Vol 3, No 1 (Winter 2017)


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    Maintenance of proper health and resistance to disease requires, in addition to sufficient supplies of energy and the essential macronutrients, provision of adequate intakes of micronutrients ─ vitamins and minerals. It is known that such sub-clinical deficiency symptoms of various micronutrients as fatigue, impaired immunity, irritability, pains, etc. maybe non-specific and, consequently, difficult to diagnose. Hence, comprehensive policy-making, adoption of strategies, preventive measures and interventions at the population level would be a great challenge.

    Deficiencies of micronutrient imperil health of man in various forms: slow growth and development; impaired immunity, vision and wound healing; bleeding; anemia; bone disorders; etc. At least two billion people ─ different age/sex groups ─ suffer from deficiencies of essential vitamins and minerals, termed “hidden hunger”. Based on the Hidden Hunger Index, strongly inversely associated with the Human Development Index, preschool children in at least twenty countries in Asia and Africa suffer from multiple micronutrient deficiencies, as well as stunting (1). It has also been reported that in Mangolia 78% of children are at risk of at least two coexisting micronutrient deficiencies, while 14.5% are stunted and wasting, which is one of the forms of child malnutrition prevalent in many countries, is not a problem (2). Preliminary findings of national micronutrient surveys in IR Iran, too, show that multiple micronutrient deficiencies may be common in some vulnerable groups. In this issue of our journal Samadpour and colleagues also emphasize micronutrient deficiencies among young Iranian children.

    Inadequate intakes and deficiencies of vitamins and minerals have been found even in generally well-nourished populations such as, for example, Canada, where the daily B-vitamins and zinc intakes of some women were below the respective estimated average requirements ─ between 25% and 39% (3). In the European countries, too, sections of the population have low intakes of several micronutrients, namely, iodine, magnesium, iron, vitamin D, calcium, selenium, thiamin and riboflavin (4), and in USA, 5.7% of the population are reported to be at risk of at least two vitamin deficiencies (5).

    Another important point to consider is that metabolic disturbances related to obesity, a disease and a risk factor for several other diseases, currently quite prevalent and on the increase globally, could be a cause, as well as an undesirable consequence, of deficiency of several vitamins, including vitamins C, B12, folate, and the fat-soluble vitamins. It has been reported that the risk of deficiency of these vitamins may increase in obese individuals (6). Athletes, too, may be at risk of oxidative stress if they do not receive sufficient amounts of micronutrients ─ some of the B-vitamins and minerals ─ involved in energy production.

    Strategies to combat micronutrient deficiencies include dietary diversification, dietary supplementation, mass food fortification and home food fortification. As regards vitamin and mineral supplements, now very popular in many countries, it is to be noted that even individuals who are on adequate diets will be at a lower risk of deficiency when they take multivitamin-multimineral supplements. Also, the risk of pregnant women giving birth to low-birth weight and small-for-gestational-age babies will decrease when they receive iron and folic acid supplements during pregnancy. In India, where deficiencies of some micronutrients are prevalent, salt fortified with iron and vitamin A, was found to improve the status of these two micronutrients among children in Tamilnadu (7).

    In conclusion, considering that multiple micronutrient deficiencies are widespread globally,   national health and nutrition policy-makers and planners should attempt to adopt policies, design and implement strategies and programs, aiming at combating multiple micronutrient deficiencies rather than concentrating on one single micronutrient, for example, iron or vitamin D alone. That is to say, the emphasis should be on reducing the overall burden of micronutrients deficiencies.

Original Article(s)

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    Aims: Type2 diabetes, is a common metabolic diseases in the world. Non-pharmaceutical and pharmaceutical strategies for control and treatment of diabetes are proposed. Nutrition and exercise as non-drug strategies for the prevention and control of diabetes are considered. Heavy and acute exercises may increase oxidative stress, thus it is necessary to take nutrition strategies to help diabetic athletes.

    Methods: This study was a semi-experimental research. Therefore, 24 men with type2 diabetes were divided randomly into four groups including saffron extract, aerobic exercises, aerobic exercises plus saffron extract and control groups. Saffron extract with 3 mg/kg was used. Aerobic exercises, three days a week, for eight- week, with 55-70% of maximum heart rate were performed. At the end of the intervention period, levels of  Malondialdehyde (MDA) and Glutathione Peroxidase (GPX) were measured. Data were analyzed by One-way ANOVA, Tukey tests and Paired t.

