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Background and objective: Malnutrition is a very common clinical disorder risk factor in elderly people, which is not diagnosed in most cases and, therefore, remains untreated. The objective of this study was to determine the prevalence of malnutrition in free-living elderly people and its relationship with socioeconomic factors (SEF) in the elderly subjects in Khorasan Razavi Province, Iran. Methods: To assess the nutritional status of the free-living elderly people (n=2000 using cluster sampling, 917 male/1045 female, aged>60), the standard Mini Nutritional Assessment (MNA) was used. Socio-economic information was obtained through interviews. Results: In 42.7% of the subjects the nutritional status was satisfactory, 12.0% were malnourished, and the remaining 45..3% were at risk of malnutrition. The MNA score was associated with some of the SEF, and the proportions of malnourished subjects were higher in females, rural subjects, the illiterate, subjects living alone, and the unemployed . Prevalence of central obesity in females and males was 63.1% and 18.6%, respectively. Conclusion: The findings of this study are alarming. The government, physicians, and nutrition experts need to be aware of the problem and its dimenensions. Nutritional status was associated with some socio-economic factors. In particular, problems such as loneliness and poverty have to be addressed.

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Background and Objectives: Malnutrition is an important health problem in hospitals and its association with increased morbidity and mortality has been well-documented. Since the condition can be readily treated, often at low cost, it is logical that efforts should be made to identify malnutrition for timely nutritional interventions. A nutrition screening tool (a questionnaire) was designed on the basis of recommendations of the British Association for Parenteral and Enteral Nutrition and used to identify individuals who are malnourished, at-risk of malnutrition, or may need nutritional support. The aim of this study was to evaluate the validity and reliability of this tool in a hospital in Tehran, Iran. Materials and Methods: A total of 446 patients, aged over 18 years, admitted consecutively to different wards of Taleghani Hospital in Tehran, Iran during six months were studied in the first 24 hours of admission. For testing validity of the questionnaire used, first a nutritionist made a full nutritional assessment of all the patients. The assessment included the following items: a. measurements of weight, height, body mass index (BMI), triceps skinfold (TSF), and mid-arm circumference (MAC) b. weight history and percentage of involuntary weight loss over the previous 3-6 months a 24-hour dietary recall c. gastro-intestinal symptoms. The results of the assessment were, then, compared with the results obtained from the screening questionnaire. The inter-rater reliability of the screening tool was assessed by two nurses who completed the screening questionnaire separately during 72 hours following admission of the patients. The agreement between results was calculated. .Results: There was 66% agreement between the nutritionist’s assessment results and the nurses’s assessment results using the nutritional screening tool. The sensitivity and specificity of the screeing tool were 83.7% (95%CI: 80.0-87.4 %) and 84.7% (95%CI: 81.1-88.1 %), respectively. Further analysis of the data showed the positive predictive value to be 92.3% (95%CI: 89.6-95./0 %) and the negative predictive value to be 70.2% (95%CI: 65.8-74.8%). The mean inter-rater reliability (K=0.51) was moderate. Conclusion: The screening tool, completed separately for each patient by the two nurses, is reliable and, in comparison with the more objective nutritional assessment, has an acceptable validity. The questionnaire is useful for identifying malnourished patients in a hospital setting.

