Publications by authors named "Hamed Pouraram"

21 Publications

  • Page 1 of 1

Iranian population exposures to heavy metals, PAHs, and pesticides and their intake routes: a study protocol of a national population health survey.

Environ Sci Pollut Res Int 2021 Apr 4;28(13):16744-16753. Epub 2021 Jan 4.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Cancer is the second leading cause of death in the world and the third leading cause of death in Iran. It has been proven that numerous cancer cases are caused by exposure to environmental pollutants. There is a public health concern regarding an increase in exposure to carcinogens across Iran through different sources (air, food, and water) and a lack of research to address this issue. This study aims to gather data on exposure to heavy metals, polycyclic aromatic hydrocarbons (PAHs), and pesticides and their intake routes during the implementation of a national population health survey. This is a cross-sectional study of environmental pollutants in Iran, with a stratified multi-stage random sampling method, which led to 660 nationally representative samples in 132 clusters in three sequential parts. The first will be questionnaires to obtain demographics, assets, food records, air quality, and food frequency. The second will be physical measurements, including anthropometric and body composition. The third will be lab assessments that measure 26 types of environmental pollutants (7 heavy metals, 16 PAHs, and 3 pesticides) in urine, inhaled air, and consumed food and water of the population under study using ICP-MS and GS-MS devices. The results of this study will inform policymakers and the general population regarding the level of threat and will provide evidence for the development of interventional and observatory plans on the reduction of exposures to these pollutants. It could also be used to develop local standards to control contaminants through the three exposure routes. This study protocol will obtain data needed for policymakers to set surveillance systems for these pollutants at the national and provincial level to address the public concerns regarding the contamination of food, air, and water.
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http://dx.doi.org/10.1007/s11356-020-12004-3DOI Listing
April 2021

Glycemic Index (GI) Values for Major Sources of Dietary Carbohydrates in Iran.

Int J Endocrinol Metab 2020 Jul 27;18(3):e99793. Epub 2020 Jun 27.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Background: The glycemic index (GI) values of staple foods are not available in a standardized method in Iran.

Objectives: The aim of this study was to measure the GI values of the major carbohydrate sources in a typical Iranian diet.

Methods: Using the international standard method, the GI values were determined for four wheat flatbreads, barley and rye bread, white and brown rice, as well as white and brown rice mixed with lentils. Twelve healthy adults were given 50 g anhydrous glucose three times (as the reference carbohydrate) and the test foods once each throughout the study. Using finger-prick blood samples, capillary blood glucose was measured using a reliable glucometer. The GI was calculated using the trapezoidal method.

Results: The GI values of the following types of bread were: Barley 66, Lavash 72, Taftoon 79, Sangak 82, rye 84, and Barbari 99. The GI values for brown and white rice were 65 and 71, respectively. The mixture of brown rice with lentils had a GI value of 55, and the mixture of white rice with lentils had a GI of 79.

Conclusions: The most common types of bread and white rice consumed in Iran have high GI values. There is potential to reduce the overall GI values in the Iranian diet by encouraging the consumption of barley bread and brown rice.
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http://dx.doi.org/10.5812/ijem.99793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695225PMC
July 2020

Discretionary Salt Intake and Readiness for Behavioral Change Among Women in Tehran.

Int J Prev Med 2019 9;10:167. Epub 2019 Oct 9.

Department of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Since women's readiness for dietary behavioral change can be one of the most effective fundamental measures for reducing dietary salt intake in line with preventing chronic diseases in developing countries, the present study is aimed to determine the readiness for behavioral change in discretionary salt intake among women living in Tehran.

Methods: The present cross-sectional study was conducted on 561 women referring to the women care units across city of Tehran. The self-administered questionnaire included assessment of nutrition-related knowledge on salt intake and its association with diseases, discretionary salt intake, stages of change, and self-efficacy of women. In addition, the logistic regression test was used to determine the predictors of women's readiness for behavioral change in discretionary salt intake.

Results: 40% women had someone in the family who had such a limitation (salt intake-limited exposure group), while 81.6% always or often added salt to their foods. Moreover, one-third of the participants were in the stage of pre-contemplation and 41.2% were in the stage of preparation for reducing salt intake. Self-efficacy and salt intake-limited exposure were the two most important determinants of the women's readiness for behavioral change in discretionary salt intake, respectively: (OR = 1.1 95% CI: 1.06--1.14 < 0.001; OR = 1.58, 95% CI: 1.03--2.42 < 0.03).