    Results: The serum MDA decreased significantly in saffron extract and aerobic exercises plus saffron extract groups in type 2 diabetic men(P=0.001, P =0.026 respectively). Saffron extract consumption and aerobic exercises did not significantly influence on erythrocyte GPX activity (P =0.12, P =0.14 respectively). But erythrocyte GPX activity increased significantly in aerobic exercises plus saffron extract group (P =0.041).

    Conclusions: Antioxidant compounds of saffron, is effective in reduction and inhibition of tissue damages after physical activities. Aerobic exercises plus saffron extract can decrease and increase levels of MDA and erythrocyte GPX activity in men with type2 diabetes, respectively.



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    Objectives: Cinnamon, as a flavoring additive and a drug in traditional medicine, has a long history. Today, several studies have been carried out on the effects of cinnamon on blood glucose, obesity, and hypertension in type 2 diabetic patients. The aim of this study was to determine the effect of cinnamon powder onweight loss and blood pressure in patients with type 2 diabetes.
    Materials and Methods: This study was a randomized double-blind clinical trial conducted for 3 months on 81 patients with type 2 diabetes from the city of Maku, Iran. Patients were randomly divided into 3 groups receiving (a) two 500- mg cinnamon capsules (n = 27), (b) four 500-mg capsules (n = 28), and (c) placebo (n = 26). The biochemical parameters, systolic and diastolic blood pressure, height, weight, waist circumference (WC), body mass index (BMI), and body fat and leanmass were measured at the beginning and end of the study. Data analysis was performed using SPSS 16 software. 
    Results: The mean age of participants was 51.73 ± 6.40 years. Weight, BMI, and WC decreased significantly following the intervention in the group receiving the higher dose of cinnamon supplementation (p = 0.009). Statistically significantdifferences were also observable among the 3 groups in weight (p = 0.03), BMI (p = 0.02), WC (p = 0.02), fat mass (p = 0.03 , and lean mass (p = 0.04) after theintervention. There was no significant difference in systolic and diastolic blood  pressure between preintervention and postintervention values.
    Conclusion: This study showed that supplementation with dietary cinnamonpowder in type 2 diabetic patients significantly decreases weight, BMI, WC, and body fat and increases lean mass.

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    Background: Fortification has an important role in correction of dietary micronutrients deficiencies. The aim of the present study is to assess the fortification of wheat flour with premix, which includes iron and folic acid, in Zanjan province.
    Methods: Totally 479 samples were obtained from active flour producing factories of Zanjan (5 Factories) during year 2016. Amount of fortification in bakery products was measured with spot test and UV spectrophotometric method and was compared with the standard values of Iran Food and Drug Administration (IFDA).
    Results: Qualitative assessment of iron in Tafton/Lavash and Barbari flours has revealed that the fortification program was successful in all the cases (100%) according to the standard values of IFDA. Quantitative evaluation of iron in Tafton/Lavash and Barbari flours has indicated that 72.68% and 68.46% of samples had iron in standard ranges (40-85ppm), respectively. The average concentrations of iron in Tafton/Lavash and Barbari flours were 62 and 57.91ppm, respectively. According to the results, an average Iranian receives about 7.5mg/d iron from the fortified wheat flour.
    Conclusions: The results suggest that fortification of wheat flour with premix is in an acceptable condition in Zanjan province.

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    Objective:  Micronutrient deficiencies among young Iranian children continue to be prevalent despite the implementation of a national supplementation program.  We determined associations between the prevalence of iron, zinc, vitamin A and vitamin D deficiencies among Iranian infants with supplementation patterns and socio-economic factors to assess what factors may contribute to this continued prevalence.    

    Design: Mean serum concentrations of ferritin, transferrin receptor (S-TfR), zinc, retinol and vitamin D and the prevalence of micronutrient deficiencies were determined among 364 children 6-18 months of age recruited from Health Centres in Hashtgerd, Iran in 2007. Associations between deficiencies and child gender, birth order and household socio-economic characteristics as well as supplementation patterns were determined using chi-square tests. 

    Results: Approximately 39.3 percent of infants were anaemic, 23.1 percent were iron deficient (ID) and 38 percent were zinc deficient while 3.3 and 1.4 percent of infants were marginally vitamin A deficient (VAD) and vitamin D deficient (VDD), respectively.  Mean zinc concentrations were greater among iron-deficient infants compared to non iron deficient infants.  A greater proportion of ID was found among children who were not supplemented with iron, vitamin A, or vitamin D compared to supplemented children while marginal VDD is more prevalent in the group not receiving zinc supplements.

