Tehran University Medical Journal

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Background: Increase in obesity prevalence in recent years are associated to genetics as well environmental and behavioral factors. Change in dietary patterns including fatty and high density energy foods consumption have been reported to be very important. This study aimed to determine dietary factors (daily energy and macronutrient intakes, energy percentage of macronutrient, energy and macronutrient intakes per kilogram body weight, frequency of cola, natural fruit juice drinking, dairy products except cheese, tomato chips, puff, chocolate and fast food consumption and eating speed) associated to obesity in Ahwaz primary school pupils.

Materials and Methods: Using two stage cluster sampling from 35 Ahwaz primary schools, all 10-11y students who had a BMI 95th percentile of Hosseini et al. (1999) reference, were identified as obese (n=150) and 150 same age and gender pupils (having BMI<85 percentile) were studied. Data on daily energy and macronutrient intakes were collected using 24 hour recall. Frequency of cola, natural fruite juice, dairy products except cheese, tomato chips, puff, chocolate and fast food consumption were obtained by food frequency questionnaire. Eating speed was asked from the pupil mother.

Results: Results indicated that daily energy, protein and carbohydrate intakes were significantly higher in obese students (p<0.05), but daily fat intake and energy percentage of macronutrient had no significant difference between two groups (p>0.05). macronutrient intakes per kilogram body weight were significantly lower in obese group (p<0.001). obese students had significantly higher potato chips and puff consumption (p<0.05). There was no significant difference between other foods consumption (p>0.05). Obese students used to eat faster (p<0.05).

Conclusion: In conclusion, high intakes of energy, protein, carbohydrate, tomato chips and puff and high eating speed were associated to obesity in Ahwaz primary school pupils.

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Background: The high incidence of Rheumatoid Arthritis (RA), the conventional treatments and the experimental observations have shown that by taking particular foods or omitting some foods form ordinary diet, the disease symptoms of the patients reduce. The interesting point is that fasting lowers the objective and subjective indexes of disease activities in most patients who suffer from rheumatoid arthritis. The effects of a short-time fast and subsequent vegetarian diets for one year, on the rheumatoid arthritis patients were studied in this research.
Materials and Methods: 52 patients (40 females and 12 males) with definite rheumatoid arthritis, based on the American College of Rheumatology (ACR) criteria were selected and duly studied with single blind method. 28 patients were selected after one month fasting at Ramadan. From the tenth day, a vegetarian diet was prescribed for them. This diet was continued for three moths. After three moths, the diet was changed to a combination of milk, vegetables and fruits. Two of the patients left the study at the end of Ramadan. A group of 24 non-fasting patients with ordinary food diet were selected as control group.
Results: In the patients subject of study (with the average age of 39+14.5) and average 36 months disease, after four weeks of fasting under vegetarian diet, significant improvement was found in many of their disease indexes based on ACR criteria, such as joint pain and joint swelling, length of morning stiffness and responds to a health evaluation questionnaires. These suitable effects have still remained the same after one year. With respect to the findings, it is concluded that fasting and a changed diet had left significant effects on all calculated indexes. Although short time fasting had suitable effects in most patients suffering from rheumatoid arthritis, almost in all cases, the disease recurred when the patient returned to his/her ordinary food diet.
Conclusion: The results of the study show that the patient’s improvement can continue through selecting a type of food diet and based on a regulated diet, the rheumatoid arthritis activities decrease. It is suggested to set a tolerable food diet for the rheumatoid arthritis patients and those foods, which involve in the disease, should be omitted or at least, balanced.

