Adherence to Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Relation to Chronic Obstructive Pulmonary Disease (COPD): A Case–Control Study

Objective: This case–control study was designed to investigate the association between adherences to the Dietary Approaches to Stop Hypertension (DASH) diet in patients with chronic obstructive pulmonary disease (COPD) in comparison to subjects without COPD.

Design: This is a case–control study. Usual dietary intake was assessed using a validated food frequency questionnaire. Lung function was evaluated with spirometry testing, and one of the researchers inquired about other respiratory symptoms, including chronic cough, sputum, and breathlessness. Adherence to the DASH dietary pattern was assessed according to the Fung method.

Setting: This study was conducted at Alzahra University Hospital of Isfahan, Iran, in 2015.

Subjects: Eight-four patients with COPD and 80 subjects without a history of COPD participated in study.

Results: The mean age of participants was 57 years. Average smoking in the case group was about 27.5 pack-years. Spirometry tests including forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC were significantly lower in patients with COPD (p = 0.0001). Among COPD symptoms, cough was significantly decreased across tertiles of DASH score (p = 0.03). Significant differences were found for DASH score between patients with COPD and control subjects (19.82 + 3.63 vs 21.13 + 3.82, p = 0.02). Vitamin C, vitamin E, and dietary fiber intake were lower in patients with COPD (144.32 + 70.51 vs 166.97 + 71.88, p = 0.04, 7.49 + 3.91 vs 8.72 + 3.21, p = 0.02 and 19.34 + 7.05 vs 22.19 + 7.87, p = 0.01, respectively).

Conclusion: We observed that adherence to a DASH dietary pattern among patients with COPD was significantly lower compared to the control group. Cough was significantly decreased by increments in adherence to a DASH dietary pattern.     

White Rice Consumption,Body Mass Index,and Waist Circumference among Iranian Female Adolescents

Objective: Refined grains consumption is positively associated with obesity. White rice is the most usual refined grain in Iran. However, few studies have assessed the association between rice intake and anthropometric measures among adolescents. Therefore, we aimed to compare anthropometric measures as well as the diet quality indices across the tertiles of white rice consumption among Iranian adolescents.

Methods: This cross-sectional study was conducted on 415 female adolescents who were chosen by using a systematic cluster random sampling. Dietary intake assessment was done using a validated semiquantitative food frequency questionnaire. Anthropometric measures were done according to the standard protocols. Diet quality indices (including dietary energy density [DED], nutrient adequacy ratio [NAR], and mean adequacy ratio [MAR]) were calculated using standard definitions.

Results: The prevalence of overweight across the tertiles of rice consumption was 11.6, 17.8, and 24.6%, respectively (p = 0.03). Corresponding values for obesity were 2.1, 5.7, and 8.6%, respectively (p = 0.04). A significant positive association was observed for the prevalence of central obesity across the tertile of rice intake (13.1, 21.4, and 28.1%; p = 0.02). Dietary fiber and energy intake and diet quality indices were significantly different among different tertiles of white rice intake. Those in the highest tertiles of white rice intake had the lowest scores for MAR and NAR and highest scores for DED.

Conclusion: There was significant association between rice consumption and obesity as well as diet quality indices among Iranian adolescents.     

Energy Balance–Related Behaviors,Perinatal, Sociodemographic,and Parental Risk Factors Associated with Obesity in Italian Preschoolers

Objective: The obesity epidemic stems from the complex interplay between genetics and environmental factors. Identifying age-specific risk factors in preschoolers may allow implementing more effective intervention strategies.

The aim of the present investigation was to examine the association of overweight/obesity with several perinatal, parental, socioeconomic status (SES), and lifestyle-related risk factors in a large sample of Italian preschoolers.

Methods: One thousand eleven children (age 2.0 to 5.7 years) were included in the study. Family pediatricians measured weight and height and collected information on obesity risk factors by means of questionnaires. Perinatal risk factors were recalled from electronic medical records. Weight status was defined according to cutoffs of the International Obesity Task Force (IOTF).

Results: Seven hundred sixty-four children (75.6%) were normal weight, and 247 (24.4%) were overweight/obese. Multivariate analysis showed that skipping breakfast (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.32–10.51), daily drinking of sugar-sweetened beverages (OR = 2.0; 95% CI, 1.02–4.03), meat consumption <5 times/week (OR = 2.2; 95% CI, 1.11–4.57), and formula feeding (OR = 2.1; 95% CI, 0.8–4.5) were significantly (p < 0.05) associated with increased risk of obesity.

