Observational studies in Ethiopia have identified a positive association between hot wheat porridge consumption and oesophageal carcinoma. However, a single dietary intake cannot be a sufficient predictor of cancer among populations that have diverse dietary practices. The present study was carried out to explore the community's perspectives on the role of hot foods in the pathogenesis of oesophageal cancer in Ethiopia. Focus group discussions were conducted from May to August 2019 among purposefully selected 112 participants. Data were collected by using open-ended questions; memo writing, audio recordings and photo pictures. All tape-recorded interviews were transcribed verbatim and inductively coded using Atlas.ti Version 7.0.71 software. Finally, the analysis was performed according to the standard thematic framework analysis techniques. The finding showed that hot foods (porridge, coffee and soup) consumption patterns were perceived as the principal dietary risk of oesophageal cancer. Cooking in unventilated rooms, monotonous cereal-based foods, poor vegetable, and fruit intake, not taking milk with porridge, eating fast, swallowing large bolus of hot porridge and exposure to carcinogens in foods were regarded as predisposing dietary practices to oesophageal carcinoma. Socio-demographic, economic and cultural backgrounds were reported as the underlying risk factors associated with oesophageal cancer. There was a strong perception within the community that oesophageal cancer is linked to several but sequentially interlinked dietary and related practices. Cumulative thermal injuries from the consumptions of hot food could be the immediate dietary risk factors associated with increased risk of oesophageal cancer.

Dietary intake modification is important for the treatment of chronic kidney disease (CKD); however, little is known about the association between dietary intake of antioxidant vitamins and kidney function based on gender difference. We examined the relationship of dietary intake of antioxidant vitamins with decreased kidney function according to gender in Japanese subjects. This population-based, cross-sectional study included 936 Japanese participants with the age of 40 years or older. A validated brief self-administered diet history questionnaire was used to measure dietary intakes of vitamin E and its four isoforms, vitamin A and vitamin C. Decreased kidney function was defined as estimated glomerular filtration rate <60 ml/min/1·73 m2. A total of 498 (53·2 %) of the study participants were women. Mean age was 62·4 ± 11·3 years. Overall, 157 subjects met the criteria of decreased kidney function. In the fully adjusted model, a high vitamin E intake is inversely associated with decreased kidney function in women (odds ratio, 0·886; 95 % confidence interval, 0·786–0·998), whereas vitamin E intake was not associated with decreased kidney function (odds ratio, 0·931; 95 % confidence interval, 0·811–1·069) in men. No significant association between dietary intake of vitamins A and C and decreased kidney function was observed in women and men. Higher dietary intake of vitamin E was inversely associated with decreased kidney function in middle-aged and older women, and the result may provide insight into the more tailored dietary approaches to prevent CKD.

Portion size images are advantageous in dietary assessment. The aim of the present study was to develop and validate new culturally specific image-series for portion size estimation to be used in a new Norwegian version of a British web-based dietary assessment tool (myfood24). Twenty-three image-series of different foods, each containing seven portion size images, were created and validated in a group of adults (n 41, 58 % female) aged 19–44 (median 23), out of which 63 % had higher (tertiary) education. The participants compared 46 portions of pre-weighed foods to the portion size images (1886 comparisons in total). Portion size estimations were either classified as correct, adjacent or misclassified. The weight discrepancy in percentage between the chosen and the correct portion size image was also calculated. Mann–Whitney U tests were used to explore if portion size estimation accuracy differed across sample characteristics, or if it depended on how the foods were presented. For thirty-eight of the forty-six presented food items, the participants selected the correct or adjacent portion size image 98 % on average. The remaining eight food items were on average misclassified by 27 % of the participants. Overall, a mean weight discrepancy of 2⋅5 % was observed between the chosen and the correct portion size images. Females estimated portion size more accurately than males (P = 0⋅019). No other significant differences in estimation accuracy were observed. In conclusion, the new image-series performed satisfactorily, except for the image-series depicting bread, caviar spread and marzipan cake, which will be altered. The present study demonstrates the importance of validating portion size estimation tools.

