To the best of our knowledge, no information is available to link major dietary patterns to stunting during childhood, although dietary patterns are associated with chronic diseases. This study was conducted to determine the relationship between major dietary patterns and stunting in the first grade pupils of Tehran in 2009. In this case-control study, 86 stunted children (defined as height-for-age of less than the 5th percentile of CDC2000 cutoff points) were enrolled from among 3,147 first grade pupils of Tehran, selected using a multistage cluster random-sampling method. Participants for the control group (n=308) were selected randomly from non-stunted children (height-for-age more than the 5th percentile of CDC2000 cutoff points), after matching for age, sex, and area of residence. Dietary data were collected using two 24-hour dietary recalls through face-to-face interview with mothers. Factor analysis was used for identifying major dietary patterns. Mean consumption of dairy products (308±167 vs 382±232 g/day, p<0.05), dried fruits and nuts (2.58±9 vs 7.15±26 g/day, p<0.05) were significantly lower among stunted children than those in the control group. Three major dietary patterns were identified: ‘traditional dietary pattern’ that was dominated by bread, potato, fats, eggs, flavours, vegetables other than leafy ones, sugar, drinks, and fast food; ‘mixed dietary pattern’ that was dominated by leafy vegetables, fast foods, nuts, fats, cereals other than bread, fruits, legumes, visceral meats, sugars, eggs, and vegetables other than leafy vegetables; and ‘carbohydrate-protein pattern’ that was dominated by sweets and desserts, poultry, dairy, fruits, legumes, and visceral meats. No significant relationships were found between traditional and mixed dietary patterns and stunting. Individuals in the third quartile of carbohydrate-protein dietary pattern were less likely to be stunted compared to those in the bottom quartile (OR: 0.31, 95% CI 0.13-0.78, p<0.05). Adherence to dietary patterns high in protein (e.g. dairy, legumes, and meat products) and carbohydrates (e.g. fruits, sweets, and desserts) might be associated with reduced odds of being stunted among children.
Food safety is an essential public health issue for all countries. This study was the first attempt to design and develop a home food safety questionnaire (HFSQ), in the conceptual framework of the PRECEDE (predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation) model, and to assess its validity and reliability. The HFSQ was developed by reviewing electronic databases and 12 focus group discussions with 96 women volunteers. Ten panel members reviewed the questionnaire, and the content validity ratio and content validity index were computed. Twenty women completed the HFSQ, and face validity was assessed. Women who were responsible for food handling in their households (n =320) were selected randomly from 10 health centers and completed the HFSQ based on the PRECEDE model. To examine the construct validity, a principal components factor analysis with varimax rotation was used. Internal consistency was determined with Cronbach's α. Reproducibility was checked by Kendall's τ after 4 weeks with 30 women. The developed HSFQ was considered acceptable with a content validity index of 0.88. Face validity revealed that 95% of the participants understood the questions and found them easy to answer, and 90% confirmed the appearance of the HFSQ and declared the layout acceptable. Principal component factor analysis revealed that the HFSQ could explain 33.7, 55.3, 34.8, and 60.0% of the total variance of the predisposing, reinforcing, practice, and enabling components, respectively. Cronbach's α was acceptable at 0.73. For Kendall's τ, r = 0.89, with a 95% confidence interval of 0.85 to 0.93. The HFSQ developed based on the PRECEDE model met the standards of acceptable reliability and validity, which can be generalized to a wider population. These results can provide information for the development of effective communication strategies to promote home food safety.
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