دکترعمار حسن زاده کشتلی

The relationship between meat consumption and mental disorders is less investigated. We examined the association of meat consumption with the odds of depression, anxiety, and psychological distress in Iranian adults.

This cross-sectional study was conducted on 3362 subjects with18-55 years. Usual dietary intakes were assessed through the use of a dish-based 106-item semi-quantitative food frequency questionnaire (FFQ). Hospital Anxiety and Depression Scale(HADS), and General Health Questionnaire(GHQ), all validated in the Iranian population, were applied to collect data on anxiety, depression, and psychological distress, respectively.

In the current study, 28.6, 13.6 and 22.6%, of participants suffered from depression, anxiety, and psychological distress, respectively. Individuals in the top quartile of red meat intake had a 43% increased risk of depression (OR=1.43; 95%CI:1.09-1.89), compared to those in the first quartile, after adjustment for potential confounders. The highest vs. lowest red meat intake was related to a 92% greater risk of depression (OR=1.92;95%CI:1.17-3.15) in males. In overweight or obese individuals, despite the lack of any association between red meat intake and mental disorders, high intake of white meat was associated with a lower odd of psychological distress (OR=0.64;95%CI:0.42-0.99) and depression (OR=0.68;95%CI:0.45-1.00). In normal-weight participants, the highest vs. lowest red meat intake was related to 66% greater odds for depression than those (OR=1.66; 95%CI:1.14-2.42).

Red meat consumption was associated with an increased risk of depression, especially in men and normal-weight participants. In overweight or obese subjects, white meat intake was inversely associated with psychological distress.

Irritable bowel syndrome (IBS) is a chronic intestinal disorder, which is characterized by irritating pain during defecation or alteration of the bowel habits. In the curent study, the association of dietary glycemic index (GI) and glycemic load (GL) with the risk of this syndrome, was investigated in a large population of Iranian adults. This cross-sectional study was performed on 3363 adults in Isfahan. To assess GI and GL, a diet was used. The presence of IBS was evaluated using a modified Persian version of the ROME III questionnaire. General characteristics and dietary intakes of the participants across quintiles of dietary GI and GL, were investigated using one-way ANOVA, Chi square, and logistic regression in different models. In total, 748 subjects (22.2%) had IBS. The participants with the highest dietary GI had higher risk for IBS compared to those in the lowest category (OR: 1.34; 95% CI: 1.03-1.75). However, this association was not significant after adjusting for potential confounders (OR: 1.14; 95% CI: 0.81-1.61). A positive significant relationship was found between dietary GI and odds of IBS-constipation predominant (IBS-C) (OR: 1.96; 95% CI: 1.09-3.52), but was not observed for IBS-diarrhea predominant (IBS-D) (OR: 0.78; 95% CI: 0.43-1.40). There was no significant association between dietary GL and risk of total IBS or its subtypes. No significant association was found between dietary GI and GL and severity of IBS. The results of this study showed a significant association between dietary GI and risk of IBS and IBS-D as well as severity of IBS. However, a significant positive association was found between dietary GI and IBS-C, and no significant association was found between dietary GL and risk of total IBS or its subtypes as well as IBS severity.

Few studies have been performed on the adherence to the Mediterranean diet in relation to psychological health, particularly in the Middle East region. In the present study, the association between adherence to Mediterranean dietary pattern and psychological disorders (including depression, anxiety, and psychological distress), was investigated among a large population of Iranian adults.   This cross-sectional study was performed on 3172 adults (aged 18-55 years). The Mediterranean regimen model, was derived from the Trichopoulou et al. method. To investigate the relationship between Mediterranean diet and mental disorders, logistic regression was used with three modified models. In addition to the Mediterranean diet, the same analysis was performed for that pattern of food associated with psychological disorders.   The participants with the highest adherence to the Mediterranean diet had lower risk for depression (OR: 0.60, 95% CI: 0.46-0.78), anxiety (OR: 0.61, 95% CI: 0.42-0.86), and psychological distress (OR: 0.60, 95% CI: 0.45-0.79) compared to those with the lowest adherence. high intake of fruits and vegetables was associated with a lower risk of depression (Fruits: OR: 0.41; 95% CI: 0.31-0.54 and vegetables: OR: 0.53; 95% CI: 0.40-0.70), anxiety (Fruits: OR: 0.56; 95% CI: 0.39-0.79; vegetables: OR: 0.57; 95% CI: 0.39-0.84), and psychological distress (Fruits: OR: 0.47; 95% CI: 0.36-0.63; vegetables: OR: 0.46; 95% CI: 0.34-0.62). In contrast, high intake of grains was positively associated with depression (OR: 1.59, 95% CI: 1.12-2.27), anxiety (OR: 1.77, 95% CI: 1.11-2.82) and psychological distress (OR: 1.69, 95% CI: 1.16-2.45).   The findings of this study indicated an inverse association between adherence to Mediterranean dietary pattern and risk of psychological disorders (such as depression, anxiety, and psychological distress).