Conclusions: Though exclusive formula or mixed feeding represents an age-specific risk factor for overweight/obesity, lifestyle factors associated with increased risk in Italian preschoolers include habits that are common to school-age children, such as skipping breakfast and consumption of sugar-sweetened beverages. The reduced consumption of meat emerged as a risk factor for overweight/obesity, but future research is required to better understand this relationship. Our data suggest, on the whole, that prevention of such unhealthy behaviors must be pursued in preschoolers by means of age-specific interventions.     

Effect of Different Obesity Phenotypes on Incidence of Chronic Kidney Disease in Tehranian Adults

Background: The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults.

Study Design: A prospective cohort study, the Tehran Lipid Glucose Study (TLGS).

Setting and Participants: Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD.

Predictor: Obesity phenotypes.

Outcome: Incidence of chronic kidney disease.

Measurements: Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study.

Results: CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p < 0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91–1.43) and 1.43 (95% CI, 1.09–1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93–1.62) and 1.43 (95% CI, 1.08–1.90), respectively.

Conclusion: Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.     

Dietary Patterns and Attention Deficit Hyperactivity Disorder Among Iranian Children: A Case-Control Study

Objective: Associations between nutritional/dietary factors and mental disorders have been suggested. This study was conducted to assess the relation of major dietary patterns determined by factor analysis with attention-deficit/hyperactivity disorder (ADHD) in a group of Iranian preschool- and school-aged children.

Methods: This case-control study was conducted with 500 preschool- and school-aged children (4–12?years old) matched by age and sex, in Isfahan, Iran. Dietary intake was identified by a 168-item questionnaire, and major dietary patterns were identified by factor analysis. The multivariable logistic regression is used for the association of dietary patterns with the diagnosis of ADHD. ADHD diagnosis was carried out with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Results: Two major dietary patterns were identified: healthy and Western. The healthy dietary pattern was rich in fruits, vegetables, vegetable oils, whole grains, legumes, and dairy products. The Western pattern was rich in processed meat, red meat, pizza, eggs, snacks, animal fat, hydrogenated fat, and salt. After controlling for potential confounders, children in the top quintile of the Western dietary pattern score had greater odds having ADHD, compared with those in the lowest quintile (odds ratio [OR]?=?3.45; 95% confidence interval [CI], 1.17–18.3; p_trend?=?0.03). The healthy pattern was inversely associated with ADHD (OR = 0.46; 95% CI, 0.38–0.91; p_trend?=?0.01).

Conclusions: A significant independent association was found between the Western dietary pattern and the odds of ADHD. The healthy dietary pattern was associated with lower odds of having ADHD. Prospective studies are needed to confirm these findings.     

Effect of Incorporating Stevia and Moringa in Cookies on Postprandial Glycemia,Appetite, Palatability,and Gastrointestinal Well-Being

Background: Medicinal plants including stevia and moringa constitute an important source of health-beneficial bioactive components, and hence their intake may beneficially modulate biomarkers of chronic diseases.

Objective: The objective of the present study was to investigate the effect of incorporating stevia and moringa leaf powder in cookies on postprandial glycemia, appetite, palatability, and gastrointestinal well-being in humans.

Method: In a randomized crossover design, 20 healthy subjects consumed 3 isocaloric test foods (each providing 50 g available carbohydrates) of control cookies (CC) made from 100% wheat flour, cookies containing stevia leaf powder (SC, 3% w/w), and cookies containing moringa leaf powder (MC, 5% w/w) as breakfast. Blood glucose and subjective appetite were measured at fasting and at 15, 30, 45, 60, 90, and 120 min after the consumption of the cookies. Palatability and gastrointestinal well-being were measured using standard questionnaires.

Results: Compared to CC, MC resulted in a significant decrease in postprandial blood glucose concentration at 30 and 45 min (p = 0.002 and p = 0.003, respectively) and showed a tendency (p = 0.077) for lower blood glucose incremental area under the curve (iAUC). Subjects were significantly less hungry after SC and MC intake (p = 0.035 and p = 0.041, respectively) compared to CC. All the cookies were liked by the subjects without any reported gastrointestinal discomfort.