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Background: The NCEP step II diet produced a desirable lipoprotein response in hypercholesterolemia. A relation between plasma concentrations of small dense LDL and cardiovascular risk factors has also been mentioned in children. This study was conducted to determine the effects of the National Cholesterol Education Program (NCEP) step 2 diets on the low density and high density lipoprotein particle size in dyslipidemic adolescents.
Methods: Forty- four dyslipidemic adolescents, aged 10-18 years, participated in this case-control study. The control group was not given a diet prescription and was simply instructed to “eat as usual”. Their eating patterns reflected the consumption of macronutrients, fruit, vegetables and dairy products, typical of what many Tehranian eat. NCEP step 2 diets was a diet with 30% of calories as total fat, less than 7% saturated fat, less than 200 mg cholesterol, less than 15% of calories as monounsaturated fat and less than 10% as polyunsaturated fat per day. Lipoprotein particle size was the major outcome variables, which was measured after 3 months of intervention. Lipoprotein particle size was estimated by nondenaturing polyacrylamide gradient gel electrophoresis using Krauss and Burke methodtion.
Results: The mean body mass index was 26.3±4.2 kg/m2. Baseline characteristics of these adolescents did not differ significantly across the NCEP step 2 and control diet groups. The NCEP diet resulted in higher reduction in total cholesterol (-13±4 vs –2±0.3 mg/dl, p<0.001), LDL (-9±2 vs 3±0.6 mg/dl, p<0.01) and higher increase in size of the LDL (1.7±0.4 vs 0.1±0.4 mg/dl, p<0.001). HDL particle size did not change significantly. The prevalence of hypercholesterolemia decreased significantly (p<0.05) in NCEP step 2 group (68% in NCEP step 2 vs 100% in the control group) after 3 months.
Conclusion: NCEP step 2 diet not only reduces the serum LDL concentration of hypercholesterolemic adolescents but also has a favorable effect on the LDL particle size distribution. The related mechanism needs to be studied in future experimental designs.

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Background: Food security is defined as access, for all people at all times, to enough food for an active and healthy life. Food security includes: 1) the ready availability of nutritionally-adequate and safe food, and 2) an assured ability to acquire acceptable foods in socially acceptable ways. The increase in childhood as well as adulthood obesity and food insecurity has caused many recent investigations on obesity, food insecurity and some associated factors. However, there appears to be a lack of published information regarding some factors affecting obesity and food insecurity. This study aimed to determine the prevalence obesity and food insecurity and some associated factors among Yazd province primary school students in Iran.

Methods: Using two-stage cluster sampling, a total of 3245 students (1587 boys and 1658 girls), aged 9-11 years, were randomly selected from primary school pupils in Yazd, Iran. From these, 187 students having BMIs ≥95^th percentile, as defined by Hosseini et al. (1999), were identified as obese and 187 pupils of the same age and gender having BMIs between the 15^th and 85^th percentiles were selected as controls. Data were collected using 24-hour food-recall and USDA food insecurity questionnaires.

Results: We found that the prevalence of obesity among students aged 9-11 years was 13.3%, and the prevalence of food insecurity was 30.5%. Daily energy intakes, compared to those recommended by the RDA, carbohydrate intake and energy percentages from proteins and carbohydrates were higher in obese children, and all macronutrient intakes per kilogram of body weight were significantly higher. An association between obesity and food insecurity was observed with adjusted fat intake.

Conclusion: In conclusion, the prevalence of obesity and food insecurity is high among Yazd primary school students, and high-level intakes of energy, protein, carbohydrate are associated with obesity. Furthermore, variation in the rate of fat intake is a relative factor for food insecurity.

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Background: Primary clear cell adenocarcinoma of cervix (CCAC) is usually seen in women with a history of in utero exposure to diethyl acetyl bestrol (DES). We report two cases of clear cell adenocarcinoma of cervix with no history of exposure to DES in embryonic period. Case presentation: The first case was a 14-year-old women with complaint of painless vaginal bleeding. There was atypical cells in Pap Smear and a bleeding tumor with 1.5 cm in diameter was found in vagina. She was admitted with a diagnosis of CCAC of the uterine cervix stage Ib2 according to FIGO classification. The second case was a 23-year-old patient with complaint of painless vaginal bleeding. The results of cervical cytology was normal. Evaluation of the punch biopsy sample revealed CCAC. Her clinical exam showed stage IIb according to FIGO classification. Both patients had no history of exposure to DES during embryonic period. The first patient treated with radical abdominal hysterectomy and systematic pelvic lymphadenectomy and for the another one external beam radiotherapy and brachytherapy was performed. There was no any recurrence or metastasis after an 18-24 months follow-up Conclusions: Primary clear cell carcinoma of cervix could be unrelated to HPV infection or exposure to DES during embryonic period and in approach to these patients this subject should be considered.