Conclusions: Results of the present study showed that increased self-efficacy is associated with higher levels of behavioral change among women. Since self-efficacy is very important for initiating and maintaining the behavioral change, women's empowerment for reducing salt intake necessitates putting the emphasis on increased self-efficacy as well as community-based nutritional interventions.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_523_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826771PMC
October 2019

Policy analysis of salt reduction in bread in Iran.

AIMS Public Health 2019 9;6(4):534-545. Epub 2019 Dec 9.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Given that average salt intake among Iranians is approximately 10-15 g per day particularly from sodium hidden in bread, cheese, and fast food; lowering this mineral has been followed up seriously in this country for almost 10 years (since 2009). The main objective of the present study was to provide an opportunity to recognize unwanted and unfavorable outcomes of implementing decisions and policies together with associated problems of salt reduction in bread in order to achieve national and global health promotion goals. Thus, this qualitative and retrospective policy analysis was completed to evaluate the policy of salt reduction in bread in Iran. To collect the data, the researchers traveled to six cities in different regions, wherein relevant documents were utilized added to interviews with key actors. Related websites were correspondingly searched to find reports on this policy. Moreover, the researchers referred to some organizations in-person to search documents in this area. Five group discussions were also held to obtain public opinions in this regard. Data analysis was further carried out using framework analysis. The findings revealed that allocation of the highest rates of subsidy to wheat, flour, and bread had led to elimination of competitiveness in wheat, flour, and bread supply chain in Iran. Despite the presence of proper structures as coordinators of other organizations working on public health, there was no intersectoral collaboration in terms of maintaining health of bread products and lowering salt content in this staple food. With regard to changes in priorities of the Iranian Ministry of Health and Medical Education, attempts made to improve bread quality had also failed. In addition, first-line staff (i.e. bakers) had viewed formulation and implementation of the given policy as a top-down one. Given the ambiguities in establishment of new standards, there were similarly contradictions in execution of the policy at various levels. With reference to education provided at a national level, it was concluded that some people had become more sensitive to salt reduction in bread to some extent.
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http://dx.doi.org/10.3934/publichealth.2019.4.534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940570PMC
December 2019

The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children.

Eat Weight Disord 2021 Feb 3;26(1):211-218. Epub 2020 Jan 3.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.

Purpose: Wasting is a main indicator of Child's undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years.

Methods: This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < - 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated.

Results: The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27-0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34-0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31-0.91).

Conclusion: The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders.

Level Of Evidence: Level III, case-control analytic studies.
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http://dx.doi.org/10.1007/s40519-019-00834-1DOI Listing
February 2021

Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study.

Int J Vitam Nutr Res 2021 Jan 1;91(1-2):48-55. Epub 2019 Jul 1.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P < 0.05). After adjusting for potential confounders, adherence to AHEI-2010 was not significantly associated with a reduced risk of stroke (OR: 0.92; 95% CI: 0.56-1.51). We found that adherence to AHEI-2010 was not associated with risk of stroke in Iranian adults. Further prospective studies are warranted to validate this finding and clarify the relationship between whole diet and stroke.
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http://dx.doi.org/10.1024/0300-9831/a000603DOI Listing
January 2021

The effect of melatonin supplementation on lipid profile and anthropometric indices: A systematic review and meta-analysis of clinical trials.

Diabetes Metab Syndr 2019 May - Jun;13(3):1901-1910. Epub 2019 Apr 23.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Epidemiological evidence suggests that melatonin has some effects on the serum lipid. However, these results are controversial. The aim of this systematic review and meta-analysis is to examine the effect of melatonin supplement on dyslipidemia and anthropometric indices.

Methods: We searched electronic databases including Medline, Embase, Scopus, Web of Science and Cochrane Library up to Des 2018 without any language restriction. To compare the effects of melatonin with placebo, differences in standardized means difference (SMD) with 95% confidence intervals (95% CI) were pooled using random effects model.

