Academic journal article Journal of Health Population and Nutrition

Healthy Bread Initiative: Methods, Findings, and Theories-Isfahan Healthy Heart Program

Academic journal article Journal of Health Population and Nutrition

Healthy Bread Initiative: Methods, Findings, and Theories-Isfahan Healthy Heart Program

Article excerpt


Bread has been considered "staff of life" since the beginning of recorded time. A characteristic of the Iranian diet is the dependence on bread and rice as the major energy sources (1). Several epidemiological studies have shown that intake of whole-grain products is associated with reduced risk of type 2 diabetes, hypercholesterolaemia, metabolic syndrome, and coronary heart disease as well as cardiovascular mortality (2-6). Empirical evidence shows that consumption of whole-wheat meals, like wholegrain bread, compared to white bread, even for 3 or 4 weeks, reduces total serum cholesterol level (2), LDL cholesterol, non-HDL cholesterol, triglyceride (3), body fat, and abdominal obesity (4,5). It might be because of the high fibre content in this kind of bread. Furthermore, it improved the bioavailability of vitamins and minerals, such as varieties of vitamin B, calcium, and magnesium (6). Thus, it has greater diet quality and is attributed to lower risk of cardiovascular disease (CVD). These facts make bread a relevant subject for health promotion.

The Iranians are traditionally accustomed to fresh hot bread; so, bakers have to do their business only in special short periods of day before breakfast, lunch, and dinner. Consequently, bakeries encounter queue of consumers during the mentioned times while they are idle for the rest of the day. Therefore, there has been little room for industrial bread business compared to small-scale local bakeries. There are technical problems in producing this thin bread as well as in keeping it. On the other hand, modernization made it possible to refine grains much more than before and as the fallacy of "appeal to novelty" usually works, the white flatbread came in vogue. Under these circumstances, bakers tend to add sodium bicarbonate, also known as baking soda (NaHC[O.sub.3]) to dough as a substitute for natural fermentation process. It releases carbon dioxide (C[O.sub.2]) at baking temperatures (>60[degrees]C) and helps dough rise. This innovation eliminates the need for dough rest time and reduces work pressure on bakers but is not healthy and decreases the keeping quality of bread, particularly out of fridge (at room temperature) to less than one day. Several attempts were made to deal with the situation but almost all were not succeeded, and bread production and consumption pattern remained nearly unchanged.

As a public-health response to the high prevalence of CVDs in Iran, a six-year action-oriented comprehensive and integrated community-based intervention titled "Isfahan Healthy Heart Program (IHHP)" was designed and launched in 2001. The long-term objectives of IHHP were to decrease the incidence of non-communicable diseases (NCDs), including CVD, diabetes, hypertension, cancers as well as to decrease disability and mortality associated with NCDs. The short-term objectives were to improve knowledge and awareness about the causes and consequences of NCDs in the general population and among health professionals, to improve individual skills to control risk factors and promote healthy behaviours. The IHHP objectives were described in details elsewhere. Healthy Food for Healthy Communities (HFHC) was a component of IHHP project, consisting of a wide variety of strategies, including initiatives regarding oil consumption and labelling as well as intake of healthy bread (7,8,9,10).

The goal of the Healthy Bread (HB) Initiative was to introduce this product to an urban community and increase its consumption. This report aimed to describe the experience of implementing the HB Initiative and its supporting theories, to criticize it from health promotion perspective, to explain supportive activities, and to report the project's outcomes and shortcomings at the community level as well as individual level.


The IHHP was launched in two interventional areas (Isfahan and the neighbouring Najafabad city) and one reference area Arak--all located in central part of Iran. …

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