Stressful life events can lead to psychological problems, heart disease, stroke, etc. Multidimensional nature of stress calls for advanced statistical methods that could evaluate these dimensions based on symptoms of stress. Therefore, current study aimed at identifying and redefining the dimensions of the stressful life events (SLE) questionnaire using a higher order factor model. This cross-sectional study was done in 4763 people participating in a project called SEPAHAN in Isfahan, Iran 2010. The perceived stress level was evaluated by the Iranian version of SLE questionnaire. First and second order exploratory and confirmatory factor models were applied for data analysis using AMOS V20. According to exploratory factor analysis, 11 domains of stress (first order factors) were extracted from 44 items, which explained 51.42% of the total variance. Based on these domains, two dimensions were identified as second-order factors (stressors), including individual and social stressors that explained 17.3% and 25.6% of total variance, respectively. The similar structure was identified both in total sample and in men and women separately. Also, the results in exploratory factor analysis were confirmed by confirmatory factor analysis (CFI =0.78, GFI =0.89, RMSEA =0.05). It was found that the second-order factor model well fitted to the dimensions of the questionnaire identified. SLE questionaire has11 domains and two higher dimensions (individual and social stressors). Studying the types of stressors could be used in preventive strategies against mental health problems and also in training useful copying styles.

Although several studies are available linking individual dietary antioxidants to the risk of psychological disorders, data about the association of dietary total antioxidant capacity (TAC) with depression and anxiety are scarce. This study was conducted to investigate the association between dietary TAC and odds of depression and anxiety among Iranian adults. Material & Methods: In this cross-sectional study, dietary intakes of 3297 apparently healthy adults in Isfahan province, Iran, were assessed using a validated detailed food frequency questionnaire. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Depression and anxiety were assessed using a validated Persian translated version of Hospital Anxiety and Depression Scale (HADS) questionnaire. Having the scores 0-7 in either subscales was considered as “normal” and the scores of 8 or more as the presence of depression or anxiety. Overall, 28.6% (n= 943) of study participants were depressed or at the borderline level, and 13.6% (n= 448) had anxiety or were at the borderline level. After controlling for potential confounders, including dietary intakes of omega-3 fatty acids, we found that those in the top quintile of dietary TAC were 43% less likely to be depressed than those in the bottom category (OR: 0.57; 95% CI: 0.40-0.82, Ptrend= 0.001). Regarding anxiety, there was a significant inverse association between dietary TAC and anxiety comparing extreme quintiles (OR: 0.62; 95% CI: 0.39-0.99, Ptrend= 0.06). A significant inverse association between dietary TAC and odds of depression and anxiety was found among adults. Further prospective studies are required to confirm these findings.

No previous study has examined the associations between egg consumption and prevalence of psychological disorders. To determine the association between egg consumption and depression in a large sample of Iranian adults. This cross-sectional study was conducted on 3,172 adults in Isfahan, Iran. Egg consumption was assessed by using a validated, self-administrated, dish-based, semi-quantitative food frequency questionnaire. The Iranian validated version of Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. Also, the Iranian validated version of General Health Questionnaire (GHQ) with 12-items was used to assess psychological distress. Depression, anxiety and psychological distress were defined according to the standard criteria. Mean age of study participants was 36.5±7.9. Depression, anxiety and psychological distress were prevalent among 28.4%, 13.6%, and 23% of the study participants, respectively. After controlling for potential confounders, no significant association was observed between egg intake and depression (OR for comparing extreme quartiles: 1.08; 95% CIs: 0.80-1.45) and anxiety (OR: 0.79; 95% CIs: 0.54-1.16), as well as psychological distress (OR: 1.03; 95% CIs: 0.76-1.41) in the whole population. In men, significant positive associations were observed between egg intake and depression before controlling for BMI (OR: 1.68; 95% CIs: 1.01-2.80); however, the associations became non-significant after taking BMI into account (OR: 1.62; 95% CIs: 0.96-2.72). In individuals with higher than median fish intake, egg intake was positively associated withpsychological distress (OR: 2.07; 95% CIs: 1.00-4.28). We found no significant association between egg intake and psychological disorders. Further studies, in particular of prospective design, are warranted.
Conflict of interest: non declared

