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Abstract Purpose Dietary factors might contribute to the risk of lung cancer by increasing the concentration of inflammatory markers. The literature-derived Dietary Inflammatory Index (DII) has been established to evaluate the inflammatory potential of diet correlated with inflammatory markers. The association between DII scores and the risk of lung cancer has been conflicting. So, in the current study, we aimed to assess the effect of pro-inflammatory dietary patterns measured with DII and the risk of lung cancer. Methods A multi-center case-control study was carried out on 616 patients with lung cancer and 3412 healthy controls. Dietary intakes were collected using a 131-item food frequency questionnaire during a face-to-face interview. The DII scores including thirty-six nutrients were calculated after energy adjustments. Finally, the association between DII level and the risk of lung cancer was evaluated by performing a multi-variable regression method after adjusting for potential confounders. Results The risk of overall lung cancer, small cell, and squamous cell carcinoma was elevated in the third tertile compared to the first tertile of the DII score, (odds ratio [OR] T3 vs. T1 of overall lung cancer = 1.38 (95% confidence interval [CI] 1.08–1.77), P trend = 0.01, OR T3 vs. T1 of squamous cell lung cancer = 1.82 (95% CI 1.02–3.24), P trend = 0.04, OR T3 vs. T1 of small cell lung cancer = 1.66 (95% CI 1.08–2.54), P trend = 0.019). However, no increase was observed in the risk of adenocarcinoma by adherence to a pro-inflammatory dietary pattern. Conclusion A positive link was found between DII and the risk of overall lung cancer, small-cell, and squamous-cell lung cancer. However, there was no association between DII and the risk of lung adenocarcinoma.

Limited data exists regarding the association between dietary patterns and asthma. This study aims to determine the relationship between empirically derived dietary patterns and the likelihood of asthma among a large population of children and adolescents living in central Iran. Methods: A total of 7667 of male and female students aged 6-14 from 48 public and private schools in YAZD urban areas entered the current cross-sectional study. Data on dietary intakes, as well as asthma symptoms and other possible confounders, were collected using a self-administered questionnaire filled by parents. Factor analysis was applied to find major dietary patterns. Multivariate logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for asthma development across quintiles of dietary patterns. Results: Two main dietary patterns were established. A “traditional diet” was determined by meat, fish, fruits, cooked vegetable, raw vegetable, legumes, cereals, bread, macaroni, rice, margarine, butter, olive oil, milk, yogurt, egg, nuts, potato, and a “western-like diet” was characterized by high intakes of simple sugars, fast food(hamburger), fast food (pizza), soft drinks, jelly, chocolate and biscuits of cocoa, ice cream, and sauce. After adjusting for potential confounders, individuals in the top quintile of traditional diet were 0.31 times less likely to have asthma than those in the lowest quintile (OR=0.69; 95% CI: 0.47-1.00). Moreover, individuals in the top quintile of traditional diet were 0.43 times less likely to have wheezing compared with those in the lowest quintile (OR=0.57, 95% CI: 0.46-0.70). However, individuals in the top quintile of the western diet were 0.35 times more likely to have wheezing than those in the lowest quintile (OR=1.35, 95% CI: 1.10-1.66). Conclusions: According to the results, a traditional diet might be associated with lower odds of asthma; however, a western-like diet might be adversely associated with asthma symptoms.

Abstract Background A few studies have examined the association between different types of dietary fiber as well as their sources and the risk of breast cancer (BC) and the present study aimed to investigate these associations in a case-control study among Iranian women. Methods A total of 464 women with pathologically confirmed breast cancer within the past year and 498 age-matched healthy controls were included. Dietary intakes were assessed using a 168-item food frequency questionnaire. The association between dietary soluble, insoluble, total dietary fiber, as well as, fiber from fruits, vegetables, legumes, cereals, and nuts intake with odds of breast cancer was assessed using multivariate logistic regression analysis. Results Mean total dietary fiber intake of patients with and without cancer were 33.1 ± 15.3 g per day (g/d) and 34.2 ± 16.5 (g/d), respectively. Dietary total fiber (OR = 0.65; 95%CI: 0.47–0.90, Ptrend = 0.01), insoluble fiber (OR = 0.68; 95%CI: 0.49–0.93, Ptrend = 0.01), fruits’ fiber (OR = 0.68; 95%CI: 0.49–0.94, Ptrend = 0.02), and vegetables’ fiber (OR = 0.66; 95%CI: 0.48–0.91, Ptrend = 0.01) were significantly associated with reduced likelihood of developing breast cancer in all participants. Furthermore, dietary total and insoluble fiber, as well as, fiber from fruits were significantly associated with lower odds of breast cancer in premenopausal women (P

