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1. Assessment of the reliability and acceptability of the Uniscale

Author: Sheikholeslam R., Sadighi J., Samadpour S., and Pouraram H.
Subjects: uniscale, reliability, acceptability, children, weight, Medicine, Medicine (General), R5-920
Abstract: Objective(s): Monitoring childrenchr('39')s weights using an appropriate scale is one practical way of assessing their nutritional status. This study examined the reliability and acceptability of the Uniscale, an instrument used for weighing mothers and children. Methods: This study was conducted from December 2000 to February 2001 within the Savojbolagh District Health System, Iran. In the first part of the study, weights of subjects in three groups were obtained using the Uniscale and compared with weights obtained from the currently used scales (current scales). The sample comprised pregnant women and children under 5 who visited the health centers. The main measure of interest was reliability, assessed by two indicators: intra-instrument error for each of the two types of scales, and inter• instrument error. The second part was a descriptive study to test providerschr('39') (health workerschr('39')) perceptions of the acceptability of Uniscale measurements. The main measure was acceptability, assessed by the frequency of problems with usage of the Uniscale and the recommendations by test providers regarding the use of Uniscale. Results: In the first section, a total of 458 clients participated in the study. Overall, mean values of repeated measurements with the two 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
Published: 2007

2. Mid-term evaluation: flour fortification with iron in Iran

Author: Sadighi J, Sheikholeslam R, Mohammad K, Pouraram H, Abdollahi Z, Samadpour S, Kolahdooz F, and Naghavi M
Subjects: anemia, iron deficiency, fortification, bread, flour, women, Medicine, Medicine (General), R5-920
Abstract: Objective(s): Iron deficiency anemia is one of the common nutritional problems in Iran. Therefore, the flour fortification with iron program was launched on May 2001, and mid-term evaluation conducted after 3 years (2004), focusing on effectiveness and coverage of the program. Methods: Two studies have been designed: Study 1: A field trial to determine effectiveness of the program. Locations of the study were the Bushehr province (intervention group) and three districts of Fars province (control group). Target populations were women aged 15-49 years. For all women, blood samples were taken to measure hemoglobin and ferritin. In addition, data were collected on potential confounding variables and adjustments were made using a logistic regression model. Study 2: A cross sectional study to determine program coverage in Bushehr province. In this study, we measured the iron in samples of bread consumed by households and also iron content of the flour in bakeries. Results: The results of this study showed that the coverage of fortified flour was 100% and the coverage of fortified bread at householdschr('39') level was 99.7% in Bushehr province. A total of 863 women (567 women in Bushehr province and 296 women in Fars) entered into the effectiveness study. The fortification program decreased the prevalence of low ferritin and iron deficiency anemia (low hemoglobin and low ferritin) among women. There were no significant changes in mean hemoglobin or in the prevalence of low hemoglobin. Conclusion: The findings of the mid-term evaluation of the flour fortification program in Iran demonstrated that the iron fortification program has beneficial effects. Flour fortification alone will not prevent iron deficiency anemia but it is an important component of a public health strategy. Therefore, more time and information are needed for interpreting the current trends in anemia indicators.
Published: 2005

3. Association of vitamin D, retinol and zinc deficiencies with stunting in toddlers: findings from a national study in Iran

Author: Sharif, Y., Sadeghi, O., Dorosty, A., Siassi, F., Jalali, M., Djazayery, A., Shokri, A., Mohammad, K., Parsaeian, M., Abdollahi, Z., Heshmat, R., Yarparvar, A., Pouraram, H., and Esmaillzadeh, A.
Published: 2020
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4. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Iurilli, M.L.C. Zhou, B. Bennett, J.E. Carrillo-Larco, R.M. Sophiea, M.K. Rodriguez-Martinez, A. Bixby, H. Solomon, B.D. Taddei, C. Danaei, G. Di Cesare, M. Stevens, G.A. Riley, L.M. Savin, S. Cowan, M.J. Bovet, P. Damasceno, A. Chirita-Emandi, A. Hayes, A.J. Ikeda, N. Jackson, R.T. Khang, Y.-H. Laxmaiah, A. Liu, J. Miranda, J.J. Saidi, O. Sebert, S. Sorić, M. Starc, G. Gregg, E.W. Abarca-Gómez, L. Abdeen, Z.A. Abdrakhmanova, S. Ghaffar, S.A. Rahim, H.F.A. Abu-Rmeileh, N.M. Garba, J.A. Acosta-Cazares, B. Adams, R.J. Aekplakorn, W. Afsana, K. Afzal, S. Agdeppa, I.A. Aghazadeh-Attari, J. Aguilar-Salinas, C.A. Agyemang, C. Ahmad, M.H. Ahmad, N.A. Ahmadi, A. Ahmadi, N. Ahmed, S.H. Ahrens, W. Aitmurzaeva, G. Ajlouni, K. Al-Hazzaa, H.M. Al-Lahou, B. Al-Raddadi, R. Alarouj, M. AlBuhairan, F. AlDhukair, S. Ali, M.M. Alkandari, A. Alkerwi, A. Allin, K. Alvarez-Pedrerol, M. Aly, E. Amarapurkar, D.N. Amiri, P. Amougou, N. Amouyel, P. Andersen, L.B. Anderssen, S.A. Ängquist, L. Anjana, R.M. Ansari-Moghaddam, A. Aounallah-Skhiri, H. Araújo, J. Ariansen, I. Aris, T. Arku, R.E. Arlappa, N. Aryal, K.K. Aspelund, T. Assah, F.K. Assunção, M.C.F. Aung, M.S. Auvinen, J. Mária Avdicová Avi, S. Azevedo, A. Azimi-Nezhad, M. Azizi, F. Azmin, M. Babu, B.V. Bæksgaard Jørgensen, M. Baharudin, A. Bahijri, S. Baker, J.L. Balakrishna, N. Bamoshmoosh, M. Banach, M. Bandosz, P. Banegas, J.R. Baran, J. Barbagallo, C.M. Barceló, A. Barkat, A. Barros, A.J.D. Barros, M.V.G. Basit, A. Bastos, J.L.D. Bata, I. Batieha, A.M. Batista, R.L. Battakova, Z. Batyrbek, A. Baur, L.A. Beaglehole, R. Bel-Serrat, S. Belavendra, A. Romdhane, H.B. Benedics, J. Benet, M. Bergh, I.H. Berkinbayev, S. Bernabe-Ortiz, A. Bernotiene, G. Bettiol, H. Bezerra, J. Bhagyalaxmi, A. Bharadwaj, S. Bhargava, S.K. Bhutta, Z.A. Bi, H. Bi, Y. Bia, D. Lele, E.C.B. Bikbov, M.M. Bista, B. Bjelica, D.J. Bjerregaard, P. Bjertness, E. Bjertness, M.B. Björkelund, C. Bloch, K.V. Blokstra, A. Bo, S. Bobak, M. Boddy, L.M. Boehm, B.O. Boeing, H. Boggia, J.G. Bogova, E. Boissonnet, C.P. Bojesen, S.E. Bonaccio, M. Bongard, V. Bonilla-Vargas, A. Bopp, M. Borghs, H. Braeckevelt, L. Braeckman, L. Bragt, M.C.E. Brajkovich, I. Branca, F. Breckenkamp, J. Breda, J. Brenner, H. Brewster, L.M. Brian, G.R. Brinduse, L. Brophy, S. Bruno, G. Bueno-de-Mesquita, H.B. Bugge, A. Buoncristiano, M. Burazeri, G. Burns, C. de León, A.C. Cacciottolo, J. Cai, H. Cama, T. Cameron, C. Camolas, J. Can, G. Candido, A.P.C. Cañete, F. Capanzana, M.V. Capková, N. Capuano, E. Capuano, V. Cardol, M. Cardoso, V.C. Carlsson, A.C. Carmuega, E. Carvalho, J. Casajús, J.A. Casanueva, F.F. Celikcan, E. Censi, L. Cervantes-Loaiza, M. Cesar, J.A. Chamukuttan, S. Chan, A.W. Chan, Q. Chaturvedi, H.K. Chaturvedi, N. Rahim, N.C.A. Chee, M.L. Chen, C.-J. Chen, F. Chen, H. Chen, S. Chen, Z. Cheng, C.-Y. Cheraghian, B. Chetrit, A. Chikova-Iscener, E. Chiolero, A. Chiou, S.-T. Chirlaque, M.-D. Cho, B. Christensen, K. Christofaro, D.G. Chudek, J. Cifkova, R. Cilia, M. Cinteza, E. Claessens, F. Clarke, J. Clays, E. Cohen, E. Concin, H. Confortin, S.C. Cooper, C. Coppinger, T.C. Corpeleijn, E. Costanzo, S. Cottel, D. Cowell, C. Craig, C.L. Crampin, A.C. Crujeiras, A.B. Csilla, S. Cucu, A.M. Cui, L. Cureau, F.V. Czenczek-Lewandowska, E. D’Arrigo, G. d’Orsi, E. Dacica, L. Dal Re Saavedra, M.A. Dallongeville, J. Damsgaard, C.T. Dankner, R. Dantoft, T.M. Dasgupta, P. Dastgiri, S. Dauchet, L. Davletov, K. De Backer, G. De Bacquer, D. de Gaetano, G. De Henauw, S. de Oliveira, P.D. De Ridder, D. De Ridder, K. de Rooij, S.R. De Smedt, D. Deepa, M. Deev, A.D. DeGennaro, V., Jr Dehghan, A. Delisle, H. Delpeuch, F. Demarest, S. Dennison, E. Dereń, K. Deschamps, V. Dhimal, M. Di Castelnuovo, A.F. Dias-da-Costa, J.S. Díaz-Sánchez, M.E. Diaz, A. Dika, Z. Djalalinia, S. Djordjic, V. Do, H.T.P. Dobson, A.J. Donati, M.B. Donfrancesco, C. Donoso, S.P. Döring, A. Dorobantu, M. Dorosty, A.R. Doua, K. Dragano, N. Drygas, W. Duan, J.L. Duante, C.A. Duboz, P. Duda, R.B. Duleva, V. Dulskiene, V. Dumith, S.C. Dushpanova, A. Dzerve, V. Dziankowska-Zaborszczyk, E. Eddie, R. Eftekhar, E. Egbagbe, E.E. Eggertsen, R. Eghtesad, S. Eiben, G. Ekelund, U. El-Khateeb, M. Ati, J.E. Eldemire-Shearer, D. Eliasen, M. Elliott, P. Engle-Stone, R. Enguerran, M. Erasmus, R.T. Erbel, R. Erem, C. Eriksen, L. Eriksson, J.G. Escobedo-de la Peña, J. Eslami, S. Esmaeili, A. Evans, A. Faeh, D. Fakhretdinova, A.A. Fall, C.H. Faramarzi, E. Farjam, M. Sant’Angelo, V.F. Farzadfar, F. Fattahi, M.R. Fawwad, A. Felix-Redondo, F.J. Ferguson, T.S. Fernandes, R.A. Fernández-Bergés, D. Ferrante, D. Ferrao, T. Ferrari, M. Ferrario, M.M. Ferreccio, C. Ferrer, E. Ferrieres, J. Figueiró, T.H. Fijalkowska, A. Fink, G. Fischer, K. Foo, L.H. Forsner, M. Fouad, H.M. Francis, D.K. Maria do Carmo Franco Frikke-Schmidt, R. Frontera, G. Fuchs, F.D. Fuchs, S.C. Fujiati, I.I. Fujita, Y. Fumihiko, M. Furusawa, T. Gaciong, Z. Gafencu, M. Galbarczyk, A. Galenkamp, H. Galeone, D. Galfo, M. Galvano, F. Gao, J. Garcia-de-la-Hera, M. García-Solano, M. Gareta, D. Garnett, S.P. Gaspoz, J.-M. Gasull, M. Gaya, A.C.A. Gaya, A.R. Gazzinelli, A. Gehring, U. Geiger, H. Geleijnse, J.M. Ghanbari, A. Ghasemi, E. Gheorghe-Fronea, O.-F. Giampaoli, S. Gianfagna, F. Gill, T.K. Giovannelli, J. Gironella, G. Giwercman, A. Gkiouras, K. Godos, J. Gogen, S. Goldberg, M. Goldsmith, R.A. Goltzman, D. Gómez, S.F. Gomula, A. da Silva, B.G.C. Gonçalves, H. Gonzalez-Chica, D.A. Gonzalez-Gross, M. González-Leon, M. González-Rivas, J.P. González-Villalpando, C. González-Villalpando, M.