    Conclusions:  These findings emphasize the importance of assessing new forms of supplement which combine multiple micronutrients into a single delivery mechanism. Such supplements may more effectively reduce micronutrient deficiencies among young Iranian children.  

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    Objective: To investigate the relation between female ovulatory infertility and major dietary patterns among women attending fertility clinics.
    Methods: This case-control study was conducted on 167 infertile women with PCOS and 251 controls. PCOS was determined by using 2003 Rotterdam criteria. Usual dietary intake was assessed using a validated 168-item semi-quantitative food frequency questionnaire. Major dietary patterns were identified using factor analysis.
    Results: Two main dietary patterns, healthy dietary pattern and western dietary pattern, were identified. Cases were statistically more overweight and abdominally fat than controls (p<0.01). No statistical significant difference was seen in total energy intake, nutrient intakes and dietary fiber between the two groups. Lower adherence to western dietary pattern was associated with decreased chance of infertility (OR=0.61; 95% CI: 0.41-0.91, p=0.01). The association remained significant even after taking other confounders into account (OR=0.62, 95%CI: 0.41-0.96, p=0.03). However, after adjusting for energy and macronutrient intakes, the association altered to marginally significant relation (p=0.07). Associations between having healthy dietary pattern and infertility regarding PCOS was not statistically significant (p=0.45).
    Conclusion: Lower adherence to western dietary pattern may protect women in reproductive age against infertility. Further studies are needed to confirm the role of different dietary patterns on fertility outcomes.

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    Background and Objective: Diet quality indices are unique approach to studying relations between diet and disease. Our objective was to investigate the relationship between healthy eating index (HEI) and risk of multiple sclerosis (MS).
    Methods: We recruited 68 subjects with MS and 140 control subjects in a case-control study. Dietary intake was collected using a valid and reliable food frequency questionnaire. The HEI was calculated. Logistic regression was used to evaluate the relationship between HEI score and MS, after adjustment for season of the birth, daily amount of imposed stress, total energy intake, and age.
    Results: in comparison to controls, Cases had lower scores of total HEI (68.4vs 72.5 ; P = 0.04), vegetable (7.5vs 8.8; P = 0.006), fruit (6.3vs 8.0; P = 0.02), and Food variety (8.0vs 10; P = 0.008).when comparing the highest  and the lowest quintiles of HEI ,We observed a significant decreasing trend in the risk of MS (p- for trend=0.04 ). Although insignificant (p- value>0.05), MS risk was reduced when comparing each quintile to the reference quintile (OR = 0.95, 95% CI: 0.37–2.38), (OR = 0.62, 95% CI: 0.24–1.62), (OR = 0.36, 95% CI: 0.12–1.14). ), (OR = 0.38, 95% CI: 0.13–1.19), respectively.
    Conclusions: Our study suggests that a high quality diet assessed by HEI may decrease the risk of MS.

Review Article(s)

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    Objective: Vitamin D may have anti-inflammatory actions however; there is no consensus on the effects of vitamin D supplementation on C-reactive protein (CRP) level in randomized clinical trials. In a systematic review and meta-analysis, we hypothesized that vitamin D supplementation would reduce serum CRP levels.
    Materials and Methods: A systematic research of randomized controlled trials has been conducted on MEDLINE and EMBASE through PubMed, Scopus, and completed by a manual review of the literature up from January 2000 to May 2015. Pooled effect estimated by using random-effect model and heterogeneity was assessed by Cochran’s Q and I2 tests.
    Results: Of 157 potentially relevant studies we found in a systematic search, 20 clinical trials met the inclusion criteria. Mean baseline CRP levels in the intervention group and in the control group were 3.5±2.6 and 3.3±2.3 mg/L, respectively. Mean duration of the studies were 29.0±30.2.0 (SD) weeks (8 to 144 weeks). Doses of vitamin D3 supplementation varied between 200 to 57142 IU/day. Pooled analysis showed a non-significant increase of 0.04 mg/L (95% CI, −0.12 to 0.21; p < 0.61), with no evidence of heterogeneity (I2 = 17.8%, p < 0.17).
    Conclusion: The results of this meta-analysis showed that vitamin D supplementation may not be effective for the reduction of CRP. However, a more accurate estimate of the effect requires further large and well-designed clinical trials.