Abstract Purpose The risk of breast cancer (BC) and related mortality have increased in Middle-East countries during recent decades. The relationship between several nutrient intakes and the risk of BC has been investigated in several studies. However, few studies have estimated the effects of patterns of different nutrient intake on the risk of BC in this region. Methods A total of 453 patients who were recently diagnosed with breast cancer and 516 healthy women participated in the current case–control study. To evaluate the dietary intakes, we used a validated 168-item food frequency questionnaire (FFQ) during the last year. Nutrient Patterns (NPs) were extracted through factor analysis (FA) of energy-adjusted twenty-six nutrients. The relationship between nutrient patterns and the risk of breast cancer in pre and post-menopausal women was estimated by multivariable regression. Results Four major nutrient patterns were identified in the current study. The first nutrient pattern was rich in animal protein, retinol, riboflavin, pantothenic acid, cobalamin, and calcium. Higher saturated fatty acids (SFAs), mono-unsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and trans fatty acids (TFAs), and lower intakes of niacin were observed in nutrient pattern 2. The third nutrient pattern was rich in fiber, potassium, and vitamin C. Nutrient pattern 4, was associated with higher intakes of vegetable protein, alpha-tocopherol, and magnesium. A significant inverse relationship was observed between adherence to nutrient pattern 3 and the risk of BC in all participants [odds ratio (OR) = 0.70, 95% confidence interval (CI): 0.50, 0.97, P = 0.03) and pre-menopausal women (OR = 0.59 (0.39–0.89), P = 0.01). Conclusion Decreasing odds of breast cancer were observed by adherence to a nutrient pattern high in dietary fiber, vitamin C, and potassium. Future prospective investigations are recommended to confirm these findings.

Highlights Lung cancer (LC) is the most common cancer among males and the third most common cancer among females worldwide. Focusing on primary prevention may be the main strategy for reducing the overall mortality of LC, especially in LMICs. This study showed that dTAC assessed either by FRAP or TRAP procedure is inversely associated with the odds of LC. The strong association in all subgroups, emphasizes the importance of an antioxidant-rich diet in all subjects even in nonsmokers with a lower odds of lung cancer.

Background: Limited investigations have focused on the association between the Mediterranean dietary (MeD) and asthma among children and adolescents. We aimed to study the associations between a modified Mediterranean dietary pattern and asthma symptoms in children living in Iran. Method: This cross-sectional study was conducted among 7667 children and adolescence. Data on dietary intakes, asthma symptoms and other possible confounders, were collected using a questionnaire completed by parents. The relationship between Mediterranean diet (MeD) and asthma was assessed using logistic regression. Results: We found that participants in the highest quartile of MeD score had 32% lower odds of wheezing in the past 12 months in the whole population when compared with those in the lowest quartile (OR: 0.68; 95% CI: 0.51–0.90; Ptrend

Abstract Background The Dietary Approaches to Stop Hypertension (DASH) diet, which has a lot of emphasis on the consumption of fruits, vegetables, and whole grains, and on the other hand, the consumption of red meat and sodium is limited, due to its anti-inflammatory properties, which can be related to reducing the risk of asthma. Objectives The aim of this study was to determine the relationship between the DASH diet and asthma symptoms among children and adolescents. Methods This cross-sectional study was conducted among7667 children (3414 boys and 4253 girls) aged 6–7 and 13–14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between the DASH-like diet with current asthma and asthma symptoms. Results Our findings revealed that higher adherence to a DASH-like diet resulted in lower odds of asthma confirmed by a doctor among the whole population (OR = 0.53; 95%CI: 0.36–0.76) and also in females (OR = 0.47; 95%CI: 0.29–0.78). Moreover, the higher adherence to the DASH-like diet was inversely associated with the chance of wheezing in the past 12 months in all subjects (OR = 0.67; 95%CI: 0.51–0.86) and in boys (OR = 0.57; 95%CI: 0.38–0.85). Conclusion The findings of the present study showed that following the DASH diet can be associated with the improvement of asthma symptoms in children and adolescents. However, more research is needed to improve dietary recommendations for asthma prevention.

Abstract Background and objective We are not aware of studies examining the association between dietary meal intake habits (DMIH) and severity of coronary artery stenosis (CAS). This study was conducted to investigate the relationship between DMIH and the severity of CAS as well as cardiometabolic risk factors in adults undergoing coronary angiography. Methods This cross-sectional study was done on 720 patients undergoing coronary angiography (aged 35–75 years) who were admitted to Afshar Hospital, a referral hospital for cardiovascular diseases in Yazd, Iran. Data on DMIH were gathered by interview. Blood samples were taken for biochemical analysis. Blood pressure, anthropometric indices, and body composition were also evaluated. The relationship between DMIH and the severity of CAS [examined by angiography based on Gensini Score (GS) and Syntax Score (SS)] and cardiometabolic risk factors were assessed using logistic regression and the analysis of covariance (ANCOVA), respectively, in crude and multivariable adjusted models. Results After adjustment for all possible confounding variables, the study revealed that people who ate 3 meals/day had a lower risk of severe CAS compared to people who ate 2 or fewer meals (OR = 0.48, 95% CI: 0.26, 0.88, P-trend = 0.02). There was an inverse association between the number of snacks /day and the severity of CAS (OR = 0.43, 95% CI: 0.22, 0.87, P-trend = 0.02). There was also an inverse relationship between breakfast frequency/week and the severity of CAS based on both GS and SS (P

