolescent males. The FTO gene polymorphisms might have greater effects on anthropometric indices than what was previously imagined. Moreover, we suggested that the FTO gene exerted their effects on anthropometric measurements through haplotypes (and not single SNPs).

Food and nutrition literacy (FNLIT) and its predictors in primary schoolchildren in Iran

This study used a locally designed and validated questionnaire to describe the distribution of food and nutrition literacy (FNLIT) in a cross-sectional sample of 803 students aged 10-12 years from elementary schools in Tehran city, Iran. Logistic regression was used to assess the extent to which various independent covariates were associated with low FNLIT. The data were used to identify significant differences using a range of social and cultural variables relevant to the context of school students in Iran. The results of the study showed that although the total FNLIT level was good, this headline finding masked important differences in the sub-domains. More than half of the children (69%) had high levels of FNLIT in the cognitive domain, but in the skills domain, very few (3%) scored highly. The study also identified some associations between the total FNLIT and its subscales and sociodemographic variables including gender, parents education and age, birth order. These results highlighted groups within the school population who were at higher risk of having lower FNLIT levels. They also indicate that girls feel more able to exert choice and control over food and nutrition decisions than boys are but may be less able to do so in practice. Overall, these results are a general reminder to schools of the different learning needs of children from different family backgrounds. The article highlights the need for continuous improvement in the health education curriculum of schools in Iran, particularly highlighting the importance of giving greater attention to the development of practical food and nutrition skills alongside more traditional food and nutrition knowledge. Additional studies (with long-term follow-up) are needed to more fully assess and understand the predictors of FNLIT.

Combination of APACHE Scoring Systems with Adductor Pollicis Muscle Thickness for the Prediction of Mortality in Patients Who Spend More Than One Day in the Intensive Care Unit

Background The objective of the present study was to compare the ability of Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems with the combination of an anthropometric variable score “adductor pollicis muscle (APM) thickness” to the APACHE systems in predicting mortality in the intensive care unit. Methods A prospective observational study was conducted with the APM thickness in the dominant hand, and APACHE II and III scores were measured for each patient upon admission. Given scores for the APM thickness were added to APACHE score systems to make two composite scores of APACHE II-APM and APACHE III-APM. The accuracy of the two composite models and APACHE II and III systems in predicting mortality of patients was compared using the area under the ROC curve. Results Three hundred and four patients with the mean age of 54.75 ± 18.28 years were studied, of which 96 (31.57%) patients died. Median (interquartile range) of APACHE II and III scores was 15 (12–20) and 47 (33–66), respectively. Median (interquartile range) of APM thickness was 15 (12–17) mm, respectively. The area under the ROC curves for the prediction of mortality was 0.771 (95% CI: 0.715–0.827), 0.802 (95% CI: 0.751–0.854), 0.851 (95% CI: 0.807–0.896), and 0.865 (95% CI: 0.822–0.908) for APACHE II, APACHE III, APACHE II-APM, and APACHE III-APM, respectively. Conclusion Although improvements in the area under ROC curves were not statistically significant when the APM thickness added to the APACHE systems, but the numerical value added to AUCs are considerable.