Results: Twelve trials including 641 participants included in meta-analysis finally. The dose of melatonin was reported at 0.8-30 mg. Comparing with the control group, melatonin may improve low density lipoprotein cholesterol (LDL-C) (-0.31 mmol/L, 95% CI (-0.61, 0.01), P = 0.049, I2 = 42%) and triglyceride (TG) level (SMD = -0.45 mmol/L; 95% CI, -0.77, -0.13, P = 0.006, I2 = 47%). No significant effect of melatonin on high density lipoprotein cholesterol (HDL-C) and anthropometric indices was found.

Conclusions: The results of our systematic review and Meta-analyzes showed that supplementation of melatonin could be effective in improving lipid parameters and should be considered in the prevention of cardiovascular disease, although the effect of this supplement on anthropometric indices needs further investigation.
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http://dx.doi.org/10.1016/j.dsx.2019.04.043DOI Listing
December 2019

Association between dietary insulin index and load with obesity in adults.

Eur J Nutr 2020 Jun 30;59(4):1563-1575. Epub 2019 May 30.

Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: Hyperinsulinemia is linked to the development of various chronic diseases, especially obesity given to the role of insulin responses in body fat accumulation; hence, the current study aimed to examine the association of insulinemic potential of the diet with general and abdominal obesity among a large population of Iranian adults.

Methods: This cross-sectional study was carried out among 8691 adult participants aged 18-55 years. Dietary data were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. Dietary insulin index (DII) was computed through considering food insulin index values published earlier. Dietary insulin load (DIL) was also calculated using a standard formula. Assessment of anthropometric measures was conducted through a self-administered questionnaire. General obesity was defined as body mass index ≥ 25 kg/m, and abdominal obesity as waist circumference ≥ 94 cm for men and ≥ 80 cm for women.

Results: Mean age of study participants was 36.8 ± 8.1 years; 60.3% were women. Compared with the lowest quintile, women in the highest quintile of DIL were less likely to be abdominally obese (OR 0.73; 95% CI 0.57-0.92). Such significant association was not seen after controlling for potential confounders (OR 0.86; 95% CI 0.44-1.67). Neither in crude nor in adjusted models, we observed a significant association between DIL and general obesity among men and women. In terms of dietary insulin index, men in the top quintile of DII were more likely to be generally overweight or obese compared with those in the bottom quintile (OR 1.27; 95% CI 1.00-1.62). This association became non-significant after controlling for demographic characteristics (OR 1.14; 95% CI 0.84-1.56). Furthermore, in thefully adjusted model, women in the top quintile of DII were more likely to have general obesity compared with those in the bottom quintile (OR 1.40; 95% CI 1.07-1.84).

Conclusions: We found that adherence to a diet with a high DII was associated with greater odds of general obesity among women, but not in men. Although such information might help to draw conclusions on the practical relevance of the shown findings, further studies, specifically of prospective design, are warranted.
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http://dx.doi.org/10.1007/s00394-019-02012-6DOI Listing
June 2020

Serum Levels of Vitamin D, Retinol and Zinc in Relation to overweight among Toddlers: Findings from a National Study in Iran.

Arch Iran Med 2019 04 1;22(4):174-181. Epub 2019 Apr 1.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Background: Some studies have examined the association between micronutrient deficiencies and overweight in children, but data in this regard are conflicting. This study was done to investigate the association between serum levels of vitamin D, A and zinc with overweight in a large sample of Iranian toddlers.

Methods: A total of 4261 toddlers, aged 15-23 months, who had an Iranian birth certificate and attended primary health care, were included in the current cross-sectional study. Weight and height were measured by experts based on standard protocols and body mass index (BMI) was calculated. Based on WHO criteria, overweight was defined as BMI-z-score of ≥1SD. Serum levels of 25(OH)D3 , retinol and zinc were measured for each toddler. Binary logistic regression was applied to assess the association of 25(OH)D3 , retinol and zinc levels with overweight.

Results: Mean age of study participants was 19.2 ± 8.4 months. After controlling for potential confounders, children in the highest quartile of serum 25(OH)D3 levels had lower odds of overweight compared with those in the lowest quartile (OR: 0.79, 95% CI: 0.63-0.99). Furthermore, a marginally significant inverse association was found between serum levels of 25(OH)D3 and overweight among urban toddlers (OR: 0.75, 95%CI: 0.56-1.00). Such a relationship was not seen for rural children. No other significant association was seen between serum levels of retinol and zinc and overweight either before or after controlling for covariates.

