{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T10:04:54Z","timestamp":1793613894662,"version":"4.5.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nutr"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which poor diet is the leading risk factor. It is estimated that 20% of all death is related to food. The Unhealthy diet includes many foods with excessive salt, sugar and fat. This paper reports a national study on the socio-cultural determinants affecting salt, sugar and fat consumption in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a qualitative study. We conducted semi-structured interviews with 30 various purposefully identified key stakeholders to collect data from December 2018 until August 2019 in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified socio-cultural determents of salt, fat and sugar consumption as follows: Inadequate structure of traditional medicine and people\u2019s desire for traditional foods, low health literacy, the global trend of nutritional transition and its impact on Iranian society, The progressive decline of people\u2019s trust in NGOs, and Inappropriate media management. Worse still, the global trend of nutritional transition and people\u2019s tendency towards fast foods, unhealthy diet and junk foods, partially due to establishing children\u2019s taste mainly with salty, high-fat and sweet foods, has jeopardized their desire to eat healthily during adulthood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reducing salt, fat and sugar consumption is problematic in Iran, mainly due to multi-dimensional socio-cultural determinants. In line with sustainable development goal (SDG) 3.4 to reduce 30% of premature death due to NCDs and related risk factors by 2030 in Iran, various stakeholders from multiple sectors need to initiate coherent series of interventions to alter people\u2019s approach to select food so that they may reduce the consumption of foods with excessive salt, fat and sugar.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40795-022-00518-7","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T04:03:00Z","timestamp":1648180980000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran"],"prefix":"10.1186","volume":"8","author":[{"given":"Mohammad","family":"Amerzadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirhossein","family":"Takian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Pouraram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Akbari","family":"Sari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin","family":"Ostovar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"issue":"10100","key":"518_CR1","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","volume":"390","author":"M Naghavi","year":"2017","unstructured":"Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980\u20132016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1151\u2013210.","journal-title":"Lancet"},{"key":"518_CR2","unstructured":"Murray CJ, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet.\u00a02020;17;396(10258):1223\u201349."},{"key":"518_CR3","volume-title":"Noncommunicable diseases\/fact sheets","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. Noncommunicable diseases\/fact sheets. Geneva: WHO; 2018. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases. Accessed 17 March 2020"},{"key":"518_CR4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l296","volume":"364","author":"F Branca","year":"2019","unstructured":"Branca F, Lartey A, Oenema S, Aguayo V, Stordalen GA, Richardson R, et al. Transforming the food system to fight non-communicable diseases. Bmj. 2019;364:l296.","journal-title":"Bmj."},{"issue":"10184","key":"518_CR5","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1016\/S0140-6736(19)30041-8","volume":"393","author":"A Afshin","year":"2019","unstructured":"Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990\u20132017: a systematic analysis for the global burden of disease study 2017. Lancet. 2019;393(10184):1958\u201372.","journal-title":"Lancet"},{"key":"518_CR6","doi-asserted-by":"crossref","unstructured":"Hooper L, Abdelhamid A, Bunn D, Brown T, Summerbell CD, Skeaff CM. Effects of total fat intake on body weight.\u00a0Cochrane Database Syst Rev.\u00a02015(8).","DOI":"10.1002\/14651858.CD011834"},{"key":"518_CR7","volume-title":"Diet, nutrition, And the prevention of chronic diseases: report of a joint WHO\/FAO expert consultation","author":"Organization WH","year":"2003","unstructured":"Organization WH. Diet, nutrition, And the prevention of chronic diseases: report of a joint WHO\/FAO expert consultation: World Health Organization; 2003."},{"key":"518_CR8","first-page":"1","volume":"91","author":"Food, Nations AOotU","year":"2010","unstructured":"Food, Nations AOotU. Fats and fatty acids in human nutrition: report of an expert consultation. FAO Food Nutr Pap. 2010;91:1\u2013166.","journal-title":"FAO Food Nutr Pap"},{"key":"518_CR9","unstructured":"Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015"},{"key":"518_CR10","volume-title":"Guideline: Sodium intake for adults and children","author":"Organization WH","year":"2012","unstructured":"Organization WH. Guideline: Sodium intake for adults and children: World health Organization; 2012."