-E. Gonzalez, A.R. Gottrand, F. Graça, A.P. Graff-Iversen, S. Grafnetter, D. Grajda, A. Grammatikopoulou, M.G. Gregor, R.D. Grodzicki, T. Grøholt, E.K. Grøntved, A. Grosso, G. Gruden, G. Gu, D. Gualdi-Russo, E. Guallar-Castillón, P. Gualtieri, A. Gudmundsson, E.F. Gudnason, V. Guerrero, R. Guessous, I. Guimaraes, A.L. Gulliford, M.C. Gunnlaugsdottir, J. Gunter, M.J. Guo, X.-H. Guo, Y. Gupta, P.C. Gupta, R. Gureje, O. Gurzkowska, B. Gutiérrez-González, E. Gutierrez, L. Gutzwiller, F. Ha, S. Hadaegh, F. Hadjigeorgiou, C.A. Haghshenas, R. Hakimi, H. Halkjær, J. Hambleton, I.R. Hamzeh, B. Hange, D. Hanif, A.A.M. Hantunen, S. Hao, J. Kumar, R.H. Hashemi-Shahri, S.M. Hassapidou, M. Hata, J. Haugsgjerd, T. He, J. He, Y. He, Y. Heidinger-Felso, R. Heinen, M. Hejgaard, T. Hendriks, M.E. dos Santos Henrique, R. Henriques, A. Cadena, L.H. Herrala, S. Herrera, V.M. Herter-Aeberli, I. Heshmat, R. Hill, A.G. Ho, S.Y. Ho, S.C. Hobbs, M. Holdsworth, M. Homayounfar, R. Homs, C. Hopman, W.M. Horimoto, A.R.V.R. Hormiga, C.M. Horta, B.L. Houti, L. Howitt, C. Htay, T.T. Htet, A.S. Htike, M.M.T. Hu, Y. Huerta, J.M. Huhtaniemi, I.T. Huiart, L. Petrescu, C.H. Huisman, M. Husseini, A. Huu, C.N. Huybrechts, I. Hwalla, N. Hyska, J. Iacoviello, L. Ibarluzea, J.M. Ibrahim, M.M. Wong, N.I. Ikram, M.A. Iotova, V. Irazola, V.E. Ishida, T. Islam, M. Islam, S.M.S. Iwasaki, M. Jacobs, J.M. Jaddou, H.Y. Jafar, T. James, K. Jamil, K.M. Jamrozik, K. Janszky, I. Janus, E. Jarani, J. Jarvelin, M.-R. Jasienska, G. Jelakovic, A. Jelakovic, B. Jennings, G. Jha, A.K. Jiang, C.Q. Jimenez, R.O. Jöckel, K.-H. Joffres, M. Johansson, M. Jokelainen, J.J. Jonas, J.B. Jonnagaddala, J. Jørgensen, T. Joshi, P. Joukar, F. Jovic, D.P. Jóźwiak, J.J. Juolevi, A. Jurak, G. Simina, I.J. Juresa, V. Kaaks, R. Kaducu, F.O. Kafatos, A. Kajantie, E.O. Kalmatayeva, Z. Kalter-Leibovici, O. Kameli, Y. Kampmann, F.B. Kanala, K.R. Kannan, S. Kapantais, E. Karakosta, A. Kårhus, L.L. Karki, K.B. Katibeh, M. Katz, J. Katzmarzyk, P.T. Kauhanen, J. Kaur, P. Kavousi, M. Kazakbaeva, G.M. Keil, U. Boker, L.K. Keinänen-Kiukaanniemi, S. Kelishadi, R. Kelleher, C. Kemper, H.C.G. Kengne, A.P. Keramati, M. Kerimkulova, A. Kersting, M. Key, T. Khader, Y.S. Khalili, D. Khaw, K.-T. Kheiri, B. Kheradmand, M. Khosravi, A. Khouw, I.M.S.L. Kiechl-Kohlendorfer, U. Kiechl, S. Killewo, J. Kim, D.W. Kim, H.C. Kim, J. Kindblom, J.M. Klakk, H. Klimek, M. Klimont, J. Klumbiene, J. Knoflach, M. Koirala, B. Kolle, E. Kolsteren, P. König, J. Korpelainen, R. Korrovits, P. Korzycka, M. Kos, J. Koskinen, S. Kouda, K. Kovacs, V.A. Kowlessur, S. Koziel, S. Kratenova, J. Kratzer, W. Kriemler, S. Kristensen, P.L. Krokstad, S. Kromhout, D. Kruger, H.S. Kubinova, R. Kuciene, R. Kujala, U.M. Kujundzic, E. Kulaga, Z. Kumar, R.K. Kunešová, M. Kurjata, P. Kusuma, Y.S. Kuulasmaa, K. Kyobutungi, C. La, Q.N. Laamiri, F.Z. Laatikainen, T. Lachat, C. Laid, Y. Lam, T.H. Lambrinou, C.-P. Landais, E. Lanska, V. Lappas, G. Larijani, B. Latt, T.S. Lauria, L. Lazo-Porras, M. Le Coroller, G. Bao, K.L.N. Le Port, A. Le, T.D. Lee, J. Lee, J. Lee, P.H. Lehmann, N. Lehtimäki, T. Lemogoum, D. Levitt, N.S. Li, Y. Liivak, M. Lilly, C.L. Lim, W.-Y. Lima-Costa, M.F. Lin, H.-H. Lin, X. Lin, Y.-T. Lind, L. Linneberg, A. Lissner, L. Litwin, M. Liu, L. Lo, W.-C. Loit, H.-M. Long, K.Q. Lopes, L. Lopes, O. Lopez-Garcia, E. Lopez, T. Lotufo, P.A. Lozano, J.E. Lukrafka, J.L. Luksiene, D. Lundqvist, A. Lundqvist, R. Lunet, N. Lunogelo, C. Lustigová, M. Łuszczki, E. Ma, G. Ma, J. Ma, X. Machado-Coelho, G.L.L. Machado-Rodrigues, A.M. Macieira, L.M. Madar, A.A. Maggi, S. Magliano, D.J. Magnacca, S. Magriplis, E. Mahasampath, G. Maire, B. Majer, M. Makdisse, M. Mäki, P. Malekzadeh, F. Malekzadeh, R. Malhotra, R. Rao, K.M. Malyutina, S.K. Maniego, L.V. Manios, Y. Mann, J.I. Mansour-Ghanaei, F. Manzato, E. Margozzini, P. Markaki, A. Markey, O. Ioannidou, E.M. Marques-Vidal, P. Marques, L.P. Marrugat, J. Martin-Prevel, Y. Martin, R. Martorell, R. Martos, E. Maruszczak, K. Marventano, S. Mascarenhas, L.P. Masoodi, S.R. Mathiesen, E.B. Mathur, P. Matijasevich, A. Matsha, T.E. Mavrogianni, C. Mazur, A. Mbanya, J.C.N. McFarlane, S.R. McGarvey, S.T. McKee, M. McLachlan, S. McLean, R.M. McLean, S.B. McNulty, B.A. Benchekor, S.M. Medzioniene, J. Mehdipour, P. Mehlig, K. Mehrparvar, A.H. Meirhaeghe, A. Meisfjord, J. Meisinger, C. Menezes, A.M.B. Menon, G.R. Mensink, G.B.M. Menzano, M.T. Mereke, A. Meshram, I.I. Metspalu, A. Meyer, H.E. Mi, J. Michaelsen, K.F. Michels, N. Mikkel, K. Milkowska, K. Miller, J.C. Minderico, C.S. Mini, G.K. Miquel, J.F. Mirjalili, M.R. Mirkopoulou, D. Mirrakhimov, E. Mišigoj-Durakovic, M. Mistretta, A. Mocanu, V. Modesti, P.A. Moghaddam, S.S. Mohajer, B. Mohamed, M.K. Mohamed, S.F. Mohammad, K. Mohammadi, Z. Mohammadifard, N. Mohammadpourhodki, R. Mohan, V. Mohanna, S. Yusoff, M.F.M. Mohebbi, I. Mohebi, F. Moitry, M. Molbo, D. Møllehave, L.T. Møller, N.C. Molnár, D. Momenan, A. Mondo, C.K. Monroy-Valle, M. Monterrubio-Flores, E. Monyeki, K.D.K. Moon, J.S. Moosazadeh, M. Moreira, L.B. Morejon, A. Moreno, L.A. Morgan, K. Morin, S.N. Mortensen, E.L. Moschonis, G. Mossakowska, M. Mostafa, A. Mota-Pinto, A. Mota, J. Motlagh, M.E. Motta, J. Moura-dos-Santos, M.A. Mridha, M.K. Msyamboza, K.P. Mu, T.T. Muc, M. Mugoša, B. Muiesan, M.L. Mukhtorova, P. Müller-Nurasyid, M. Murphy, N. Mursu, J. Murtagh, E.M. Musa, K.I. Milanovic, S.M. Musil, V. Mustafa, N. Nabipour, I. Naderimagham, S. Nagel, G. Naidu, B.M. Najafi, F. Nakamura, H. Námešná, J. Nang, E.E.K. Nangia, V.B. Nankap, M. Narake, S. Nardone, P. Nauck, M. Neal, W.A. Nejatizadeh, A. Nekkantti, C. Nelis, K. Nelis, L. Nenko, I. Neovius, M. Nervi, F. Nguyen, C.T. Nguyen, N.D. Nguyen, Q.N. Nieto-Martínez, R.E. Nikitin, Y.P. Ning, G. Ninomiya, T. Nishtar, S. Noale, M. Noboa, O.A. Nogueira, H. Norat, T. Nordendahl, M. Nordestgaard, B.G. Noto, D. Nowak-Szczepanska, N. Al Nsour, M. Nuhoglu, I. Nurk, E. O’Neill, T.W. O’Reilly, D. Obreja, G. Ochimana, C. Ochoa-Avilés, A.M. Oda, E. Oh, K. Ohara, K. Ohlsson, C. Ohtsuka, R. Olafsson, O. Olinto, M.T.A. Oliveira, I.O. Omar, M.A. Onat, A. Ong, S.K. Ono, L.M. Ordunez, P. Ornelas, R. Ortiz, A.P. Ortiz, P.J. Osler, M. Osmond, C. Ostojic, S.M. Ostovar, A. Otero, J.A. Overvad, K. Owusu-Dabo, E. Paccaud, F.M. Padez, C. Pagkalos, I. Pahomova, E. de Paiva, K.M. Pajak, A. Palli, D. Palloni, A. Palmieri, L. Pan, W.-H. Panda-Jonas, S. Pandey, A. Panza, F. Papandreou, D. Park, S.-W. Park, S. Parnell, W.R. Parsaeian, M. Pascanu, I.M. Pasquet, P. Patel, N.D. Pecin, I. Pednekar, M.S. Peer, N. Pei, G. Peixoto, S.V. Peltonen, M. Pereira, A.C. Peres, M.A. Pérez-Farinós, N. Pérez, C.M. Peterkova, V. Peters, A. Petersmann, A. Petkeviciene, J. Petrauskiene, A. Pettenuzzo, E. Peykari, N. Pham, S.T. Pichardo, R.N. Pierannunzio, D. Pigeot, I. Pikhart, H. Pilav, A. Pilotto, L. Pistelli, F. Pitakaka, F. Piwonska, A. Pizarro, A.N. Plans-Rubió, P. Poh, B.K. Pohlabeln, H. Pop, R.M. Popovic, S.R. Porta, M. Posch, G. Poudyal, A. Poulimeneas, D. Pouraram, H. Pourfarzi, F. Pourshams, A. Poustchi, H. Pradeepa, R. Price, A.J. Price, J.F. Providencia, R. Puder, J.J. Pudule, I. Puhakka, S.E. Puiu, M. Punab, M. Qasrawi, R.F. Qorbani, M. Bao, T.Q. Radic, I. Radisauskas, R. Rahimikazerooni, S. Rahman, M. Rahman, M. Raitakari, O. Raj, M. Rakhimova, E. Rakhmatulloev, S. Rakovac, I. Rao, S.R. Ramachandran, A. Ramke, J. Ramos, E. Ramos, R. Rampal, L. Rampal, S. Rarra, V. Rascon-Pacheco, R.A. Rasmussen, M. Rech, C.R. Redon, J. Reganit, P.F.M. Regecová, V. Revilla, L. Rezaianzadeh, A. Ribas-Barba, L. Ribeiro, R. Riboli, E. Richter, A. Rigo, F. Rinaldo, N. de Wit, T.F.R. Rito, A. Ritti-Dias, R.M. Rivera, J.A. Robitaille, C. Roccaldo, R. Rodrigues, D. Rodríguez-Artalejo, F. del Cristo Rodriguez-Perez, M. Rodríguez-Villamizar, L.A. Roggenbuck, U. Rojas-Martinez, R. Rojroongwasinkul, N. Romaguera, D. Romeo, E.L. Rosario, R.V. Rosengren, A. Rouse, I. Roy, J.G.R. Rubinstein, A. Rühli, F.J. Ruidavets, J.-B. Ruiz-Betancourt, B.S. Ruiz-Castell, M. Moreno, E.R. Rusakova, I.A. Jonsson, K.R. Russo, P. Rust, P. Rutkowski, M. Sabanayagam, C. Sacchini, E. Sachdev, H.S. Sadjadi, A. Safarpour, A.R. Safiri, S. Saki, N. Salanave, B. Martinez, E.S. Salmerón, D. Salomaa, V. Salonen, J.T. Salvetti, M. Samoutian, M. Sánchez-Abanto, J. Sans, S. Marina, L.S. Santos, D.A. Santos, I.S. Santos, L.C. Santos, M.P. Santos, O. 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Viswanathan, B. Vladulescu, M. Vlasoff, T. Vocanec, D. Vollenweider, P. Völzke, H. Voutilainen, A. Voutilainen, S. Vrijheid, M. Vrijkotte, T.G.M. Wade, A.N. Wagner, A. Waldhör, T. Walton, J. Wambiya, E.O.A. Bebakar, A.M.W. Mohamud, W.N.W. de Souza Wanderley Júnior, R. Wang, M.-D. Wang, N. Wang, Q. Wang, X. Wang, Y.X. Wang, Y.-W. Wannamethee, S.G. Wareham, N. Weber, A. Wedderkopp, N. Weerasekera, D. Weghuber, D. Wei, W. Weres, A. Werner, B. Whincup, P.H. Widhalm, K. Widyahening, I.S. Wiecek, A. Wilks, R.J. Willeit, J. Willeit, P. Williams, J. Wilsgaard, T. Wojtyniak, B. Wong-McClure, R.A. Wong, A. Wong, J.E. Wong, T.Y. Woo, J. Woodward, M. Wu, F.C. Wu, J. Wu, L.J. Wu, S. Xu, H. Xu, L. Yaacob, N.A. Yamborisut, U. Yan, W. Yang, L. Yang, X. Yang, Y. Yardim, N. Yaseri, M. Yasuharu, T. Ye, X. Yiallouros, P.K. Yoosefi, M. Yoshihara, A. You, Q.S. You, S.-L. Younger-Coleman, N.O. Yusof, S.M. Yusoff, A.F. Zaccagni, L. Zafiropulos, V. Zainuddin, A.A. Zakavi, S.R. Zamani, F. Zambon, S. Zampelas, A. Zamrazilová, H. Zapata, M.E. Zargar, A.H. Zaw, K.K. Zdrojewski, T. Zejglicova, K. Vrkic, T.Z. Zeng, Y. Zhang, L. Zhang, Z.-Y. Zhao, D. Zhao, M.-H. Zhao, W. Zhen, S. Zheng, W. Zheng, Y. Zholdin, B. Zhou, M. Zhu, D. Zins, M. Zitt, E. Zocalo, Y. Cisneros, J.Z. Zuziak, M. Ezzati, M. Filippi, S. NCD Risk Factor Collaboration (NCD-RisC)
Subjects: nutritional and metabolic diseases, sense organs, skin and connective tissue diseases
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright.
Published: 2021

5. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults

Author: Ezzati, M, Bentham, J, Di Cesare, M, Bilano, V, Bixby, H, Zhou, B, Stevens, GA, Riley, LM, Taddei, C, Hajifathalian, K, Lu, Y, Savin, S, Cowan, MJ, Paciore, CJ, Chiritaemandi, A, Hayes, AJ, Katz, J, Kelishadi, R, Kengne, AP, Khang, Y-H, Laxmaiah, A, Li, Y, Ma, J, Miranda, JJ, Mostafa, A, Neovius, M, Padez, C, Rampal, L, Zhu, A, Bennet, JE, Danaei, G, Bhutta, ZA, Abarca-Gomez, L, Abdeen, ZA, Hamid, ZA, Abu-Rmeileh, NM, Acosta-Cazares, B, Acuin, C, Adams, RJ, Aekplakorn, W, Afsana, K, Aguilar-Salinas, CA, Agyemng, C, Ahmadvand, A, Ahrens, W, Ajlouni, K, Akhtaeva, N, Al-Hazzaa, HM, Al-Othman, AR, Al-Raddadi, R, AlBuhairan, F, AlDhukai, S, Ali, MM, Ali, O, Alkerwi, A, Alvarez-Pedrerol, M, Aly, E, Amarapurkar, DN, Amouyel, P, Amuzu, A, Andersen, LB, Anderssen, SA, Andrade, DS, Angquist, LH, Anjana, RM, Aounallah-Skhiri, H, Araujo, J, Arianse, I, Aris, T, Arlappa, N, Arveiler, D, Aryal, KK, Aspelund, T, Assah, FK, Assuncao, MCF, Aung, MS, Avdicova, M, Azevedo, A, Azizi, F, Babu, BV, 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Subjects: SDG 3 - Good Health and Well-being, Medicine (all)
Abstract: Made available in DSpace on 2018-11-26T20:04:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-16 Wellcome Trust AstraZeneca Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128.9 million participants aged 5 years and older, including 31.5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0.01 kg/m (2) per decade; 95% credible interval -0.42 to 0.39, posterior probability [PP] of the observed decrease being a true decrease= 0.5098) in eastern Europe to an increase of 1.00 kg/m(2) per decade (0.69-1.35, PP> 0.9999) in central Latin America and an increase of 0.95 kg/m (2) per decade (0.64-1.25, PP> 0.9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0.09 kg/m(2) per decade (-0.33 to 0.49, PP= 0.6926) in eastern Europe to an increase of 0.77 kg/m (2) per decade (0.50-1.06, PP> 0.9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0.7% (0.4-1.2) in 1975 to 5.6% (4.8-6.5) in 2016 in girls, and from 0.9% (0.5-1.3) in 1975 to 7.8% (6.7-9.1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9.2% (6.0-12.9) in 1975 to 8.4% (6.8-10.1) in 2016 in girls and from 14.8% (10.4-19.5) in 1975 to 12.4% (10.3-14.5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22.7% (16.7-29.6) among girls and 30.7% (23.5-38.0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Imperial Coll London, Sch Publ Hlth, London W2 1PG, England Univ Kent, Canterbury, Kent, England Imperial College London, London, England Middlesex Univ, London, England WHO, Geneva, Switzerland Cleveland Clin, Cleveland, OH 44106 USA Yale Univ, New Haven, CT 06520 USA Univ Calif Berkeley, Berkeley, CA USA Victor Babes Univ Med & Pharm Timisoara, Timisoara, Romania Univ Sydney, Sydney, NSW, Australia Johns Hopkins Univ, Baltimore, MD 21218 USA Isfahan Univ Med Sci, Esfahan, Iran South African Med Res Council, Cape Town, South Africa Seoul Natl Univ, Seoul, South Korea Natl Inst Nutr, Secunderabad, India Harvard TH Chan Sch Publ Hlth, Boston, MA USA Peking Univ, Beijing, Peoples R China Univ Peruana Cayetano Heredia, Lima, Peru Ain Shams Univ, Cairo, Egypt Karolinska Inst, Stockholm, Sweden Univ Coimbra, Coimbra, Portugal Univ Putra Malasia, Seri Kembangan, Malaysia Hosp Sick Children, Toronto, ON, Canada Aga Khan Univ, Karachi, Pakistan Caja Costarricense Seguro Social, San Jose, Costa Rica Al Quds Univ, Jerusalem, Palestine Ctr Diabet & Endocrine Care, Bengaluru, India Birzeit Univ, Birzeit, Palestine Inst Mexicano Seguro Social, Mexico City, DF, Mexico Int Rice Res Inst, Los Banos, Philippines Univ Adelaide, Adelaide, SA, Australia Mahidol Univ, Salaya, Nakhon Pathom, Thailand BARC, Dhaka, Bangladesh Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico Univ Amsterdam, Amsterdam, Netherlands Noncommun Dis Res Ctr, Tehran, Iran Leibniz Inst Prevent Res & Epidemiol BIPS, Leipzig, Germany Natl Ctr Diabet Endocrinol, Amman, Jordan Kazakh Natl Med Univ, Alma Ata, Kazakhstan King Saud Univ, Riyadh, Saudi Arabia Kuwait Inst Sci Res, Kuwait, Kuwait Minist Hlth, Riyadh, Saudi Arabia King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia Univ Malaysia Sabah, Kota Kinabalu, Malaysia Luxembourg Inst Hlth, Luxembourg, Luxembourg ISGlobal Ctr Res Environm Epidemol, Barcelona, Spain WHO, Reg Off Eastern Mediterranean, Cairo, Egypt Bombay Hosp & Med Res Ctr, Bombay, Maharashtra, India Lille Univ & Hosp, Lille, France London Sch Hyg & Trop Med, London, England Western Norway Univ App Sci, Bergen, Norway Norwegian Sch Sport Sci, Oslo, Norway Univ Cuenca, Cuenca, Ecuador Bispebjerg Hosp, Copenhagen, Denmark Frederiksberg Univ Hosp, Copenhagen, Denmark Madras Diabet Res Fdn, Madras, Tamil Nadu, India Natl Inst Publ Hlth, Tunis, Tunisia Univ Porto, Oporto, Portugal Norwegian Inst Publ Hlth, Oslo, Norway Minist Hlth Malaysia, Putrajaya, Malaysia Natl Inst Nutr, Bangalore, Karnataka, India Univ Strasbourg, Strasbourg, France Strasbourg Univ Hosp, Strasbourg, France Nepal Hlth Res Council, Kathmandu, Nepal Univ Iceland, Reykjavik, Iceland Univ Yaounde, Yaounde, Cameroon Univ Fed Pelotas, Pelotas, Brazil Univ Med, Yangon, Myanmar Univ Porto, Med Sch, Oporto, Portugal Shahid Beheshti Univ Med Sci, Tehran, Iran Indian Council Med Res, New Delhi, India King Abdulaziz Univ, Riyadh, Saudi Arabia Univ Sci & Technol, Taizi, Yemen Med Univ Lodz, Lodz, Poland Med Univ Gdansk, Gdansk, Poland Univ Autonoma Madrid, Madrid, Spain Univ Palermo, Palermo, Italy Pan Amer Hlth Org, Washington, DC USA Mohammed V Univ Rabat, Rabat, Morocco Univ Pernambuco, Recife, PE, Brazil Dalhousie Univ, Calgary, AB, Canada Jordan Univ Technol, Amman, Jordan Univ Fed Maranhao, Sao Luis, Brazil Univ Auckland, Auckland, New Zealand Univ Tunis El Manar, El Manar, Tunisia Fed Minist Hlth & Womens Affairs, Vienna, Austria CAFAM Univ Fdn, Bogota, Colombia Imperial Coll London, London, England Lithuanian Univ Hlth Sci, Kaunas, Lithuania Univ Sao Paulo, Sao Paulo, Brazil BJ Med Coll, Pune, Maharashtra, India Chirayu Med Coll, Bhopal, India Sunder Lal Jain Hosp, Delhi, India Shandong Univ Tradit Chinese Med, Shanghai, Peoples R China Shanghai Jiao Tong Univ, Sch Med, Shanghai, Peoples R China Norwegian Inst Publ, Oslo, Norway Ufa Eye Res Inst, Moscow, Russia Univ Montenegro, Montenegro, Mexico Univ Southern Denmark, Lyngby, Denmark Univ Oslo, Oslo, Norway Univ Gothenburg, Gothenburg, Sweden Natl Inst Publ Hlth & Environm, Amsterdam, Netherlands Univ Turin, Turin, Italy UCL, London, England Liverpool John Moores Univ, Liverpool, Merseyside, England Nanyang Technol Univ, Singapore, Singapore German Inst Human Nutr, Hamburg, Germany Univ Republica, Montevideo, Uruguay CEMIC, La Plata, Buenos Aires, Argentina IRCCS Ist Neurol Mediterraneo Neuromed, Naples, Italy Toulouse Univ, Sch Med, Toulouse, France Univ Lausanne, Minist Hlth, Lausanne, Switzerland Flemish Agcy Care & Hlth, Brussels, Belgium Univ Ghent, Ghent, Belgium FrieslandCampina, Amersfoort, Netherlands Univ Cent Venezuela, Caracas, Venezuela Bielefeld Univ, Bielefeld, Germany WHO, Reg Off Europe, Copenhagen, Denmark German Canc Res Ctr, Heidelberg, Germany Fred Hollows Fdn New Zealand, Auckland, New Zealand Carol Davila Univ Med & Pharm, Bucharest, Romania Natl Inst Publ Hlth & Environm, Amersroot, Netherlands Univ Southern Denmark, Copenhagen, Denmark Inst Publ Hlth, Tirana, Albania Cork Inst Technol, Cork, Ireland Univ La Laguna, San Cristobal la Laguna, Spain Univ Malta, Msida, Malta Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA Minist Hlth, Pangai, Tonga Canadian Fitness & Lifestyle Res Inst, Ottawa, ON, Canada Hosp Santa Maria, Lisbon, Portugal Istanbul Univ, Istanbul, Turkey Univ Fed Juiz de Fora, Juiz De Fora, Portugal Food & Nutr Res Inst, Manila, Philippines Santiago de Compostela Univ, Santiago De Compostela, Spain Assoc Calabrese Epatol, Perugia, Italy India Diabet Res Fdn, Delhi, India Duke NUS Med Sch, Singapore, Singapore Natl Inst Med Stat, New Delhi, India Acad Sinica, Taipei, Taiwan Capital Inst Pediat, Beijing, Peoples R China Duke Univ, Durham, NC 27706 USA Kailuan General Hospital, Tangshan, Peoples R China Univ Oxford, Oxford, England Duke NUS MEd Sch, Singapore, Singapore Gertner Inst Epidemiol & Hlth Policy Res, Tel Aviv, Israel Natl Ctr Publ Hlth & Anal, Sofia, Bulgaria Univ Bern, Bern, Switzerland Minist Hlth & Welfare, Taipei, Taiwan Murcia Reg Hlth Council, Murcia, Spain Seoul Natl Univ, Coll Med, Seoul, South Korea Korea Ctr Dis Control & Prevent, Seoul, South Korea Univ Estadual Paulista, Sao Paulo, Brazil Med Univ Silesia, Katowice, Poland Charles Univ Prague, Prague, Czech Republic Katholieke Univ Leuven, Leuven, Belgium Agcy Prevent & Social Med, Vienna, Austria Univ Fed Santa Catarina, Sao Carlos, SP, Brazil Univ Southampton, Southampton, Hants, England Inst Pasteur, Lille, France CIBEROBN, Barcelona, Spain Natl Inst Publ Hlth, Bucharest, Romania Natl Council Res, Rome, Italy Univ Fed Santa Catarin, Sao Carlos, SP, Brazil Eduardo Mondlane Univ, Maputo, Mozambique Univ Copenhagen, Copenhagen, Denmark Res Ctr Prevent & Hlth, Glostrup, Denmark Tabriz Hlth Serv Managemnet Ctr, Tabriz, Iran Lille Univ Hosp, Lille, France Sci Inst Publ Hlth, Brussels, Belgium Madaras Diabet Res Fdn, Chennai, India Natl Res Ctr Prevent Med, Moscow, Russia Erasmus MC, Rotterdam, Netherlands Univ Montreal, Montreal, PQ, Canada Inst Rech Dev, Montpellier, France French Publ Hlth Agcy, St Maurice, France Univ Vale Rio Sino, Sao Leopoldo, Brazil Natl Council Sci & Tech Res, Buenos Aires, DF, Argentina Univ Zagreb, Zagreb, Croatia Univ Tehran Med Sci, Tehran, Iran Natl Inst Nutr, Hanoi, Vietnam Univ Queensland, Brisbane, Qld, Australia Ist Super Sanita, Rome, Italy Helmholtz Zentrum Munchen, Munich, Germany Minist Sante & Lutte Contre Sida, Abidjan, Cote Ivoire Cardinal Wyszynski Inst Cardiol, Warsaw, Poland Beijing Ctr Dis Prevent & Control, Beijing, Peoples R China Univ Latvia, Riga, Latvia Univ Benin, Benin, Nigeria Univ Skovde, Skovde, Sweden Natl Inst Nutr & Food Technol, Tunis, Tunisia Univ Calif Davis, Davis, CA 95616 USA Univ Stellenbosch, Stellenbosch, South Africa Karadeniz Tech Univ, Trabzon, Turkey Univ Southern Copenhagen, Copenhagen, Denmark Natl Inst Hlth & Welfare, Helsinki, Finland Queens Univ Belfast, Belfast, Antrim, North Ireland Univ Zurich, Zurich, Switzerland Primary Health Care, Floriana, Malta Ctr Salud Villanueva Norte, Villanueva De La Serena, Spain Univ West Indies, Mona, Jamaica Hosp Don Benito Villanueva de la Serena, Villanueva De La Serena, Spain Minist Hlth, Buenos Aires, DF, Argentina Council Agr Res & Econ, Rome, Italy Pontificia Univ Catolica Chile, Santiago, Chile Univ Toulouse, Sch Med, Toulouse, France Univ Manchester, Manchester, Lancs, England Univ Tartu, Tartu, Estonia Inst Nacl Salud Publ, Cuernavaca, Morelos, Mexico Univ Sains Malaysia, George Town, Malaysia Umea Univ, Umea, Sweden Dalarna University, Falun, Sweden Univ West Indies, Kingston, Jamaica Univ Fed Sao Paulo, Sao Paulo, Brazil Hosp Univ Son Espases, Palma De Mallorca, Spain Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil Univ Fed Rio Grande do Sul, Rio Grande, Brazil Kindai Univ, Higashiosaka, Osaka, Japan Kyoto Univ, Kyoto, Japan Med Univ Warsaw, Warsaw, Poland Minist Hlth, Rome, Italy Univ Catania, Catania, Italy CIBER Epidemiol & Salud Publ, Barcelona, Spain Univ KwaZulu Natal, Durban, South Africa Geneva Univ Hosp, Geneva, Switzerland Australian Bur Stat, Canberra, ACT, Australia Agcy Prevent & Social Med, Innsbruck, Austria Wageningen Univ, Wageningen, Netherlands Noncommunicable Dis Res Ctr, Shiraz, Iran Univ Insubria, Varese, Italy Lund Univ, Lund, Sweden Minist Hlth, Ankara, Turkey Minist Hlth, Jerusalem, Israel McGill Univ, Montreal, PQ, Canada Andes Clin Cardiometab Studies, Timotes, Venezuela Univ Politecn Madrid, Madrid, Spain Univ Lille 2, Lille, France Minist Hlth, Lisbon, Portugal Inst Clin & Expt Med, Prague, Czech Republic Childrens Mem Hlth Inst, Warsaw, Poland Alexander Technol Educ Inst, Sindos, Greece Dalhousie Univ, Halifax, NS, Canada Jagiellonian Univ, Med Coll, Krakow, Poland Univ Southern Denmark, Odense, Denmark Azienda Osped Univ Policlin Vittorio Emanuele, Catania, Italy Univ Novi Sad, Novi Sad, Serbia Natl Ctr Cardiovasc Dis, Beijing, Peoples R China Univ Ferrara, Ferrara, Italy Singapore Eye Res Inst, Singapore, Singapore Iceland Heart Assoc, Kopavogur, Iceland Univ Icesi, Cali, Colombia Univ Estadual Montes Claros, Montes Claros, Brazil Kings Coll London, London, England Int Agcy Res Canc, Lyon, France Capital Med Univ, Beijing, Peoples R China Healis Sekhsaria Inst Publ Hlth, Navi Mumbai, India Eternal Heart Care Ctr Res Inst, Jaipur, Rajasthan, India Univ Ibadan, Ibadan, Nigeria Childrens Memorial Hlth Inst, Warsaw, Poland Inst Clin Effectiveness & Hlth Policy, Buenos Aires, DF, Argentina Res & Educ Inst Child Hlth, Nicosia, Cyprus Minist Hlth, Seri Begawan, Brunei Danish Canc Soc, Res Ctr, Copenhagen, Denmark Univ West Indies, Bridgetown, Barbados Alexander Technol Educ Inst Thessaloniki, Sindos, Greece Kyushu Univ, Fukuoka, Japan Tulane Univ, New Orleans, LA 70118 USA