The present study aimed to assess the associations of the stages of Fe deficiency (Fe deficiency without anaemia (ID) and Fe-deficiency anaemia (IDA)) and anaemia with metabolic syndrome (MetS) in Ecuadorian women. A cross-sectional study was conducted in 5894 women aged 20–59 years, based on data from the 2012 Ecuadorian National Health and Nutrition Survey. The sample was stratified by age. A χ2 test was used to assess the possible associations of ID, IDA and anaemia with MetS. The prevalence ratio (PR) for each stage of Fe deficiency and anaemia was estimated considering women without MetS as a reference. The total prevalence of MetS, ID, IDA and anaemia was 32⋅3 % (se 0⋅6), 6⋅2 % (se 0⋅3), 7⋅1 % (se 0⋅3) and 5⋅0 % (se 0⋅3), respectively. In women aged 20–29, 30–39 and 40–49 years, MetS was associated with a lower prevalence of ID (PR (95 % CI; P-value)): 0⋅17 (0⋅06, 0⋅46; P < 0⋅001), 0⋅69 (0⋅48, 0⋅99; P = 0⋅044) and 0⋅44 (0⋅29, 0⋅67; P < 0⋅001), respectively. In women aged 50–59 years, MetS was associated with IDA and anaemia (PR (95 % CI; P-value)): 0⋅12 (0⋅02, 0⋅96; P = 0⋅026) and 0⋅22 (0⋅07, 0⋅64; P = 0⋅002), respectively. In conclusion, Ecuadorian women of reproductive age with MetS have a lower prevalence of ID compared with those without MetS. Furthermore, the MetS and IDA coexist at the population level. These findings require an analysis from a dietary pattern approach, which could provide key elements for developing public policies that simultaneously address all forms of malnutrition.

Type II diabetes is considered the most common metabolic disorder in the developed world and currently affects about one in ten globally. A therapeutic target for the management of type II diabetes is the inhibition of α- glucosidase, an essential enzyme located at the brush border of the small intestinal epithelium. The inhibition of α-glucosidase results in reduced digestion of carbohydrates and a decrease in postprandial blood glucose. Although pharmaceutical synthetic inhibitors are available, these are usually associated with significant gastrointestinal side effects. In the present study, the impact of inhibitors derived from edible brown algae is being investigated and compared for their effect on glycaemic control. Carbohydrate- and polyphenolic-enriched extracts derived from Ascophyllum nodosum, Fucus vesiculosus and Undaria pinnatifida were characterised and screened for their inhibitory effects on maltase and sucrase enzymes. Furthermore, enzyme kinetics and the mechanism of inhibition of maltase and sucrase were determined using linear and nonlinear regression methods. All tested extracts showed a dose-dependent inhibitory effect of α-glucosidase with IC50 values ranging from 0⋅26 to 0⋅47 mg/ml for maltase; however, the only extract that was able to inhibit sucrase activity was A. nodosum, with an IC50 value of 0⋅83 mg/ml. The present study demonstrates the mechanisms in which different brown seaweed extracts with varying composition and molecular weight distribution differentially inhibit α-glucosidase activities. The data highlight that all brown seaweed extracts are not equal in the inhibition of carbohydrate digestive enzymes involved in postprandial glycaemia.