Conclusion: The results showed that compared to CC, MC improved postprandial glycemia and reduced hunger, while SC reduced hunger only. Future studies are now warranted to explore the mechanisms responsible for these observed effects.     

Association between Vitamin D Receptor Polymorphism and Serum Vitamin D Levels in Children with Low-Energy Fractures

Objective: Fractures of bones, especially forearm fractures, are very common in children and their number is increasing. This study was designed to determine the impact of vitamin D serum levels and vitamin D receptor (VDR) polymorphisms on the occurrence of low-energy fractures in children.

Methods: The study group consisted of 100 children with clinically relevant bone fractures and a control group consisted of 127 children without fractures. Total vitamin D [25(OH)D3 plus 25(OH)D2] serum concentrations were evaluated in every patient. Genotypes for 4 restriction fragment length polymorphisms of the vitamin D receptor gene (FokI, ApaI, TaqI, and BsmI) were determined by standard polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) techniques.

Results: Differences in concentrations of vitamin D were observed between the group with bone fractures (median = 12 ng/ml) and the control group (median = 16 ng/ml; p = 0.000044).

Higher levels of vitamin D reduced the risk of fracture by 1.06 times (p = 0.0005). No impact of particular VDR polymorphism on the occurrence of low-energy fractures in children was detected. However, there were significant differences in the prevalence of FokI polymorphism genotypes between the fracture and control groups (p = 0.05). Furthermore, the recessive “aa” genotype of ApaI polymorphism and the dominant “TT” genotype of TaqI polymorphism were associated with higher levels of vitamin D (p = 0.005 and p = 0.036, respectively).

Conclusions: Vitamin D deficiency is an independent risk factor for fractures in children. ApaI polymorphism recessive “aa” and TaqI polymorphism dominant “TT” genotypes are associated with higher levels of vitamin D in serum.     

Instant Oatmeal Increases Satiety and Reduces Energy Intake Compared to a Ready-to-Eat Oat-Based Breakfast Cereal: A Randomized Crossover Trial

Background: Foods that enhance satiety can help consumers to resist environmental cues to eat and help adherence to calorie restriction. The objective of this study was to compare the effect of 2 oat-based breakfast cereals on appetite, satiety, and food intake.

Methods: Forty-eight healthy individuals, 18 years of age or older, were enrolled in a randomized, crossover trial. Subjects consumed isocaloric servings of either oatmeal or an oat-based ready-to-eat breakfast cereal (RTEC) in random order at least a week apart. Visual analogue scales measuring appetite and satiety were completed before breakfast and throughout the morning. Lunch was served 4 hours after breakfast. The physicochemical properties of oat soluble fiber (β-glucan) were determined. Appetite and satiety responses were analyzed by area under the curve. Food intake and β-glucan properties were analyzed using t tests.

Results: Oatmeal increased fullness (p = 0.001) and reduced hunger (p = 0.005), desire to eat (p = 0.001), and prospective intake (p = 0.006) more than the RTEC. Energy intake at lunch was lower after eating oatmeal compared to the RTEC (p = 0.012). Oatmeal had higher viscosity (p = 0.03), β-glucan content, molecular weight (p < 0.001), and radius of gyration (p < 0.001) than the RTEC.

Conclusions: Oatmeal suppresses appetite, increases satiety, and reduces energy intake compared to the RTEC. The physicochemical properties of β-glucan and sufficient hydration of oats are important factors affecting satiety and subsequent energy intake.     

Effect of the Shaping Healthy Choices Program,a Multicomponent,School-Based Nutrition Intervention,on Physical Activity Intensity

Objective: Physical activity has been shown to have a wide range of beneficial health effects, yet few youth meet the United States physical activity recommendation of 60 minutes of moderate-to-vigorous physical activity (MVPA) everyday. The objective of this study was to determine whether physical activity patterns improved in a subsample of fourth-graders participating in the multicomponent intervention, the Shaping Healthy Choices Program (SHCP).

Methods: At pre- and post-intervention assessments, youth at the control and intervention schools wore a Polar Active monitor on their nondominant wrist 24 h/d for at least 2 consecutive days. Multiple linear regression was used to evaluate change in physical activity by adjusting for covariates and other potential confounders, including ethnicity/race, household income, and sex. Statistical significance was set at p < 0.05.