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Background and objectives: Protein-energy malnutrition (PEM) is common in hemodialysis patients. So far, no comprehensive study has been performed on prevalence of PEM in various areas of Iran, including Tehran with the largest number of hemodialysis patients in the country. Furthermore, according to the available literature, there is no report on prevalence of various types of PEM in hemodialysis patients. Therefore, the present study was designed to investigate prevalence of PEM and its various types in Tehran hemodialysis patients in 2008. Materials and methods: In this cross-sectional study, using systematic sampling, 291 hemodialysis patients were randomly selected from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment (SGA) and their dietary intakes were assessed using a 4-day dietary recall (2 dialysis and 2 non-dialysis days). At the end of the first dialysis session, patients' heights and weights were recorded. Finally, after a 12- to 14- hour fast, 4 mL of blood were obtained from each patient before dialysis and analyzed for the serum urea, creatinine, albumin and CRP. Results: The prevalence of mild-to-moderate and severe PEM based on SGA was 60.5% and 1% in Tehran hemodialysis patients, respectively. The distribution of the malnourished hemodialysis patients according to type of PEM was as follows: 20.5%, type I (inadequate energy or protein intake, without inflammation) 65.5%, type IIa (inadequate energy or protein intake, with inflammation) and 14% type IIb (adequate energy and protein intake, with inflammation). The distribution of those hemodialysis patients who did not suffer from PEM was as follows: 3.5%, type Ia normal nutritional status (adequate energy and protein intake, without inflammation) 34% type Ib normal nutritional status (inadequate energy or protein intake, without inflammation) 55.5% type IIa normal nutritional status (inadequate energy or protein intake, with inflammation) and 7% type IIb normal nutritional status (adequate energy and protein intake, with inflammation). Conclusion: The results of the present study indicate that PEM in Tehran hemodialysis patients is considerably prevalent and type IIa is the most common type. In addition, hemodialysis patients with no PEM based on SGA should also be paid attention to because they may have inadequate intake‎ of energy and/or protein and inflammation. Keywords: Subjective global assessment, Protein-energy malnutrition, Inflammation, Hemodialysis

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Background and Objectives: Protein-energy malnutrition (PEM) is prevalent among hemodialysis patients. So far, no study has compared various methods for determination of PEM, including subjective global assessment (SGA), dialysis malnutrition score (DMS), malnutrition inflammation score (MIS), and body mass index (BMI), in hemodialysis patients. The present study was designed to determine sensitivity, specificity, accuracy, positive and negative predictive values, as well as positive and negative likelihood ratios of DMS, MIS and BMI in comparison with SGA as the most common method for determination of PEM inhemodialysis patients. Subject and Methods: A total of 291 hemodialysis patients were randomly selected by systematic sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was assessed by completing SGA, DMS and MIS forms and determining BMI. In addition, after a 12- to 14-hour fast, 4-mL blood samples were obtained from each patient before dialysis for measurement of serum urea, creatinine, albumin and total iron binding capacity. Results: Based on SGA, DMS, MIS, and BMI, the prevalence of mild-to-moderate PEM in Tehrani hemodialysis patients was, respectively, 60.5%, 61.5%, 54%, and 16.5%, and that of severe PEM 1%, 1.5%, 1%, and 1%. In comparison with SGA, the sensitivity, specificity, accuracy, area under the receiver operating characteristic (ROC) curve, positive and negative predictive values, and positive and negative likelihood ratios were, respectively, 94%, 88%, 92%, 97%, 93%, 92%, 7.8, and 0.07 for DMS 87%, 96%, 91%, 97%, 97%, 83%, 22.0, and 0.13 for MIS and 23%, 91%, 50%, 64%, 80%, 43%, 2.5, and 0.85 for BMI. Conclusion: The results of the present study indicate that the DMS and MIS are almost similar to SGA, in identifying malnutrition in hemodialysis patients, while BMI is not an appropriate index in this regard. In addition, it appears that the DMS is a more appropriate alternative method for SGA in routine hospital assessments. Keywords: Protein-energy malnutrition, Hemodialysis, Subjective global assessment, Dialysis malnutrition score, Malnutrition inflammation score