Abstract Several risk factors including environmental exposures, socioeconomic status, and dietary factors including dietary patterns have been considered for childhood Asthma. The present study tried to examine the association between a western-style pattern and the likelihood of asthma and its symptoms in Yazd, Iran. In the present cross-sectional study, dietary intakes of elementary and high-school children were obtained through a validated GAN questionnaire. The GAN questionnaire, derived from the ISAAC questionnaire was used to assess the symptoms of allergic diseases and their related risk factors. A western dietary pattern score considered 9 food groups including chicken eggs, margarine, butter, sugar, fast foods, soft drinks, snacks, sauce, and chocolate. In total 7667 children aged 10.9 ± 3.35 years were included in the current investigation. Boys with higher adherence to western dietary pattern had a higher risk of wheezing in the past 12 months (OR 1.37, 5% CI 1.01–1.87, P = 0.04) and this association was also observed in the whole population (OR 1.30, 5% CI 1.05–1.60, P = 0.01). However, after adjustment for confounders this relation did not remain significant in boys. Our results support the hypothesis that a western dietary pattern is associated with an increased risk of wheezing in the past 12 months in children with asthma. Future prospective studies are needed to confirm this finding.

There is a growing concern about the health-threatening effects of pesticide residues in fruits and vegetables worldwide. This study systematically reviewed the published data on pesticide residues in Iranian fruits and vegetables to clarify the gap in this issue. Method: The authors systematically searched PubMed, Google Scholar, Scopus, SID, and Iran Medex to find published studies on pesticide residues in Iranian foods without time and language restrictions. The title and abstract of all articles were evaluated after removing duplicate articles (2289 articles) by two independent reviewers. Finally, 25 articles were found that reported pesticide residues in fruits and vegetables. There was a great variation in measurement methods and pesticides reported across studies, which precluded meta-analysis. Therefore, a summary of the included studies was only reported. Results: Twenty-four studies reporting pesticide residues in Iranian fruits and vegetables were included. The percentage of Iranian fruits and vegetables contaminated with pesticides exceeding the maximum residue limit (MRL) was less than 10% in most studies. Contaminated samples were collected mainly from cultivated areas such as fields, orchards, or greenhouses. Conclusion: Pesticide residues in food have not been systematically reported in Iran. It was found that only limited articles were published by academic societies on this issue. Considering the current scenario, there is an urgent need to facilitate reliable and continuous measurements of toxic residues in Iranian food.

Abstract Background The current studies explore the effect of omega-3 polyunsaturated fatty acids (PUFAs) on appetite. Objective To examine the effect of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on appetite using a systematic review and meta-analysis of controlled clinical trials (CTs). Patients and methods Online databases including PubMed, Scopus, ISI Web of Science, and Google Scholar were searched up to January 2022. A random-effects model was used to compare the overall standardized mean difference in appetite scores between n-3 PUFAs supplemented and control individuals. Results Fifteen eligible CTs with 1504 participants (872 for n-3 PUFA supplementation and 632 for placebo groups) were included in our systematic review. The meta-analysis showed no significant difference in overall appetite score between n-3 PUFAs supplemented and control groups (standardized mean difference [SMD] = 0.458, 95% confidence interval [CI] − 0.327, 1.242, P value = 0.25). However, the n-3 PUFA supplementation significantly increased the desire to eat (SMD = 1.07, 95% CI 0.116, 2.029, P = 0.02) compared to control. Conclusion Although we found no effect of omega-3 supplementation on overall appetite score, it modestly increases the desire to eat. Further CTs evaluating the effect of PUFAs on appetite are still needed to confirm these findings.