Results: Mean minutes of MVPA significantly increased at the intervention school (22.3 + 37.8; p = 0.01) and at the control school (29.1 + 49.5; p = 0.01). There were no significant differences in the change in MVPA between the schools. Youth at the intervention school significantly decreased mean minutes in sedentary activity compared to the controls (p = 0.02).

Conclusions: Youth who participated in the SHCP decreased time spent in sedentary activity and increased very vigorous physical activity from pre- to post-intervention, while these changes were not observed at the control school. The overall small physical activity intensity pattern shift supports that physical activity is an important area to target within a multicomponent nutrition intervention aimed at preventing childhood obesity.     

Mediterranean Diet and Cognitive Status in Free-Living Elderly: A Cross-Sectional Study in Northern Italy

Objective: Few data are available on the Italian elderly population with regard to adherence to the Mediterranean diet (MD) and cognitive impairment. Our aim was to investigate adherence to the MD and its association with cognitive function in an Italian urban sample.

Methods: A cross-sectional study of 279 participants aged ≥ 65 years (80 men, 199 women) was carried out at a nutritional center. Adherence to the MD was evaluated using a 14-item questionnaire. Cognitive function was assessed with the Mini-Mental State Examination (MMSE).

Results: The clinical and nutritional assessments performed revealed 30.1% to have a dietary pattern in accordance with the MD; 13.6% had suspected or mild cognitive impairment (MMSE score ≤ 23). The MD pattern was associated with a lower risk of cognitive impairment (odds ratio [OR] = 0.39; 95% confidence interval [CI], 0.15–0.99; p = 0.045), as was the consumption of wine (OR = 0.37; 95% CI, 0.16–0.84; p = 0.018) and nuts (OR = 0.30; 95% CI, 0.13–0.69, p = 0.005). No association was found with other food groups.

Conclusion: A closer adherence to the MD was associated with a better cognitive status. Further cohort studies and randomized controlled trials are warranted.     

Overweight and Obesity Associated with Higher Depression Prevalence in Adults: A Systematic Review and Meta-Analysis

Objective: This study aims to review and synthesize scientific evidence to assess the association between excess body weight and depression among adults.

Methods: The systematic research of observational studies was held from January to March 2015 on Pubmed, Web of Science, Scopus, Embase, PsycInfo, Psicodoc, Psycarticles, and Isi Web. A prevalence ratio (PR) was adopted as a summary measurement. All articles were evaluated for methodological quality and risk of bias. Metaregression was used to investigate heterogeneity and to identify the variation between the studies in relation to the estimates of the effects.

Results: In this review, 9 studies (N = 171,701) met the inclusion criteria. All articles obtained adequate methodological quality. Most studies had high or unclear risk of bias. Overweight and obesity were assessed by body mass index. People with obesity were 32% more likely to have depression compared to those who were eutrophic (PR = 1.32; 95% confidence interval [CI], 1.26–1.38). After a gender analysis, the results showed statistically significant differences in obese versus eutrophic women (PR = 1.36; 95% CI, 1.28–1.34).

Conclusions: There is consistent evidence that overweight or obesity was associated with depression.     

Low Adherence to Dietary Guidelines in Spain,Especially in the Overweight/Obese Population: The ANIBES Study

Objective: The objective of this study was to analyze the dietary intake of the Spanish population according to ponderal status and body fat distribution.

Methods: Data were obtained from ANIBES (Anthropometry, Intake, and Energy Balance in Spain), a cross-sectional study of a nationally representative sample (1013 men, 996 women) of the Spanish population (18–64 years). The final fieldwork was carried out from mid-September to November (three months) 2013. A 3-day dietary record provided information about food and beverage consumption. Height, weight, and waist circumference were assessed, and body mass index (BMI) and waist–height ratio (WHtR) calculated.

Results: The Spanish population had a low consumption of fruits and vegetables, cereals, whole cereals, and dairy and high consumption of meat products. Individuals with overweight/obesity (BMI ≥ 25 kg/m²) and abdominal adiposity (WHtR ≥ 0.5) showed lower compliance with dietary guidelines. In the male group, adjusting by age, inadequate consumption of cereals (<4 servings/day) and vegetables and fruit (<5 servings/day) was associated with higher risk of overweight (odds ratio [OR] = 1.704, 95% confidence interval [CI], 1.187–2.447, p = 0.001, for cereals and OR = 3.816, 95% CI, 1.947–7.480, p = 0.001, for vegetables and fruits) and abdominal adiposity (OR = 2.081, 95% CI, 1.419–3.053, p = 0.000 and OR = 4.289, 95% CI, 2.108–8.726, p = 0.001, respectively).