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Background and Objective: The risk of cardiovascular diseases among hemodialysis patients with energy-protein malnutrition (PEM) is higher compared to well-nourished hemodialysis patients. Traditional risk factors for cardiovascular diseases such as a high body mass index and serum total cholesterol cannot explain the high prevalence of cardiovascular diseases in hemodialysis patients with PEM. Therefore, the present study was designed to study the association of PEM with nontraditional risk factors of cardiovascular diseases in hemodialysis patients. Materials and Methods: A total of 291 hemodialysis patients were selected with systematic randoml sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment (SGA). In addition, dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS) of the patients were determined and their dietary intakes assessed using a 4-day dietary recall including 2 dialysis days and 2 non-dialysis days. Also, after a 12- to 14-hour fast, an 8 mL- sample of blood was taken from each patient before dialysis and serum urea, creatinine, albumin, CRP, sICAM-1, sVCAM-1, sE-selectin, MDA, NO, endothelin-1, and Lp(a) were measured. Results: The serum concentrations of CRP and sICAM-1 were significantly higher in hemodialysis patients with PEM as compared to those without PEM (p<0.01), whereas there were no significant differences in serum concentrations of sVCAM-1, sE-selectin, MDA, NO, endothelin-1 or Lp(a) between the two groups. In addition, compared to hemodialysis patients with PEM types IIa or IIb, those with PEM type I had significantly lower serum CRP and sICAM-1 levels (p <0.01). There were significant direct correlations between DMS and MIS, as two PEM indicators, with serum CRP and sICAM-1 (P <0.01). Conclusion: The results of the present study indicate that nontraditional risk factors of cardiovascular diseases do not increase in hemodialysis patients with PEM type I, whereas serum CRP and sICAM-1, two risk factors of cardiovascular diseases, increase in PEM type II, which is accompanied with inflammation. Keywords: Protein-energy malnutrition, Hemodialysis, Cardiovascular risk factors

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Background and Objective: Malnutrition can potentially prone a disabled child to further morbidities thus imposing further suffering to the affected child and his/her family. Present study investigates prevalence of malnutrition among physically disabled children based on anthropometry data. Materials and Methods: A total of 290 physically disabled children aged 6- 12 yeas old, of both sexes, and from all specialized schools in Tehran, Meshed and Rasht were enrolled in a descriptive cross- sectional study. Weight and height were assessed and body mass index (BMI) was calculated for all subjects. In those disabled children whose heights could not be measured directly, height was estimated using Arm Lengh (AL) and Tibia Length (TL). Percent of low weight, thinness and short stature was determined in both disabled and healthy children using CDC standards and Z- score. Results: Z score of weight showed that over 40% of disabled girls and boys were underweight. Comparison with anthropometric data from other studies showed that low weight was more prevalent in disabled than in non- disabled children (p<0.001). Moreover, both disabled boys and girls had significantly shorter statures than their non disabled counterparts. Conclusions: Malnutrition (low weight and stunting) is quite prevalent among Iranian children with motor disabilities. Further prevention programs are necessary to induct. Keywords: Malnutrition, Physically disabled children, Anthropometry data

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Malnutrition is common in the patients admitted to the hospitals and medical centers. If the symptoms of malnutrition go unnoticed or be mistaken for those of the patient’s main disorder, disease prognosis is likely to be poor, hospital stay lengthened and the patients may be less able to respond to surgical and medical procedures, including medication. This article assesses the prevalence of malnutrition in some medical centers in Iran and the other countries. In this systematic review, article were gathered the from the databases like Medline, Iranmedex, SID, Magiran, Pubmed, Scopus by using Thesaurus-based keywords like malnutrition, hospital, prevalence, nutritional management between 1984 to 2012 years. According to reviewing the articles, about 20% to 50% of all medical and surgical patients admitted to medical centers are affected by malnutrition prevalence being significantly higher in patients with malignant compared to benign disease and after surgical treatment. Malnutrition correlated with primary undiagnosed malnutrition at admission, age, sex, presence of cancer or infection, longer hospital stay, insufficient food intake, impaired digestion or absorption, increased nutrient requirements and excess nutritional losses. High nutritional risk medical units were identified as geriatrics, critical care, nephrology, internal medicine, gastroenterology and cardiovascular surgery, respectively. Keywords: Malnutrition, Medical center, Hospital, Prevalence