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Background: The effects of consumption of nutrients on coronary artery disease (CAD) are widely observed. The aim of this study is to assess the exclusive Iranian dietary pattern on coronary artery diseases (CAD) and its risk factors. Methods: In this description-cross sectional study, 801 inhabitants of Borujerd City were included by random stratification method and a questionnaire regarding micro- and macronutrients for subjects over 35 years old from March 2011 to February 2012 was filed out. Of all the subjects consent to participate were prepared by volunteers. The complete description and a standard questionnaire to record demographic and socioeconomic status of people were taken. The prevalence of coronary artery disease and its risk factors determined Based on rose questionnaire and Monica questionnaire respectively. Results: In this study mean age of the subjects were 54.8±1.2 years, 388 male and 413 female. There was no meaningful relation between red meat consumption and coronary artery disease (P= 0.117). Nut consumption was higher in patients with CAD (P= 0.028). Use of fresh and cooked vegetables, dried fruit, animal oils cakes, french fries and some dairies are correlated with CAD (P< 0.05). However, artificially flavored soda in contrast to ordinary soda was not associated with coronary artery disease. Conclusion: Although there are some differences between dietary pattern in patient with coronary artery disease, nutritional attitudes are not significantly different in normal and CAD patients. However, according to the importance of diet in CAD, balancing these attitudes should be on the educational system high priority.

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Background: Nurses are prone to continuous stress due to their job situation that lead to many physical and psychological disorders. this job stress also affects their personal life and career. The aim of this study was to evaluate the association between major dietary patterns and anthropometry in nurses.

Methods: We conducted a cross-sectional study from February to October 2014. In this cross-sectional study, 320 female nurses were selected randomly from eight hospitals affiliated to Tehran University of Medical Sciences in 2014. This research project carried out with the code 24371 Tehran University of Medical Sciences in Research Ethics Committee approved. Anthropometry and blood pressure measurement was done. Data on physical activity were obtained using the short version of international physical activity questionnaire.

Results: Three dietary patterns were identified using factor analysis and labeled: healthy, unhealthy and traditional. The healthy dietary pattern score was significantly related to weight and body mass index (BMI) of participants after adjusting for confounders (P=0.05, P=0.01, respectively). There was not significant association between the unhealthy dietary pattern and anthropometry measures. The unhealthy dietary pattern score was inversely related to systolic and diastolic blood pressure after adjusting for confounders (P=0.001, P=0.03, respectively). There was not any significant association between the traditional dietary pattern and anthropometry and blood pressure measures (P>0.05). Conclusion: According to the result of this study, three dietary patterns including, healthy, unhealthy and traditional were identified in nurses. The healthy dietary pattern was associated with weight and BMI and the unhealthy dietary pattern was inversely associated with blood pressure. The traditional dietary pattern had no effect on anthropometry and blood pressure measures.

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Background: Breast cancer is the most common cancer among females in the world. Identifying the nutrients that modify the risk of the disease is one of the key strategies for improving the quality of life and reducing treatment costs. Epidemiological studies support the role of macronutrients and vitamins involved in one carbon metabolism in the etiology of the disease. This study aimed in investigation of the relationship between the intake of macronutrients and vitamins involved in one carbon metabolism with breast cancer risk. Methods: This case-control hospital base study was conducted at Shohada Hospital, Tehran from April to February 2015. Demographic data, physical activity level and nutrients’ intake from diet and supplements were collected through interview from 151 cases and 154 controls. Dietary intake was assessed by a valid and reliable 168-item semi-quantitative food frequency questionnaire. Then intake of macronutrients and B vitamins was assessed by Nutritionist 4 software (First Databank Inc., CA, USA). Comparing categorical variables between the two groups was done by Chi-squared test and the relationship between intake of studied nutrients and risk of breast cancer was determined using logistic regression test. Results: There were no difference in age, menarche age, menopause age, body mass index (BMI), number of live births between two groups. But the difference in physical activity, energy intake, marital status, educational level, occupation, oral contraceptives use was significant (P< 0.001). After modifying the effects of confounding variables, the risk of breast cancer was significantly lower in the highest intake quartile category relative to the lowest quartile category for total protein, total fiber, intake of vitamins B2, B6, B12 and folate (Ptrend< 0.001). Before modifying the effects of confounding variables, the risk of breast cancer was significantly higher in the highest intake quartile category relative to the lowest quartile category for carbohydrate and fat; but after modifying the effects of confounding variables, results were not significant.

Conclusion: The results showed that high intake of protein, fiber, vitamins B₂, B₆, B₁₂ and folate are associated with lower risk of breast cancer.

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