Abstract Background Metabolic syndrome (MetS) is regarded as a complex metabolic disorder. Recently, the role of dietary antioxidants in the underlying pathogenesis and complications of MetS has come into focus. Pistacia atlantica oil is known as a high antioxidant oil which might improve the antioxidant status of dietary oils and also oxidative stress markers. On the other hand, tert-Butylhydroquinone (TBHQ) is an approved food-grade synthetic antioxidant that acts both as an inducer and inhibitor of carcinogenesis. The current trial will explore the possible effect of a blend of Pistacia atlantica seed-canola oils, corn-canola oils with TBHQ, and corn-canola oil without TBHQ on oxidative stress markers in patients with MetS. Methods We will conduct a single-center, triple-blind, three-way randomized cross-over clinical trial (RCT) among 72 patients with MetS. After a 1-month run-in period, eligible participants will consume the intervention oils as their regularly consumed oils in a random order. Each intervention period will last 8 weeks separated by 4-week washout periods. Anthropometric indices, body composition, physical activity, blood pressure, and 24-h dietary food recall measurements will be assessed at the beginning and the end of each intervention period. The primary outcome will be oxidative stress markers including serum total antioxidant capacity, total oxidant status, malondialdehyde, nitric oxide, and the enzyme activity of myeloperoxidase, superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase. The secondary outcomes will be changes in MetS components including blood pressure, fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, and anthropometric measurements. Discussion Pistacia atlantica seed oil is high in antioxidants. An intervention with this oil could offer an option for oxidative stress prevention among patients with metabolic syndrome. The present clinical trial will be the first one assessing the impact of Pistacia atlantica oil on human oxidative stress markers. Trial registration Iranian Registry of Clinical trials IRCT20130223012571N8 . Registered on 4 March 2022.

Background and objectiveDairy products may be associated with an increased risk of asthma, although there is little scientific evidence to support this association. The goal of this study was to explore the association between dairy consumption and asthma symptoms.Materials and methodsThis cross-sectional study was conducted on children and adolescents aged 6–8 and 13–14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between milk, other dairy products, and total dairy consumption with the risk of asthma symptoms.ResultsIn total, 7,667 participants (3,414 boys and 4,253 girls) were included in the current study. Milk intake and total dairy consumption were not associated with the likelihood of wheezing, asthma confirmed by a doctor, current asthma, and asthma medication use. In addition, there was no association between other dairy product intake and the odds of wheezing in the past 12 months in the crude model. However, after adjusting for several confounders, those in the top category had lower odds of wheezing in the past 12 months than those in the bottom category (OR: 0.58; 95% CI: 0.40–0.85).ConclusionThe consumption of dairy products other than milk, including cheese and yogurt, might reduce the likelihood of wheezing in children and adolescents.

Abstract Background Heme and non-heme irons are two forms of iron in the diet. Few studies have evaluated the association between heme iron intake and the risk of gastric cancer (GC). We aimed to investigate the association between heme, non-heme and total iron intake and risk of GC in Iran. Methods In a hospital-based case–control study, nutritionists interviewed 178 pathologically confirmed GC patients and 276 controls using a valid Diet History Questionnaire. Multiple logistic regression model was used to estimate Odds Ratios (OR) and 95% Confidence Intervals (CIs) for iron intake and risk of GC. Results Subjects in the highest tertile of total iron intake were 46% less likely to get GC than those in the lowest (OR = 0.54, 95% CI: 0.32–0.92), however, the associations were not significant for intake of heme and non-heme iron. The risk of GC in the highest tertile of total meat intake was 2.51 times higher than the lowest. We found significant associations between GC and chicken (OR = 2.95; 95% CI: 1.66–5.22) and fish intake (OR = 1.89; 95% CI: 1.09–3.27), However, we found no associations between the risk of GC and intake of red meat, salted fish, and liver. Conclusion Total iron intake was associated with a lower risk of GC which could be partly due to the high prevalence of anemia in Iran. Although, we could not find any significant association between the risk of GC and the intake of heme and non-hem iron among the Iranian population.

Abstract Background Dietary patterns and food items have been associated with gastroesophageal reflux disease (GERD) risk and they have led to conflicting findings. The aim of this study was to determine the association between a dietary approach to stop hypertension (DASH)-style diet with the risk of GERD and its symptoms in adolescents. Study design Cross-sectional. Methods This study was performed on 5,141 adolescents aged between 13 and 14 years. Dietary intake was evaluated using a food frequency method. The diagnosis of GERD was done by using a six-item GERD questionnaire that asked about GERD symptoms. A binary logistic regression was used to assess the association between the DASH-style diet score and GERD and its symptoms in crude and multivariable-adjusted models. Results Our findings revealed that after adjustment for all confounding variables, the adolescents with the highest adherence to the DASH-style diet had a lower chance of developing GERD [odds ratio (OR) = 0.50; 95%CI 0.33–0.75, Ptrend< 0.001)], reflux (OR = 0.42; 95%CI 0.25–0.71, Ptrend=0.001), nausea (OR = 0.59; 95% CI:0.32–1.08, Ptrend=0.05) and stomach pain (OR = 0.69; 95%CI 0.49–0.98, P trend=0.03) compared to those with the lowest adherence. Similar results were found for odds of GERD among boys, and the total population (OR = 0.37; 95%CI: 0.18–0.73, Ptrend=0.002, OR = 0.51; 95%CI: 0.34–0.77, P trend