Conclusion: In conclusion, we found a significant inverse association between serum levels of vitamin D and overweight among toddlers. Further studies, particularly of prospective nature, are required to confirm our findings.
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April 2019

Egg consumption and prevalence of psychological disorders in adults.

Eur J Nutr 2019 Aug 13;58(5):1923-1932. Epub 2018 Jun 13.

Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: No previous study has examined the associations between egg consumption and prevalence of psychological disorders. The present study was conducted to determine the association between egg consumption and depression in a large sample of Iranian adults.

Methods: This cross-sectional study was conducted on 3172 adults in Isfahan, Iran. Egg consumption was assessed by using a validated, self-administered, dish-based, semi-quantitative food frequency questionnaire. The Iranian validated version of Hospital Anxiety and Depression Scale was used to screen for anxiety and depression. The Iranian validated version of General Health Questionnaire with 12 items was used to assess psychological distress. Depression, anxiety and psychological distress were defined according to standard criteria.

Results: The mean age of the study participants was 36.5 ± 7.9 years. Depression, anxiety and psychological distress were prevalent among 28.4, 13.6 and 23% of the study subjects, respectively. After controlling for potential confounders, no significant association was observed between egg intake and depression (OR for comparing extreme quartiles: 1.08; 95% CIs 0.80-1.45) and anxiety (OR 0.79; 95% CIs 0.54-1.16), as well as psychological distress (OR 1.03; 95% CIs 0.76-1.41) in the whole population. In men, significant positive associations were observed between egg intake and depression before controlling for BMI (OR 1.68; 95% CIs 1.01-2.80); however, the associations became non-significant after taking BMI into account (OR 1.62; 95% CIs 0.96-2.72).

Conclusions: We found no significant association between egg intake and psychological disorders. Further studies, in particular of prospective design, are warranted.
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http://dx.doi.org/10.1007/s00394-018-1739-5DOI Listing
August 2019

Second National Integrated Micronutrient Survey in Iran: Study Design and Preliminary Findings.

Arch Iran Med 2018 04 1;21(4):137-144. Epub 2018 Apr 1.

School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: The main objective of the Second National Integrated Micronutrient Survey (NIMS-II) was to assess the nutritional status of four micronutrients, namely iron, zinc, and vitamins A and D, and also to conduct an anthropometric assessment of selected groups of children, adolescents, pregnant women, and adults, disaggregated by sex and residential area in nationally representative samples. This paper reports the design of the study along with preliminary findings.

Methods: In this study, 32 770 individuals were selected by using single-stage cluster sampling. Venous blood samples were collected on site for laboratory analysis; interviews were conducted, and anthropometric measurements were performed.

Results: The prevalence of anemia was highest (17.1%) among 15- to 23-month-old children; vitamin A deficiency was 18.3% in this age group. As regards iron deficiency anemia, the prevalence in all age/sex groups was less than 5%, ranging from 0.5% in 6-year-old children to 4.2% in 15- to 23-month-old children. Zinc and vitamin D deficiencies were highest among pregnant women (8% and 85.3%, respectively). Finally, the prevalence of overweight and obesity among adults was 40.3% and 29.2%, respectively.

Conclusion: Results of this study can help in designing nutritional intervention programs for nationwide implementation. Of all micronutrient deficiencies, vitamin D deficiency was the most prevalent in all study groups. Thus, appropriate actions should be taken in our community.
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April 2018

An Explanation for Variation in Age at Menopause in Developing Countries Based on the Second National Integrated Micronutrient Survey in Iran.

Arch Iran Med 2017 Jun;20(6):361-367

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: It is reported that women in developing countries reach menopause earlier compared to developed countries. This seems to be due to underestimation of age at menopause as pre-menopause women who will reach menopause at older ages are commonly excluded in cross-sectional settings. In this study, we propose an estimation method which can deal with this bias. We also assessed major determinants of menopause.