Univ Pecs, Pecs, Hungary Univ Coll Dublin, Dublin, Ireland Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico Oulu Univ Hosp, SF-90100 Oulu, Finland Univ Autonoma Bucaramanga, Bucaramanga, Colombia Swiss Fed Inst Technol, Zurich, Switzerland Chron Diseases Res Ctr, Tehran, Iran Univ Hong Kong, Hong Kong, Hong Kong, Peoples R China Chinese Univ Hong Kong, Hong Kong, Hong Kong, Peoples R China Univ Western Australia, Perth, WA, Australia Kingston Gen Hosp, Kingston, ON, Canada Heart Inst, Sao Paulo, Brazil Fdn Oftalmol Santander, Floridablanca, Colombia Univ Oran 1, Oran, Algeria Minist Hlth, Naypyitaw, Myanmar Vrije Univ Amsterdam, Med Ctr, Amsterdam, Netherlands Vrije Univ Amsterdam, Amsterdam, Netherlands Amer Univ Beirut, Beirut, Lebanon IRCCS Ist Neurol Mediterraneo Neuromed, Pozzilli, Italy Cardiol Mercato S Severino, Mercato San Severino, Italy Cairo Univ, Giza, Egypt Natl Inst Hlth & Nutr, Tokyo, Japan UHC Zagreb, Zagreb, Croatia Niigata Univ, Niigata, Japan Hadassah Univ, Med Ctr, Jerusalem, Israel Jordan Univ Sci & Technol, Irbid, Jordan Norwegian Univ Sci & Technol, Trondheim, Norway Sports Univ Tirana, Tirana, Albania Univ Zagreb, Sch Med, Zagreb, Croatia Heart Fdn, Fortitude Valley, Australia Natl Hlth Insurance Serv, Seoul, South Korea Guangzhou 12th Hosp, Guangzhou, Guangdong, Peoples R China Natl Inst Hyg Epidemiol & Microbiol, Havana, Cuba Simon Fraser Univ, Burnaby, BC, Canada Heidelberg Univ, Heidelberg, Germany World Hlth Org Country Off, Agra, Uttar Pradesh, India Inst Publ Hlth Serbia, Belgrade, Serbia Czestochowa Tech Univ, Czestochowa, Poland Univ Ljubljana, Ljubljana, Slovenia Univ Crete, Rethimnon, Greece Univ Kebangsaan Malaysia, Bangi, Malaysia Hellen Med Assoc Obes, Athens, Greece Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA Univ Eastern Finland, Joensuu, Finland Natl Inst Epidemiol, Madras, Tamil Nadu, India Ufa Eye Res Inst, Ufa, Russia Univ Munster, Munster, Germany Israel Ctr for Dis Control, Ramat Gan, Israel Oulu Univ Hosp, Oulu, Finland Isfahan Univ Med Sci, Isfahan, Israel Kyrgyz State Med Acad, Bishkek, Kyrgyzstan Res Inst Child Nutr, Dortmund, Germany Natl Ctr Diabetes & Endocrinol, Amman, Jordan Univ Cambridge, Cambridge, England Med Univ Innsbruck, Innsbruck, Austria Muhimbili Univ Hlth & Allied Sci, Dar Es Salaam, Tanzania Natl Canc Ctr, Goyang Si, South Korea Natl Hlh Insurance Serv, Seoul, South Korea Stat Austria, Vienna, Austria BP Koirala Inst Hlth Sci, Dharan, Nepal Inst Trop Med, Antwerp, Belgium Tartu Univ Clin, Tartu, Estonia Natl Inst Pharm & Nutr, Budapest, Hungary Minis Hlth & Qual Life, Port Louis, Mauritius Polish Acad Sci, Anthropol Unit Wroclaw, Wroclaw, Poland Univ Hosp Ulm, Ulm, Germany Univ Groningen, Groningen, Netherlands North West Univ, Potchefstroom, South Africa Natl Inst Publ Hlth, Prague, Czech Republic Univ Jyvaskyla, Jyvaskyla, Finland Amrita Inst Med Sci, Thiruvananthapuram, Kerala, India Inst Endocrinol, Prague, Czech Republic All India Inst Med Sci, New Delhi, India African Populat & Hlth Res Ctr, Nairobi, Kenya Hanoi Univ Publ Hlth, Hanoi, Vietnam Higher Inst Nursing Profess & Tech Hlth Morocco, Rabat, Morocco Natl Inst Publ Hlth Algeria, Algiers, Algeria Minist Salud Publ, Havana, Cuba Sahlgrens Acad, Gothenburg, Sweden Endocrinol & Met Res Ctr, Arak, Iran Indicium Res, Manila, Philippines Food & Agr Org, Rome, Italy Natl Univ Singapore, Singapore, Singapore Tampere Univ Hosp, Tampere, Finland Univ Cape Town, Cape Town, South Africa West Virginia Univ, Morgantown, WV USA Fundacao Oswaldo Cruz, Rene Rachou Res Inst, Belo Horizonte, MG, Brazil Natl Taiwan Univ, Taipei, Taiwan Univ Chinese Acad Sci, Beijing, Peoples R China Uppsala Univ, Uppsala, Sweden Capital Med Univ, Beijing An Zhen Hosp, Beijing, Peoples R China Natl Inst Hlth Dev, Tallinn, Estonia Univ Med Greifswald, Greifswald, Germany Consejeria Sanidad Junta Castilla & Leon, Valladolid, Spain Univ Fed Ouro Pret, Ouro Preto, Brazil Jikei Univ, Sch Med, Tokyo, Japan CNR, Rome, Italy Baker Heart & Diabet Inst, Melbourne, Vic, Australia Agr Univ Athens, Athens, Greece Univ Putra Malaysia, Seri Kembangan, Malaysia Inst Rech Dev, Marseille, France Hosp Israelita Albert Einstein, Sao Paulo, Brazil Shiraz Univ Med Sci, Shiraz, Iran Inst Internal & Prevent Med, Novosibirsk, Russia Harokopio Univ, Kallithea, Greece Univ Otago, Dunedin, New Zealand Univ Padua, Padua, Italy Technol Educ Inst Crete, Iraklion, Greece Loughborough Univ Technol, Loughborough, Leics, England Univ Fed Santa Catarina, Florianopolis, SC, Brazil Lausanne Univ Hosp, Lausanne, Switzerland Inst Hosp Mard Invest Med, Barcelona, Spain Mary Immaculate Coll, Limerick, Ireland Emory Univ, Atlanta, GA 30322 USA Hungarian Soc Sports Med, Budapest, Hungary Sherikashmir Inst Med Sci, Srinagar, Jammu & Kashmir, India UiT Arctic Univ Norway, Tromso, Norway Cape Peninsula Univ Technol, Cape Town, South Africa Univ Rzeszow, Rzeszow, Poland Univ Yaounde I, Yaounde, Cameroon Brown Univ, Providence, RI 02912 USA Univ Edinburgh, Edinburgh, Midlothian, Scotland Stat Canada, Ottawa, ON, Canada Int Med Univ, Kuala Lumpur, Malaysia INSERM, Villejuif, France Helmholtz Zentrum Munchen, Oberschleissheim, Germany Robert Koch Inst, Berlin, Germany Lusofona Univ, Lisbon, Portugal Democritus Univ Greece, Komotini, Greece Grigore T Popa Univ Med & Pharm, Iasi, Romania Univ Firenze, Florence, Italy Hypertens Res Ctr, Esfahan, Iran Mulago Hosp, Kampala, Uganda Univ Limpopo, Polokwane, South Africa Seoul Natl Univ, Childrens Hosp, Seoul, South Korea Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil Univ Med Sci, Havana, Cuba Univ Zaragoza, Zaragoza, Spain R CSI Dublin, Dublin, Ireland Int Inst Mol & Cell Biol, Warsaw, Poland Ain Shams University, Cairo, Egypt Ahvaz Jundishapur Univ Med Sci, Ahwaz, Iran Gorgas Memorial Inst Publ Hlth, Panama City, Panama Dept Publ Hlth, Nay Pyi Taw, Myanmar Univ Brescia, Brescia, Italy Helmholtz Zentrum Munchen, Neuherberg, Germany Univ Eastern Finland, Kuopio, Finland Mary Immaculate Coll, Tours, France Bushehr Univ Med Sci, Bushehr, Iran Ulm Univ, Ulm, Germany Inst Publ Hlth, Kuala Lumpur, Malaysia Kobe Univ, Kobe, Hyogo, Japan Banska Bystrica Reg Author Publ Hlth, Banska Bystrica, Slovakia Suraj Eye Inst, Nagpur, Maharashtra, India Helen Keller Int, Yaounde, Cameroon Karolinska Inst, Solna, Sweden Natl Inst Hyg & Epidemiol, Hanoi, Vietnam Univ Pharm & Med Ho Chi Minh City, Ho Chi Minh City, Vietnam Hanoi Med Univ, Hanoi, Vietnam Miami Vet Affairs Healthcare Syst, Miami, FL USA Heartfile, Islamabad, Pakistan Natl Canc Ctr, Tokyo, Japan Eastern Mediterranean Publ Hlth Network, Amman, Jordan State Univ Med & Pharm, Kishinev, Moldova Tachikawa Gen Hosp, Tachikawa, Tokyo, Japan Acad Hosp Paramaribo, Paramaribo, Surinam Univ Vale Rio dos Sinos, Sao Leopoldo, Brazil Natl Food & Nutr Inst, Warsaw, Poland Minist Hlth, Bandar Seri Begawan, Brunei Univ Fed Santa Catarin, Florianopolis, SC, Brazil Univ Madeira, Funchal, Portugal Univ Puerto Rico, San Juan, PR USA MRC Lifecourse Epidemiol Unit, Southampton, Hants, England Aarhus Univ, Aarhus, Denmark Kwame Nkrumah Univ Sci & Technol, Kumasi, Ghana Inst Social & Prevent, Lausanne, Switzerland Canc Prevent & Res Inst, Florence, Italy Univ Wisconsin Madison, Madison, WI USA IRCCS Casa Sollievo Sofferenz, San Giovanni Rotondo, Italy Zayed Univ, Dubai, U Arab Emirates Catholic Univ Daegu, Gyongsan, South Korea Tg Mures Univ Med & Pharm, Targu Mures, Romania Jivandeep Hosp, Surat, India South African Med Res Council, Tygerberg, South Africa Univ Med Ctr Utrecht, Utrecht, Netherlands Fundacao Oswaldo Cruz, Rene Rachou Res Inst, Rio De Janeiro, Brazil Spanish Agcy Consumer Affairs Social Serv & Nutr, Madrid, Spain Univ Puerto Rico, Med Sci Campus, San Juan, PR USA Minist Hlth & Med Educ, Tehran, Iran Vietnam Natl Heart Inst, Hanoi, Vietnam Leibniz Inst Prevent Res & Epidemiol BIPS, Bremen, Germany Univ Sarajevo, Sarajevo, Bosnia & Herceg Cardiovasc Prevent Ctr Udine, Udine, Italy Univ Hosp Pisa, Pisa, Italy Minist Hlth & Med Serv, Honiara, Solomon Islands Publ Hlth Agcy Catalonia, Barcelona, Spain Univ Kebangsaan Malaysia, Kuala Lumpur, Malaysia Univ Montenegro, Podgorica, Montenegro Inst Hosp Mar Invest Med, Barcelona, Spain Agcy Prevent and Social Med, Innsbruck, Austria Digest Oncol Res Ctr, Tehran, Iran Digest Dis Res Inst, Tehran, Iran CHU Vaudois, Lausanne, Switzerland Ctr Dis & Prevent Control, Riga, Latvia Al Quds Univ, Jerusalem, Israel Alborz Univ Med Sci, Karaj, Iran Minist Hlth, Hanoi, Vietnam BRAC, Dhaka, Bangladesh Inst Epidemiol Dis Control & Res, Dhaka, Bangladesh Univ Turku, Turku, Finland India Diabet Res Fdn, Madras, Tamil Nadu, India Univ New South Wales, Sydney, NSW, Australia Inst Univ Invest Atencio Primaria Jordi Gol, Barcelona, Spain Univ Malaya, Kuala Lumpur, Malaysia Univ Valencia, Valencia, Spain Univ Philippines, Quezon City, Philippines Nutr Res Fdn, Barcelona, Spain Minas Gerais State Secretariat Hlth, Belo Horizonte, MG, Brazil Hlth Ctr San Agustin, San AgustIn, Spain PharmAccess Fdn, Amsterdam, Netherlands Natl Inst Hlth Doutor Ricardo Jorge, Lisbon, Portugal Publ Hlth Agcy Canada, Ottawa, ON, Canada Canarian Hlth Serv, Barcelona, Spain Univ Ind Santander, Bucaramanga, Colombia Inst Nacl Salud Publ, Mexico City, DF, Mexico CIBEROBN, Madrid, Spain Gothenburg Univ, Gothenburg, Sweden Fiji Natl Univ, Suva, Fiji CNR, Inst Food Sci, Rome, Italy Sitaram Bhartia Inst Sci & Res, New Delhi, India Univ Tunis El Mana, Tunis, Tunisia Natl Inst Publ Hlth, Mexico City, DF, Mexico Univ Helsinki, Helsinki, Finland Natl Inst Hlth Peru, Lima, Peru Minist Hlth, South Jakarta, Indonesia Catalan Dept Hlth, Barcelona, Spain Publ Hlth Subdelegate Off, Barcelona, Spain Univ Lisbon, Lisbon, Portugal Prevent Med & Publ Hlth, Lisbon, Portugal Univ Sao Paulo, Clin Hosp, Sao Paulo, Brazil South Karelia Social & Hlth Care Dist, Lappeenranta, Finland Isfahan Cardiovasc Res Ctr, Esfahan, Iran Hosp Italiano Buenos Aires, Buenos Aires, DF, Argentina Rigshosp, Copenhagen, Denmark Minist Hlth, Naypyidaw, Myanmar Lagos State Univ, Coll Med, Lagos, Nigeria Univ Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain Baker Heart and Diabet Inst, Melbourne, Vic, Australia Univ Tokyo, Tokyo, Japan Samsung Med Ctr, Seoul, South Korea Finnish Inst Occupat Hlth, Helsinki, Finland St Vincents Hosp, Melbourne, Vic, Australia Acad Med Ctr Amsterdam, Amsterdam, Netherlands Hlth Polytech Jakarta II Inst, Jakarta, Indonesia Univ Bari, Bari, Italy Inst Reg Sante Publ, Cotonou, Benin Univ Bordeaux, Bordeaux, France Inst Publ Hlth Republ Macedonia, Skopje, Macedonia Univ Leuven, Leuven, Belgium Lamprecht & Stamm Sozialforsch & Beratung AG, Zurich, Switzerland INSERM, Paris, France Univ Bonn, Bonn, Germany Sotiria Hosp, Athens, Greece Natl Inst Publ Hlth, Natl Inst Hyg, Warsaw, Poland Swansea Univ, Swansea, W Glam, Wales Fu Jen Catholic Univ, New Taipei, Taiwan Minist Hlth, Amman, Jordan Natl Inst Hlth, Lima, Peru UNICEF, Yaounde, Cameroon Danish Canc Soc Res Ctr, Copenhagen, Denmark Hlth Serv Murcia, Murcia, Spain Res & Educ Inst, Nicosia, Cyprus IB SALUT Area Salut Menorca, Palma de Mallorca, Spain Univ Bologna, Bologna, Italy Hellen Hlth Fdn, Athens, Greece Univ Pharm & Med Ho Chi Min City, Ho Chi Minh, Vietnam Governm Med Coll, Secunderabad, India Sefako Makgatho Hlth Sci Univ, Kangnung, South Korea Addis Ababa Univ, Addis Ababa, Ethiopia Dasman Diabet Inst, Kuwait, Kuwait Minist Hlth, Thorndon, New Zealand Hellen Med Associat Obes, Athens, Greece Univ Ctr Occidental Lisandro Alvarado, Barquisimeto, Venezuela Meharry Med Coll, Nashville, TN USA Dokuz Eylul Univ, Izmir, Turkey Univ Tampere, Tays Eye Ctr, Tampere, Finland Polytech Inst Porto, Oporto, Portugal Univ Utrecht, Utrecht, Netherlands Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil Natl Inst Publ Hlth & Environm, Bilthoven, Netherlands Fed Univ Pelota, Pelotas, Brazil Italian Natl Res Council, Rome, Italy Univ Miguel Hernandez, Elche, Spain Minist Hlth, Victoria, Seychelles North Karelian Ctr Publ Hlth, Joensuu, Finland ISGlobal Ctr Res Environm Epidemiol, Barcelona, Spain Univ Witwatersrand, Johannesburg, South Africa Med Univ Vienna, Vienna, Austria Univ Coll Cork, Cork, Ireland Inst Med Res, Kuala Lumpur, Malaysia Xinjiang Med Univ, Urumqi, Peoples R China St Georges Univ London, London, England Univ Indonesia, Depok, Indonesia Natl Inst Hyg, Warsaw, Poland Caja Costarricense Seguro Social, Atenas, Costa Rica Univ Kebangsaan Malaysia, Bangi Selangor, Malaysia Univ New South Wales, Kensington, NSW, Australia Univ Mancheste, Manchester, Lancs, England Shandong Univ Tradit Chinese Med, Jinan, Shandong, Peoples R China Kailuan Gen Hosp, Tangshan, Peoples R China Minist Agr, Inst Food & Dev, Beijing, Peoples R China Fudan Univ, Childrens Hosp, Shanghai, Peoples R China Chinese Ctr Dis Control & Prevent, Beijing, Peoples R China Univ Cyprus, Nicosia, Cyprus Univ Teknol MARA, Shah Alam, Malaysia Capital Med Univ Beijing, An Zhen Hosp, Beijing, Peoples R China West Kazakhstan State Med Univ, Aktobe, Kazakhstan Inner Mongolia Med Univ, Hohhot, Peoples R China Gorgas Mem Inst Publ Hlth, Panama City, Panama Univ Estadual Paulista, Sao Paulo, Brazil
Published: 2017

