Nutrition assessment
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Islamic Republic of Iran

The Islamic Republic of Iran is a predominantly agricultural country. As a result of effective population policies and programmes and socio-economic and cultural changes during the last few decades, the population growth rate has had a downward trend; the rate is now 1.4% and the population about 66 million. The Human Development Index, which was 0.642 in 1988, is presently 0.715.

According to a 1995 survey, the prevalences of moderate+severe underweight, stunting, and wasting in under-five year children were 15.7%, 18.9%, and 6.6%, respectively, which decreased to 10.9%, 15.9%, and 4.9% by 1997, when the prevalence of overweight was 4.3%. Provincial and urban-rural variations are considerable. Generally, malnutrition is more prevalent in villages; it is most prevalent in the south and south-east and least prevalent in the north. The peak is in the second year of life, and the average growth rate slows down after 6 months of age in many cases, probably due to late introduction of non-milk foods. Contributing factors to malnutrition are a low socio-economic status, a low health and nutritional awareness, inadequate access to food, and insufficient access to heath services; the relative weights of these factors vary considerably in different parts of the country.

No national studies have been conducted on the nutritional status of adolescents or adults. Based on studies in Tehran and a few other large cities, the body mass index (BMI) is around 16-18 and 20-22 in 11-12 and 20-22 year olds, respectively. The BMI increases with age, indicating that the rate of linear growth is lower than that of weight increase. Some of the girls tend to undereat for fear of obesity; over 13% of Tehrani girls are obese. As regards adults, the limited available data indicate that overweight-and to a smaller extent obesity-are common in the country, the prevalence varying in the provinces; obesity is more widespread among women.

Cereals are the most widely consumed food item, followed by fruits, vegetables, and dairy products. Provincial variations are wide. The Province of Tehran, where the percentages of dietary energy from fat and animal products are the highest, has the lowest cereal , and the highest fat, intake. The share of foods in energy intake varies considerably: meats+eggs provide 0.2% in Sistan-va-Baluchestan and 11.0% in the Province of Tehran; the share of dairy products in Chaharmahal-va-Bakhtiari (7.0%) is five times that in Bushehr.

At the national level, the average energy and protein intakes are higher than the respective RDAs. The distribution is, however, such that 20% have a relatively low intake, 40% overeat and are at risk of, or suffering from, chronic nutritional diseases, the remaining 20% having a nutritionally desirable intake. The average proportions of dietary energy from protein (11%), fat (22%), and carbohydrate (67%) are desirable from a nutritional point of view.

About 85% of infants are exclusively breastfed for 6 months; 70% continue up to one year. Complementary feeding starts shortly after the age of 5-6 months.

Based on findings of nationwide surveys, goitre is endemic to different extents in various provinces, the total goitre rate being 55% (1996), although the average urinary iodine level (>10mcg/dl) indicates a sufficient intake and 97% of households apparently consume iodised salt. Iron deficiency and anaemia are the other major micronutrient problem. Anaemia (all degrees) afflicts 1/3 of child-bearing age women and children. The prevalence seems to be the same in urban and rural areas, but gender differences exist at the age of 15 years, the prevalence being higher in females. On the whole, anaemia prevalence is low (<5%) in the central provinces, high in five provinces in various regions, and medium (5-20%) in the remaining provinces. Factors contributing to anaemia include parasitic and infectious diseseas, poor weaning practices, gastrointestinal bleeding, and short birth intervals; a low dietary iron bio-availability is another important factor, as most iron sources are of a plant origin and surveys show an apparently sufficient intake. No national data are available as regards vitamin A deficiency (VAD); judging from small-scale, local surveys in different parts of the country, severe VAD does not seem to be a public health problem.

Over 80% of the population is covered by an effective primary heath care system. Age-specific mortality rates have declined over the last decades. Infant, under-5 year, and maternal mortality rates are now 29/1000, 33/1000, and 37/100000, respectively.