The association between the speed of eating and gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries. We aimed to find the relationship between the speed of eating and gastroesophageal reflux disease symptoms in a large sample of Iranian adults.
In this cross-sectional study, 4669 individuals fulfilled a questionnaire about their eating habits. Regarding the speed of eating, participants were asked: ‘How thoroughly do you chew foods? (not very well, well, very well)’, ‘How long does it take you to eat lunch? How long does it take you to eat dinner? ( 20 minutes). Gastroesophageal reflux disease was defined as having heartburn sometimes or more during the last three months. The severity of disease was assessed with a four-item scale rating (mild, moderate, severe, and very severe).
Findings: The prevalence of gastroesophageal reflux disease in study population was 23.7%. After adjustment of potential confounders, the association remained the same. Individuals who had “not very well” and ”well” chewed their food, had an increased risk of 94% and 38% to have gastroesophageal reflux disease with great frequency. When the mutual effect of other potential confounders were taken into account, association remained meaningful, those who had “not very well” and “well” chewed their food had an increased risk of 91% and 35% to have gastroesophageal reflux disease with great frequency. On the other hand, individuals who ate their lunch during more than 10 minutes had a reduced risk of 30% and 25% to have gastroesophageal reflux disease with great frequency.
We found a significant association between the speed of eating and gastroesophageal reflux disease symptoms and heartburn.

Limited data are available linking dietary total antioxidant capacity (TAC) to the risk of stroke. This study was conducted to investigate the association between dietary TAC and odds of stroke among Iranian adults.
This case-control study was done on 195 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary intake of participants was assessed using a validated detailed food frequency questionnaire. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Stroke was confirmed by a trained neurologist using standard imaging methods. Demographic information were obtained by related questionnaire. Anthropometric data were measured by appropriate scale and meter. Physical activity was also assessed by specific questionnaire and reported as MET-min/day.
Mean dietary TAC was not significantly different comparing cases and controls (10.2±6.0 vs 10.4±4.8, P= 0.61). However, after adjustment for potential confounders including dietary intakes of fiber and omega-3 fatty acids, we found almost significant inverse association between dietary TAC and odds of stroke; such that each unit increase in dietary TAC was associated with 29% reduced odds of stroke (OR: 0.71; 95% CI: 0.50-1.01, P= 0.06). When we examined the association across tertiles of dietary TAC, we found that after controlling for potential confounders, those in the top tertile of dietary TAC were 51% less likely to have stroke than those in the bottom tertile (marginally significant) (OR=0.49; 0.49-1.00, p=0.12).
We found an almost significant inverse association between dietary TAC and odds of stroke. Further studies of prospective design are required to confirm these findings.

Breakfast skipping was related to obesity and obesity has been associated with psychological disorders, but limited data are available linking breakfast consumption to psychological symptoms.
The association between breakfast consumption and psychological disorders, including depression and anxiety, was studied among Iranian adults.
This cross-sectional study was conducted on 4378 healthy adults in Isfahan, Iran. Breakfast consumption was assessed using a validated detailed dietary habits’ questionnaire; and depression and anxiety using an Iranian validated Hospital Anxiety and Depression Scale (HADS) questionnaire. Psychological distress was also examined by means of Iranian validated version of General Health Questionnaire.
Findings: Overall, 611 numbers (13.95%) of study participants had anxiety, 1253 numbers (28.62%) depression, and 1015 numbers (23.18%) probable mental disorders symptoms. After controlling for the confounding variables, participants with every day breakfast consumption had lower odds for depression symptoms (OR: 0.49; 95% CI: 0.36-0.66) compared with those with the least frequent intake of breakfast, even after further adjustment for BMI (OR: 0.47; 95% CI: 0.34-0.63). Frequent breakfast consumption was inversely associated with anxiety before and after controlling for BMI (P This study showed an inverse relation between breakfast consumption and symptoms of depression, anxiety, and probable mental disorders among Iranian adults. Further prospective studies are needed to confirm these findings.