Background: This study investigated the association between vitamins intakes and risk of gastric cancer (GC) among Iranian population. Methods: In this hospital-based case-control study, 178 pathologically confirmed GC patients and 276 healthy controls were interviewed to answer a valid diet history questionnaire. Unconditional logistic regression, in which potential confounders were taken into account, was applied to determine the association of vitamin intakes and odds of GC in total population and in stratums of body mass index (BMI), helicobacter pylori (H-pylori) infection, and smoking. Results: GC was directly associated with vitamin D (OR 1.59; CI 95% 1.07, 2.36) and cobalamin (OR 1.25; CI 95% 1.08, 1.44). Thiamin (OR 0.50; 95%CI 0.30, 0.83), pantothenic acid (OR 0.71; 95%CI 0.58, 0.87), folate (OR 0.99; 95%CI 0.99, 0.99) and vitamin E (OR 0.98; 95%CI 0.96, 0.99) were inversely associated with GC. In 231 H-pylori infected participants, consumption of thiamin (OR 0.3; 95% CI 0.59, 0.86), pyridoxine (OR 0.52; 95%CI 0.31, 0.85), and folate (OR 0.99; 95%CI 0.99, 0.99) reduced GC risk. In H-pylori negative participants, only vitamin­ E (OR 0.96; 95%CI 0.93, 0.99) reduced the risk and vitamin D (OR 1.99; 95%CI 1.18, 3.36), riboflavin (OR 1.91; 95%CI 1.37, 2.66), pantothenic acid (OR 1.34; 95%CI 1.13, 1.64), biotin (OR 1.03; 95%CI 1.01, 1.05), and cobalamin (OR 1.36; 95%CI 1.13, 1.64) increased the risk. In BMI stratums, only vitamin D (OR 1.81; 95%CI 1.07, 3.08) was associated with the risk of GC among normal weight participants. Vitamin E was associated with lower risk of GC in ever smokers (OR 0.97; 95%CI 0.95, 0.99) and thiamin (OR 0.41; 95%CI 0.19, 0.86) and niacin (OR 0.93; 95%CI 0.87, 0.99) were associated with lower risk in never smokers. Positive associations were observed by increasing vitamin D (OR 2.08; 95%CI 1.12, 3.85) and cobalamin (OR 1.33; 95%CI 1.08, 1.65) in never smokers. Conclusion: This study provided support for a possible protective effect of vitamin E, thiamin, pantothenic acid, and folate on GC risk. Vitamin D and cobalamin intake increased the risk.

BackgroundData on the association between head and neck cancer (HNC) and dietary factors are inconclusive. No study has so far investigated the association between dietary total antioxidant capacity (dTAC) and HNC concerning interactions with other risk factors.MethodPathologically confirmed new diagnosed HNC patients were included in this study. The control group was healthy hospital visitors who were frequently matched with patients on age (5 years interval), gender, and province of residence. Trained interviewers administered a validated Food Frequency Questionnaire (FFQ) to assess the participants’ food intake 1 year before the cancer diagnosis. Data on TAC scores of foods was collected by Ferric Reducing Antioxidant Power (FRAP) and Total Radical-trapping Antioxidant Parameters (TRAP) from published data. We applied logistic regression adjusted for age, sex, energy intake, socioeconomic status, province, opium use, alcohol use, physical activity, and dental health. We also studied the interaction of dTAC with tobacco smoking status, and opium use on the risk of HNC.ResultsWe recruited 876 HNC patients and 3,409 healthy controls. We observed a significant decrease in the odds of HNC with increasing dTAC scores. The OR of HNC for the third vs. the first tertile was 0.49 (95%CI 0.39–0.61) for FRAP and 0.49 (95%CI 0.39–0.62) for TRAP. Both dTAC scores were inversely associated with lip and oral (T3 ver. T1 OR = 0.51; 95%CI 0.36–0.71 for FRAP and OR = 0.59; 95% CI 0.44–0.82 for TRAP) and larynx (T3 ver. T1 OR = 0.43; 95%CI 0.31–0.61 for FRAP and OR = 0.38; 95% CI 0.26–0.55 for TRAP) cancers. There was no interaction between tobacco smoking, opium use; and TRAP or FRAP on the risk of HNC.ConclusionAn antioxidant-rich diet in terms of FRAP or TRAP could decrease the risk of HNC and its subtypes.

Background: Most of previous studies have investigated the association of specific food or nutrient with risk of breast cancer (BC) rather than overall diet and there is lack of evidence regarding dietary pattern in BC development. This study aims to examine the association between dietary patterns and risk of BC among Iranian women. Methods: This case–control study was carried out on 453 BC women and 496 healthy controls. A reliable and valid FFQ was used to evaluate usual dietary intake. Factor analysis was also applied to address the most major dietary patterns which were known as the healthy and unhealthy dietary patterns. Results: Those in the highest quartile of healthy dietary pattern had lower risk of BC (P = 0.001). However, being in the highest quartile of unhealthy pattern was associated with 2.04-fold increase of BC risk (P = 0.004) compared to the lowest quartile. In premenopausal women, risk of BC in upper quartile of healthy pattern was lower than the lowest quartile (OR = 0.47; CI = 0.26 – 0.83, P = 0.004). More adherence to the unhealthy dietary pattern was associated with higher risk of BC (OR = 2.85; 95% CI = 1.57- 5.17, P < 0.0001). No significant association was observed between the healthy or unhealthy dietary patterns among postmenopausal women. Conclusion: The findings indicated that the healthy dietary pattern could be considered as a protective factor in terms of BC in women and particularly among premenopausal women.