Conclusion: Nutritional campaigns should be conducted to improve the dietary habits of the Spanish population in general, especially men, who have poorer ponderal status and abdominal adiposity, due to their lower adherence to dietary guidelines.     

Effect of Incorporating Bay Leaves in Cookies on Postprandial Glycemia,Appetite, Palatability,and Gastrointestinal Well-Being

Background: Previous studies of patients with type 2 diabetes showed that capsules containing 1, 2, and 3 g of bay leaves lower fasting blood glucose, triglycerides, low-density lipoprotein cholesterol, and total cholesterol concentrations after 30 days of treatment. However, the acute effect of bay leaves on postprandial glycemic and appetite responses has not yet been determined.

Objective: The objective of this study was to determine the effect of cookies containing different doses of bay leaves on postprandial glycemia, appetite, palatability, and gastrointestinal well-being in healthy subjects.

Methods: In a randomized crossover study, 20 subjects consumed 3 test foods each providing 50 g of available carbohydrates. The test foods were provided as breakfast, 1–2 weeks apart, and were control cookies (CC) made from 100% wheat flour, cookies containing 3% (w/w) bay leaf powder (B3), and cookies containing 6% (w/w) bay leaf powder (B6). Blood glucose, subjective appetite, and gastrointestinal well-being were assessed at fasting and postprandially for 2 hours. Palatability of the test cookies was measured using 9-point hedonic scale.

Results: There was a significant effect of time (p < 0.001), treatment (p = 0.033), and Time × Treatment interaction (p = 0.001) on postprandial blood glucose concentrations. Post hoc pairwise comparison showed that blood glucose concentration was significantly reduced by B6 compared to CC at 30 and 45 minutes (p = 0.014 and p = 0.010, respectively). However, there were no significant differences (p = 0.411) in blood glucose incremental areas under the curves (iAUCs) among the treatments. No significant effect on any of the appetite parameters was observed among the treatments. All of the cookies were rated as acceptable and subjects did not report any gastrointestinal discomfort.

Conclusion: In conclusion, the results indicate that cookies containing bay leaf powder at 6% (w/w) incorporation level provides a palatable product that induces a reduced glycemic response.     

Supplementation with Watermelon Extract Reduces Total Cholesterol and LDL Cholesterol in Adults with Dyslipidemia under the Influence of the MTHFR C677T Polymorphism

Dyslipidemia and genetic polymorphisms are associated with increased risk for developing cardiovascular diseases, and watermelon appears to have the potential to improve hyperlipidemia due to the presence of nutrients such as arginine and citrulline.

Objective: To test the hypolipidemic effect of watermelon extract (Citrullus lanatus) and the influence of the methylenetetrahydrofolate reductase genotype (MTHFR C677T) on supplementation response.

Methods: This is an experimental clinical phase II randomized and double-blind study. Forty-three subjects with dyslipidemia were randomly divided into 2 groups: experimental (n = 22) and control (n = 21) groups. The subjects were supplemented daily for 42 days with 6 g of watermelon extract or a mixture of carbohydrates (sucrose/glucose/fructose).

Results: The use of watermelon extract reduced plasma total cholesterol (p < 0.05) and low-density lipoprotein (p < 0.01) without modifying triglycerides, high-density lipoprotein, and very low-density lipoprotein values. Only carriers of the T allele (MTHFR C677T) showed decreasing concentrations of low-density lipoprotein (p < 0.01). No changes in anthropometric parameters analyzed were observed. This is the first study to demonstrate the beneficial effect of the consumption of watermelon extract in reducing plasma levels of lipids in humans. The MTHFR C677T polymorphism did not affect the plasma lipid concentration but made individuals more responsive to treatment with watermelon.

Conclusions: The consumption of this functional food represents an alternative therapy in the combined treatment of patients with dyslipidemia, promoting health and minimizing the development of risk factors for cardiovascular diseases.     

Dairy Food Consumption and Health-Related Quality of Life in Boys: Preliminary Findings from a 5-Year Cohort Study

Objectives: There are few reported data on the relationship between dairy food consumption and health-related quality of life (QOL). In this cohort study, we aimed to assess the association between dairy food intake and QOL scores during adolescence.