The relationship of the number of daily meals and snacks with gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries. We aimed to find this relationship in a large sample of Iranian adults.
In this cross-sectional study, 4669 individuals fulfilled a questionnaire about their number of daily meals and snacks. Frequency of total meals was defined by summing up the frequency of main meals and snacks and participants were categorized into 4 categories: Findings: The prevalence of GERD in study population was 23.7%. After adjustment of all potential confounders, women who consumed 1-2 or 3-5 snacks per day, compared to those who never used snack, had a 41% (OR:0.59; 95% CI: 0.42-0.84) and 51% (OR: 0.49; 95% CI: 0.32-0.75) reduced risk of having GERD, respectively. Women who consumed 6-7 or ≥ 8 snacks and meals per day had a 38% (OR: 0.62; 95% CI: 0.41-0.96) and 43% (OR: 0.57; 95% CI: 0.34-0.95) risk reduction for GERD, in comparison with those who ate We found an inverse significant relationship between the meal frequency and GERD symptoms in Iranian women, but not in men. Prospective studies are required to confirm this association in Middle-Eastern populations.

Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders (FGIDs), there is no epidemiologic data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia (FD), its symptoms and gastro-esophageal reflux disease (GERD) in a large group of Iranian adults.
This descriptive -analytic study was conducted on 3363 Iranian adults (19-70 yr), whom were working in 50 health centers across Isfahan province in Iran during 2012. We used easy non-random sampling to select participants. The “healthy lifestyle score” for each participant was calculated by summing up the binary score given for five lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. A validated Persian version of ROME III questionnaire was used, to assess functional gastrointestinal disorders.
The prevalence of FD and GERD among study participants was 14.5 and 23.6%, respectively. After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD (95% CI: 0.05-0.92, OR: 0.21, P=0.03) and GERD (95% CI: 0.09-0.69, OR: 0.26, P=0.01), respectively, compared with those with the lowest score. They were also less likely to have early satiation (95% CI: 0.11-0.73, OR: 0.28, P=0.001), postprandial fullness (95% CI: 0.09-0.50, OR: 0.22, P This study showed that adherence to a healthy lifestyle was associated with lower odds of GERD, FD and its symptoms in this group of Iranian adults. Individual lifestyle-related factors were also associated with these conditions.

Earlier studies have shown a protective association between adherence to healthy eating guidelines and mental disorders in western nations; however, data in this regard are limited from the understudies region of Middle-East. We aimed to examine the association between adherence to healthy eating guidelines, as measured by AHEI, and prevalence of anxiety and depression in a large sample of Iranian adults.
In this cross-sectional study, data on dietary intakes of 3363 adult participants were collected using a validated dish-based 106-item semi-quantitative Food Frequency Questionnaire (FFQ). Adherence to healthy eating was quantified using AHEI as suggested by earlier publications. The Iranian validated version of Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression in study participants. Data on other covariates were gathered using a pre-tested questionnaire.
Overall, the frequency of anxiety and depression was 15.2% and 30.0%, respectively. After taking potential confounders into account, participants with greater adherence to AHEI had 48% lower odds of depression compared with those in the bottom quartile (OR = 0.52; 95% CI: 0.39-0.70). Those in the highest quartile of AHEI had a 29% lower odds of anxiety, compared with those in the lowest quartile (OR=0.71; 95% CI: 0.54-0.94); however, adjustment for dietary intakes and body mass index attenuated the association (OR = 0.75, 95% CI: 0.52-1.09).
Adherence to healthy eating was inversely associated with a lower chance of depression in Iranian adults. Further studies, especially with prospective design, are required to confirm these associations in Middle-Eastern populations.

Constipation and functional constipation are of the prevalent functional gastrointestinal disorders with negative effects on health-related quality of life and have high socioeconomic burden. In this study, the prevalence of these disorder and their related factors were evaluated.
This study was a part of a great study with 4763 participants that evaluated constipation and functional constipation using Rome III questionnaire and demographic questionnaire.
Findings: The prevalence of constipation and functional constipation were 33.4% and 15.2%, respectively and both were more common in women than men. Sensation of incomplete defecation was the most prevalent symptom. Using manual maneuver was the less prevalent and most severe symptom. Having hard stool was the mildest symptom among participants. All Symptoms was more prevalent in women.
Constipation and functional constipation are prevalent disorders around the world. These conditions need more attention and attempts to prevent and treat.