Diabetes requires challenging lifelong dietary management, affects quality of life and heightens the impact of affective functioning. The aim of this study was to investigate the relationship between Nutrition Quality of Life (NQOL) and affective functioning in a sample of Omani patients with type 2 diabetes. A sample of 149 adults with type 2 diabetes was conveniently recruited from seven Primary Health Centers (PHCs) during follow-up visits. Data were gathered via face-to-face interviews. Pearson correlation and χ2 test of independence were applied to examine associations at P < 0⋅05. Most patients had poor glycemic control (71⋅1 %), BMI ≥ 25 kg/m2 (85⋅2 %) and central obesity (75⋅8 %), and moderate (54⋅4 %) and poor (32⋅9 %) level of NQOL. Based on the Hospital Anxiety and Depression Scale (HADS), 16⋅1 and 23⋅5 % of the sample endorsed the presence of anxiety and depression, respectively. A significant negative correlation was found between NQOL and HADS (r −0⋅590, P = 0⋅000), anxiety (r −0⋅597, P = 0⋅000) and depression (r −0⋅435, P = 0⋅000). There was a significant association between NQOL and HADS, χ2 (2) = 38⋅21, P < 0⋅01 that was large, Cramer's V = 0⋅51. Also, there were significant associations (P < 0⋅01) between NQOL and HADS when controlling for HbA1c, BMI, waist circumference and HMNT that were moderately to largely strong, Cramer's V = 0⋅43–0⋅55. There is an evident association between NQOL and affective functioning in adults with type 2 diabetes. Further research is recommended to confirm these relationships and to guide intervention programmes at PHCs to help improve the general quality of life of such patients.

The aim of the present study was to determine whether the association between body mass index (BMI) and the intake of macronutrients varies along the BMI distribution of German adults. Based on a sample of 9214 men and women aged 18–80 years from the representative cross-sectional German National Nutrition Survey (NVS) II, quantile regression was used to investigate the association between BMI and the intake of macronutrients independent of energy intake and other predictors. In both sexes, BMI was positively associated with the intake of total protein and animal protein over its entire range and negatively associated with vegetable protein. A negative association between BMI and the intake of polysaccharides was found along the entire range of BMI in men. There was a weak negative association between BMI and the intake of total fat and saturated fatty acids observed in normal-weight-range women only. In conclusion, the association between BMI and the intake of macronutrients varies along the BMI range. Animal protein intake is positively associated with BMI independent of energy intake in both sexes whereas only in men an inverse association of polysaccharide intake with BMI was shown.

The present study aimed to investigate the interaction of Apo A-II polymorphism and dietary total antioxidant capacity (DTAC) with lipid profile and anthropometric markers in patients with type 2 diabetes (T2DM) that are at risk for atherosclerosis. This cross-sectional study was conducted on 778 patients with T2DM (35–65 years). Dietary intakes were assessed by a 147-item food frequency questionnaire. DTAC was computed using international databases. Participants were categorised into two groups based on rs5082 genotypes. The gene–diet interaction was analysed by an ANCOVA multivariate interaction model. Total cholesterol, TC; triacylglycerol, TG; high- and low-density lipoprotein, HDL and LDL; TC–HDL ratio; waist circumference, WC and body mass index, BMI were obtained according to standard protocols. Overall, the frequency of CC homozygous was 12⋅1 % among study participants. We found that a significant interaction between rs5082 variants and DTAC on mean WC (PTEAC = 0⋅044), TC concentration (PFRAP = 0⋅049 and PTEAC = 0⋅031) and TC/HDL (PFRAP = 0⋅031 and PTRAP = 0⋅040). Among patients whose DTAC was higher than the median intake, the mean of weight, WC and TC/HDL were significantly higher only in individuals with CC genotype. Also, the high DTAC was associated with a lower TC concentration only in T-allele carriers (PFRAP = 0⋅042). We found that adherence to a diet with high total antioxidant capacity can improve the complications of diabetes and atherosclerosis in the T carrier genotype more effectively than the CC genotype. These results could indicate the anti-atherogenic properties of Apo A-II. However, further studies are needed to shed light on this issue.

