fatemeh toorang

 The inflammatory potential of diet may affect carcinogenesis. This study aimed to determine the association between dietary inflammatory index (DII) and the risk of head and neck cancer (HNC), as well as the interaction between DII and cigarette smoking in HNC development within the Iranian population.

Study Design: 

This is a case-control study.

 In this multicenter case-control study, participants’ dietary intake was assessed using a validated 130-item food frequency questionnaire, from which DII was computed. The study recruited 876 new cases from referral hospitals across 10 provinces and 3409 healthy controls who were frequency-matched based on age, gender, and residential place. Logistic regression was used to obtain odds ratios (ORs) for HNC across tertiles of DII, which were adjusted for confounding variables.

 A higher pro-inflammatory diet was associated with an increased risk of all HNC (OR T3 vs. T1 [95% CI]: 1.31 [1.06, 1.62]; P-trend=0.013). There was a significant association between lip and oral cavity cancers and DII (OR T3 vs. T1 [95% CI]: 1.56 [1.16, 1.66]; P-trend=0.004). Furthermore, an inflammatory diet was associated with an increased risk of pharynx cancer (OR T3 vs. T1 [95% CI]: 2.08 [1.14, 3.79]; P-trend=0.02). Additionally, no significant association was observed between DII and larynx cancer, while an interaction was found between DII and tobacco use on the risk of HNC (OR T3 vs. T1 [95% CI]: 2.52 [1.78, 3.57]; P-interaction=0.03).

 DII was positively associated with HNC risk. There was a significant association between DII and the risk of lip, oral cavity, and pharynx cancers. Additionally, there was an interaction between tobacco use and DII in determining the risk of HNC.

There is a growing concern about the health-threatening effects of pesticide residues in fruits and vegetables worldwide. This study systematically reviewed the published data on pesticide residues in Iranian fruits and vegetables to clarify the gap in this issue.

The authors systematically searched PubMed, Google Scholar, Scopus, SID, and Iran Medex to find published studies on pesticide residues in Iranian foods without time and language restrictions. The title and abstract of all articles were evaluated after removing duplicate articles (2289 articles) by two independent reviewers. Finally, 25 articles were found that reported pesticide residues in fruits and vegetables. There was a great variation in measurement methods and pesticides reported across studies, which precluded meta-analysis. Therefore, a summary of the included studies was only reported.

Twenty-four studies reporting pesticide residues in Iranian fruits and vegetables were included. The percentage of Iranian fruits and vegetables contaminated with pesticides exceeding the maximum residue limit (MRL) was less than 10% in most studies. Contaminated samples were collected mainly from cultivated areas such as fields, orchards, or greenhouses.

Pesticide residues in food have not been systematically reported in Iran. It was found that only limited articles were published by academic societies on this issue. Considering the current scenario, there is an urgent need to facilitate reliable and continuous measurements of toxic residues in Iranian food.

DNA oxidation is one of the essential destructive effects of reactive oxygen species (ROS) on the cell membrane macromolecules leading to the deformation of cellular DNA. The most abundant oxidative DNA product on which most studies have focused is re-oxidized DNA, 8 oxo-deoxyguanosine (8-oxodG). This deformation of cellular DNA is associated with various cancer initiation and progression. DNA damage can be a cancer marker including 8-oxodG, thymidine glycol, 8-oxoadenine, etc. DNA oxidation is affected by environmental and non-environmental factors. Age, diet, and metabolism are at the heart of this process. This review study summarizes the types of cancer-related DNA oxidation that serve as a cancer biomarker. Also we will look at the factors influencing their formation.

This study investigated the association between vitamins intakes and risk of gastric cancer (GC) among Iranian population.

In this hospital-based case-control study, 178 pathologically confirmed GC patients and 276 healthy controls were interviewed to answer a valid diet history questionnaire. Unconditional logistic regression, in which potential confounders were taken into account, was applied to determine the association of vitamin intakes and odds of GC in total population and in stratums of body mass index (BMI), helicobacter pylori (H-pylori) infection, and smoking.