Dietary intakes, especially dairy products, can be the cause of change or onset of the symptoms in functional gastrointestinal disorders (FGIDs) like irritable bowel syndrome (IBS). This study aimed to investigate the relationship between dairy consumption and prevalence of IBS in Iranian adults.
This cross-sectional study was based on SEPAHAN project that was done among 4763 of staffs of Isfahan University of Medical Sciences, Iran, during 2 phases. IBS and nutrient intake were assessed using ROME III criteria and validated food frequency questionnaire (FFQ), respectively. Completed questionnaires of the 2 phases which were of the subjects with lactose intolerance were excluded which resulted in 2849 questionnaires. Cases were devided to 3 consecutive groups of dairy consumption named dairy intake tertiles. The odds ratios (OR) were evaluated for IBS in dairy intake tertiles.
Findings: Prevalence of IBS was estimated 20.7%. There was no significant difference between odds ratio of IBS in crude models of low- and high-fat dairy consumption. Controlling for potential confounders did not change the results. However, there was a positive and negative association between consumption of average amount of high fat (OR: 1.11, Confidence interval of 95%: 0.87-1.41) and higher intake of low-fat dairy products (OR: 0.87, Confidence interval of 95%: 0.69-1.10) with higher prevalence of IBS. In addition, abdominal pain was related adversely to average amount of dairy consumption (OR: 0.79, Confidence interval of 95%: 0.64-0.98).
There was no significant association between IBS prevalence and dairy consumption; although, average intake of dairy products can be protective against abdominal pain.

The linkage between consumption of fried foods and constipation was less studied. We aimed to assess the relationship between fried foods intake with constipation and functional constipation and its components in a large group of Iranian adults.
In this cross-sectional study on 4517 adults, fried foods intake was assessed using an eating-behavior questionnaire. Subjects were classified into four categories based on their fried foods intake: "never", "1-3 times per week", "4-6 times per week" and "every day". The prevalence of functional constipation and its components was defined according to Rome III criteria.
Findings: The prevalence of functional constipation and constipation among study population was 15.3% and 33.5%, respectively. After adjustment for potential confounding factors, individuals who ate 4 to 6 meals of fried foods per week had lower odds ratios for functional constipation (OR: 0.67; 95% CI: 0.45-0.99), in comparison to those in the lowest category of fried food intake; more adjustment for dietary fiber intake disappeared this association. However, fried foods intake raised the risk of "sensation of incomplete evacuation" and "fewer than three defecations per week" by 36% (OR: 1.36; 95% CI: 1.02-1.79) and 159% (OR: 2.59; 95% CI: 1.00-6.71) in females as well as frequency and severity of these symptoms in whole population.
There was no significant association between fried foods intake and odds ratios for functional constipation. However, fried foods intake raised frequency and severity of some components of functional constipation.

Association of a combination of lifestyle-related factors and mental health is less studied in earlier studies, especially in Middle Eastern countries.
This study aimed to examine how combinations of several lifestyle-related factors is related to depression and anxiety in a large group of middle-age Isfahani population.
In a cross-sectional study in 2012 on 3363 Isfahani adults (19-70 yr), a healthy lifestyle score was constructed by the use of data from dietary intakes, physical activity, smoking status, psychological distress and obesity. A dish-based 106-item semi-quantitative validated food frequency questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ) and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. The Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression.
The prevalence rates of anxiety and depression among study participants were 15.2 and 30.0%, respectively. After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle were 93% less likely to be anxious (OR: 0.07; 95% CI: 0.02-0.30) and 97% less likely to be depressed (OR: 0.03; 95% CI: 0.01-0.11), compared with those with the lowest score. In addition, non-smokers had lower odds of anxiety (OR: 0.65; 95% CI: 0.47-0.89) and depression (OR: 0.63; 95% CI: 0.48-0.82), compared with smokers. Individuals with low levels of psychological distress had expectedly lower odds of anxiety (OR: 0.13; 95% CI: 0.10-0.16) and depression (OR: 0.10; 95% CI: 0.08-0.12) than those with high levels. Individuals with a healthy diet had 25% lower odds of depression (OR: 0.75; 95% CI: 0.61-0.91) than those with a non-healthy diet.
We found evidence indicating that healthy lifestyle score was associated with lower odds of anxiety and depression in this group of Isfahani adults. Healthy diet, psychological distress, and smoking status were independent predictors of mental disorders.