6. Comparison of Knowledge, Attitude and Practice of Urban and Rural Households toward Iron Deficiency Anemia in three Provinces of Iran

Author: Heshmat, R., Azemati, B., Keshtkar, A. A., Salehi, F., Abdollahi, Z., Kolahdouz, F., Pouraram, H., Faezeh Farivar, Bagheri, M., Sheykh-Ol-Eslam, R., and Nadim, A.
Subjects: Practice, Knowledge, Attitude, Iron deficiency anemia, lcsh:Public aspects of medicine, Urban, Rural, lcsh:RA1-1270, Iran
Abstract: "nBackground: Lack of nutritional knowledge is one of the most important reasons of nutritional problems and consequently improper practice, which can lead to several complications. This study has been designed in order to compare knowledge, attitude and practices of the urban and rural households regarding iron deficiency anemia (IDA) in Boushehr, Golestan and Sistan & Balouchestan provinces in 2004."nMethods: The sampling method at household's level in each province was the single-stage cluster sampling with equal size clusters. The necessary data were gathered with a structured questionnaire and via the interviews between the questioners and the eligible people in each household. Comparison of frequency of variables between urban and rural areas were tested by chi square test."nResults: A total of 2306 households were selected as overall sample size. In urban areas, people recognized iron food sources better than rural areas. Knowledge level of respondents about vulnerable group for IDA and the favorite attitude of households toward IDA were better in urban areas of Sistan & Blouchestan and Golestan provinces. In Sistan & Balouchestan and Golestan, rural households who drank tea immediately before or after meal was more than urban ones. The majority of pregnant and lactating mothers (except for rural areas of Bushehr) did not take iron supplement regularly. Less than 60 percent of children used iron drop regularly."nConclusion: Knowledge, attitude, and practice levels of households toward IDA were not acceptable. One of the best ways of improving nutritional practice is nutritional education with focus on applying available food resources.
Published: 2009

7. Flour fortification with iron and folic acid in Bushehr and Golestan provinces, Iran: Program evaluation.

Author: Sadighi, J., Mohammad, K., Sheikholeslam, R., Torabi, P., Salehi, F., Abdolahi, Z., and Pouraram, H.
Subjects: FLOUR microbiology, IRON deficiency, FOLIC acid in human nutrition, NUTRITIONAL anemia
Abstract: Background and Aim: Anemia is an important public health problem in Iran. The most prevalent type (50%) is iron-deficiency anemia. Flour fortification with iron and folic acid is one of the main strategies usually adopted to combat anemia. Two pilot projects were conducted in 2 Iranian provinces: the first one in Bushehr in 2001 and the second one in Golestan in 2007. The present study was conducted in January 2009 to evaluate the process and determine the effectiveness of the flour fortification pilot project in the 2 provinces. Materials and Methods: To evaluate the effectiveness of the project, blood hemoglobin and ferritin levels were measured in a sample population of child-bearing women aged 15-49 years in Bushehr Province (n=600) and Golestan Province (n=625), selected by multi-stage sampling before and after the intervention. For process evaluation, the iron content in samples of flour and bread made from the flour were measured in a descriptive study. Results: We found similar trends in the indicators of anemia/iron deficiency among the women in Bushehr and Golestan provinces. The flour fortification project appears to have had beneficial effects on the serum ferritin levels (low levels indicate iron deficiency) in both provinces. The prevalence of iron deficiency decreased from 22.2% to 15.7% (p<0.002) and from 26.7% to 14.6% (p<0.001), in Bushehr and Golestan, respectively. However, the prevalence of anemia was significantly higher after intervention in Golestan (p<0.001). Further analysis of the data also revealed that the intervention did not have any statistically significant effect on the prevalence of iron-deficiency anemia in either province. The coverages of fortified flour and bread were 90% and 98.7% in Bushehr and 94.1% and 95% in Golestan, respectively. Conclusion: The flour fortification pilot project in Iran resulted in reducing prevalence of iron deficiency and improving body iron reserves in women, but it had no effect on anemia prevalence. It can be concluded that in circumstances where iron deficiency is not a major cause of anemia, interventions such as flour fortification with iron alone will not produce any significant effect. [ABSTRACT FROM AUTHOR]
Published: 2010

8. Continuous Spectrum of Trigonometric Rosen-Morse and Eckart Potentials from Free Particle Spectrum.

Author: Panahi, H. and Pouraram, H.
Published: 2011
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9. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Author: Rodriguez-Martinez, Andrea, Zhou, Bin, Sophiea, Marisa K, Bentham, James, Paciorek, Christopher J, Iurilli, Maria LC, Carrillo-Larco, Rodrigo M, Bennett, James E, Di Cesare, Mariachiara, Taddei, Cristina, Bixby, Honor, Stevens, Gretchen A, Riley, Leanne M, Cowan, Melanie J, Savin, Stefan, Danaei, Goodarz, Chirita-Emandi, Adela, Kengne, Andre P, Khang, Young-Ho, Laxmaiah, Avula, Malekzadeh, Reza, Miranda, J Jaime, Moon, Jin Soo, Popovic, Stevo R, Sorensen, Thorkild IA, Soric, Maroje, Starc, Gregor, Zainuddin, Ahmad A, Gregg, Edward W, Bhutta, Zulfiqar A, Black, Robert, Ezzati, Majid, Abarca-Gomez, Leandra, Abdeen, Ziad A, Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Rahim, Hanan F Abdul, Abu-Rmeileh, Niveen M, Garba, Jamila Abubakar, Acosta-Cazares, Benjamin, Adams, Robert J, Aekplakorn, Wichai, Afsana, Kaosar, Afzal, Shoaib, Agdeppa, Imelda A, Aghazadeh-Attari, Javad, Aguilar-Salinas, Carlos A, Agyemang, Charles, Ahmad, Mohamad Hasnan, Ahmad, Noor Ani, Ahmadi, Ali, Ahmadi, Naser, Ahmed, Soheir H, Ahrens, Wolfgang, Aitmurzaeva, Gulmira, Ajlouni, Kamel, Al-Hazzaa, Hazzaa M, Al-Othman, Amani Rashed, Al-Raddadi, Rajaa, Alarouj, Monira, AlBuhairan, Fadia, AlDhukair, Shahla, Ali, Mohamed M, Alkandari, Abdullah, Alkerwi, Ala'a, Allin, Kristine, Alvarez-Pedrerol, Mar, Aly, Eman, Amarapurkar, Deepak N, Amiri, Parisa, Amougou, Norbert, Amouyel, Philippe, Andersen, Lars Bo, Anderssen, Sigmund A, Angquist, Lars, Anjana, Ranjit Mohan, Ansari-Moghaddam, Alireza, Aounallah-Skhiri, Hajer, Araujo, Joana, Ariansen, Inger, Aris, Tahir, Arku, Raphael E, Arlappa, Nimmathota, Aryal, Krishna K, Aspelund, Thor, Assah, Felix K, Assuncao, Maria Cecilia F, Aung, May Soe, Auvinen, Juha, Avdicova, Maria, Azevedo, Ana, Azimi-Nezhad, Mohsen, Azizi, Fereidoun, Azmin, Mehrdad, Babu, Bontha V, Jorgensen, Maja Baeksgaard, Baharudin, Azli, Bahijri, Suhad, Baker, Jennifer L, Balakrishna, Nagalla, Bamoshmoosh, Mohamed, Banach, Maciej, Bandosz, Piotr, Banegas, Jose R, Baran, Joanna, Barbagallo, Carlo M, Barcelo, Alberto, Barkat, Amina, Barros, Aluisio JD, Barros, Mauro Virgilio Gomes, Basit, Abdul, Bastos, Joao Luiz D, Bata, Iqbal, Batieha, Anwar M, Batista, Rosangela L, Battakova, Zhamilya, Batyrbek, Assembekov, Baur, Louise A, Beaglehole, Robert, Bel-Serrat, Silvia, Belavendra, Antonisamy, Ben Romdhane, Habiba, Benedics, Judith, Benet, Mikhail, Berkinbayev, Salim, Bernabe-Ortiz, Antonio, Bernotiene, Gailute, Bettiol, Heloisa, Bezerra, Jorge, Bhagyalaxmi, Aroor, Bharadwaj, Sumit, Bhargava, Santosh K, Bi, Hongsheng, Bi, Yufang, Bia, Daniel, Lele, Elysee Claude Bika, Bikbov, Mukharram M, Bista, Bihungum, Bjelica, Dusko J, Bjerregaard, Peter, Bjertness, Espen, Bjertness, Marius B, Bjorkelund, Cecilia, Bloch, Katia V, Blokstra, Anneke, Bo, Simona, Bobak, Martin, Boddy, Lynne M, Boehm, Bernhard O, Boeing, Heiner, Boggia, Jose G, Bogova, Elena, Boissonnet, Carlos P, Bojesen, Stig E, Bonaccio, Marialaura, Bongard, Vanina, Bonilla-Vargas, Alice, Bopp, Matthias, Borghs, 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Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nicholas, Weber, Adelheid, Wedderkopp, Niels, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Yusof, Safiah Md, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassilis, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Zamrazilova, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Zaw, Ko Ko, Zdrojewski, Tomasz, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zocalo, Yanina, Cisneros, Julio Zuniga, Zuziak, Monika, Faculdade de Ciências da Nutrição e Alimentação, Instituto de Saúde Pública da Universidade do Porto, Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Environnement, Santé, Sociétés (ESS), Centre National de la Recherche Scientifique (CNRS), European Project: 774548, Reproductive Origins of Adult Health and Disease (ROAHD), Rodriguez-Martinez A, Zhou B, Sophiea MK, Bentham J, Paciorek CJ, Iurilli ML, Carrillo-Larco RM, Bennett JE, Di Cesare M, Taddei C, Bixby H, Stevens GA, Riley LM, Cowan MJ, Savin S, 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Nordestgaard B.G., Noto D., Nowak-Szczepanska N., Nsour M.A., Nuhoglu I., Nurk E., O'Neill T.W., O'Reilly D., Obreja G., Ochimana C., Ochoa-Aviles A.M., Oda E., Oh K., Ohara K., Ohlsson C., Ohtsuka R., Olafsson O., Olinto M.T.A., Oliveira I.O., Omar M.A., Onat A., Ong S.K., Ono L.M., Ordunez P., Ornelas R., Ortiz A.P., Ortiz P.J., Osler M., Osmond C., Ostojic S.M., Ostovar A., Otero J.A., Overvad K., Owusu-Dabo E., Paccaud F.M., Padez C., Pagkalos I., Pahomova E., Paiva K.M.D., Pajak A., Palli D., Palloni A., Palmieri L., Pan W.-H., Panda-Jonas S., Pandey A., Panza F., Papandreou D., Park S.-W., Park S., Parnell W.R., Parsaeian M., Pascanu I.M., Pasquet P., Patel N.D., Pednekar M.S., Peer N., Peixoto S.V., Peltonen M., Pereira A.C., Peres M.A., Perez-Farinos N., Perez C.M., Peterkova V., Peters A., Petersmann A., Petkeviciene J., Petrauskiene A., Pettenuzzo E., Peykari N., Pham S.T., Pichardo R.N., Pierannunzio D., Pigeot I., Pikhart H., Pilav A., Pilotto L., Pistelli F., Pitakaka F., 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Subjects: Male, body-mass index, ADULTHOOD, Adolescents, pituuskasvu, Pediatrics, Body Mass Index, 0302 clinical medicine, Child Development, nuoret, Public health surveillance, Medicine, Health Status Indicators, 10. No inequality, Child, 11 Medical and Health Sciences, Body mass index, ComputingMilieux_MISCELLANEOUS, education.field_of_study, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, General Medicine, Body mass indexes, kansainvälinen vertailu, 3. Good health, Geography, Health, 030220 oncology & carcinogenesis, Child, Preschool, Medical and Health sciences, purl.org/becyt/ford/3 [https], medicine.medical_specialty, School-aged adolescents, Socio-culturale, lapset (ikäryhmät), Nursing, territories, ravinto, purl.org/becyt/ford/3.3 [https], 03 medical and health sciences, School Children, SDG 3 - Good Health and Well-being, SYSTEMATIC ANALYSIS, Humans, school-aged children and adolescents, Montenegro, education, Science & Technology, Omvårdnad, Health sciences, Medical and Health sciences, Ciências médicas e da saúde, Bayes Theorem, Anthropometry, Adolescent Development, medicine.disease, TRENDS, Height and Body-mass Index, Faculdade de Ciências Sociais, UNDERNUTRITION, Height index trajectories, Height, body mass index, children , epidemiology, risk factors, growth, Stature, Demography, Settore MED/09 - Medicina Interna, Internationality, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Body-mass index trajectories, Epidemiology, Medicine and Health Sciences, risk factors, countries, EPIDEMIOLOGY, height, children, adolescents, BMI, 030212 general & internal medicine, painoindeksi, Child development, 2. Zero hunger, Medicine(all), School age child, obestity children cardiovascular, Population Health, 1. No poverty, Pediatrik, Public Health, Global Health, Social Medicine and Epidemiology, 3142 Public health care science, environmental and occupational health, Pooled analysis, NUTRITION, Female, medicine.symptom, pooled analysis, Life Sciences & Biomedicine, terveys, height, BMI, nutrition, health, children, adolescents, Adolescent, growth, Population, body-mass, Population based, Body-mass index, Young Adult, Medicine, General & Internal, Meta-Analysis as Topic, General & Internal Medicine, parasitic diseases, Weight gain, School-aged childrens, Age trajectories, business.industry, Height, Weight, Body Height, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, ONSET, Ciências da Saúde, Ciências médicas e da saúde, School-aged children, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, terveysriskit, Estilos de Vida e Impacto na Saúde
Abstract: BACKGROUND: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents., METHODS: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence., FINDINGS: We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls., INTERPRETATION: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks., Wellcome Trust, AstraZeneca Young Health Programme, EU., peer-reviewed
Published: 2020

10. Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Author: Bixby, Honor, Bentham, James, Zhou, Bin, Di Cesare, Mariachiara, Paciorek, Christopher J., Bennett, James E., Taddei, Cristina, Stevens, Gretchen A., Rodriguez-Martinez, Andrea, Carrillo-Larco, Rodrigo M., Khang, Young-Ho, Soric, Maroje, Gregg, Edward W., Miranda, J. Jaime, Bhutta, Zulfiqar A., Savin, Stefan, Sophiea, Marisa K., Iurilli, Maria L. C., Solomon, Bethlehem D., Cowan, Melanie J., Riley, Leanne M., Danaei, Goodarz, Bovet, Pascal, Chirita-Emandi, Adela, Hambleton, Ian R., Hayes, Alison J., Ikeda, Nayu, Kengne, Andre P., Laxmaiah, Avula, Li, Yanping, McGarvey, Stephen T., Mostafa, Aya, Neovius, Martin, Starc, Gregor, Zainuddin, Ahmad A., Abarca-Gomez, Leandra, Abdeen, Ziad A., Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Hamid, Zargar Abdul, Garba, Jamila Abubakar, Abu-Rmeileh, Niveen M., Acosta-Cazares, Benjamin, Adams, Robert J., Aekplakorn, Wichai, Afsana, Kaosar, Agdeppa, Imelda A., Aguilar-Salinas, Carlos A., Agyemang, Charles, Ahmad, Mohamad Hasnan, Ahmad, Noor Ani, Ahmadi, Naser, Ahmadvand, Alireza, Ahrens, Wolfgang, Ajlouni, Kamel, AlBuhairan, Fadia, AlDhukair, Shahla, Al-Hazzaa, Hazzaa M., Ali, Mohamed M., Ali, Osman, Alkerwi, Ala'a, Al-Othman, Amani Rashed, Al-Raddadi, Rajaa, Alvarez-Pedrerol, Mar, Aly, Eman, Amarapurkar, Deepak N., Amouyel, Philippe, Amuzu, Antoinette, Bo, Lars, Anderssen, Sigmund A., Angquist, Lars H., Anjana, Ranjit Mohan, Ansari-Moghaddam, Alireza, Aounallah-Skhiri, Hajer, Araujo, Joana, Ariansen, Inger, Aris, Tahir, Arku, Raphael E., Arlappa, Nimmathota, Aryal, Krishna K., Aspelund, Thor, Assah, Felix K., Assuncao, Maria Cecilia F., Aung, May Soe, Auvinen, Juha, Avdicova, Maria, Azevedo, Ana, Azizi, Fereidoun, Azmin, Mehrdad, Babu, Bontha V., Baharudin, Azli, Bahijri, Suhad, Baker, Jennifer L., Balakrishna, Nagalla, Bamoshmoosh, Mohamed, Banach, Maciej, Bandosz, Piotr, Banegas, Jose R., Barbagallo, Carlo M., Barcelo, Alberto, Barkat, Amina, Barros, Aluisio J. D., Barros, Mauro V. G., Bata, Iqbal, Batieha, Anwar M., Batista, Rosangela L., Battakova, Zhamilya, Batyrbek, Assembekov, Baur, Louise A., Beaglehole, Robert, Bel-Serrat, Silvia, Ben Romdhane, Habiba, Benedics, Judith, Benet, Mikhail, Berkinbayev, Salim, Bernabe-Ortiz, Antonio, Bernotiene, Gailute, Bettiol, Heloisa, Bhagyalaxmi, Aroor, Bharadwaj, Sumit, Bhargava, Santosh K., Bi, Hongsheng, Bi, Yufang, Biehl, Anna, Lele, Elysee Claude Bika, Bikbov, Mukharram, Bista, Bihungum, Bjelica, Dusko J., Bjerregaard, Peter, Bjertness, Espen, Bjertness, Marius B., Bjorkelund, Cecilia, Blokstra, Anneke, Bo, Simona, Bobak, Martin, Boddy, Lynne M., Boehm, Bernhard O., Boeing, Heiner, Boggia, Jose G., Boissonnet, Carlos P., Bonaccio, Marialaura, Bongard, Vanina, Bopp, Matthias, Borchini, Rossana, Borghs, Herman, Braeckevelt, Lien, Braeckman, Lutgart, Bragt, Marjolijn C. E., Brajkovich, Imperia, Branca, Francesco, Breckenkamp, Juergen, Breda, Joao, Brenner, Hermann, Brewster, Lizzy M., Brian, Garry R., Brinduse, Lacramioara, Bruno, Graziella, Bueno-de-Mesquita, H. Bas, Bugge, Anna, Buoncristiano, Marta, Burazeri, Genc, Burns, Con, Cabrera de Leon, Antonio, Cacciottolo, Joseph, Cai, Hui, Cama, Tilema, Cameron, Christine, Camolas, Jose, Can, Gamze, Can, Gunay, Candido, Ana Paula C., Canete, Felicia, Capanzana, Mario V., Capuano, Eduardo, Capuano, Vincenzo, Cardoso, Viviane C., Carlsson, Axel C., Carmuega, Esteban, Carvalho, Maria J., Casanueva, Felipe F., Casas, Juan-Pablo, Caserta, Carmelo A., Celikcan, Ertugrul, Censi, Laura, Cesar, Juraci A., Chamukuttan, Snehalatha, Chan, Angelique W., Chan, Queenie, Chaturvedi, Himanshu K., Chaturvedi, Nishi, Rahim, Norsyamlina Che Abdul, Chen, Chien-Jen, Chen, Fangfang, Chen, Huashuai, Chen, Shuohua, Chen, Zhengming, Cheng, Ching-Yu, Cheng, Yiling J., Chetrit, Angela, Chikova-Iscener, Ekaterina, Chiolero, Arnaud, Chiou, Shu-Ti, Chirlaque, Maria-Dolores, Cho, Belong, Cho, Yumi, Christensen, Kaare, Christofaro, Diego G., Chudek, Jerzy, Cifkova, Renata, Cilia, Michelle, Cinteza, Eliza, Claessens, Frank, Clarke, Janine, Clays, Els, Concin, Hans, Confortin, Susana C., Cooper, Cyrus, Coppinger, Tara C., Costanzo, Simona, Cottel, Dominique, Cowell, Chris, Craig, Cora L., Crampin, Amelia C., Crujeiras, Ana B., Cruz, Juan J., Cucu, Alexandra, Cui, Liufu, Dallongeville, Jean, Damasceno, Albertino, Damsgaard, Camilla T., Dankner, Rachel, Dantoft, Thomas M., D'Arrigo, Graziella, Dasgupta, Parasmani, Dastgiri, Saeed, Dauchet, Luc, Davletov, Kairat, De Backer, Guy, De Bacquer, Dirk, De Curtis, Amalia, de Gaetano, Giovanni, De Henauw, Stefaan, de Oliveira, Paula Duarte, De Ridder, Karin, de Rooij, Susanne R., De Smedt, Delphine, Deepa, Mohan, Deev, Alexander D., Dehghan, Abbas, Delisle, Helene, Delpeuch, Francis, Dennison, Elaine, Deschamps, Valerie, Dhana, Klodian, Dhimal, Meghnath, Di Castelnuovo, Augusto F., Dias-da-Costa, Juvenal Soares, Diaz, Alejandro, Dika, Zivka, Djalalinia, Shirin, Do, Ha T. 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Jasienska G, Jelakovic A, Jelakovic B, Jennings G, Jeong S-L, Jiang CQ, Jimenez RO, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Jovic DP, Józwiak J, Juolevi A, Jurak G, Juresa V, Kaaks R, Kafatos A, Kajantie EO, Kalter-Leibovici O, Kamaruddin NA, Kameli Y, Kapantais E, Karki KB, Kasaeian A, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva G, Keil U, Keinan-Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khateeb M, Khaw K-T, Kheiri B, Khosravi A, Khouw IMSL, Kiechl S, Kiechl-Kohlendorfer U, Killewo J, Kim J, Kim Y-Y, Klimont J, Klumbiene J, Knoflach M, Koirala B, Kolle E, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Koskinen S, Kouda K, Kovacs VA, Kowlessur S, Koziel S, Kratzer W, Kriemler S, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kuh D, Kujala UM, Kujundzic E, Kulaga Z, Kumar RK, Kunešová M, Kurjata P, Kusuma YS, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Laatikainen T, Lachat C, Laid Y, Lam TH, Lang Morovic M, Lanska V, Lappas G, Larijani B, Latt TS, Laugsand LE, Lauria L, Lazo-Porras M, Le Nguyen Bao K, Le Port A, Le TD, Lee J, Lee PH, Lehtimäki T, Lemogoum D, Levitt NS, Lilly CL, Lim W-Y, Lima-Costa MF, Lin H-H, Lin X, Lind L, Linneberg A, Lissner L, Litwin M, Liu J, Loit H-M, Lopes L, Lopez T, López-García E, Lorbeer R, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lytsy P, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Machi S, Maggi S, Magliano DJ, Magriplis E, Maire B, Majer M, Makdisse M, Malekzadeh F, Malekzadeh R, Malhotra R, Malyutina S, Maniego LV, Manios Y, Mann JI, Manzato E, Margozzini P, Markaki A, Markey O, Markidou Ioannidou E, Marques LP, Marques-Vidal P, Marrugat J, Martin R, Martin-Prevel Y, Martorell R, Martos E, Marventano S, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matsha TE, Mazur A, Mbanya JCN, McFarlane SR, McKee M, McLachlan S, McLean RM, McLean SB, McNulty BA, Md Yusof S, Mediene-Benchekor S, Medzioniene J, Mehdipour P, Meirhaeghe A, Meisfjord J, Meisinger C, Menezes AMB, Menon GR, Mensink GBM, Mereke A, Meshram II, Metspalu A, Meyer HE, Mi J, Michaelsen KF, Michels N, Mikkel K, Miller JC, Minderico CS, Miquel JF, Mirkopoulou D, Mirrakhimov E, Misigoj-Durakovic M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohammad K, Mohammadifard N, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebi F, Moitry M, Molbo D, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monterrubio EA, Monyeki KDK, Moon JS, Moreira LB, Morejon A, Moreno LA, Morgan K, Morin S, Mortensen EL, Moschonis G, Mossakowska M, Mota J, Mota-Pinto A, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muc M, Mugoša B, Muiesan ML, Mukhtorova P, Müller-Nurasyid M, Murphy N, Mursu J, Murtagh EM, Milanovic SM, Musil V, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Nakamura H, Námešná J, Nang EEK, Nangia VB, Nankap M, 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H, Zapata ME, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhao D, Zhao W, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zhussupov B, Zimmermann E, Zuñiga Cisneros J, Ezzati M, Yiallouros, Panayiotis K. [0000-0002-8339-9285], APH - Societal Participation & Health, APH - Aging & Later Life, Epidemiology and Data Science, Public and occupational health, APH - Health Behaviors & Chronic Diseases, and APH - Personalized Medicine
Subjects: Male, Rural Population, obesity, Obesity, body mass index, Settore MED/09 - Medicina Interna, Letter, Urban Population, Epidemiology, [SDV]Life Sciences [q-bio], humanos, body-mass index, adolescente, Geographic Mapping, Sex Factor, países desarrollados, Rural Health, purl.org/pe-repo/ocde/ford#3.03.09 [https], systematic analysis, Body Mass Index, países en desarrollo, 80 and over, risk factors, Age Factor, physical-activity, mediana edad, mapeo geográfico, Aged, 80 and over, anciano, purl.org/pe-repo/ocde/ford#3.02.18 [https], dieta, Age Factors, health, adulto, Middle Aged, Multidisciplinary Sciences, adulto joven, [SDV] Life Sciences [q-bio], estado nutricional, nutrition, Science & Technology - Other Topics, NUTRITION, Female, HEALTH, pooled analysis, Diet, Healthy, worldwide trends, Human, Developed Countrie, Adult, Adolescent, purl.org/pe-repo/ocde/ford#3.03.04 [https], FOOD SYSTEM, Socio-culturale, Nutritional Status, URBAN, Aged, Developed Countries, Developing Countries, Humans, Obesity, Sex Factors, Urban Health, Young Adult, POOLED ANALYSIS, Developing Countrie, MIDDLE-INCOME COUNTRIES, SYSTEMATIC ANALYSIS, Urban rural Obesity Body-Mass-Index, obesidad, Middle-income countries, food system, urban, weight, Healthy, Science & Technology, índice de masa corporal, Diet, PHYSICAL-ACTIVITY, WORLDWIDE TRENDS, Risk factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, WEIGHT
Abstract: Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories., This study was funded by the Wellcome Trust. H.B. was supported by a Medical Research Council Doctoral Training Partnership Studentship, J.B. by a Royal Society Research Grant, and M.D.C. by an Academy of Medical Sciences Springboard Award. We thank L. Jaacks, B. Popkin, S. Sundberg and W. Willett for recommendations of relevant citations. The authors are responsible for the views expressed in this Letter and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.
Published: 2019

11. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Author: NCD Risk Factor Collaboration (NCD-RisC), Abarca-Gómez, L., Abdeen, Z.A., Hamid, Z.A., Abu-Rmeileh, N.M., Acosta-Cazares, B., Acuin, C., Adams, R.J., Aekplakorn, W., Afsana, K., Aguilar-Salinas, C.A., Agyemang, C., Ahmadvand, A., Ahrens, W., Ajlouni, K., Akhtaeva, N., Al-Hazzaa, H.M., Al-Othman, A.R., Al-Raddadi, R., Al Buhairan, F., Al Dhukair, S., Ali, M.M., Ali, O., Alkerwi, A., Alvarez-Pedrerol, M., Aly, E., Amarapurkar, D.N., Amouyel, P., Amuzu, A., Andersen, L.B., Anderssen, S.A., Andrade, D.S., Ängquist, L.H., Anjana, R.M., Aounallah-Skhiri, H., Araújo, J., Ariansen, I., Aris, T., Arlappa, N., Arveiler, D., Aryal, K.K., Aspelund, T., Assah, F.K., Assunção, MCF, Aung, M.S., Avdicová, M., Azevedo, A., Azizi, F., Babu, B.V., Bahijri, S., Baker, J.L., Balakrishna, N., Bamoshmoosh, M., Banach, M., Bandosz, P., Banegas, J.R., Barbagallo, C.M., Barceló, A., Barkat, A., Barros, A.J., Barros, M.V., Bata, I., Batieha, A.M., Batista, R.L., Batyrbek, A., Baur, L.A., Beaglehole, R., Romdhane, H.B., Benedics, J., Benet, M., Bennett, J.E., Bernabe-Ortiz, A., Bernotiene, G., Bettiol, H., Bhagyalaxmi, A., Bharadwaj, S., Bhargava, S.K., Bhatti, Z., Bhutta, Z.A., Bi, H., Bi, Y., Biehl, A., Bikbov, M., Bista, B., Bjelica, D.J., Bjerregaard, P., Bjertness, E., Bjertness, M.B., Björkelund, C., Blokstra, A., Bo, S., Bobak, M., Boddy, L.M., Boehm, B.O., Boeing, H., Boggia, J.G., Boissonnet, C.P., Bonaccio, M., Bongard, V., Bovet, P., Braeckevelt, L., Braeckman, L., Bragt, M.C., Brajkovich, I., Branca, F., Breckenkamp, J., Breda, J., Brenner, H., Brewster, L.M., Brian, G.R., Brinduse, L., Bruno, G., Bueno-de-Mesquita, HBA, Bugge, A., Buoncristiano, M., Burazeri, G., Burns, C., de León, A.C., Cacciottolo, J., Cai, H., Cama, T., Cameron, C., Camolas, J., Can, G., Cândido, APC, Capanzana, M., Capuano, V., Cardoso, V.C., Carlsson, A.C., Carvalho, M.J., Casanueva, F.F., Casas, J.P., Caserta, C.A., Chamukuttan, S., Chan, A.W., Chan, Q., Chaturvedi, H.K., Chaturvedi, N., Chen, C.J., Chen, F., Chen, H., Chen, S., Chen, Z., Cheng, C.Y., Chetrit, A., Chikova-Iscener, E., Chiolero, A., Chiou, S.T., Chirita-Emandi, A., Chirlaque, M.D., Cho, B., Cho, Y., Christensen, K., Christofaro, D.G., Chudek, J., Cifkova, R., Cinteza, E., Claessens, F., Clays, E., Concin, H., Confortin, S.C., Cooper, C., Cooper, R., Coppinger, T.C., Costanzo, S., Cottel, D., Cowell, C., Craig, C.L., Crujeiras, A.B., Cucu, A., D'Arrigo, G., d'Orsi, E., Dallongeville, J., Damasceno, A., Damsgaard, C.T., Danaei, G., Dankner, R., Dantoft, T.M., Dastgiri, S., Dauchet, L., Davletov, K., De Backer, G., De Bacquer, D., De Curtis, A., de Gaetano, G., De Henauw, S., de Oliveira, P.D., De Ridder, K., De Smedt, D., Deepa, M., Deev, A.D., Dehghan, A., Delisle, H., Delpeuch, F., Deschamps, V., Dhana, K., Di Castelnuovo, A.F., Dias-da-Costa, J.S., Diaz, A., Dika, Z., Djalalinia, S., Do, H.T., Dobson, A.J., Donati, M.B., Donfrancesco, C., Donoso, S.P., Döring, A., Dorobantu, M., Dorosty, A.R., Doua, K., Drygas, 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Veronesi, G., Verschuren, W.M., Victora, C.G., Viegi, G., Viet, L., Viikari-Juntura, E., Vineis, P., Vioque, J., Virtanen, J.K., Visvikis-Siest, S., Viswanathan, B., Vlasoff, T., Vollenweider, P., Völzke, H., Voutilainen, S., Vrijheid, M., Wade, A.N., Wagner, A., Waldhör, T., Walton, J., Bebakar, WMW, Mohamud, WNW, Wanderley, R.S., Wang, M.D., Wang, Q., Wang, Y.X., Wang, Y.W., Wannamethee, S.G., Wareham, N., Weber, A., Wedderkopp, N., Weerasekera, D., Whincup, P.H., Widhalm, K., Widyahening, I.S., Wiecek, A., Wijga, A.H., Wilks, R.J., Willeit, J., Willeit, P., Wilsgaard, T., Wojtyniak, B., Wong-McClure, R.A., Wong, J.Y., Wong, J.E., Wong, T.Y., Woo, J., Woodward, M., Wu, F.C., Wu, J., Wu, S., Xu, H., Xu, L., Yamborisut, U., Yan, W., Yang, X., Yardim, N., Ye, X., Yiallouros, P.K., Yngve, A., Yoshihara, A., You, Q.S., Younger-Coleman, N.O., Yusoff, F., Zaccagni, L., Zafiropulos, V., Zainuddin, A.A., Zambon, S., Zampelas, A., Zamrazilová, H., Zdrojewski, T., Zeng, Y., Zhao, D., Zhao, W., Zheng, W., Zheng, Y., Zholdin, B., Zhou, M., Zhu, D., Zhussupov, B., Zimmermann, E., Cisneros, J.Z., Bentham, J., Di Cesare, M., Bilano, V., Bixby, H., Zhou, B., Stevens, G.A., Riley, L.M., Taddei, C., Hajifathalian, K., Lu, Y., Savin, S., Cowan, M.J., Paciorek, C.J., Zhu, A., and Ezzati, M.
Abstract: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Wellcome Trust, AstraZeneca Young Health Programme.
Published: 2017

12. Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review.