The authors investigate the association of breakfast skipping and its interaction with a dietary inflammatory index (DII) with the severity of psychological disorders. A total of 2876 Iranian general adults were enrolled in this cross-sectional study. Psychological problems profile score was calculated using the regression method in the framework of factor analysis based on depression, anxiety and psychological distress. The higher scores indicate more severity of mental problem. The frequency of breakfast eating in a week was assessed. Dietary intakes were assessed using a food-frequency questionnaire and twenty-seven items were included in the calculation of DII. In the crude model, individuals who ate breakfast seldom had the highest odds for having worse psychological problems profile (OR 3⋅59; 95 % CI 2⋅52, 5⋅11). Adjustment for various confounders did not change the associations (OR 3⋅35; 95 % CI 2⋅11, 5⋅32). In the adjusted multinomial logistic regression model, participants with high DII (>median) who skipped breakfast had highest risk of being in the higher tertiles of psychological problems profile compared with those who had low DII (<median) and ate breakfast (OR 6⋅67; 95 % CI 3⋅45, 12⋅90). Similar results were observed in women and men regarding the impact of breakfast skipping alone and interaction with DII on scores of psychological problems profile. Breakfast skipping is associated with higher risk of psychological problems. Similar findings were obtained in the stratified analysis by sex. Our findings confirmed that the DII and breakfast skipping are associated with mental health, interactionally. Further longitudinal studies are needed to confirm the true link between breakfast skipping and psychological problems.

The present study was aimed at (1) the differences between current weight v. ideal weight, (2) total energy intake and comparing it with required energy (Rkeer), (3) absolute protein intake in g/kg per d and g/1000 calories, (4) how energy and protein intake relate to the nutritional status of the subjects in terms of overall overweight (OEW) [overweight + obesity] and conservative overweight (CEW) [obesity] and (5) the contribution (%) of protein to total energy intake based on the acceptable macronutrient distribution range (AMDR). A dietary study was carried out in Colombia with 29 259 subjects between 1 and 64 years of age, based on cross-sectional data collected in 2015 by a 24-h dietary recall (24HR) administered as part of the National Nutrition Survey. Energy and protein intake did not differ by nutritional status. In the general population, energy intake was 2117 kcal/d (95 % CI 1969, 2264). The total protein intake was 64⋅3 g/d (95 % CI 61⋅4, 67⋅3). Adequate energy intake ranged from 90 to 100 %, except for the 1–4-year-old group, which ranged from 144 to 155 %. Protein intake was 1⋅64 g/kg per d (95 % CI 1⋅53, 1⋅75). The mean AMDR for protein to total energy intake was 13⋅3 % (95 % CI 12⋅9, 13⋅7). Excess weight began during the first 4 years of age. In conclusion, it is worth reviewing and updating energy and protein intake recommendations and dietary guidelines for the Colombian population and designing and modifying public policy.

Vitamin D insufficiency is associated with various disease processes. We determined whether consumption of a diet supplemented with HyD®, a 25-hydroxycholecalciferol (25(OH)D3) source, would safely increase plasma 25(OH)D3 concentrations in Golden Retrievers with low vitamin D status. We hypothesised that dietary supplementation with HyD® would rapidly increase and sustain plasma 25(OH)D3 levels in healthy Golden Retrievers with low vitamin D status compared with supplementation with vitamin D3. Of fifty-seven privately owned dogs recruited with written owner consent, eighteen dogs with low vitamin D status were identified and sorted between two groups to have similar initial plasma 25(OH)D3 concentrations, sex distributions, ages and body weights. Dogs of each group were fed a dry dog food supplemented with either 16 μg/kg of 25(OH)D3 as HyD® (n 10) or 81 μg/kg of cholecalciferol (D3) (n 8) for 4 months. Plasma 25(OH)D3 concentrations were determined monthly. A significant time effect (P < 0⋅001) and time by group interaction (P = 0⋅0045) were found for monthly determined plasma 25(OH)D3 concentrations. Dogs fed the HyD®-supplemented diet experienced a 40⋅5 % rise in plasma 25(OH)D3 values after 1 month (P < 0⋅001) and no change thereafter. Plasma 25(OH)D3 values of dogs supplemented with vitamin D3 did not increase (P > 0⋅05) and were less than values of dogs supplemented with HyD® (P = 0⋅044). With few exceptions, average haematologic, biochemical and urinalyses results remained within the reference range for both groups. Dietary supplementation with HyD® is sufficient to safely increase and sustain plasma 25(OH)D3 levels in healthy dogs.