GC was directly associated with vitamin D (OR 1.59; CI 95% 1.07, 2.36) and cobalamin (OR 1.25; CI 95% 1.08, 1.44). Thiamin (OR 0.50; 95%CI 0.30, 0.83), pantothenic acid (OR 0.71; 95%CI 0.58, 0.87), folate (OR 0.99; 95%CI 0.99, 0.99) and vitamin E (OR 0.98; 95%CI 0.96, 0.99) were inversely associated with GC. In 231 H-pylori infected participants, consumption of thiamin (OR 0.3; 95% CI 0.59, 0.86), pyridoxine (OR 0.52; 95%CI 0.31, 0.85), and folate (OR 0.99; 95%CI 0.99, 0.99) reduced GC risk. In H-pylori negative participants, only vitamin E (OR 0.96; 95%CI 0.93, 0.99) reduced the risk and vitamin D (OR 1.99; 95%CI 1.18, 3.36), riboflavin (OR 1.91; 95%CI 1.37, 2.66), pantothenic acid (OR 1.34; 95%CI 1.13, 1.64), biotin (OR 1.03; 95%CI 1.01, 1.05), and cobalamin (OR 1.36; 95%CI 1.13, 1.64) increased the risk. In BMI stratums, only vitamin D (OR 1.81; 95%CI 1.07, 3.08) was associated with the risk of GC among normal weight participants. Vitamin E was associated with lower risk of GC in ever smokers (OR 0.97; 95%CI 0.95, 0.99) and thiamin (OR 0.41; 95%CI 0.19, 0.86) and niacin (OR 0.93; 95%CI 0.87, 0.99) were associated with lower risk in never smokers. Positive associations were observed by increasing vitamin D (OR 2.08; 95%CI 1.12, 3.85) and cobalamin (OR 1.33; 95%CI 1.08, 1.65) in never smokers.

This study provided support for a possible protective effect of vitamin E, thiamin, pantothenic acid, and folate on GC risk. Vitamin D and cobalamin intake increased the risk.

Most of previous studies have investigated the association of specific food or nutrient with risk of breast cancer (BC) rather than overall diet and there is lack of evidence regarding dietary pattern in BC development. This study aims to examine the association between dietary patterns and risk of BC among Iranian women.

This case–control study was carried out on 453 BC women and 496 healthy controls. A reliable and valid FFQ was used to evaluate usual dietary intake. Factor analysis was also applied to address the most major dietary patterns which were known as the healthy and unhealthy dietary patterns.

Those in the highest quartile of healthy dietary pattern had lower risk of BC (P = 0.001). However, being in the highest quartile of unhealthy pattern was associated with 2.04-fold increase of BC risk (P = 0.004) compared to the lowest quartile. In premenopausal women, risk of BC in upper quartile of healthy pattern was lower than the lowest quartile (OR = 0.47; CI = 0.26 – 0.83,
P = 0.004). More adherence to the unhealthy dietary pattern was associated with higher risk of BC (OR = 2.85; 95% CI = 1.57- 5.17, P < 0.0001).  No significant association was observed between the healthy or unhealthy dietary patterns among postmenopausal women.

The findings indicated that the healthy dietary pattern could be considered as a protective factor in terms of BC in women and particularly among premenopausal women.

Stomach cancer (SC) is one of the most common cancers in the world. Dietary risk factors of SC are not fully understood. This study aimed to investigate the association between macronutrient intakes and the risk of SC. Study design: A hospital-based case-control study.

The data were obtained from a hospital-based case-control study conducted at the Cancer Institute of Iran from 2010 to 2012. Patients were 40 years or older and were diagnosed with SC in less than one year with no history of any cancers. On the other hand, the controls were healthy subjects who were caregivers or visitors of the patients. Demographic characteristics were collected using a structured questionnaire through face to face interviews by trained interviewers. Dietary data were obtained using a validated Diet History Questionnaire. The age and gender-adjusted odds ratios (ORs), as well as the adjusted ORs of age, gender, energy, education, smoking, and body mass index, were reported for continuous and tertiles of intakes.

Totally, 207 SC patients and 217 controls participated in this study. In the full adjusted model, after comparing the highest tertiles to the lowest ones, the intake of sucrose (OR: 2.94; 95% CI: 1.66-5.19; P-trend<0.001), protein (OR: 2.04; 95% CI: 1.17-3.55; P-trend=0.011), cholesterol (OR: 2.22; 95% CI: 1.28-3.85; P-trend=0.005), and percent of calories from protein (OR: 3.09; 95% CI: 1.69-5.61; P-trend<1.001) showed a positive significant association with SC. Moreover, a significantly negative association was found between the percent of calories obtained from carbohydrates and SC (OR: 0. 57; 95% CI: 0.33-0.98; P-trend=0.015).

The findings in this study showed that macronutrient intakes might be associated with the etiology of SC in Iran.

Childhood malnutrition is the main risk factor for impaired mental and physical growth and several diseases and leads to premature death worldwide. Therefore, reducing childhood malnutrition is a top priority in most countries. In this regard, several studies have explored the effects of nutritional intervention on reducing childhood malnutrition, although mostly in controlled conditions and with small sample sizes. Data on community-based interventions are limited. In this study, we investigated the effects of providing hot meals at lunchtime on the growth of children in day care centers in rural areas of the city of Birjand, Iran.

This was a quasi-experimental study. Hot meals were offered for 6 months to all the children (n = 1809) in day care centers of rural Birjand. Height and weight of the children were measured before and after the intervention. Z-score indicators were calculated using WHO Anthro and Anthro plus software packages. SPSS was used for data analyses.