There were few researches indicating the association between irritable bowel syndrome (IBS) and obesity. This study aimed toassess the association of IBS with obesity and abdominal obesity.
During this cross-sectional study, 4763 Iranian adults filled out self-administered questionnaires on demographics and IBS. Data on self-reported height, weight and waist circumference were used to calculate body mass index and abdominal obesity. The prevalence and symptom frequency of IBS and its subtypes was evaluated in each subgroup. Modified Persian version of ROME III questionnaire was applied for this purpose.
Findings: We found that IBS was more prevalent in individuals with abdominal obesity compared with normal individuals (25% vs. 18%). Additionally, these people had a greater probability to have frequent symptoms even after adjustment for potential confounders although control for these factors attenuated this relationship (OR: 1.30, 95%CI: 1.04-1.63). IBS-Mixed was also observed to have more symptom frequency in people with abdominal obesity (OR: 2.71, 95%CI: 1.09-6.72). No significant association was observed between IBS and different BMI categories although obese people had a greater probability to be affected by IBS-Diarrhea (OR: 1.51, 95%CI: 0.98-2.30). Besides, we showed that overweight people reported more frequent symptoms of IBS-Diarrhea (OR: 2.51, 95%CI: 1.24-5.08).
Obesity whether in general or abdominal was associated with symptom frequency rather than prevalence of IBS in this group of adults. In addition, this association was more prominent between obesity and IBS-Diarrhea subtype.

The growing evidence suggest on the association between dietary patterns and obesity. This study was done to determine the relation between pattern of nutrient intake and obesity in Isfahanian adults.
In this descriptive - analytical study, dietary data were collected using a semi-quantitative food frequency questionnaire in 8,691 subjects aged 18-55 years. Complete data of 6,724 and 5,203 adults were available for general and abdominal obesity, respectively. Daily intakes of 38 nutrients and bioactive compounds were calculated for each participant. Factor analysis was applied to derive major nutrient patterns.
Three major nutrient patterns were identified: 1) pattern high in fatty acids, cholesterol, vitamin B12, vitamin E, zinc, choline, protein, pyridoxine, phosphorus, and pantothenic acid; 2) high in thiamine, betaine, starch, folate, iron, selenium, niacin, calcium, and manganese; and 3) high in glucose, fructose, sucrose, vitamin C, potassium, dietary fiber, copper and vitamin K. Men in the highest quintile of the second pattern were less likely to be generally obese in the fully adjusted model (95% CI: 0.20-0.76, OR: 0.39, P0.05).
Nutrient patterns were significantly associated with general, but not abdominal obesity in the male Iranians participating in SEPAHAN study.

Findings from few studies that investigated the relation between dietary behaviors and obesity are inconsistent. We aimed to assess the relation between patterns of dietary habits, identified by latent class analysis (LCA) and obesity in a large sample of Iranian adults.
In a cross-sectional study on 7958 adults, dietary behaviors were assessed in five domains (meal patterns, eating rate, intra-meal fluid intake, meal-to-sleep interval and fatty foods intake) using a pretested questionnaire. LCA was applied to identify classes of diet-related practices. Anthropometric measures were assessed through the use of a validated self-reported questionnaire. General and abdominal obesities were defined as a body mass index ≥30 kg/m2 and a waist circumference ≥88 cm for women, ≥102 cm for men.
General and abdominal obesityies were prevalent in 9.7 and 27.7% of the study population, respectively. We identified three distinct classes of eating rates (moderate, moderate-to-slow and moderate-to-fast), two classes of meal patterns (­regular and irregular), two classes of intra-meal fluid intake (moderate and much intra-meal drinking), three classes of meal-to-sleep interval (short, moderate and long meal-to-sleep interval), and three classes of fatty foods intake (low, moderate and high intake of fatty foods). After adjustment for potential confounders, individuals with ‘irregular meal pattern’ were 21%, 24% and 22%, respectively more likely to be overweight/obese, abdominally overweight/obese and abdominally obese, compared with those who had a ‘regular meal pattern’. Individuals with ‘much intra-meal drinking’ had greater odds of overweight (OR: 1.37; 1.19-1.58) and obesity (OR: 1.51; 1.16-1.97) than those with ‘moderate intra-meal drinking’. Moderate intake of fatty foods was inversely associated with abdominally overweight/obese (OR: 0.85; 0.73-1.00) and abdominally obesity (OR: 0.80; 0.68-0.96) compared with ‘low intake of fatty foods’. No significant association was observed between eating rate, meal-to-sleep interval and general or abdominal obesity, after controlling for confounders.
Irregular meal pattern and much intra-meal drinking were associated with increased odds of general and abdominal obesities, whereas moderate intake of fatty foods was related to the decreased odds of central obesity among Iranian adults.