},{"key":"518_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/s12571-017-0678-y","volume-title":"Global panel on agriculture and food systems for nutrition: food systems and diets: facing the challenges of the 21st century","author":"P Scott","year":"2017","unstructured":"Scott P. Global panel on agriculture and food systems for nutrition: food systems and diets: facing the challenges of the 21st century: Springer; 2017."},{"key":"518_CR12","volume-title":"Global action plan for the prevention and control of noncommunicable diseases 2013-2020","author":"Organization WH","year":"2013","unstructured":"Organization WH. Global action plan for the prevention and control of noncommunicable diseases 2013-2020: World Health Organization; 2013."},{"issue":"1","key":"518_CR13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-020-8446-x","volume":"20","author":"A Bakhtiari","year":"2020","unstructured":"Bakhtiari A, Takian A, Majdzadeh R, Haghdoost AA. Assessment and prioritization of the WHO \u201cbest buys\u201d and other recommended interventions for the prevention and control of non-communicable diseases in Iran. BMC Public Health. 2020;20(1):1\u201316.","journal-title":"BMC Public Health"},{"key":"518_CR14","doi-asserted-by":"crossref","unstructured":"Amerzadeh M, Salavati S, Takian A, Namaki S, Asadi-Lari M, Delpisheh A, et al. Proactive agenda setting in creation and approval of national action plan for prevention and control of non-communicable diseases in Iran: The use of multiple streams model. J\u00a0Diab Metabol\u00a0Disord. 2020:1\u20132.","DOI":"10.1007\/s40200-020-00591-4"},{"issue":"3","key":"518_CR15","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1017\/S0029665108008616","volume":"67","author":"J Brug","year":"2008","unstructured":"Brug J, Kremers SP, Van Lenthe F, Ball K, Crawford D. Environmental determinants of healthy eating: in need of theory and evidence: symposium on \u2018Behavioural nutrition and energy balance in the young\u2019. Proc Nutr Soc. 2008;67(3):307\u201316.","journal-title":"Proc Nutr Soc"},{"issue":"1","key":"518_CR16","first-page":"10","volume":"9","author":"K Resnicow","year":"1999","unstructured":"Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999;9(1):10\u201321.","journal-title":"Ethn Dis"},{"issue":"19","key":"518_CR17","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1161\/01.cir.0000435173.25936.e1","volume":"128","author":"B Spring","year":"2013","unstructured":"Spring B, Ockene JK, Gidding SS, Mozaffarian D, Moore S, Rosal MC, et al. Better population health through behavior change in adults: a call to action. Circulation. 2013;128(19):2169\u201376.","journal-title":"Circulation."},{"key":"518_CR18","volume-title":"University of Washington Center for Health Trends and Forecasts","author":"Institute for Health Metrics and Evaluation","year":"2018","unstructured":"Institute for Health Metrics and Evaluation. University of Washington Center for Health Trends and Forecasts. 2018. http:\/\/www.healthdata.org\/iran."},{"key":"518_CR19","unstructured":"Shahraz S, Forouzanfar MH, Sepanlou SG, Dicker D, Naghavi P, Pourmalek F, et al. Population health and burden of disease profile of Iran among 20 countries in the region: from Afghanistan to Qatar and Lebanon. Archives of Iranian Med. 2014\u00a0;17(5):0-."},{"issue":"1","key":"518_CR20","first-page":"934","volume":"34","author":"M Amerzadeh","year":"2020","unstructured":"Amerzadeh M, Takian AH. Reducing sugar, fat, and salt for prevention and control of noncommunicable diseases (NCDs) as an adopted health policy in Iran. Med J Islam Repub Iran. 2020;34(1):934\u201341.","journal-title":"Med J Islam Repub Iran"},{"key":"518_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/obr.12087","volume":"14","author":"B Swinburn","year":"2013","unstructured":"Swinburn B, Sacks G, Vandevijvere S, Kumanyika S, Lobstein T, Neal B, et al. INFORMAS (I nternational N etwork for F ood and O besity\/non-communicable diseases R esearch, M onitoring and A ction S upport): overview and key principles. Obes Rev. 2013;14:1\u201312.","journal-title":"Obes Rev"},{"key":"518_CR22","doi-asserted-by":"crossref","unstructured":"Hawkes C. Food policies for healthy populations and healthy economies. BMJ. 2012;344.","DOI":"10.1136\/bmj.e2801"},{"issue":"11","key":"518_CR23","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1017\/ice.2016.171","volume":"37","author":"N Safdar","year":"2016","unstructured":"Safdar N, Abbo LM, Knobloch MJ, Seo SK. Research methods in healthcare epidemiology: survey and qualitative research. Infect Control Hosp Epidemiol. 2016;37(11):1272\u20137.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"2","key":"518_CR24","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.healthpol.2007.07.011","volume":"85","author":"A Rashidian","year":"2008","unstructured":"Rashidian A, Eccles MP, Russell I. Falling on stony ground? A qualitative study of implementation of clinical guidelines\u2019 prescribing recommendations in primary care. Health Policy. 2008;85(2):148\u201361.","journal-title":"Health Policy"},{"issue":"1","key":"518_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2288-9-47","volume":"9","author":"V Hagens","year":"2009","unstructured":"Hagens V, Dobrow MJ, Chafe R. Interviewee transcript review: assessing the impact on qualitative research. BMC Med Res Methodol. 