Author: Salehi Z, Askari M, Jafari A, Ghosn B, Surkan PJ, Hosseinzadeh-Attar MJ, Pouraram H, and Azadbakht L
Subjects: Humans, Diet, COVID-19 prevention & control, COVID-19 epidemiology, Micronutrients administration & dosage, Respiratory Tract Infections prevention & control, Respiratory Tract Infections epidemiology
Abstract: Background: COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition., Methods: This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria., Results: Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D., Conclusion: This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet., (© 2024. The Author(s).)
Published: 2024
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13. Effect of ketogenic diet on blood pressure: A GRADE-Assessed systematic review and meta-analysis of randomized controlled trials.

Author: Amini MR, Askarpour M, Ghalandari H, Gholizadeh M, and Pouraram H
Subjects: Humans, Treatment Outcome, Female, Male, Middle Aged, Adult, Aged, Adolescent, Young Adult, Child, Risk Assessment, Diet, Ketogenic adverse effects, Randomized Controlled Trials as Topic, Blood Pressure, Hypertension physiopathology, Hypertension diet therapy, Hypertension diagnosis, Hypertension prevention & control
Abstract: Aims: Cardiovascular diseases (CVDs) are major causes of mortality around the world. High blood pressure (BP) or hypertension is one of the most significant predisposing factors to CVDs. Ketogenic diets (KDs) have been the center of attention for their possible health benefits. The aim of this analysis is to study the impact of KDs on BP through the existing literature., Data Synthesis: We investigated the impact of KDs on systolic and diastolic blood pressures (SBP and DBP) conducted in the format of randomized controlled trials (RCTs). Four online databases (PubMed/Medline, SCOPUS, Cochrane Library, and Google Scholar) were searched from inception up to November 2022. Subgroup analyses were carried out to find the sources of heterogeneities. Twenty-three RCTs with 1664 participants were identified. KDs did not exert any significant impacts on SBP (WMD: -0.87 mmHg, 95% CI: -2.05, 0.31) nor DBP (WMD: -0.11 mmHg, 95% CI -1.14, 0.93). Subgroup analyses did not reveal any further information. Also, non-linear dose-response analysis could not detect any associations between the percentage of calorie intake from fat in the KD format and BP levels., Conclusion: KDs do not seem to be effective in improving BP. Nonetheless, further investigations are recommended to examine the proportion of fat intake needed to induce favorable clinical impacts., Competing Interests: Declaration of competing interest There is no conflict of interest to declare., (Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)
Published: 2024
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14. Worse becomes the worst: obesity inequality, its determinants and policy options in Iran.

Author: Toorang F, Amiri P, Djazayery A, Pouraram H, and Takian A
Subjects: Child, Humans, Female, Iran epidemiology, Socioeconomic Factors, Policy, Obesity epidemiology, Poverty
Abstract: Background: This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities., Methods: This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran's policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study., Results: Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary., Conclusion: Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Toorang, Amiri, Djazayery, Pouraram and Takian.)
Published: 2024
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15. Human biomonitoring and reference values of urinary 1-hydroxypyrene among Iranian adults population.

Author: Soleimani Z, Haghshenas R, Farzi Y, Yunesian M, Khalaji A, Behnoush AH, Karami A, Mehrabi M, Ghasemi E, Ashkani F, Naddafi K, Djazayeri A, Pouraram H, Mesdaghinia A, and Farzadfar F
Subjects: Humans, Adult, Iran, Male, Female, Cross-Sectional Studies, Middle Aged, Reference Values, Environmental Pollutants urine, Biomarkers urine, Pyrenes urine, Biological Monitoring, Polycyclic Aromatic Hydrocarbons urine
Abstract: Polycyclic aromatic hydrocarbons (PAHs) are one of the most important environmental pollutants. Urinary concentrations of 1-hydropyren metabolites of PAHs have been used as biomarkers of these chemicals' exposure in humans. This cross-sectional study was conducted on 468 healthy Iranian adults over 25 years old and non-smokers in six provinces who were selected based on the clustering method. Fasting urine sampling and body composition and demographic measurements were performed. Urine samples were analyzed by GC-MS. The analysis included descriptive statistics and analytical statistics using multiple linear regression by Python software. 1-Hydroxypyrene was found in 100% of samples, and the mean (Reference Value 95%) concentration of 1-hydroxypyrene was 6.12 (RV 95%: 20) μg/L and 5.95 (21) μg/gcrt. There was a direct relationship between the amount of body composition (body fat, visceral fat), BMI, and age with the urinary concentrations of 1-hydropyren metabolites, and this relationship was significant for BMI with urinary concentrations of 1-hydropyren metabolites (P = 0.045). The amount of 1-hydroxypyrene in healthy Iranian adults has been higher than in similar studies in other countries. These results provide helpful information regarding the exposure of Iranian adults to 1-hydroxypyrene, and these data can be used to supplement the national reference values of human biomonitoring for the interpretation of biomonitoring results., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Published: 2023
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16. Impact of Targeted Subsidies Reform on Household Nutrition: Lessons Learned from Iran.

Author: Saeediankia A, Emamgholipour S, Pouraram H, Mousavi A, and Majdzadeh R
Abstract: Background: In 2010, Iran became the first major oil-exporting country to reduce substantially implicit energy subsidies by increasing domestic energy and agricultural prices by up to 20 times. The current research aims to evaluate the profound impact of the countywide implementation of this targeted subsidy reform (TSR) on the consumption patterns of households in Iran, specifically in relation to the consumption of healthy food commodities., Methods: This study employed a robust approach to examine the impact of the TSR on household food consumption, as a natural experiment, using pooled cross-section data from the Household Income and Expenditure Survey (HIES) spanning the years 1992 to 2019. The analysis was based on a comprehensive interpretation of survey data, which served as the primary source for analysis. The estimation procedure utilized an interrupted time series (ITS) model to capture the parameters associated with food consumption., Results: The findings revealed a substantial increase in household expenditures on food immediately following the policy intervention, with an impressive rise of 823 thousand Rials (equivalent to approximately $6.36 based on the floating exchange rate in 2019). Furthermore, the results strongly indicate a significant annual upward trend in total monthly food expenditures per adult person, surpassing the pre-intervention trend by 441 thousand Rials (approximately $3.40) (P=0.044, CI=[12.86, 1016.81]). Moreover, the implementation of the policy led to an annual per capita increase in fruit consumption by 1.02 grams per day (P=0.225, CI=[-0.68; 2.72])., Conclusion: This study shows that the initial positive effects of the TSR have gradually been eroded by inflation in subsequent years. This experience can serve as a lesson for all countries that TSR should be accompanied by other measures, such as poverty alleviation interventions, in order to achieve desired long-term results., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2023 Saeediankia et al. Published by Tehran University of Medical Sciences.)
Published: 2023
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17. The national health program for vitamin D supplementation in a developing country.

Author: Saberi-Karimian M, Ghazizadeh H, Zanganeh Baygi M, Minaie M, Sadeghi F, Pouraram H, Elmadfa I, Esmaily H, Khadem Rezaian M, Tavallaei S, Mohammadi Bajgiran M, Zare Feyz-Abadi R, Timar A, Sharifan P, Bahrami Taghanaki H, Gholian M, Farahmand SK, Abasalti Z, Farkhani EM, Akhgari A, Smailzadeh A, Izanloo H, Nikpour M, Haghveysi A, Mohammadkarimi A, Yaghoubi A, Rahimi A, Tabatabaei SM, Sheikhzadeh K, Sheikhi M, Shahraki F, Farajian F, Salehizadeh M, Khanavi M, Ghanouni F, Goudarzi S, Ferns GA, Abdollahi Z, and Ghayour-Mobarhan M
Subjects: Male, Aged, Middle Aged, Humans, Female, Adolescent, Young Adult, Adult, Vitamin D, Vitamins, Dietary Supplements, National Health Programs, Developing Countries, Vitamin D Deficiency epidemiology, Vitamin D Deficiency prevention & control
Abstract: Background: Previous studies have reported a high frequency of vitamin D deficiency (VDD) among different age groups in Iran., Aims: In this study, the current coverage, status of vitamin D supplement taking, and program efficacy have been evaluated by the Office of Nutrition Department Society in Iran since 2014., Methods: This study was conducted in collaboration with the International UNESCO center for Health-Related Basic Sciences and Human Nutrition and the Office of Nutrition Department Society. Sixty three medical universities were included in the current study to calculate the availability, accessibility and acceptability coverages. Furthermore, 3 medical universities including Mashhad (MUMS), Qom (QUMS) and Zahedan (ZAUMS) University of Medical Sciences were selected based on the results of the National Integrated Micronutrient Survey 2012 (NIMS-II study), in order to assess the status of vitamin D supplement intake in all age ranges., Results: Quantitative analysis showed that availability coverage was 74.96% and 77.56% and accessibility was 80.70% and 83.26% in elderly and middle-aged subjects, respectively in 2018. The acceptability was approximately 43.7% and 43.9% among elderly and middle-aged participants, respectively. The availability and acceptability coverage was 80.99% and 85.0% among students in high schools. The mean vitamin D supplement uptake frequency was 27.0% (n = 387); 20.7% and 29.2% in rural and urban area, respectively (P = 0.001). The results showed that there was no significant difference in serum vitamin D levels between urban (20.41 ± 6.43 ng/ml) and rural areas, (P = 0.887). There was no significant difference in the serum vitamin D concentrations between men and women (P = 0.461)., Conclusions: The frequency of taking vitamin D supplements was 27.0% in Iran in 2018. The frequency of taking of vitamin D supplements among vitamin D deficient group (serum vitamin D levels <19.99 ng/ml) was 43.6%. Lack of knowledge was the most important reason for not taking vitamin D supplement. Moreover, the serum vitamin D levels have increased in subjects aged 18-30 years old after the implementation of the vitamin D supplementary program., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)
Published: 2023
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18. What do we Need to Start a Multimedia Salt Reduction Campaign?

Author: Pouraram H, Afshani F, Ladaninejad M, and Siassi F
Abstract: As reports of the first national study reveal, Iranian salt intake reaches 9.52 g/day (two times more than recommended by World Health Organization). Meanwhile ignoring the consequences of high salt intake has led to an increased rate of cardiovascular diseases (CVD), stroke, stomach cancer, osteoporosis, obesity, etc., To tackle these threatening issues, a nationwide intervention campaign could be an effective solution based on global experiences. A review of previous work in Iran shows that despite numerous efforts conducted in the prevention of CVDs, they were not well reflected in worldwide sources. Furthermore, a comprehensive campaign was not implemented particularly concerning the salt reduction in Iran. As a result, we first reviewed the major successful initiatives conducted in reducing salt intake around the world and Iran. Then we introduced the components of a comprehensive social marketing campaign along with customized actions related to Iranian nutrition habits, their attitude, and behavior toward salt consumption. These employed components were SWOT analysis, identifying target group, determining communication goals and objectives based on models and theories, planning executive plan, designing communication messages and materials, media planning and promotional actions, and determining campaign budget plus monitoring and evaluation., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Preventive Medicine.)
Published: 2023
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19. Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study.

Author: Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, and Ostovar A
Subjects: Humans, Iran epidemiology, Food, Diet, Sugars, Cardiovascular Diseases etiology, Cardiovascular Diseases prevention & control
Abstract: Background: Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations., Methods: This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball sampling method to select participants. All interviews were transcribed verbatim and thematically analyzed using MAXQDA 11., Results: Economic problems and inflation in Iran caused people to eat more unhealthy foods, while a healthy diet consumption was reduced due to higher prices. Unfair political sanctions imposed on the country caused economic pressure and adversely affected family nutrition. Worse still, despite legal bans, advertising unhealthy foods via media, mainly to generate revenue, encouraged more consumption of unhealthy food. The lack of targeted subsidies and failure in tax legislation and implementation related to the unhealthy products deteriorated the conditions., Conclusion: Some economic barriers have hampered plans to reduce salt, fat, and sugar consumption in Iran. Fundamental reforms in the tax and subsidy system are required to improve people's eating habits. In particular, citizens' income that has been continuously shrinking due to economic conditions, imposed sanctions, and the inevitably high inflation needs to be addressed urgently. Unless the government of Iran deals with the economic barriers to healthy nutrition, the pathway for implementing the national action plan for prevention and control of NCDs toward a 30% mortality reduction due to NCDs by 2030 looks unlikely to reach., (© 2023. The Author(s).)
Published: 2023
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20. The health system barriers to a healthy diet in Iran.

Author: Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, and Ostovar A
Subjects: Humans, Iran, Qualitative Research, Fast Foods, Sugars, Diet, Healthy, Sodium Chloride
Abstract: Background: Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran., Methods: This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software., Results: We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME's inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry., Conclusion: In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people's approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Amerzadeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Published: 2023
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21. Policy analysis of nutrition stewardship for prevention and control of Non-communicable diseases in Iran.

Author: Amerzadeh M, Takian A, Pouraram H, Sari AA, and Ostovar A
Subjects: Humans, Iran, Policy Making, Risk Factors, Health Policy, Noncommunicable Diseases prevention & control
Abstract: Background: Non- communicable diseases (NCDs) are the main cause of death, which lead to over 73% of death and 62% of DALYs globally. As an unhealthy diet is the leading behavioral risk factor of NCDs, in line with the national action plan for the prevention and control of NCD, this study explored the nutrition-related stewardship problems to reduce the burden of NCDs in Iran., Methods: This is a qualitative study. We interviewed 30 purposefully identified key informants, i.e., stakeholders, policymakers, and academics, from December 2018 to August 2019. All interviews were recorded and transcribed verbatim. We analyzed data using qualitative content analysis facilitated by MAXQDA 11 software., Results: Ample policies and laws were identified, most of which were not or partially implemented. Despite some plausible efforts, NCDs do not seem to be a top priority for high-level managers and decision-makers. Besides, the role of non-state actors, i.e., the private sector, is marginal in NCD's planning and management. Whereas the government, e.g., the Food and Drug Organization (FDO), is the biggest player. Worse still, many harmful products are advertised and easily distributed across the country., Conclusion: Iran's government has created a noticeable roadmap to battle NCDs despite imposing many sanctions and related socioeconomic problems. Nevertheless, more interventions are needed to strengthen the stewardship of NCDs by various stakeholders. We recommend the government to monitor the implementation of policies and advertisement of harmful products to prioritize prevention and control of NCDs. In addition, we advocate employing the capacity of non-state actors to reduce the consumption of unhealthy food and the burden of NCDs across the country, ultimately., (© 2023. The Author(s).)
Published: 2023
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22. Setting and prioritizing evidence-informed policies to control childhood obesity in Iran: a mixed Delphi and policy dialogue approach.

Author: Toorang F, Takian A, Pouraram H, Amiri P, and Abdullahi Z
Subjects: Child, Humans, Iran, Policy Making, Schools, Policy, Health Policy, Pediatric Obesity
Abstract: Background: The prevalence of childhood obesity (CO) and related complications is high and alarmingly increasing in Iran. This study applied a mixed Delphi & Policy Dialogue approach to exploring and prioritizing policy options to control childhood obesity in Iran., Methods: This study is organized in three Delphi phases followed by a policy dialogue session. This study applied the advocacy collation framework and evidence-informed policy-making approach to enhance the chance of a feasible and acceptable policy package. The first step consisted of interviews with 30 experts and primary stakeholders. Based on their answers and a comprehensive literature review, a list of presumed effective policy options to combat CO in Iran was made. Then, panelists were asked to score each policy option using a five-point Likert scale in seven constructs. To maximize the spread of opinions, panelists were chosen to represent three perspectives: policy-makers at different levels, presidents of various organizations who would implement potential policy options, and academics. Twenty-one stakeholders were invited to discuss the policy options in a policy dialogue section., Results: We introduced 27 policy options and asked stakeholders to rank them using seven criteria on a five-level Likert scale. Totally, 41 experts participated in round 2 (66.2% response rate), and 33 experts took part in round 3 (72% response rate). Participants believed that healthy schools, creating healthy environments in kindergartens and other child care centers, subsidizing healthy foods, educating healthy lifestyles in mass media, and increasing access to physical activity facilities are the most effective and feasible policies in controlling CO. After the policy dialogue, the healthy school remained the most prioritized policy. a policy package to combat CO in Iran was designed with the participation of all stakeholders., Conclusion: The advocacy collation framework and the evidence-informed policy-making approach were used to draft a policy package to combat CO, increasing the acceptability and feasibility of the developed policy package., (© 2022. The Author(s).)
Published: 2022
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23. Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran.