Obesity is among the factors that are linked with gastroesophageal reflux disease (GERD). However, findings of previous studies on the relationship between obesity and GERD were conflicting. We aimed to assess the relationship between obesity and GERD in a large group of Iranian adults.
This cross-sectional study was performed on 4457 adults. Anthropometric measures were obtained by the use a validated self-reported questionnaire. Subjects were classified into three categories based on their body mass index (BMI): normal weight, overweight and obese. Also they were classified into three categories based on their waist circumference: normal, abdominally overweight and abdominally obese. The prevalence of gastrointestinal reflux disease was assessed according to Rome III criteria. Additional information about other variables was obtained using a self-administered questionnaire.
Findings: The prevalence of GERD among study population was 23.9%. In crude model, the obese individuals had a 58% greater chance for GERD [odds ratio (OR) = 1.58, 95% confidence interval (CI): 1.25-1.98), compared to those with normal weight. However, after adjustment for dietary habits and waist circumference, this association disappeared (OR = 1.06, 95%CI: 0.75-1.48). After adjustment for confounders, those with abdominal obesity had a 43% greater odd for GERD (OR = 1.43, 95%CI: 1.13-1.85). However further adjustment for weight interaction lead to a non-significance association (OR = 1.26, 95%CI: 0.96-1.65). Stratified analysis by gender revealed no significant association between obesity and GERG in men. But obese women had 43% increased odds of GERD and abdominally obese women had 51% higher odds of GERD; although adjustment for the mutual effects of waist circumference and weight disappeared these relations. There was no significant association between general or abdominal obesity and frequency or severity of GERD, after adjustment for all potential confounders.
General obesity was significantly associated with increased risk of GERD; however, this association disappeared after controlling for dietary habits and waist circumference. Abdominally obese individuals had higher odds of GERD, compared to those with normal waist circumference.

Background and In recent decades psychosomatic disorders have emerged that complexity of their diagnosis impose large economic burdens on patients. The aim of this study was to identify and classify the profiles of psychosomatic disorders and their relationship with psychological problems (mental distress, anxiety, and depression) in an Iranian adult population.
A cross-sectional study was performed in 4763 individuals participating in a research project called SEPAHAN. Psychosomatic symptoms and psychological problems were studied using the Patient Health Questionnaire (PHQ-15) and 47 questions psychosomatic, Lacourt Questionnaire General Health Questionnaire (GHQ-12) and hospital anxiety and depression Scale (HADS).
Four categories of psychosomatic disorders including mental, gastrointestinal, respiratory, and general symptoms were extracted from psychosomatic symptoms that explained 42.02% of the total variance. Similar to that of the study population four categories of psychosomatic disorders were extracted for both males and females explaining 41.54 and 44.75 of the total variance, respectively. A significant association was seen between mental health problems and psychosomatic disorders. In other words, higher scores in psychosomatic disorders increased the prevalence of mental health problems (p To the best of our knowledge the current study was the first study that categorized psychosomatic disorders (mental, gastrointestinal, respiratory and general symptoms). The results showed higher incidences of mental health problems are associated with severity of these disorders. These results could be of great help in appropriate diagnosis of these disorders and also in treatment and prevention of mental health problems based on the observed relationships.

Constipation is a common disorder of the gastrointestinal tract which affects the quality of life (QOL) of patients. However, findings of studies on the relationship between obesity and constipation are conflicting. The aim of the present study was to assess the relationship of general and central obesity with constipation and functional constipation in a large group of Iranian adults.
This cross-sectional study was conducted on 4457 adults, through obtaining anthropometric measures using a validated self-report questionnaire. The subjects were classified into three categories of normal weight, overweight, and obese based on their body mass index (BMI) and normal, central overweight, and central obesity based on their waist circumference. The prevalence of constipation, functional constipation, and its components was investigated according to Rome III criteria.
Findings: The prevalence of constipation and functional constipation among the study population was 33.6% and 15.3%, respectively. After adjustment for potentially confounding factors, obese individuals were at a 32% greater risk of constipation compared to those with normal BMI (OR: 1.32; 95% CI: 1.03-1.71). There was no significant association between general obesity and functional constipation. Gender-stratified analysis revealed a significant association between overweight and obesity, and constipation among women in the crude model; overweight women (OR: 1.21; 95% CI: 1.02-1.45) and obese women compared to women with normal BMI (OR: 1.65; 95% CI: 1.26-2.15) were 21% and 65% more likely to have constipation. Although significant associations were found between abdominal obesity, and constipation and functional constipation in the crude model, these associations disappeared with adjustment for confounding factors. Gender-stratified analysis revealed no significant associations between abdominal obesity, and risk of constipation or functional constipation in men or women.
General obesity was associated with a significant increase in the risk of constipation, while abdominal obesity was not associated with constipation and functional constipation. General obesity was related to increased risk of constipation in women. However, no significant association was found between constipation and functional constipation, and obesity or abdominal obesity in men.