Abstract Background In recent years, nutrition has received an increasingly important role in the etiology of cancer. Thus, public education about dietary factors associated with cancer risk or prevention could be an important intervention for cancer prevention, particularly in low- and middle-income countries where the burden of cancer is increasing rapidly and the access to care is limited. The age-standardized incidence of breast cancer was 35.8 among Iranian women in 2020. We aimed to study the effect of nutrition education on the knowledge, attitude, and practice of Iranian women towards dietary factors related to cancer. Methods In this interventional study, 229 women from public health centers were recruited and underwent three 75-min sessions of education based on the Health Belief Model (HBM). Participants were interviewed by trained interviewers using a validated and reproducible nutrition-related cancer prevention knowledge, attitude, and practice questionnaire (NUTCANKAP) questionnaire designed based on the HBM. Nutritional knowledge, attitude, and practice of participants were assessed through this questionnaire. Three 24-h dietary recalls (one weekend and two nonconsecutive weekdays) were also collected before and one month after the intervention. Results The mean age of the participants was 45.14 years, and the mean BMI was 27.2 kg/m2. After the intervention, the participants had a higher intake of whole grain (p = 0.03) and a lower fat dairy (p = 0.009) and nuts (p = 0.04). However, the intake of high-fat dairy (p = 0.001) decreased after the intervention. We indicated significant differences in knowledge (p

Background. There are conflicting results about the association between dietary fat intake and asthma symptoms. Since few studies in the Middle East have been explored the relation between dietary fat consumption and risk of asthma, the present study was conducted to investigate the association between the consumption of butter, margarine, and olive oil and asthma risk in school children living in central Iran. Method. In this cross-sectional study, out of 10,240 participants, asthma and its symptoms and dietary intake of butter, margarine, and olive oil of 7,667 children and adolescents were assessed using a validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The relationship between fat subtypes and asthma was assessed using logistic regression. Results. The prevalence of asthma confirmed by a doctor in the study population was 4.22%. An inverse association was found between butter and margarine consumption once or twice a week and odds of current asthma and wheezing in the past 12 months (OR = 0.52, 95% CI: 0.28–0.96; OR = 0.7, 95% CI: 0.55–0.88, respectively); however, those with higher consumption did not have a higher chance for developing wheezing or asthma. Conclusion. We found that margarine and butter intake one or two times a week might have an inverse association with asthma and its symptoms among children. Prospective cohort studies are recommended to confirm these findings.

Abstract Background A few studies have examined the relationship between carbohydrate quality index (CQI) and risk of breast cancer (BC) among women in Middle Eastern countries. We studied the associations between carbohydrate quality index and the risk of BC in overall and by menopausal status. Methods In this case-control study, dietary intake of 461 women with pathologically confirmed BC within the past year were examined. The same information were collected for 495 apparently healthy controls using a 168-item validated FFQ. Carbohydrate quality was determined by considering four criteria including: ratio of solid carbohydrates to total carbohydrates, dietary fiber intake, GI and the ratio of whole grains to total grains. Results Mean GI and GL of participants were totally 57.5 ± 7.2 and 245.7 ± 64.7, respectively. A trend toward significant association was seen between GI and odds of BC in the whole population; such that after stratifying analysis by menopausal status, premenopausal women in the highest quartile of GI were 1.85 times higher likely to have BC than those in the lowest quartile (95% CI: 1.12, 3.07, P = 0.01). We found that women with the greatest CQI had lower odds for BC, compared with those with the lowest CQI (0.63; 95% CI: 0.43–0.94, P = 0.03). This association was remained after stratifying analysis by menopausal status in premenopausal (0.55; 95% CI: 0.34–0.90, P = 0.04). Conclusion We found that GI was directly and CQI inversely associated with odds of BC. In order to determine the effects of dietary carbohydrate quality prospective cohort studies are needed.