The long-term effect of a plant (P)-based diet was assessed by proton nuclear magnetic resonance (1H-NMR) metabolomics in rainbow trout fed a marine fish meal (FM)–fish oil (FO) diet (M), a P-based diet and a control commercial-like diet (C) starting with the first feeding. Growth performances were not heavily altered by long-term feeding on the P-based diet. An 1H-NMR metabolomic analysis of the feed revealed significantly different soluble chemical compound profiles between the diets. A set of soluble chemical compounds was found to be specific either to the P-based diet or to the M diet. Pterin, a biomarker of plant feedstuffs, was identified both in the P-based diet and in the plasma of fish fed the P-based diet. 1H-NMR metabolomic analysis on fish plasma and liver and muscle tissues at 6 and 48 h post feeding revealed significantly different profiles between the P-based diet and the M diet, while the C diet showed intermediate results. A higher amino acid content was found in the plasma of fish fed the P-based diet compared with the M diet after 48 h, suggesting either a delayed delivery of the amino acids or a lower amino acid utilisation in the P-based diet. This was associated with an accumulation of essential amino acids and the depletion of glutamine in the muscle, together with an accumulation of choline in the liver. Combined with an anticipated absorption of methionine and lysine supplemented in free form, the present results suggest an imbalanced essential amino acid supply for protein metabolism in the muscle and for specific functions of the liver.

There is little information regarding factors that determine dietary diversity among pregnant women in Ghana. The present study, therefore, sought to assess the independent predictors of dietary diversity and its relationship with nutritional status of pregnant women in the Northern Region of Ghana. The present study was an analytical cross-sectional survey involving 423 pregnant women in different stages of gestation. The 24-h dietary recall method was used to assess minimum dietary diversity for women (MDD-W), and nutritional status was assessed using mid-upper arm circumference (MUAC) measurements. Binary logistic regression was performed to assess the association between maternal dietary diversity and maternal thinness and a P value of <0⋅05 was considered statistically significant. Of the 423 women, 79⋅9 % (95 % CI 76⋅1, 83⋅7) met the MDD-W and the prevalence of undernutrition among the pregnant women was 26⋅0 %. The analysis showed that women of low household wealth index were 48 % less likely (AOR 0⋅52, CI 0⋅31, 0⋅88) of meeting the MDD-W, whereas women from households of poor food insecurity were 88 % less likely (AOR 0⋅12, CI 0⋅05, 0⋅27) of achieving the MDD-W. Women of low household size were three times more likely of meeting the MDD-W (AOR 3⋅07, CI 1⋅13, 8⋅39). MDD-W was not associated with maternal underweight during pregnancy. In conclusion, the results of the present study showed that food insecurity and not low MDD-W, associated with mothers’ thinness (underweight) during pregnancy in peri-urban setting of Northern Ghana.

Although the intake of specific flavonoid-rich foods may reduce C-reactive protein (CRP) levels, the association between dietary flavonoid intakes and CRP is inconsistent. We aim to describe dietary flavonoid intakes in a Taiwanese nationally representative sample and to investigate the association between flavonoid intakes and CRP. We conducted a cross-sectional study based on 2592 adults from the Nutrition and Health Survey in Taiwan 2005–8. Flavonoid intakes were estimated by linking the 24-h dietary recall with the U.S. Department of Agriculture flavonoid database and divided into quartiles. Adjusted estimates of the flavonoid intakes for the continuous and binary (elevated CRP: >0⋅3 mg/dl) variables were performed by using general linear and logistic regression. We found that tea, orange, tofu and sweet potato leaves/water spinach constituted the major food items of the total flavonoid intake. The total flavonoid intake was lower among women and elderly. Compared with the lowest total flavonoid intake quartile, participants in higher quartiles were associated with a lower CRP status (adjusted odds ratio (OR): 0⋅61, 95 % confidence interval (CI): 0⋅44–0⋅86 for the highest quartiles). The trends were similar for flavonol and flavan-3-ol intakes. Compared with non-consumers, tea consumers were likely to have a lower CRP status (adjusted OR: 0⋅74, 95 % CI: 0⋅57–0⋅97). In brief, a higher total flavonoid intake and tea consumption were inversely associated with CRP levels, indicating that a high-flavonoid diet may contribute to anti-inflammatory effects. A Taiwanese flavonoid content table is necessary for conducting further studies related to flavonoids in Taiwan.

