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Background The combined role of important environmental factors as a single lifestyle index in predicting non-alcoholic fatty liver disease (NAFLD) risk is not fully assessed. Therefore, we aimed to investigate the association of healthy lifestyle factor score (HLS) with the odds of NAFLD in Iranian adults. Methods This case-control study was conducted on 675 participants, aged ≥ 20–60 years, including 225 new NAFLD cases and 450 controls. We measured dietary intake information using a validated food frequency questionnaire and determined diet quality based on the alternate healthy eating index-2010(AHEI-2010). The score of HLS was calculated based on four lifestyle factors, including a healthy diet, normal body weight, non-smoking, and high physical activity. An ultrasound scan of the liver was used to detect NAFLD in participants of the case group. Logistic regression models were used to determine the odds ratios(ORs) and 95% confidence interval(CI) of NAFLD across tertiles of HLS and AHEI. Results Mean ± SD age of the participants were 38.13 ± 8.85 years. The Mean ± SD HLS in the case and control groups was 1.55 ± 0.67 and 2.53 ± 0.87, respectively. Also, the Mean ± SD AHEI in the case and control groups was 48.8 ± 7.7 and 54.1 ± 8.1, respectively. Based on the age and sex-adjusted model, the odds of NAFLD were decreased across tertiles of AHEI (OR:0.18;95%CI:0.16–0.29,Ptrendtrendtrendtrend Conclusions Our findings reported that higher adherence to lifestyle with a higher score of HLS was associated with decreased odds of NAFLD. Also, a diet with a high AHEI score can reduce the risk of NAFLD in the adult population.

Background Dietary advanced glycation end products(AGEs) may contribute to increased inflammation and oxidative stress as risk factors for chronic diseases such as liver disease. In the current study, we aimed to examine the possible association of dietary AGEs with the odds of non-alcoholic fatty liver disease (NAFLD) in Iranian adults. Methods A total of 675 participants (225 newly diagnosed NAFLD cases and 450 controls), aged 20–60 years, were recruited for this case-control study. Nutritional data were measured using a validated food frequency questionnaire, and dietary AGEs were determined for all participants. An ultrasound scan of the liver performed the detection of NAFLD in participants of the case group without alcohol consumption and other causes of hepatic disorders. We used logistic regression models, adjusted for potential confounders, to estimate the odds ratios(ORs) and 95% confidence interval(CI) of NAFLD across tertiles of dietary AGEs. Results Mean ± SD age and body mass index of the participants were 38.13 ± 8.85 years and 26.85 ± 4.31 kg/m2, respectively. The median(IQR) of dietary AGEs in participants was 3262(2472–4301). In the sex and age-adjusted model, the odds of NAFLD were increased across tertiles of dietary AGEs intake(OR:16.48;95%CI:9.57–28.40, Ptrendtrend Conclusion Our results showed that greater adherence to dietary pattern with high dietary AGEs intake was significantly related to increased odds of NAFLD.

Background Gallstone disease (GSD) and its complications are major public health issues globally. Although many community-based studies had addressed the risk factors for GSD, little is known about the associations between dietary factors and risk of disease. The present study aimed to investigate the potential associations between dietary fibers with the risk of gallstone disease. Methods In this case–control study, 189 GSD patients with less than one month of diagnosis and 342 age‑matched controls were enrolled. Dietary intakes were assessed using a 168-item semi-quantitative validated food frequency questionnaire. Crude and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through cox proportional hazards regression models. Results Comparing the highest versus the lowest tertile, significant reverse associations were observed between odds of GSD and each category of dietary fiber intake including total (OR T3 vs. T1 = 0.44, 95% CI: 0.37–0.7, P for trend = 0.015), soluble (OR T3 vs. T1 = 0.51, 95% CI: 0.3–0.8, P for trend = 0.048) and insoluble (OR T3 vs. T1 = 0.56, 95% CI: 0.3–0.9, P for trend Conclusion Comprehensive assessment of the associations of dietary fiber intake with GSD showed that higher intakes of dietary fiber were significantly associated with reduced GSD risk.

Background Liver cirrhosis is a worldwide burden and is associated with poor clinical outcomes, including increased mortality. The beneficial effects of dietary modifications in reducing morbidity and mortality are inevitable. Aim The current study aimed to evaluate the potential association of dietary protein intake with the cirrhosis-related mortality. Methods In this cohort study, 121 ambulatory cirrhotic patients with at least 6 months of cirrhosis diagnosis were followed-up for 48 months. A 168-item validated food frequency questionnaire was used for dietary intake assessment. Total dietary protein was classified as dairy, vegetable and animal protein. We estimated crude and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), applying Cox proportional hazard analyses. Results After full adjustment for confounders, analyses showed that total (HR = 0.38, 95% CI = 0.2–1.1, p trend = 0.045) and dairy (HR = 0.38, 95% CI = 0.13–1.1, p trend = 0.046) protein intake was associated with a 62% lower risk of cirrhosis-related mortality. While a higher intake of animal protein was associated with a 3.8-fold increase in the risk of mortality in patients (HR = 3.8, 95% CI = 1.7–8.2, p trend = 0.035). Higher intake of vegetable protein was inversely but not significantly associated with mortality risk. Conclusion Comprehensive evaluation of the associations of dietary protein intake with cirrhosis-related mortality indicated that a higher intake of total and dairy protein and a lower intake of animal protein are associated with a reduced risk of mortality in cirrhotic patients