Abstract Aim To examine the relationship between dietary fat intake and breast cancer (BC) development. Method This case-control study included 473 women with breast cancer (pathologically confirmed) and 501 healthy subjects matched by age and residency. Dietary intakes of different types and sources of fatty acids were assessed using a validated food frequency questionnaire. The association between dietary fats and odds of BC was assessed using a logistic regression model in crude and multivariable-adjusted models. P values below 0.05 were regarded as statistically significant. Results Participants’ age and body mass index were 44.0 ± 10.8 years and 28.4 ± 5.6 kg/m2, respectively. Individuals with the highest quartile of total fat intake and polyunsaturated fatty acid (PUFA) intake were 1.50 times more at risk to develop BC than others. A positive significant association was observed between animal fat (Q4 vs. Q1, OR = 1.89, 95 % CI = 0.93–3.81), saturated fatty acid (SFA) (Q4 vs. Q1, OR = 1.70, 95 % CI = 0.88–3.30), monounsaturated fatty acid (MUFA) (Q4 vs. Q1 OR = 1.85, 95 % CI = 0.95–3.61) and PUFA intake (Q4 vs. Q1, OR = 2.12, 95 % CI = 1.05–4.27) with BC risk in postmenopausal women. However, there was no association in premenopausal women. Conclusions Total dietary fat and its subtypes might increase the risk of BC, especially in postmenopausal women. This observational study confirms the role of dietary fat in breast cancer development. Intervention studies involving different estrogen receptor subgroups are needed.

Abstract Background Although adherence to “Dietary Approaches to Stop Hypertension” (DASH) dietary pattern has been linked with reduced risk of several cancers. To our knowledge no studies have examined the association between the DASH dietary pattern and risk of gastric cancer. This study was performed to investigate the association between adherence to the DASH dietary pattern and odds of gastric cancer in Iran. Methods This hospital-based case-control study was conducted on 178 histo-pathologically confirmed patients with gastric cancer and 276 sex-matched healthy controls. A validated 146-item Diet History Questionnaire (DHQ) was used to assess participants’ usual dietary intakes. The DASH dietary pattern scores were calculated using the method introduced by Fung. Unconditional logistic regression, in which potential confounders were taken into account, was applied to determine the association of adherence to the DASH dietary pattern and odds of gastric cancer. Results Mean age of cases and controls were 60.8 and 53.2 y, respectively. After controlling for age, sex and energy intakes, participants in the highest tertile were 62% less likely to have gastric cancer than those in the lowest tertile (OR 0.38; 95% CI 0.22,0.65; Ptrend

N-nitroso compounds (NOCs) are a class of chemical carcinogens found in various environmental sources such as food, drinking water, cigarette smoke, the work environment, and the indoor air population. We conducted a systematic review and meta-analysis to investigate the links between nitrate, nitrite, and NOCs in food and water and the risk of gastrointestinal (GI) cancers, including esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), and pancreatic cancer (PC). A systematic search of the literature in Scopus, PubMed, Google Scholar, Web of Science, ScienceDirect, and Embase was performed for studies on the association between NOCs in drinking water and food sources and GI cancers. Forest plots of relative risk (RR) were constructed for all the cancer sites and the intake sources. The random-effects model was used to assess the heterogeneity between studies. Forty articles were included after removing duplicate and irrelevant articles. The meta-analysis indicated that the intake of high dose vs. low dose of these compounds was significantly associated with the overall GI cancer risk and nitrite (RR = 1.18, 95% CI = 1.07–1.29), and N-nitrosodimethylamine (NDMA) (RR = 1.32, 95% CI = 1.06–1.65). We found that dietary nitrite intake increased GC (RR = 1.33, 95% CI = 1.02–1.73), and EC (RR = 1.38, 95% CI = 1.01–1.89). Additionally, dietary NDMA intake increased the risk of CRC (RR = 1.36, 95% CI = 1.18–1.58). This meta-analysis provides some evidence that the intake of dietary and water nitrate, nitrite, and NOCs may be associated with GI cancers. In particular, dietary nitrite is linked to GC and EC risks and dietary NDMA intake is associated with CRC.

Abstract Background Previous studies on the link between macronutrients and breast cancer have mostly focused on individual macronutrients rather than their combination. This study investigates the association between adherence to a low carbohydrate diet and odds of breast cancer among women. Methods This hospital-based case-control study was carried out on 412 women with pathologically confirmed breast cancer within the past year and 456 apparently healthy controls that were matched in terms of age and residential place. Dietary data was collected using a 168-item validated FFQ. Participants were classified in terms of quintiles of percentages of energy intake from carbohydrates, proteins, and fats. Then, individuals in the highest quintile of fat and protein intake were given a score of 5 and those in the lowest quintile of these macronutrients were given a score of 1. Participants in the other quintiles of these macronutrients were given the corresponding score. In terms of carbohydrate intake, those in the highest quintile received a score of 1 and those in the lowest quintile received 5. The scores were then summed up to calculate the total low carbohydrate diet (LCD) score, which varied from 3 to 15. A higher score meant greater adherence to a low carbohydrate diet. Results The mean age of study participants was 45.2 y and mean BMI was 28.4 kg/m2. Mean LCD score of participants was 8.9 ± 2.5 (8.9 ± 2.6 in cases and 9.0 ± 2.5 in controls). Although no significant association was observed between adherence to the LCD score and odds of breast cancer in the study population, a trend toward significant positive association was seen between consumption of LCD and odds of breast cancer in postmenopausal women; after controlling for several potential confounders, individuals in the third quartile of LCD score were 1.94 times more likely to have breast cancer than those in the lowest quartile (95% CI: 1.00, 3.76). This association strengthened after controlling for dietary variables (2.50; 1.18–5.32). Even after further adjustment for BMI, this association remained significant (2.64, 1.23–5.67). No significant relationship was observed in premenopausal women, either before or after controlling for confounders. Conclusion Adherence to LCD may be associated with increased odds of breast cancer in postmenopausal women. Prospective cohort studies are needed to confirm these findings.