Abstract

Limited data are available linking diet-related practices to functional dyspepsia (FD). We aimed to investigate the Relationship between the meal frequency and prevalence of functional dyspepsia among a large sample of Iranian adults.

In this cross-sectional study, 4763 individuals of general adult population in Isfahan, Iran, were asked to report how many main meals and snacks they consumed each day. Frequency of total meals was defined by summing up the frequency of main meals and snacks and participants were categorized into 4 categories of < 3, 3-5, 6-7 and ≥ 8 meals/day. The symptoms of functional dyspepsia were assessed using a validated Persian version of Rome III questionnaire. Functional dyspepsia was defined as bothersome postprandial fullness, early satiation, and/or epigastric pain or epigastric burning.

Compared to those who had one main meal/day, individuals who had consumed 3 main meals/day had a lower chance for early satiation (Odds Ratio: 0.44; 95% Confidence Interval: 0.21-0.90). In Addition, compared to those that never consumed snacks, individuals who had consumed 3 to 5 snacks/day were 39% less likely to have functional dyspepsia (OR: 0.61; 95% CI: 0.40-0.92), 42% lower odds of postprandial fullness (OR: 0.58; 95% CI: 0.34-0.98) and 43% lower chance of epigastric pain (OR: 0.57; 95% CI: 0.34-0.97). After adjustment for potential confounders, including diet-related behaviors, individuals with 6-7 total meal and snacks/day had lower odds of functional dyspepsia (OR: 0.51; 95% CI: 0.31-0.82) compared with those with less than 3 meal and snacks/day. Such inverse association was also seen between the meal and snack frequency and early satiation (OR: 0.32; 95% CI: 0.16-0.63) and postprandial fullness (OR: 0.54; 95% CI: 0.29-0.98).

We found an inverse association between the meal and snack frequency and prevalence of functional dyspepsia and its components. Prospective studies are required to confirm these findings.

Few studies have assessed the relationship between tooth loss and upper gastro-intestinal (GI) disorders including functional dyspepsia (FD) and gastro-esophageal reflux disease (GERD). This study aimed to investigate the relationship between dental status and FD, its components and GERD among a large group of Iranian adults. In a cross-sectional study on 4109 Isfahanian adults, dental status was evaluated and participants were categorized into three main groups: those with full dentition, individuals who had lost 1-5 teeth and those who had lost >5 teeth. FD, its components (early satiation, postprandial fullness and epigastric pain) and GERD were defined using Rome III criteria. The relationship between dental status and gastrointestinal disorders was examined using logistic regression in different models and P-values less than 0.05 were considered statistically significant. After adjustment for potential confounders, we found no significant association between dental status, FD and GERD. However, individuals who had lost 1-5 teeth and >5 teeth had 1.34 and 2.09 times the risk of early satiation, respectively. In addition, individuals who had lost 1-5 teeth were 1.24 times more likely to have postprandial fullness and epigastric pain. Stratified analyses by gender also revealed a significant association between dental status and GERD as well as FD in females; such that those who had lost 1-5 teeth had 1.33 times the chance for GERD and those who had lost >5 teeth were 2.01 times more likely to have FD, compared with those with full dentition. We found significant positive associations between tooth loss, GERD and FD in women, but not in men. We also found significant relationships between tooth loss and components of FD, especially early satiety in whole population.

Scarce data are available on validity of self-reported anthropometric indices in Iran. This cross-sectional study aimed to determine the validity of self-reported anthropometric indices in comparison with the same variables measured by technicians in a subgroup of the staff of the Isfahan University of Medical Sciences (IUMS), Isfahan, Iran. In the current study, 200 staff of Isfahan University of Medical Sciences were selected via convenience non-random sampling method. Weight, height, and waist and hip circumferences were questioned by the first technician. The same measures were taken three times by a trained technician according to standard protocols. Mean of three measurements were considered in statistical analysis. Weight (P = 0.040) and waist circumference (P < 0.001) measures were significantly lower in self-reported values compared to those that measured by the technician. Pearson correlation test between the measured and self-reported anthropometric indices ranged from 0.60 for hip circumference to 0.95 for weight. The highest agreement between the two series of values was observed for normal weight (73%) and overweight and obesity (91%). Overall, 87% of central obesity measured by the technician, was confirmed by self-reported measures. While, less than 13% of people with no abdominal obesity, according to the technician measures, were categorized as abdominally obese by self-reported values. These results indicate that self-reported anthropometric indices are highly accurate among this Iranian population, and are, therefore, appropriate for epidemiologic studies.