Prevalence of wasting and stunting decreased after the intervention in both sexes. The decrease in stunting prevalence was significantly greater in boys than in girls. However, proportions of various categories of height-for-age Z-score (HAZ) did not change significantly in either sex. In both sexes, weight, height, body mass index, and weight-for-age improved significantly after the intervention. The prevalence of obesity and overweight did not change after the intervention.

Based on the findings, providing hot food at lunchtime in day care centers can reduce wasting and stunting in children in rural regions of Birjand, Iran.

Designing cancer prevention programs needs information on knowledge, attitude, and practice of the community. Unfortunately, this information is not available in Iran.

We developed a questionnaire (NUTCANKAPQ) to assess the knowledge, attitude, and practice of Iranian women regarding cancer prevention dietary habits. We recruited women who had referred to public health‑care centers in Tehran, Iran. To assess validity, we applied face, content, and construct validity methods. We performed test–retest approaches to assess reliability, and internal consistency of the questionnaire was assessed through Cronbach’s alpha and intraclass correlation coefficients (ICCs).

Qualitative content validity was carried out by an expert panel, and internal consistency was deemed satisfactory (Cronbach’s alpha, >0.6). We also observed high reliability in the questionnaire (ICC = 0.85). The mean (± standard deviation) scores for knowledge, attitude, and practice of study participants were 28.3 (±14.1), 67.1 (±18.9), and 53.7 (±8.3), respectively. The result of exploratory factor analysis, Kaiser–Meyer–Olkin (KMO), implied that the model was reasonably fit (KMO > 0.6). The final questionnaire included seventy items.

NUTCANKAPQ is a valid and reliable tool for the assessment of cancer‑related nutrition knowledge, attitude, and practice among the Iranian population. Application of NUTCANKAPQ may provide important clues for policy‑making and improvement of cancer prevention programs among the Iranian population.

Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU.

Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded.

Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients.

Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.

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

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

Diabetes is a major cause of death. Oxidative stress mainly caused by hyperglycemia is the primary reason of related complications. Omega-3 fatty acids are prescribed in diabetes but the effect on antioxidant defense is controversial. This study investigated effects of omega-3 supplementation on antioxidant enzymes activity in type 2 diabetic patients.
A randomized, placebo controlled, double blind clinical trial was performed on 90 type2 diabetic patients. The treatment group took, daily, three capsules of omega-3 for two mo, which totally provided 2714mg omega-3 (EPA=1548 mg, DHA=828 mg and 338 mg of other omega=3 fatty acids). Placebo contained 2100 mg sunflower oil (12% SFA, 65% linoleic acid, 23% MUFA), which is the main oil used in the study population. Food intakes, anthropometric and demographic characteristics, and therapeutic regimen data were recorded before and after the intervention. Fasting blood samples were taken before and after the intervention to measure super oxide dismutase, glutathione peroxidase, glutathione reductase, catalase and total antioxidant capacity in erythrocytes.
A total of 81 subjects completed the study. Two study groups were similar as regards duration of diabetes, age and the enzymes at baseline. Energy and macro- and micronutrients intakes, weight and hypoglycemic agent consumption were similar in the two groups at baseline and did not change. Supplementation had no effect on antioxidant enzyme status. Glycated hemoglobin showed a significant reduction by supplementation.
Daily supplementation of 2714 mg mega-3 for two mo results in a significant reduction in HbA1c level in type2 diabetic patients with no effects on antioxidant enzymes activity.

Increased intake of fruits and vegetables may reduce the prevalence of certain chronic diseases. Seasonality, may affect the availability and quantity of fruit and vegetable diet.. We aimed to assess the seasonal fluctuations in intake of fruit and vegetable as well as vitamin A and C among Iranian households.. We analyzed the existing data of the latest Iranian household food pattern study, collected by three consecutive 24 hours recalls. Totally 7158 Iranian households were selected by Iranian statistic center by a systematic cluster random sampling method. Calculation of energy and nutrients consumptions were made by an access program designed using Iranian food composition table and Modified by USDA and database. Cooking coefficient has been considered for vitamin C. Data were expressed as mean and SE. Intakes during different seasons were compared by one-way ANOVA test. A Newman-Keuls post hoc analysis was used to locate statistical significance in seasons, when an ANOVA was significant.. The highest consumption of vegetables was seen in summer (289 ± 3.4 g/day) while the lowest was in winter (224 ± 3.2 g/day) (P < 0.1). Fruit consumption showed a more dramatic variation, with a peak in summer (263 ± 6/1 g/day) (P < 0.1) and the lowest level in spring (143 ± 5.0). Energy intake showed a significant but not sharp variation (P < 0.01). Vitamin C had a dramatically significant variation (P < 0.01), with the lowest in the spring. Seasonal variations were not significant in vitamin A intake.. Due to seasonal variations in fruit and vegetable dietary intakes, the interventional and case-control studies should consider seasonality. Educational and price controlling programs may control such observed seasonality in the intake of fruit and vegetables..