Methods: The second national integrated micronutrient survey in Iran completed in 2015 is a population-based study with a nationally representative sample of 4,898 Iranian women aged 50 to 60 years. We used data on menopause status and menopausal age (asked retrospectively) to estimate the median survival time. We also used Logistic regression to model menopausal status on the current age and to estimate the median age, at which 50% of women will experience menopause. Demographic, lifestyle, and anthropometric determinants were also examined.

Results: The estimated age at menopause was 51.2 (51.0-51.3) years in the logistic model and 50.5 (48.1, 53.7) years in survival analysis. In both models, the age at menopause was significantly lower among rural and underweight women. In addition, survival analysis showed that smokers and women with smaller family size had significantly lower age at menopause.

Conclusion: While many studies stress a gap in age at menopause between developed and developing countries, this study with a reliable estimation method showed that such a gap might originate from an underestimation of age at menopause in developing countries rather than a real difference.
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http://dx.doi.org/0172006/AIM.008DOI Listing
June 2017

Strategies and Opportunities Ahead to Reduce Salt Intake.

Arch Iran Med 2016 Oct;19(10):729-734

Non-Communicable Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

In Iran, as in most countries, cardiovascular diseases are the leading cause of death (highest mortality rate), but rank third in terms of disease burden. On the other hand, the relationship between high salt intake, hypertension, and cardiovascular disease has been proven. Food consumption pattern in Iran shows that consumption of salt, pickled foods and salty snacks is common. Regarding the World Health Organization (WHO) target for salt intake (about 5 g per day), the evidence indicates that Iranian people consume 2-3 times more than the recommended amount of salt. Fortunately, serious attention has been paid to this matter since 2009 and along with arrangements for it, support of all relevant sectors (public and private) has been included in the agenda. At present, reduction of salt intake is among the major priorities of planners, policy makers, and experts of the Iranian health services system. On the other hand, many studies in EMRO have shown high levels of daily salt intake in these countries. In this review, the solutions used in the Islamic Republic of Iran at various levels were considered, including determination of salt intake measurement methods, revision in the amount of salt in processed food products, food labeling, promoting awareness of various social groups, gathering support from all relevant sectors, designing a regular public awareness campaign for reducing salt intake, and lessons learned in this regard, that can be helpful to countries in the region.
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http://dx.doi.org/0161910/AIM.0011DOI Listing
October 2016

Community Interventional Trial (CITFOMIST) of Vitamin D Fortified Versus Non-fortified Milk on Serum Levels of 25(OH) D in the Students of Tehran.

Arch Iran Med 2015 May;18(5):272-6

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: As prevention of osteoporosis becomes more imperative with the global ageing of the population, establishing different measures to fight vitamin D deficiency will also become increasingly important. The aim of this study is to help assess the efficacy of vitamin D-fortified milk on circulating concentrations of 25(OH)D (as the primary outcome), a widely accepted indicator of vitamin D status, in Tehran students. Another objective of the protocol is to help assess the compliance with fortified dairy in students of different socioeconomic classes.

Method: The cluster-randomized trial (CITFOMIST) is conducted on 15- to19-year olds guidance and high school students of both genders from different districts of Tehran, in wintertime. The schools enrolled in this study are randomly assigned to receive one of the three groups of milk (whole milk, milk that contained 600 IU Vit D/1000cc, or milk that contained 1000 IU Vit D /1000cc) for a 30-day period. In order to study the effect of vitamin D-fortified milk on the circulating concentrations of 25(OH) D, a serum vitamin D levels are checked in a subgroup before and after the intervention.

Conclusion: There are few data on the efficacy of incremental doses of vitamin D from fortified foods among adolescents. This is while developing an optimal model to fight vitamin D deficiency needs further research on bone health outcomes and the safety of vitamin D-fortified products. The modified version of this protocol could be applied in different parts of the country to assess the efficacy of a vitamin-D product.
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http://dx.doi.org/0151805/AIM.004DOI Listing
May 2015

Iron-fortified flour: can it induce lipid peroxidation?

Int J Food Sci Nutr 2014 Aug 24;65(5):649-54. Epub 2014 Mar 24.

Department of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences , Tehran , Islamic Republic of Iran .