Drug use disorder is a major public health problem. Once people who use drugs (PWUD) are referred to treatment, addressing their lifestyle practices and improving their quality of life improves treatment outcomes. The present study assessed the nutritional status and lifestyle practices among PWUD undergoing treatment for recovery in Lebanon. Furthermore, it explored significant differences in these parameters depending on the offered treatment modality, namely opioid substitution treatment (OST) and rehabilitation. In total, 187 PWUD undergoing treatment for recovery participated in this cross-sectional study. Nutritional status and anthropometrics, dietary intake, nutrition knowledge, food addiction, biochemical parameters, sleep and physical activity were measured using validated tools. Of the participants, 88⋅8 % were well nourished based on the Subjective Global Assessment. In total, 67 % gained weight during treatment placing them in the overweight category. This increase in weight was significantly higher in the rehabilitation group. It came in parallel with higher protein and energy intakes, higher rate of food addiction, and poor nutrition knowledge. Biochemical parameters, including fasting blood sugar, total protein, lipid profile and white blood cell count, were in the normal ranges. Moreover, the majority of participants exhibited poor quality sleep that was accentuated among the participants undergoing rehabilitation, in addition to activity levels that were mainly low in the OST group. PWUD undergoing treatment for recovery in Lebanon are subject to various vulnerability factors creating challenges to treatment. Longitudinal assessments to better understand health problems arising during treatment and to identify the components of a comprehensive health promotion intervention during treatment for recovery are needed.

Eating habits of lactating women can influence the nutrient composition of human milk, which in turn influences nutrient intake of breastfed infants. The aim of the present study was to identify food patterns and nutritional adequacy among lactating women in Europe. Data from a multicentre European longitudinal cohort (ATLAS study) were analysed to identify dietary patterns using cluster analysis. Dietary information from 180 lactating women was obtained using 3-d food diaries over the first 4 months of lactation. Four dietary patterns were identified: ‘vege-oils’, ‘fish-poultry’, ‘confectionery-salads’ and ‘mixed dishes’. Nutrition adequacy was not significantly different between clusters, but the ‘vege-oils’ cluster tended to yield the highest nutrition adequacy measured by Mean Adequacy Ratio. Compared with European dietary reference values (DRVs) for lactating women, women in all clusters had inadequate intakes of energy, pantothenic acid, folate, vitamin C, vitamin A, vitamin D, zinc, iodine, potassium and linoleic acid. Adequate intake for fibre and α-linolenic acid was only achieved in the ‘vege-oils’ cluster. Overall, fat intake was above DRVs. The present study showed that various dietary patterns do not adequately supply all nutrients, indicating a need to promote overall healthy dietary habits for European lactating women.