2009;9(1):1\u20138.","journal-title":"BMC Med Res Methodol"},{"issue":"3","key":"518_CR26","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.pec.2010.12.016","volume":"82","author":"H Goldblatt","year":"2011","unstructured":"Goldblatt H, Karnieli-Miller O, Neumann M. Sharing qualitative research findings with participants: study experiences of methodological and ethical dilemmas. Patient Educ Couns. 2011;82(3):389\u201395.","journal-title":"Patient Educ Couns"},{"issue":"1","key":"518_CR27","first-page":"19","volume":"27","author":"TT Nguyen","year":"2018","unstructured":"Nguyen TT, Hoang MV. Non-communicable diseases, food and nutrition in Vietnam from 1975 to 2015: the burden and national response. Asia Pac J Clin Nutr. 2018;27(1):19.","journal-title":"Asia Pac J Clin Nutr"},{"issue":"1","key":"518_CR28","first-page":"38","volume":"11","author":"A Kamran","year":"2009","unstructured":"Kamran A, Malakpoor A, Bie-ria M, Bashiri J. Examined knowledge, attitude towards the consumption of salt in people referred to the health center. J Health Care (Journal Scientific and Research in School of Nursing and Midwifery). 2009;11(1):38\u201344.","journal-title":"J Health Care (Journal Scientific and Research in School of Nursing and Midwifery)"},{"issue":"3","key":"518_CR29","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.numecd.2017.10.028","volume":"28","author":"X Luta","year":"2018","unstructured":"Luta X, Hayoz S, Krause CG, Sommerhalder K, Roos E, Strazzullo P, et al. The relationship of health\/food literacy and salt awareness to daily sodium and potassium intake among a workplace population in Switzerland. Nutr Metab Cardiovasc Dis. 2018;28(3):270\u20137.","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"1","key":"518_CR30","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.healthpol.2011.06.008","volume":"102","author":"B Legowski","year":"2011","unstructured":"Legowski B, Legetic B. How three countries in the Americas are fortifying dietary salt reduction: a north and south perspective. Health Policy. 2011;102(1):26\u201333.","journal-title":"Health Policy"},{"issue":"3","key":"518_CR31","first-page":"191","volume":"40","author":"M Rafiei","year":"2008","unstructured":"Rafiei M, Boshtam M, Sarraf-Zadegan N, Seirafian S. The relation between salt intake and blood pressure among Iranians. Kuwait Med J. 2008;40(3):191\u20135.","journal-title":"Kuwait Med J"},{"issue":"1","key":"518_CR32","first-page":"37","volume":"7","author":"M Bajan","year":"2005","unstructured":"Bajan M, Kalantari N, Ghaffar PM, Houshyar Rad A, Alavi Majd H. Assessment of obesity relation and body fat distribution with food consumption among high school girl students. IJEM. 2005;7(1):37\u201346.","journal-title":"IJEM."},{"key":"518_CR33","doi-asserted-by":"publisher","unstructured":"Bishwajit G. Nutrition transition in South Asia: the emergence of non-communicable chronic diseases [version 2; peer review: 2 approved]. F1000Research.\u00a02015;4:8. https:\/\/doi.org\/10.12688\/f1000research.5732.2.","DOI":"10.12688\/f1000research.5732.2"},{"issue":"4","key":"518_CR34","doi-asserted-by":"publisher","first-page":"551","DOI":"10.2752\/175174413X13758634982010","volume":"16","author":"S Zaman","year":"2013","unstructured":"Zaman S, Selim N, Joarder T. McDonaldization without a McDonald's: globalization and food culture as social determinants of health in urban Bangladesh. Food Culture Soc. 2013;16(4):551\u201368.","journal-title":"Food Culture Soc"},{"issue":"4","key":"518_CR35","doi-asserted-by":"publisher","first-page":"534","DOI":"10.3934\/publichealth.2019.4.534","volume":"6","author":"S Loloei","year":"2019","unstructured":"Loloei S, Pouraram H, Majdzadeh R, Takian A, Goshtaei M, Djazayery A. Policy analysis of salt reduction in bread in Iran. AIMS Public Health. 2019;6(4):534.","journal-title":"AIMS Public Health"},{"key":"518_CR36","doi-asserted-by":"crossref","unstructured":"Raoofi A, Takian A, Haghighi H, Rajizadeh A, Rezaei Z, Radmerikhi S, et al. COVID-19 and comparative health policy learning; the experience of 10 countries. Archives of Iranian medicine. 2021 Mar 1;24(3):260-72.","DOI":"10.34172\/aim.2021.37"}],"container-title":["BMC Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-022-00518-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40795-022-00518-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40795-022-00518-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T04:05:47Z","timestamp":1648181147000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcnutr.biomedcentral.com\/articles\/10.1186\/s40795-022-00518-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,25]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["518"],"URL":"https:\/\/doi.org\/10.1186\/s40795-022-00518-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-653939\/v1","asserted-by":"object"}]},"ISSN":["2055-0928"],"issn-type":[{"value":"2055-0928","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,25]]},"assertion":[{"value":"24 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Ethical Committee of the TUMS- Iran approved this study. Ethical code: IR.TUMS.SPH.REC.1397.193. All methods were carried out in accordance with relevant guidelines and regulation.. We provided the interviewees with an information sheet, reassured them about anonymity, freedom to withdraw and confidentiality, explained the purpose of the study and requested them to read and approve the informed consent form.\u201d","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"We have no conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"26"}}