This community-based study was conducted to evaluate the effects of iron-fortified bread consumption on certain biomarkers of oxidative stress in an apparently healthy population. Evaluation of food intake, anthropometric and laboratory variables was performed in the beginning and after the 8-month intervention for all participants. There was no significant change in oxidative stress biomarkers in women following 8 months intervention. However, in men, final values of total antioxidant capacity, compared to the initial ones, showed a significant decrease in (p = 0.01) which was accompanied by a significant increase in superoxide dismutase (p = 0.002). It could be concluded that although the short-term period (8 months) of extra iron intake did not show severe effects of lipid per oxidation, significant changes of serum iron and some oxidative stress indices suggested that fortification of flour with iron among non-anemic adults in the long term was not without adverse effects.
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http://dx.doi.org/10.3109/09637486.2014.898254DOI Listing
August 2014

Advocacy strategies and action plans for reducing salt intake in Iran.

Arch Iran Med 2012 May;15(5):320-4

Department of Nutrition, Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/012155/AIM.0015DOI Listing
May 2012

Long-term consequences of iron-fortified flour consumption in nonanemic men.

Ann Nutr Metab 2012 17;60(2):115-21. Epub 2012 Mar 17.

Institute of Nutritional Sciences, University of Vienna, Vienna, Austria.

Background/aims: Despite the advantages of fortifying flour with iron, there are still special concerns regarding the possible adverse effects of the extra iron consumed by nonanemic individuals. This study aimed to investigate the oxidative stress and iron status following 8 and 16 months of consumption of iron-fortified flour in nonanemic men.

Methods: In a before-and-after intervention study, 78 nonanemic apparently healthy 40- to 65-year-old men were randomly selected from Semnan, in the northeast of Iran. Data were collected at three time points. Evaluation of oxidative stress biomarkers as well as the assessment of iron status was performed in all three stages. After baseline data collection, the flour fortification program was started with 30 mg/kg iron as ferrous sulfate.

Results: After 16 months, serum iron levels had significantly increased from 102.9 ± 31.5 μg/dl (baseline) to 117.2 ± 29.8 μg/dl (p < 0.001). The mean total antioxidant capacity (1.71 ± 0.10 μM) was significantly lower than that at baseline (1.83 ± 0.17 μM; p < 0.01). Among other oxidative stress biomarkers, only superoxide dismutase and glutathione peroxidase activity increased significantly compared to the beginning of the study (p < 0.001 and p < 0.001, respectively). The results of this study did not show any symptoms of iron overload after 8 and 16 months.

Conclusions: Our data did not support the safety of flour fortification with 30 mg/kg iron as ferrous sulfate as a community-based approach to control iron deficiency in nonanemic healthy men.
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http://dx.doi.org/10.1159/000336184DOI Listing
August 2012

Development of fortified biscuit using NaFeEDTA.

J Sci Food Agric 2011 Aug 14;91(11):1984-9. Epub 2011 Apr 14.

Department of Food Technology Research, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Sodium iron ethylenediaminetetraacetic acetate (NaFeEDTA) is a promising iron fortificant for populations consuming high-phytate diets. It produces fewer organoleptic effects than other fortificants do, especially when the matrix of the food vehicle contains fat, and has a bioavailability two to four times higher than that of ferrous sulfate. This study investigated the effects of varying levels of NaFeEDTA (576-1152 mg kg(-1)) on the physicochemical and sensory characteristics of Petit Beurre biscuits.

Results: There were no significant differences in pH, ash, moisture and breaking strength values among all formulae. The iron content (7.2-14.4 mg per 100 g) of the biscuits increased with increasing fortificant level. During a 60 day storage period the peroxide value increased in both fortified and non-fortified formulae, especially after 28 days. The addition of NaFeEDTA had a significant (P < 0.05) effect on the colour, texture and flavour of fortified biscuits.

Conclusion: Based on the range proposed for the use of NaFeEDTA as a fortification agent (10 mg iron and 67 mg EDTA per person per day), the results of this study reveal that 720 mg kg(-1) NaFeEDTA (9 mg iron per 100 g) is the optimum level for iron fortification in Petit Beurre biscuits.
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http://dx.doi.org/10.1002/jsfa.4405DOI Listing
August 2011

Oxidative stress among non-anemic adults following flour fortification with iron: baseline data.