Methods: Of the 1216 participants who were followed up over 5 years (i.e., from age 12 to 17), 858 participants had complete data on dietary intakes and information on QOL scores at the 5-year survey. Dairy consumption was assessed from validated semiquantitative food frequency questionnaires. Health-related QOL was assessed by the Pediatric Quality of Life Inventory (PedsQL).

Results: Among adolescent boys, after multivariable adjustment, those in the highest tertile of yogurt consumption compared to those in the lowest tertile of consumption had 4.7, 5.9, and 9.1 units higher for total score (p-trend = 0.03), and psychosocial health summary (p-trend = 0.02), and school functioning scores (p-trend = 0.01). Boys who remained in the highest tertile compared to the lowest tertile of yogurt consumption during adolescence from ages 12 to 17 had 7.4 and 12.4 units higher psychosocial health summary (p-trend = 0.04) and school functioning scores (p-trend = 0.02), respectively. Nonsignificant associations were observed among girls and with total dairy intake and milk and cheese consumption.

Conclusions: Yogurt consumption in boys could influence health-related QOL scores. Given that ours is an observational study we cannot establish a causal nature and direction of the relationship between yogurt intake and quality of life, our findings require further confirmation and clarification by other studies.     

Usual Intake Distribution of Vitamins and Prevalence of Inadequacy in a Large Sample of Iranian At-Risk Population: Application of NCI Method

Objective: This study provides an assessment of usual intake distribution of vitamins and estimating prevalence of inadequacy and excess among a large representative sample of middle-aged and elderly people in central regions of Iran.

Design: A cross-sectional study that is a second follow-up to the Isfahan Cohort Study (ICS).

Setting: The study setting included urban and rural areas from 3 cities (Isfahan, Najafabad, and Arak) in central regions of Iran.

Subjects: Subjects included 1922 people aged 40 years and older, with a mean age of 55.9 ± 10.6; 50.4% were male and the majority (79.3%) were urban.

Measures and Analysis: Dietary intakes were collected using a 24-hour recall and 2 food records. Distribution of vitamins intake was estimated using traditional and national cancer institute (NCI) methods. The proportion of subjects at risk of vitamin intake inadequacy or excess was estimated using the estimated average requirement (EAR) cut-point method and the tolerable upper intake levels (UL) index.

Results: There were differences between values obtained from traditional and NCI methods, particularly in the lower and upper percentiles of the intake distribution. High prevalence of inadequacies for vitamins A, D, E, B₂, B₃ (especially among females), and B₉ was observed. Significant gender differences were found in terms of inadequate intakes for vitamins A, B₁, B₂, B₃, B₆, B₉, B₁₂, and C (p < 0.05).

Conclusion: Imbalanced vitamin intake was observed in the middle-aged and elderly Iranian population. Nutritional interventions particularly through population-based educational programs in order to improve diet variety and consume nutrient supplements may be necessary.     

Association between Eating Behavior and Academic Performance in University Students

Objective: To determine the association between academic performance and eating behavior in university students in Chile.

Methods: A total of 680 college students, 409 (60%) women and 271 (40%) men, were randomly recruited and the mean age of the entire sample was 26. The Three-Factor Eating Questionnaire (TFEQ), which evaluates 3 dimensions of eating behavior—cognitive restriction (limiting own intake), uncontrolled eating (inclination to eat), and emotional eating (control of food intake in the context of negative emotions)—was used. Academic performance was measured by the grade point average (GPA) and was associated with eating behavior.

Results: Women had significantly higher scores in the “emotional eating” dimension than men (p = 0.002). The eating behavior analysis showed that female students with higher GPAs (above 5.5) had statistically significantly lower uncontrolled eating scores (p = 0.03) and higher cognitive restriction scores (p = 0.05) than women with lower academic performance (below 5.5). There were no significant associations between eating behavior and academic performance in men.

Conclusions: A positive association between eating behavior and academic performance was observed in female university students in Chile. Further studies are needed to explore the causes of this association and determine how to improve the nutritional habits of this population.     

The Association Between Dietary Glycemic Index and Glycemic Load and a Body Shape and Fat Distribution Among Apparently Healthy Iranian Adults

Objective: The role of dietary glycemic index (GI) and glycemic load (GL) in the development of obesity has been debated globally. The relationship with body shape and fat distribution was examined in this cross-sectional association study among apparently healthy Iranian adults.

