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Purpose: Examining the associations of a-posteriori-defined dietary patterns and health-related quality of life (HRQOL) among Iranian adolescents., Methods: This cross-sectional study was conducted among 900 apparently healthy students (mean age 15.33 years; 53.0% female) during 2020-21. The validated Persian version of self-report Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL) for healthy adolescents was used in an online survey to assess HRQOL. Total, physical health, psychosocial health, emotional functioning, social functioning, and school functioning PedsQL scores were calculated, and impaired HRQOL was defined as > 1 standard deviation below the total population sample mean PedsQL scores. A validated food frequency questionnaire was used to assess dietary intakes during telephone interviews. Daily intakes of 20 predefined food groups were calculated and submitted to the principal component factor analysis to identify a-posteriori-defined dietary patterns., Results: Three major dietary patterns labeled as Mediterranean, mixed, and unhealthy were identified, of which only the Mediterranean pattern characterized by high intakes of vegetables, fruits, olives, potatoes, eggs, nuts and legumes, pickles, low-fat dairy, fish, poultry, and vegetable oils was consistently associated with HRQOL. Controlling for covariates in the multivariable-adjusted binary logistic regression analysis, participants in the top tertile of Mediterranean pattern score were less likely to have impaired HRQOL than those in the bottom tertile (total: OR 0.25; physical health: OR 0.35; psychosocial health: OR 0.15; emotional functioning: OR 0.17; social functioning: OR 0.15; and school functioning: OR 0.18; all P < 0.010)., Conclusion: Current findings indicate that an a-posteriori-defined Mediterranean-style dietary pattern is associated with better HRQOL among healthy Iranian adolescents., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction and Purpose: So far, few studies have examined the relationship between dietary patterns and depression in adolescents. The aim of the present study was to determine this relationship in a sample of adolescent Iranian girls., Materials and Methods: 347 female high school students aged 14-17 years living in Shiraz, Iran participated in this cross-sectional study. General and physical activity questionnaires, 3-d dietary recalls, and Beck Depression Inventory-Second Edition (BDI-II) were completed for all individuals and their anthropometric characteristics were measured. The major dietary patterns were then identified using principal component factor analysis., Findings: In total, 2 major dietary patterns were identified. After adjusting for potential confounders in multivariate linear regression analysis, the Western pattern (characterized by high consumption of French fries, hydrogenated fats, mayonnaise, sweets and desserts, high-fat dairy, refined grains, red or processed meats, pickles, organ meats and soft drinks and low consumption of low-fat dairy) was positively (standardized β coefficient: 0.510, P < 0.001) and the healthy pattern (characterized by high intake of vegetables, legumes, boiled potatoes, poultry, fish, vegetable oils, olives, fruits and fruit juices and low-fat dairy and low intake of refined grains) was inversely associated (standardized β coefficient: -0.508, P < 0.001) with BDI-II score., Conclusion: Overall, findings of this study indicate that certain dietary patterns are associated with depression in adolescent Iranian girls. However, more studies are needed to further confirm these findings., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

To our knowledge, this is the first study to examine the association of oxidative balance score (OBS) and risk of osteoporosis. Findings suggest that a predominance of anti- over pro-oxidant exposures, as reflected by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women., Purpose: The oxidative balance score (OBS) is a combined measure of pro- and anti-oxidant exposure status, with a higher OBS indicating a predominance of anti- over pro-oxidant exposures. We aimed to examine the potential association of OBS and risk of osteoporosis among postmenopausal Iranian women, hypothesizing that a higher OBS is associated with lower risk of postmenopausal osteoporosis., Methods: This cross-sectional study was conducted among 151 postmenopausal Iranian women aged 50-85 y. Bone mineral density (BMD) at lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry, and osteoporosis was defined using the WHO criteria as a BMD T-score of ≤ - 2.5 standard deviations. The OBS was calculated by combining information from 17 a-priori selected pro- and anti-oxidant components classified in the following four categories: non-dietary pro-oxidants (i.e., obesity and smoking); non-dietary anti-oxidants (i.e., physical activity); dietary pro-oxidants (i.e., saturated fatty acid, poly-unsaturated fatty acid, and iron); and dietary anti-oxidants (i.e., fiber, vitamin E, folate, vitamin C, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, zinc, and selenium)., Results: After controlling for several potential covariates in the multivariable-adjusted binary logistic regression analysis, subjects in the highest tertile of OBS had a lower risk of lumbar spine osteoporosis than those in the lowest tertile (odds ratio = 0.14; 95% confidence interval, 0.04-0.45; p = 0.001). The OBS was not associated with risk of femoral neck osteoporosis., Conclusion: Findings suggest that a predominance of anti- over pro-oxidant exposures, as indicated by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women.