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Background and Objective: Cancer is a major public health concern and the third leading cause of death in Iran. The incidence of different types of cancer vary among populations and are related to occupational, social, cultural, racial, geographic, and nutritional variables. This study assessed the prevalence of malnutrition and its relationship to socio-economic variables in cancer patients admitted to Shohada-ye-Tajrish hospital, which is affiliated to Shahid Beheshti University of Medical Sciences in Tehran. Materials and Methods: The data of this study was obtained from the Cancer Research Center of Shohada-ye-Tajrish hospital and a standard PG-SGA questionnaire. The data set was for 300 patients admitted to the oncology ward of the hospital in Tehran, Iran in 2010. The data was analyzed using one-way ANOVA and the chi-square test using SPSS 16.0, which allowed examination of the quantitative and qualitative variables of this research, respectively. Results: SGA scores indicated that the prevalence of mild-to-moderate energy-protein malnutrition was 30% and severe malnutrition was 23% in cancer patients. The highest incidence of malnutrition was for gastrointestinal malignancies and the highest percentage of normal nutritional status was for breast cancer. The relationship between cancer type and age for the prevalence of malnutrition was statistically significant (p < 0.001 and p < 0.004 respectively). No significant statistical relationships were observed for the prevalence of energy-protein malnutrition in cancer patients by sex, educational level, insurance status, occupation, income sources, or type of treatment. Conclusion: The prevalence of energy-protein malnutrition in cancer patients was considerable. Continuous evaluation of the nutritional status of cancer patients and the socioeconomic factors affecting it are important throughout the treatment period to prevent side effects influencing the treatment and remission rates of cancer, increase the effectiveness of cancer treatments, and improve the quality of life of patients. Monitoring can also be effective in preventing the development of malnutrition and the resulting quality of life in patients and can play a role in related research in this field. Keywords: Malnutrition, Cancer, Socio-economic variables, PG-SGA

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Background and Objectives: Ever decreasing rate of birth and death accompanied with the increasing rate of life expectancy has led to the increase of old population, especially in the developing countries. This study aimed to estimate the association of demographic, socio-economic features and some health problems with the nutritional status in older people. Materials and Methods: A cross-sectional study was designed and conducted by utilizing two-stage cluster sampling. The total of 541 subjects were included. MNA questionnaire was used to evaluate the nutrition status of the elderly. Data were analyzed using one way ANOVA and hierarchical linear regression. The relationship between qualitative variables was also evaluated by Chi-square test. Results: The prevalence of malnutrition and the risk of getting malnutrition was 4.8% and 44.7 %, respectively. The women participants got lower score in nutritional status. The old people taking more than three drugs were were suffering from malnutrition by 58/8 %. About 22/4 % of the subjects lived alone, and there was a statistically significant relation between living alone and malnutrition. Daily consumption of 3 main meals, fruits and vegetables, and good sources of protein was higher in the elderly with well nutritional status than in at-risk and malnurished eldely. There was a significant relationship between dental and mental conditions and malnutrition, and also age and socio-economic features were negatively related with the nutritional status. Conclusion: Considering the relationship between malnutrition and such factors as socio-economic status, depression, dietary patterns and oral health, it seems that besides nutritional intervention, socio-economic support has noticeable importance, especially for women. Keywords: Elderly, MNA, Malnutrition, Depression, Socio-economic status

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Background and Objectives: Inflation and volatility in food prices affect low-income groups more than other income groups, eliminating essential food items in the household food consumption. Quality of the nutrition of households includes serious risks to the development and health requirements of disadvantaged groups in the society. Furthermore, dairy products play important roles in health and development of people. From the welfare policy-making point of view, this has been addressed as a critical factor.
 Materials & Methods: Agent-based simulation, as an advanced forecasting approach, makes it possible to assess effects of various policies on consumers’ behaviors and their expenditure patterns by considering heterogeneous agents. In this study, price elasticity of dairy products was calculated using almost ideal demand system approach. Effects of increases in dairy prices were then simulated using Netlogo6 Software.
Results: Simulation showed that the proportion of household consumption of dairy products in various groups significantly decreased. Decreased dairy consumption occurred asymmetrically between various income groups. The fifth quantile included the highest total expenditure. Adverse effects of dairy price increases decreased dairy expenditure for the first quantile to almost zero.
Conclusion: Since the increase in the price of dairy products causes a decrease in the consumption of them in the food basket, It is suggested to adopt a variety of protective policies in consumption and production sector of dairy products in order to improve and increase the low per capita consumption of these goods.
 