Methods and materials: A study population of 265 (126 males and 139 females) aged 18–55 years participated in this cross-sectional study from the communities of Tehran based on cluster sampling. GI and GL were assessed by the 147-item food frequency questionnaire (FFQ) completed by a trained dietitian. Weight, height, waist circumference (WC), and hip circumference of the participants were measured, and body mass index (BMI), waist-to-hip ratio (WHR), and A Body Shape Index (ABSI) were further calculated. Fat mass and fat-free mass were also measured using a body composition analyzer, and fat mass index (FMI) and fat-free mass index (FFMI) were then calculated. Multivariate regression models were fitted to assess the association between GI/GL and fat distribution measures such as FMI, FFMI, WC, BMI, WHR, and ABSI, considering potential confounding factors such as sex, age, BMI, and physical activity.

Results: There was a statistically significant inverse association between GL and WC, BMI, and ABSI found in the adjusted model. GL was inversely associated with WC for both the adjusted model (p-trend = 0.027) and the crude model. Also, an inverse association was seen between GL and BMI (p-trend = 0.019) in the adjusted model but a marginal association in the crude model. GL was also inversely associated with ABSI (p-trend = 0.089) in the highest tertile.

Conclusion: Dietary GL but not GI is inversely associated with fat distribution measures such as WC, BMI, and ABSI in the study population. This result may suggest a beneficial role of higher-GL diets in the prevention of obesity.     

Awareness of Health Outcomes Associated with Insufficient Physical Activity and Associations with Physical Activity Intentions and Behavior

Introduction: Little is known about people’s awareness of the link between insufficient physical activity and increased risk for multiple health outcomes.

Methods: Of 1161 respondents to an online cross-sectional survey of the US population, we randomly selected 361 and used content analysis to code up to three responses to an open-ended question asking what illnesses are caused by insufficient physical activity. Chi-square and Fisher’s exact tests examined relations between disease codes and socio-demographics; t-tests and Mann–Whitney U tests examined relations between codes and physical activity intentions and behavior.

Results: Ten codes emerged: cardiovascular (63.5% of participants), metabolic (65.8%), musculoskeletal (10.5%), fatigue (2.0%), psychiatric (8.0%), respiratory (3.4%), gastrointestinal (0.9%), cancer (3.4%), other (2.8%), unexpected interpretation (1.4%). 55.6% of participants named < 3 diseases. Code frequencies were generally similar across demographic groups, ps > .05. Physical activity intentions and behavior were higher among people who either mentioned cardiovascular (p_intentions = .001, p_behavior = .001) or metabolic (p_intentions = .01, p_behavior = .005) conditions, or who named < 3 diseases (p_intentions = .006, p_behavior = .001).

Conclusion: In our socio-demographically diverse sample, awareness of diseases that are associated with insufficient physical activity was largely related to cardiovascular and metabolic problems. Future health communication efforts should raise awareness of the harms of insufficient physical activity for cancer and other diseases.     

Predictors of Nutritional Risk According to NRS-2002 and Calf Circumference in Hospitalized Older Adults with Neoplasms

Objectives: To investigate nutritional markers that better predict nutritional risk according to the Nutritional Risk Screening (NRS-2002), to verify agreement between indicators, and to identify the calf circumference cut-off point for diagnosing nutritional risk.

Methods: Cross-sectional study with older patients hospitalized for neoplasms. The nutritional risk was assessed by NRS-2002 and the nutritional status by Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA long form), calf circumference (CC), and body mass index (BMI). Statistical analyses included the chi-square and Mann–Whitney tests, Kappa coefficient, univariate and multiple logistic regression analyses to analyze the risk factors, and the receiver operator characteristic (ROC) curve to determine the cut-off point.

Results: The NRS-2002 and MNA had good agreement (k = 0.5281), but the NRS-2002 did not agree with the other nutritional indicators. According to regression analysis, the predictors of nutritional risk were the MNA (p = 0.0010, OR = 28.270); BMI (p = 0.0419, OR = 4.681), and age (p = 0.0021, OR = 1.309). The best CC cut-off point for predicting nutritional risk according to the NRS-2002 was ≤32.25 cm.

Conclusion: Both the NRS-2002 and MNA are useful for the nutritional diagnosis of older adults hospitalized for neoplasms. When the MNA, BMI, and age are used together, they can better predict nutritional risk according to the NRS-2002.