Ann Nutr Metab 2010 22;56(4):283-7. Epub 2010 Apr 22.

Institute of Nutritional Sciences, University of Vienna, Vienna, Austria.

Background: It has been suggested that food fortification might be an inexpensive, simple and effective way to control and prevent iron deficiency and its related anemia in many countries. Despite the advantages of this approach and the fact that it has been implemented in some provinces in Iran for more than 6 years, many scientists in the country worry about the negative aspects of the extra iron distributed among non-anemic persons in the community.

Objective: This study was designed to assess the effect of the flour fortification program on oxidative stress biomarkers and iron status among non-anemic 40- to 65-year-old adults.

Study Design: This study had a special design that was implemented in 3 different parts. The main and first part was a field study. We randomized 2 cities in 1 province. In each city, 200 volunteers (100 men and 100 women) were selected using a multi-stage stratified method. Examination and interview (filling out data collection forms) were the methods of data gathering. In each of the 3 phases, demographic, anthropometric, blood pressure, micro- and macronutrient intakes, physical activities, and some oxidative stress biomarkers were the main data that were gathered. The results of this study can help health policy makers in designing future interventions in the country based on food fortification.
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http://dx.doi.org/10.1159/000290421DOI Listing
October 2010

Flour fortification with iron: a mid-term evaluation.

Public Health 2008 Mar 23;122(3):313-21. Epub 2007 Jul 23.

Institute for Health Sciences Research, Tehran, Iran.

Objectives: Iron-deficiency anaemia is a major nutritional problem in Iran. A programme of flour fortification with iron was launched in 2001. A mid-term evaluation was conducted in 2004 to determine the effectiveness and coverage of this programme.

Methods: To determine the effectiveness of the program, a field trial was conducted in which blood hemoglobin and ferritin levels were measured in a sample population from Bushehr (intervention) and Fars (control) provinces. The target population was women aged 15-49 years. The coverage of the programme was determined using a cross-sectional study that measured iron content in samples of flour and bread from Bushehr province.

Results: Five hundred and sixty-seven and 296 women were studied in the intervention and control provinces, respectively. Women in the intervention province had a lower prevalence of low ferritin levels compared with women in the control province (P=0.04). Women from the two provinces did not differ in terms of haemoglobin levels and iron-deficiency anaemia. The coverage of fortified flour and bread was 100% and 99.7%, respectively.

Conclusions: This mid-term evaluation found that the iron fortification programme in Iran has only had a beneficial effect on the prevalence of low ferritin levels. The final evaluation is likely to provide more useful information regarding the effect of this programme on a number of anaemia indicators.
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http://dx.doi.org/10.1016/j.puhe.2007.05.002DOI Listing
March 2008

Is the Uniscale an appropriate mother-child scale?

Matern Child Health J 2007 Sep 27;11(5):411-6. Epub 2007 Feb 27.

Institute for Health Sciences Research, P.O. Box 13145-483, Tehran, Iran.

Objective: To determine the reliability and acceptability of the Uniscale.

Methods: Two studies were conducted from December 2000 to February 2001 in Iran. In the first study, weights of subjects were obtained using the Uniscale and compared with weights obtained from the currently used scale. The sample comprised pregnant women and children under 5 years old. The main measure was reliability, which was assessed by two indicators: intra-instrument error for each of the two scales, and inter-instrument error. The second study was a descriptive study designed to test providers' perceptions of acceptability of Uniscale measurements.

Results: In the first study, a total of 458 subjects participated in the study. Overall, mean values of repeated measurements using each of the scales (intra-instrument error) were not significantly different. There was no significant difference between the weight measurements of the two scales (inter-instrument error) when weighing children, but a significant difference was detected when weighing pregnant women (p < 0.001). In the second study, 54 providers were included. The proportions of providers who recommended use of the Uniscale for children under 2 years, children 2-5 years and pregnant women were 57%, 75% and 80%, respectively.

Conclusions: The Uniscale had the same accuracy as the current scale when weighing children. However, for use with adults, we suggest additional studies be conducted with increased training of providers because we found that measurements were influenced by individual variation in use. It is recommended that new versions of mother-child scales be developed that are more user friendly.
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http://dx.doi.org/10.1007/s10995-007-0188-1DOI Listing
September 2007