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Background and Objectives: A recent report from the United Nation indicates that Iran is witnessing a relative decrease in the prevalence of hunger and an increase in malnutrition. Soil enrichment along with supplementation is one of the simple strategies, away from pollution, available for all people, accessible and profitable, it has the ability to prevent or control nutritional deficiencies. Investigating the relationship between malnutrition and the lack of soil nutrients in Iran's high-risk climates is necessary in line with the soil enrichment program.
Materials & Methods: The aims of this study were to improve understanding of the relationships between the lack of soil nutrients and the health of population groups, including blood parameters and anthropometric profiles, in various ages and physiology stages (children, adolescents, pregnant and middle-aged women), separated by gender and region (cities and villages) in 11 climate zones of Iran by suggesting a system of assessment indicators and compare multi-factor analyses in heterogeneous variables of various natures.
Results: Findings have shown that the highest synthesis index of anemia in the target groups of the Iranian population was linked to the lack of Fe in soil in all the target groups, lack of vitamin D was linked to the lack of P in soil and lack of Zn was associated to the lack of Zn in the soil. With limited supplementary aids, there are still challenges of soil fertility and malnutrition in provinces of Sistan and Baluchistan, South Khorasan, East Kerman, Bushehr, Hormozgan and Khuzestan.
Conclusion: In conclusion, maps of high-risk regions as well as bioenrichment and supplementary aids are suggested.
 

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Background and objectives: To-date, no studies have assessed phenotypes of frail in the elderly people living in Tehran and their relationships with nutritional status. The aim of this study was to investigate prevalence of frailty and its relationships with malnutrition in elderly people living in Tehran, 2021–2022.
Materials and Methods: In this cross-sectional study, 508 elderly people over 60 years old living in Tehran were selected using systematic random cluster sampling method. General information were collected using general questionnaires, physical function using two-part questionnaire of activities of daily living and daily activity with the help of instrumental activities of daily living tool validated for the elderly and quality of life using valid 12-item SF12 questionnaires. The 12-item questionnaires on quality of life; validity and reliability of which were verified in the Iranian society was applied. Frailty was carried out using Fried et al. 5-indices, including 1) slow walking, 2) muscle weakness, 3) fatigue, 4) low physical activity, and 5) unintentional weight loss. Muscle strength was assessed using hand grip dynamometer. Malnutrition assessment was carried out using standard 2-part MNA (mini nutritional assessment) questionnaire. Anthropometric measurements (height and weight) were carried out using standard methods and body mass index was calculated.
 Results: The mean and standard deviation of the age of the elderly people were 71.09 y ±6.88 years. The number of men and women participating in the study was almost equal (50.6% men and 49.4% women). In total, 51.4% of the participants were pre-frail and 23% were frail. More than half of the participants had low muscle strength (54.3%). After adjusting effects of confounders in comparison with healthy individuals, the probability of frailty in people at risk of malnutrition (95% CI: 1.63–5.67; OR = 3.04) and the probability of pre-frailty in the two groups of at risk of malnutrition (95% CI: 5–11/21–04; OR = 10.37) and malnutrition (95% CI: 5.31–5.31; OR = 7.18) were significantly higher (p < 0.05).
Conclusion: In this study, nutritional status was strongly associated to frailty. Identifying nutritional problems associated with muscle weakness and malnutrition can be used in health and nutrition planning of this age group.