The aim of the study was to assess dietary diversity (DD) and associated factors among human immune deficiency virus (HIV)-positive adults attending the anti-retroviral therapy (ART) clinic at Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Northwest Ethiopia. An institution-based cross-sectional study was conducted at FHCSH in 2019. A systematic random sampling technique was employed to select 352 study subjects. Data were collected using an interviewer-administered questionnaire and chart review. Statistical Package for the Social Science version 26 was used for analysis. A simple and multivariable binary logistic regression was used to determine associated factors. Two hundred and nine (59⋅4 %) adults had consumed a diversified diet. The mean individual DD score was 3⋅86 ± 1⋅18. Self-employment status (adjusted odd ratio (AOR): 4⋅60; 95 % confidence interval (CI): 1⋅72, 12⋅27), quintiles of wealth index (the second (AOR: 4⋅33; 95 % CI: 1⋅72, 10⋅89), middle (AOR: 4⋅40; 95 % CI: 1⋅71, 11⋅31), fourth (AOR: 6⋅60; 95 % CI: 2⋅36, 18⋅48) and the highest quintiles (AOR: 9⋅45: 95 % CI: 3⋅34, 26⋅77), the last CD4 count 200–349 cells/mm3 (AOR: 8⋅08; 95 % CI: 2⋅93, 22⋅23), those who took first-line ART regimen drugs (AOR: 4⋅49; 95 % CI: 2⋅19, 9⋅21), subjects who did not take co-trimoxazole prophylaxis (AOR: 6⋅36; 95 % CI: 2⋅54, 15⋅88), those who had nutritional counselling at a health institution (AOR: 2⋅36; 95 % CI: 1⋅08, 5⋅16), had no food preference (AOR: 2⋅42; 95 % CI: 1⋅14, 5⋅13) and a food-secure household (AOR: 3⋅51; 95 % CI: 1⋅85, 6⋅67) were associated factors of DD among adults on ART. This study exhibited that the DD status among adults attending the ART clinic was below two-thirds. Health institutions and health professionals working at ART clinics shall strengthen their efforts to sustain the nutritional counselling service and ART adherence at health institutions and encourage the patients to avoid food preference for their meal. It is vital to ensure the household food security of adults on ART.

Essential nutrition action (ENA) is one of the most effective preventive actions for combating nutritional problems in young children. There is, however, a paucity of evidence about mother's knowledge and attitude regarding key ENA messages. The objective of the present study was to assess the knowledge and attitude of mothers towards key ENA messages and associated factors. A representative sample of 563 mothers of children from birth up to 24 months in mainly rural North Ethiopia was included in the study. The findings showed that 66⋅4 % of the mothers have a good knowledge and 68⋅9 % have a good attitude. In the multivariable analysis using logistic regression, mothers who attended secondary school or higher education were six times more likely to have a good knowledge (AOR 6⋅1; CI 2⋅945, 12⋅719) compared with those who are illiterate. Besides, women who resided in an urban area (AOR 2⋅2; CI 1⋅14, 4⋅25), attended antenatal care (ANC) visits (AOR 3⋅7; CI 2⋅421, 5⋅742), attended postnatal care (PNC) visits (AOR 2⋅2; CI 1⋅37, 3⋅4) and heard nutritional-related information (AOR 1⋅9; CI 1⋅14, 3⋅49) were found to have a good knowledge. On the other hand, mothers who attended ANC visits were almost four times (AOR 3⋅9; CI 2⋅7, 5⋅8) more likely to have a good attitude towards key ENA. Mothers who delivered at health institutions and who attended PNC visits were also more likely to have a good attitude. In conclusion, the present study determined the level of knowledge and attitudes of mothers about ENA and several factors that influence mother's knowledge and attitude regarding ENA.

Sarcopenia is associated with frailty and disability in older adults. Adherence to current dietary guidelines in addition to physical activity could prevent muscle wasting and weakness. The Healthy Eating Index-2015 (HEI) is a tool to assess diet quality. We aimed to investigate the association between HEI scores and probable sarcopenia (PS) among older adults in Tehran. 201 randomly selected older adults were included in this cross-sectional study between May and October 2019 in Tehran, Iran. A previously validated semi-quantitative food frequency questionnaire was used to estimate HEI scores and dietary intake. Handgrip strength (HGS) was measured to evaluate the PS. Statistical evaluation included descriptive analysis, logistic and linear regression. Those probably suffering from sarcopenia had significantly lower HEI scores (P=0⋅02). After adjusting for confounders, HEI scores and HGS were still significantly associated (adjusted R2=0⋅56, slope β=0⋅03, P=0⋅09). Older adults with a low PS had a higher ratio of monounsaturated and polyunsaturated to saturated fatty acids (P= 0⋅06) and ingested less added sugars and saturated fats (P=0⋅01 and P=0⋅02, respectively). Furthermore, consuming more total protein foods correlated positively with muscle strength (P=0⋅01, R=0⋅18). To sum up, HEI scores were associated with PS, measured by HGS, indicating that adhering to the HEI might improve muscle strength in aging individuals.