Author: Amerzadeh M, Takian A, Pouraram H, Sari AA, and Ostovar A
Abstract: Background: Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which poor diet is the leading risk factor. It is estimated that 20% of all death is related to food. The Unhealthy diet includes many foods with excessive salt, sugar and fat. This paper reports a national study on the socio-cultural determinants affecting salt, sugar and fat consumption in Iran., Methods: This is a qualitative study. We conducted semi-structured interviews with 30 various purposefully identified key stakeholders to collect data from December 2018 until August 2019 in Iran., Results: We identified socio-cultural determents of salt, fat and sugar consumption as follows: Inadequate structure of traditional medicine and people's desire for traditional foods, low health literacy, the global trend of nutritional transition and its impact on Iranian society, The progressive decline of people's trust in NGOs, and Inappropriate media management. Worse still, the global trend of nutritional transition and people's tendency towards fast foods, unhealthy diet and junk foods, partially due to establishing children's taste mainly with salty, high-fat and sweet foods, has jeopardized their desire to eat healthily during adulthood., Conclusion: Reducing salt, fat and sugar consumption is problematic in Iran, mainly due to multi-dimensional socio-cultural determinants. In line with sustainable development goal (SDG) 3.4 to reduce 30% of premature death due to NCDs and related risk factors by 2030 in Iran, various stakeholders from multiple sectors need to initiate coherent series of interventions to alter people's approach to select food so that they may reduce the consumption of foods with excessive salt, fat and sugar., (© 2022. The Author(s).)
Published: 2022
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24. Social Awareness of Whole Grains and the Feasibility of Replacement with Refined Grains: A Qualitative Study.

Author: Kazemi F, Danaei G, Farzadfar F, Moradi G, Malik V, Parsaeian M, Pouraram H, Zamaninour N, and Dorosty Motlagh AR
Abstract: Background: A correlation between type 2 diabetes and refined carbohydrates has been proven, while several studies have indicated that Iranian daily diets are poor in term of proper carbohydrates. It was thus considered absolutely critical to conduct a qualitative study in terms of people's attitudes toward whole grains, and the feasibility of their replacing existing refined carbohydrates in their diets. The aim of this study is to probe Iranian awareness of whole grains, to explore barriers to refined-grain substitution with whole grains and legumes, and to assess whole-grain sensory perceptions., Methods: Focus group discussions (FGDs) and taste tests conducted between July 2016 and March 2017 in urban and rural areas of Kurdistan, Yazd, and Tehran provinces in Iran. A total of 96 healthy men and women (aged 40-65, BMI ≥25 kg/m 2 ) were selected through purposive sampling with maximum variation. FGDs were categorized by content analysis method. As for taste test, ANOVA analysis with Bonferroni post-hoc was used to determine significant differences ( P < 0.05)., Results: Four themes and 11 sub-themes emerged. Cultural beliefs, traditional eating patterns, sensory properties, and familial acceptance were the most influential factors in choosing the type of bread and rice. Simultaneously they are the most prominent barriers to consuming whole grains and legumes. Plain cooked brown rice had the lowest mean sensory attribute score and traditional whole-wheat flatbread was the highest., Conclusions: There was a higher acceptance tendency toward using traditional whole-wheat flatbread rather than refined grains, as it was consistent with preference and priority. However, low availability was the largest substitution problem., Competing Interests: The authors declare no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)
Published: 2021
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25. Iranian population exposures to heavy metals, PAHs, and pesticides and their intake routes: a study protocol of a national population health survey.

Author: Soleimani Z, Haghshenas R, Masinaei M, Naddafi K, Yunesian M, Nabizadeh Nodehi R, Namazi N, Djazayeri A, Pouraram H, Hajipour MJ, Dilmaghani-Marand A, Mesdaghinia A, and Farzadfar F
Subjects: Cross-Sectional Studies, Environmental Monitoring, Humans, Iran, Metals, Heavy analysis, Pesticides analysis, Polycyclic Aromatic Hydrocarbons analysis, Population Health
Abstract: 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.
Published: 2021
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26. The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children.

Author: Nasiri-Babadi P, Sadeghian M, Sadeghi O, Siassi F, Dorosty A, Esmaillzadeh A, and Pouraram H
Subjects: Child, Child, Preschool, Cross-Sectional Studies, Humans, Iran epidemiology, Prevalence, Zinc, Malnutrition, Vitamin D
Abstract: 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.
Published: 2021
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27. Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study.

Author: Mousavi SM, Milajerdi A, Pouraram H, Saadatnia M, Shakeri F, Keshteli AH, Tan SC, and Esmaillzadeh A
Subjects: Adult, Case-Control Studies, Diet, Humans, Iran epidemiology, Prospective Studies, Diet, Healthy, Stroke epidemiology, Stroke etiology
Abstract: Background: 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. Methods: 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. Results: 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). Conclusion: 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.
Published: 2021
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28. Glycemic Index (GI) Values for Major Sources of Dietary Carbohydrates in Iran.

Author: Kazemi F, Danaei G, Farzadfar F, Malik V, Parsaeian M, Pouraram H, Zamaninour N, Rahmani J, and Dorosty Motlagh AR
Abstract: 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., Competing Interests: Conflict of Interests: The authors declare no conflict of interest., (Copyright © 2020, International Journal of Endocrinology and Metabolism.)
Published: 2020
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29. Association between dietary insulin index and load with obesity in adults.

Author: Anjom-Shoae J, Keshteli AH, Sadeghi O, Pouraram H, Afshar H, Esmaillzadeh A, and Adibi P
Subjects: Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Iran epidemiology, Male, Middle Aged, Obesity metabolism, Surveys and Questionnaires, Young Adult, Diet adverse effects, Diet methods, Insulin administration & dosage, Insulin metabolism, Obesity epidemiology
Abstract: 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 2 , 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.
Published: 2020
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30. Policy analysis of salt reduction in bread in Iran.

Author: Loloei S, Pouraram H, Majdzadeh R, Takian A, Goshtaei M, and Djazayery A
Abstract: 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., Competing Interests: Conflict of interest: The authors declare no competing interests., (© 2019 the Author(s), licensee AIMS Press.)
Published: 2019
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31. Discretionary Salt Intake and Readiness for Behavioral Change Among Women in Tehran.

Author: Pirasteh A, Pouraram H, Kholdi N, and Abtahi M
Abstract: 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 P < 0.001; OR = 1.58, 95% CI: 1.03--2.42 P < 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., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 International Journal of Preventive Medicine.)
Published: 2019
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32. Egg consumption and prevalence of psychological disorders in adults.

Author: Shafiei F, Keshteli AH, Pouraram H, Afshar H, Salari-Moghaddam A, Esmaillzadeh A, and Adibi P
Subjects: Adult, Cross-Sectional Studies, Female, Humans, Iran epidemiology, Male, Prevalence, Surveys and Questionnaires, Anxiety Disorders epidemiology, Depressive Disorder epidemiology, Diet methods, Eggs statistics & numerical data, Stress, Psychological epidemiology
Abstract: 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.
Published: 2019
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33. The effect of melatonin supplementation on lipid profile and anthropometric indices: A systematic review and meta-analysis of clinical trials.

Author: Loloei S, Sepidarkish M, Heydarian A, Tahvilian N, Khazdouz M, Heshmati J, and Pouraram H
Subjects: Cardiovascular Diseases blood, Clinical Trials as Topic, Dyslipidemias blood, Humans, Body Composition, Body Mass Index, Cardiovascular Diseases prevention & control, Dietary Supplements, Dyslipidemias prevention & control, Lipids blood, Melatonin administration & dosage
Abstract: 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., (Copyright © 2019 Diabetes India. All rights reserved.)
Published: 2019
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34. Serum Levels of Vitamin D, Retinol and Zinc in Relation to overweight among Toddlers: Findings from a National Study in Iran.

Author: Sharif Y, Sadeghi O, Dorosty A, Siassi F, Jalali M, Djazayery A, Mohammad K, Parsaeian M, Abdollahi Z, Heshmat R, Yarparvar A, Pouraram H, and Esmaillzadeh A
Subjects: Cross-Sectional Studies, Female, Humans, Infant, Iran, Logistic Models, Male, Vitamin A blood, Zinc blood, Body Mass Index, Overweight blood, Vitamin D blood
Abstract: 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., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)
Published: 2019

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

Author: Pouraram H, Djazayery A, Mohammad K, Parsaeian M, Abdollahi Z, Dorosty Motlagh A, Djalali M, Khodaverdian K, Sotoudeh G, Yarparvar A, Heshmat R, and Siassi F
Subjects: Adolescent, Adult, Age Distribution, Anemia epidemiology, Child, Child, Preschool, Female, Humans, Infant, Iran epidemiology, Male, Middle Aged, Obesity epidemiology, Overweight epidemiology, Pilot Projects, Pregnancy, Prevalence, Sex Distribution, Surveys and Questionnaires, Young Adult, Micronutrients deficiency, Nutrition Disorders epidemiology
Abstract: 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., (© 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)
Published: 2018

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

Author: Parsaeian M, Pouraram H, Djazayery A, Abdollahi Z, Dorosty A, Jalali M, Khodaverdian K, Sotoudeh G, Yarparvar A, Heshmat R, Siassi F, and Mohammad K
Subjects: Body Weight, Cross-Sectional Studies, Developing Countries, Female, Humans, Hysterectomy, Iran, Logistic Models, Middle Aged, Nutrition Surveys, Rural Population, Smoking, Socioeconomic Factors, Women's Health, Age Factors, Menopause physiology
Abstract: 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.
Published: 2017
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37. Strategies and Opportunities Ahead to Reduce Salt Intake.

Author: Rafieifar S, Pouraram H, Djazayery A, Siassi F, Abdollahi Z, Dorosty AR, Abtahi M, Kazemeini H, and Farzadfar F
Subjects: Fast Foods standards, Food Labeling, Humans, Iran, World Health Organization, Health Knowledge, Attitudes, Practice, Health Promotion methods, Hypertension etiology, Recommended Dietary Allowances, Sodium Chloride, Dietary adverse effects
Abstract: 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.
Published: 2016
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38. Community Interventional Trial (CITFOMIST) of Vitamin D Fortified Versus Non-fortified Milk on Serum Levels of 25(OH) D in the Students of Tehran.

Author: Keshtkar AA, Ebrahimi M, Khashayar P, Abdollahi Z, Pouraram H, Salehi F, Mohammadi Z, Khosrokhavar R, and Larijani B
Subjects: Adolescent, Animals, Dietary Supplements, Female, Humans, Iran, Male, Students, Treatment Outcome, Vitamin D blood, Young Adult, Food, Fortified, Milk, Osteoporosis prevention & control, Vitamin D administration & dosage, Vitamin D analogs & derivatives, Vitamin D Deficiency prevention & control
Abstract: 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.
Published: 2015
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39. Iron-fortified flour: can it induce lipid peroxidation?

Author: Abtahi M, Neyestani TR, Pouraram H, Siassi F, Dorosty AR, Elmadfa I, and Doustmohammadian A
Subjects: Adult, Aged, Anemia prevention & control, Antioxidants metabolism, Biomarkers blood, Body Mass Index, Cross-Sectional Studies, Energy Intake, Female, Ferritins blood, Hemoglobins metabolism, Humans, Iron, Dietary blood, Male, Malondialdehyde blood, Micronutrients administration & dosage, Middle Aged, Nutrition Assessment, Oxidative Stress, Superoxide Dismutase blood, Flour analysis, Food, Fortified, Iron, Dietary administration & dosage, Lipid Peroxidation
Abstract: 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.
Published: 2014
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40. Advocacy strategies and action plans for reducing salt intake in Iran.

Author: Mohammadifard N, Fahimi S, Khosravi A, Pouraram H, Sajedinejad S, Pharoah P, Malekzadeh R, and Sarrafzadegan N
Subjects: Humans, Iran, Health Promotion, Sodium Chloride, Dietary
Published: 2012
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41. Long-term consequences of iron-fortified flour consumption in nonanemic men.

Author: Pouraram H, Elmadfa I, Dorosty AR, Abtahi M, Neyestani TR, and Sadeghian S
Subjects: Adult, Aged, Antioxidants analysis, Biomarkers, Ferrous Compounds administration & dosage, Flour analysis, Food, Fortified analysis, Humans, Iran, Iron analysis, Iron blood, Iron Overload blood, Iron Overload etiology, Iron, Dietary analysis, Male, Middle Aged, Oxidoreductases blood, Time Factors, Flour adverse effects, Food, Fortified adverse effects, Iron, Dietary adverse effects, Men's Health, Nutrition Policy, Oxidants adverse effects, Oxidative Stress
Abstract: 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., (Copyright © 2012 S. Karger AG, Basel.)
Published: 2012
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42. Development of fortified biscuit using NaFeEDTA.

Author: Mohammadi M, Abedi AS, Azizi MH, Ahmadian FS, and Pouraram H
Subjects: Anemia, Iron-Deficiency prevention & control, Chemical Phenomena, Color, Edetic Acid adverse effects, Edetic Acid chemistry, Female, Ferric Compounds adverse effects, Food Handling, Food Preferences, Humans, Iran, Iron, Dietary administration & dosage, Male, Mechanical Phenomena, Peroxides analysis, Quality Control, Sensation, Taste, Time Factors, Bread analysis, Ferric Compounds chemistry, Food, Fortified analysis, Iron, Dietary analysis
Abstract: 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., (Copyright © 2011 Society of Chemical Industry.)
Published: 2011
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43. Oxidative stress among non-anemic adults following flour fortification with iron: baseline data.

Author: Pouraram H, Elmadfa I, Siassi F, Dorosty Motlagh A, Heshmat R, and Abtahi M
Subjects: Adult, Aged, Anemia metabolism, Anemia prevention & control, Anthropometry, Biomarkers, Blood Pressure physiology, Diet, Female, Humans, Iran, Male, Middle Aged, Nutritional Status, Oxidative Stress physiology, Quality Control, Flour, Food, Fortified, Iron, Dietary pharmacology, Oxidative Stress drug effects
Abstract: 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.
Published: 2010
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44. Flour fortification with iron: a mid-term evaluation.

Author: Sadighi J, Sheikholeslam R, Mohammad K, Pouraram H, Abdollahi Z, Samadpour K, Kolahdooz F, and Naghavi M
Subjects: Adolescent, Adult, Anemia, Iron-Deficiency epidemiology, Cross-Sectional Studies, Female, Hemoglobins analysis, Humans, Iran epidemiology, Iron Compounds administration & dosage, Male, Middle Aged, Nutritional Status, Prevalence, Program Evaluation, Anemia, Iron-Deficiency drug therapy, Ferritins analysis, Flour, Food, Fortified, Iron Compounds therapeutic use
Abstract: 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.
Published: 2008
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45. Is the Uniscale an appropriate mother-child scale?

Author: Sadighi J, Sheikholeslam R, Samadpour K, and Pouraram H
Subjects: Anthropometry, Body Mass Index, Child, Preschool, Female, Humans, Infant, Infant Care, Infant, Newborn, Iran, Male, Nutritional Status, Pregnancy, Reproducibility of Results, Weights and Measures, Body Weight, Growth physiology, Weight Gain physiology
Abstract: 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.
Published: 2007
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