This is the first study to examine the potential association of adherence to the healthy eating index-2015 (HEI-2015) and bone health. Findings suggest that better diet quality (i.e., a higher HEI-2015 score) is significantly associated with a small but clinically important increase in bone mineral density among adult Iranian women., Purpose: The HEI-2015 is a multidimensional measure of diet quality used to assess how well people's dietary behaviors align with key recommendations of the 2015-2020 Dietary Guidelines for Americans for achieving a healthy dietary pattern. We examined the potential association of the HEI-2015 and bone mineral density (BMD) among adult Iranian women, hypothesizing that a higher HEI-2015 score is associated with greater BMD., Methods: Four-hundred sixteen participants (mean age 48.0 years; 64.7% premenopausal) participated in this cross-sectional study. Lumbar spine and femoral neck BMDs were measured via dual-energy X-ray absorptiometry. Dietary intakes were assessed using a valid and reliable food frequency questionnaire. The HEI-2015 score was calculated based on dietary intakes of 13 components emphasized or minimized in the HEI-2015. The higher the HEI-2015 score, the better the diet quality., Results: After adjusting for potential covariates in the multiple linear regression analysis, higher HEI-2015 scores were associated with greater lumbar spine and femoral neck BMDs (lumbar spine: standardized beta-coefficient [β] = 0.292; femoral neck: β = 0.192; both P < 0.001). Similar significant associations were found among premenopausal (lumbar spine: β = 0.337; femoral neck: β = 0.262; both P < 0.001) and postmenopausal women (lumbar spine: β = 0.198; femoral neck: β = 0.287; both P < 0.050). Overall, every 10-unit increase in the HEI-2015 score was associated with a 0.03 g/cm 2 higher multivariable-adjusted BMD at both lumbar spine and femoral neck (both P < 0.001)., Conclusion: Findings suggest that better diet quality, as indicated by a higher HEI-2015 score, is significantly associated with a small but clinically important increase in BMD among adult Iranian women.

Purpose: Diet has been shown to be associated with bone mineral density (BMD); however, the inflammatory potential of diet in modulating BMD has not yet been studied., Methods: We examined the association between a newly developed dietary inflammatory index (DII) and BMD in a sample of postmenopausal Iranian women. In this cross-sectional study, 160 postmenopausal women aged 50-85 years were studied and their femoral neck and lumbar spine BMDs were measured by dual-energy X-ray absorptiometry. The DII was computed based on dietary intake assessed using a previously validated, 168-item semiquantitative food frequency questionnaire. Logistic and linear regression models were fit to derive beta estimates and odds ratios (ORs), with DII fit as continuous and as a dichotomous variable., Results: After adjusting for potential confounders, women with higher DII scores were more likely to have BMD below the median in the lumbar spine with the DII being used as both a continuous variable [ORcontinuous 1.64, 95 % confidence interval (CI) 1.11-2.43, p value = 0.01; one-unit increase corresponding to ≈17 % of its range in the current study] and a categorical variable (ORDII>-0.06/≤ 2.30, 95 % CI 1.05-5.07, p value = 0.04). Similar associations were observed when lumbar spine BMD was used as a continuous outcome. No significant association was observed with BMD in femoral neck, although the direction was along expected lines., Conclusion: These data suggest a pro-inflammatory diet, as indicated by increasing DII score, may be a risk factor for lower BMD in lumbar spine in postmenopausal Iranian women.

Our understanding of the influence of overall nutrient intake on bone mineral density (BMD) is limited because most studies to date have focused on the intakes of calcium, vitamin D, or a few isolated nutrients. Therefore, we examined the association of major nutrient patterns with BMD in a sample of postmenopausal Iranian women. In this cross-sectional study, 160 women aged 50-85 years were studied and their lumbar spine and femoral neck BMDs were measured using dual-energy X-ray absorptiometry. Dietary intakes were assessed using a validated 168-item food frequency questionnaire, and daily intakes of 30 nutrients were calculated. All nutrient intakes were energy adjusted by the residual method and were submitted to principal component factor analysis to identify major nutrient patterns. Overall, three major nutrient patterns were identified, among which only the first pattern, which was high in folate, total fiber, vitamin B6, potassium, vitamin A (as retinol activity equivalent), vitamin C, β-carotene, vitamin K, magnesium, copper, and manganese, had a significant association with BMD. After controlling for potential confounders, multivariate adjusted mean of the lumbar spine BMD of women in the highest tertile of the first pattern scores was significantly higher than those in the lowest tertile (mean difference 0.08; 95% confidence interval 0.02-0.15; P = 0.01). A nutrient pattern similar to pattern 1, which is associated with high intakes of fruits and vegetables, may be beneficial for bone health in postmenopausal Iranian women.