Background: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population. Methods: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based on Iranian food habits and cooking methods. We recruited 244 healthy adults with a mean age of 42.83 ± 0.75 yrs. from healthy individuals who were friends or relatives of patients in the Cancer Institute of Iran from April 2011 to February 2012. We used the DHQ to assess dietary intakes through interviews as well as at least four 24-h recalls one in every season. Reliability was estimated by comparing data of DHQ with mean intake from 24-hour recalls using deattenuated and energy-adjusted Spearman correlation coefficients. We classified dietary intakes of two methods into three groups to probe if DHQ correctly allocates subjects into different intake groups compared to reference method. The results are reported as percent of disagreement, adjacent agreement, and complete agreement. Results: Deattenuated spearman correlation ranged from 0.18 for vitamin B12 and fat to 0.60 for sugar. It ranged from 0.13 for pantothenic acid to 0.60 for sugar in men and from 0.07 for fat to 0.58 for sugar in females. The complete agreement of methods ranged from 51% for selenium to 36% for carotene in the entire sample, from 50% for energy to 31% for niacin in males and from 49% for sugar to 27% for vitamin B12 in females. Conclusion: The DHQ is a valid tool for assessing most nutrients intake among Iranian population. In addition, it is a proper instrument in categorizing individuals based on their dietary intakes.

Background: Muslim cancer patients and healthcare professionals face several challenges about the necessity of fasting and its possible side effects during the holy month of Ramadan. We aimed to study the prevalence of fasting among cancer patients during Ramadan and opinions of health care professionals about fasting among cancer patients in Iran. Methods: We conducted a cross-sectional survey during the Ramadan (July-August) in 2013. Participants were 620 cancer patients and, 187 healthcare professionals in several cancer clinics from different provinces of Iran. We used self-administered questionnaires and collected data from patients, and healthcare professionals to collect data. We performed descriptive analysis by using Stata statistical software. Results: Out of 620 patients who participated in this study, 428 (69%) were women. 76 (13%) of patients had fasted for at least a day during Ramadan and, from which 41 (7%) had fasted whole months because of their religious belief. Among patients who had refrained from fasting, the reasons were lack of sufficient physical strength (403, 65%), excessive thirst (141, 23%). 275 (44%) of participants had consulted with their physician about fasting. We found that more than 50% of physicians advised against fasting for patients following surgery, pre-operation, recent hospitalization, and consumption of oral or intravenous chemotherapy. Most of the healthcare professionals (68%) believed that cancer survivors could not fast even if they have no signs or symptoms or side-effects after the treatment. Conclusion: Although most of the cancer patients refrain from fasting, some cancer patients practice fasting and face challenges during the holy month of Ramadan in Iran. Most patients consult about fasting in Ramadan with their doctor who has variable opinions about this issue. Development of guidelines for healthcare professional and cancer patients regarding Ramadan fasting is needed.

Background: Designing cancer prevention programs needs information on knowledge, attitude, and practice of the community. Unfortunately, this information is not available in Iran. Materials and Methods: We developed a questionnaire (NUTCANKAPQ) to assess the knowledge, attitude, and practice of Iranian women regarding cancer prevention dietary habits. We recruited women who had referred to public health-care centers in Tehran, Iran. To assess validity, we applied face, content, and construct validity methods. We performed test–retest approaches to assess reliability, and internal consistency of the questionnaire was assessed through Cronbach's alpha and intraclass correlation coefficients (ICCs). Results: Qualitative content validity was carried out by an expert panel, and internal consistency was deemed satisfactory (Cronbach's alpha, >0.6). We also observed high reliability in the questionnaire (ICC = 0.85). The mean (± standard deviation) scores for knowledge, attitude, and practice of study participants were 28.3 (±14.1), 67.1 (±18.9), and 53.7 (±8.3), respectively. The result of exploratory factor analysis, Kaiser–Meyer–Olkin (KMO), implied that the model was reasonably fit (KMO > 0.6). The final questionnaire included seventy items. Conclusion: NUTCANKAPQ is a valid and reliable tool for the assessment of cancer-related nutrition knowledge, attitude, and practice among the Iranian population. Application of NUTCANKAPQ may provide important clues for policy-making and improvement of cancer prevention programs among the Iranian population.