Findings of studies on the link between dietary acid-base balance and bone mass are relatively mixed. We examined the association between dietary acid-base balance and bone mineral density (BMD) in a sample of Iranian women, hypothesizing that a higher dietary acidity would be inversely associated with BMD, even when dietary calcium intake is adequate. In this cross-sectional study, lumbar spine and femoral neck BMDs of 151 postmenopausal women aged 50-85 years were measured using dual-energy x-ray absorptiometry. Dietary intakes were assessed using a validated food frequency questionnaire. Renal net acid excretion (RNAE), an estimate of acid-base balance, was then calculated indirectly from the diet using the formulae of Remer (based on dietary intakes of protein, phosphorus, potassium, and magnesium; RNAERemer) and Frassetto (based on dietary intakes of protein and potassium; RNAEFrassetto), and was energy adjusted by the residual method. After adjusting for potential confounders, multivariable adjusted means of the lumbar spine BMD of women in the highest tertiles of RNAERemer and RNAEFrassetto were significantly lower than those in the lowest tertiles (for RNAERemer: mean difference -0.084 g/cm2; P=0.007 and for RNAEFrassetto: mean difference -0.088 g/cm2; P=0.004). Similar results were observed in a subgroup analysis of subjects with dietary calcium intake of >800 mg/day. In conclusion, a higher RNAE (i. e. more dietary acidity), which is associated with greater intake of acid-generating foods and lower intake of alkali-generating foods, may be involved in deteriorating the bone health of postmenopausal Iranian women, even in the context of adequate dietary calcium intake.

Controversy exists as to whether eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) or both are responsible for the efficacy of n-3 polyunsaturated fatty acids in depression. We conducted a single-center, randomized, double-blind, placebo-controlled, multi-arm, parallel-group trial, comparing the efficacy of EPA versus DHA as adjuvants to maintenance medication treatments for mild-to-moderate depression. Eighty-one mild-to-moderately depressed outpatients were randomly assigned to receive either 1g/d of EPA or DHA or placebo (coconut oil) for 12 weeks. The primary outcome measure was the 17-item Hamilton Depression Rating Scale (HDRS) final score in the modified intention-to-treat population, which comprised of all randomized patients with at least 1 post-randomization observation (n=62; 61.3% female; mean age 35.1 ± 1.2 years). Allocated treatments were well tolerated. Although there was no significant difference between groups at baseline, patients in the EPA group showed a significantly lower mean HDRS score at study endpoint compared with those in the DHA (p<0.001) or placebo (p=0.002) groups. Furthermore, response to treatment (defined as a ≥ 50% decrease from the baseline HDRS score) was only observed in 6 patients receiving EPA, while no one in any of DHA or placebo groups responded to treatment. Overall, these data suggest greater efficacy of EPA compared to DHA or placebo as an adjunctive treatment in mild-to-moderate depression. However, further, randomized controlled trials are needed to support these findings., (Copyright © 2012 Elsevier B.V. and ECNP. All rights reserved.)

The association of dietary patterns and bone health is not yet well known, and findings from the rare previous studies conducted on this issue are contradictory. We assessed the dietary patterns in relation to bone mineral density (BMD) in a sample of menopausal Iranian women. In this cross-sectional study, 160 menopausal women aged 50-85 were studied and their femoral neck and lumbar spine BMDs were measured by dual-energy X-ray absorptiometry. Dietary intakes were assessed with a validated 168-item food frequency questionnaire, and dietary patterns were identified by a principal component factor analysis method. Overall, six dietary patterns emerged, two of which had a significant association with BMD. After adjusting for potential confounders, women who had higher scores for the first (high in high-fat dairy products, organ meats, red or processed meats and nonrefined cereals) and the second (high in French fries, mayonnaise, sweets and desserts and vegetable oils) dietary patterns we identified were more likely to have BMD below the median in the lumbar spine (odds ratio 2.29; 95 % confidence interval 1.05-4.96; p = 0.04) and the femoral neck (odds ratio 2.83, 95 % confidence interval 1.31-6.09; p < 0.01), respectively, compared to women with lower scores. Dietary patterns abundant in foods with high content of saturated fatty acids (similar to factor 1) or with low density of nutrients (similar to factor 2) are detrimental to bone health in menopausal Iranian women. These findings highlight the importance of proper food selection for maintaining bone health.