Background A dietary pattern with a high glycemic index (GI) and glycemic load (GL) can be a precursor to sleep disorders that link to many chronic diseases. We aimed to assess the association of dietary GI and GL with the risk of insomnia in Iranian adults. Methods A total of 111 newly diagnosed insomnia cases and 333 controls aged 18–60 years were included in this case–control study. The participants’ dietary intakes were collected using a valid and reliable food frequency questionnaire. The diagnosis of insomnia in subjects was performed by a neurologist using the Insomnia Severity Index (ISI) questionnaire. Multivariable logistic regression models, adjusted for the potential confounders, were used to determine the risk of insomnia according to tertiles of dietary glycemic indices. Results The mean (SD) age and BMI of the study population (78.6% female) were 31.8 (10.0) years and 24.70 (3.62) kg/m2, respectively. The median (IQR) of dietary GI and GL in subjects was 62.7 (57.0–68.6) and 213.5(167.4–268.5), respectively. Based on the multivariable-adjusted model, after controlling for age, sex, physical activity, obesity, smoking, socioeconomic score, general health questionnaire (GHQ) score, and dietary energy intake, the odds of insomnia were increased across tertiles of dietary GL[(OR:2.72,95%CI:1.10–6.70),(Ptrend = 0.017)], however, no significant association was observed between high GI diet and insomnia risk [(OR:1.38,95%CI:0.77–2.47),(Ptrend = 0.298)]. Conclusions Our results revealed that greater adherence to dietary pattern with high GL could be increased the odds of insomnia in Iranian adults.

Background Potential dietary inflammation can precursor chronic diseases such as hepatic disorders. We aimed to examine the association of empirical dietary inflammatory patterns (EDIP) and dietary inflammation scores (DIS) with the risk of nonalcoholic fatty liver diseases (NAFLD) in Iranian adults. Methods This case–control study was conducted on 225 newly diagnosed NAFLD cases and 450 controls aged 20–60 years. The individuals’ dietary data were collected using a validated food frequency questionnaire. The detection of NAFLD in subjects was done using the ultrasonography scan of the liver and confirmation of gastroenterologists. To calculate of EDIP score, the average daily intakes of each item (15 food items) were multiplied by the proposed weights, and then all the weighted values were summed. Also, to calculate the DIS score, each food item (18 food items) is multiplied by its specific weight to obtain the weighted values of each item. The weighted values were then standardized using the Z-score. Finally, the standardized weighted values of all the items were summed to get the overall DIS score for the individuals. Logistic regression models, adjusted for potential confounders, were used to estimate the odds ratios and 95% confidence interval (CI) of NAFLD across tertiles of EDIP and DIS. Results The mean (SD) age and BMI of the study population (53% male) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. The median (IQR) of EDIP and DIS scores in individuals were 0.52 (0.34, 0.73), and 0.04 (− 0.55, 0.59), respectively. Based on the multivariable-adjusted model, after controlling for age, sex, physical activity, smoking, marital status, waist-to-hip ratio, and dietary energy intake, individuals in the second (OR 2.01, 95% CI 1.07–3.76) and third tertiles of DIS (OR 2.54, 95% CI 1.39–4.63) had a higher odds of NAFLD compared to the lowest tertile of DIS (Ptrend = 0.003). Also, in the final model, there is a significant direct association between EDIP score and odds of NAFLD [(OR T2 vs. T1 = 0.88, 95% CI 0.50–1.57) and (OR T3 vs. T1 = 1.82, 95% CI 1.02–3.23)], (Ptrend = 0.031). Conclusion Our results suggested that higher scores of EDIP and DIS, indicating the high inflammatory potential of dietary pattern, are associated with increased odds of NAFLD in Iranian adults.

PurposeThis study aims to investigate the association of vitamin D intake and the risk of depression, anxiety and stress among Tehranian female adolescents.Design/methodology/approachThis cross-sectional analysis included 263 participants. A valid and reliable food frequency questionnaire was used to determine dietary intake of vitamin D. Depression, anxiety and stress scores were characterized by Depression Anxiety Stress Score-21 questionnaire. Multivariable logistic regression was used to estimate the odds ratio (OR) for the occurrence of depression, anxiety and stress according to the tertiles of vitamin D intake.FindingsThe mean ± standard deviation age and body mass index (BMI) of participants were 16.2 ± 1.0 years and 22.2 ± 4.1 kg/m2, respectively. Mean score of depression, anxiety and stress of participants were 9.8 (low-grade depression), 8.4 (low-grade anxiety) and 14.0 (borderline for stress), respectively. In the final model, after adjustment for age, BMI, physical activity, mother/father’s education level, dietary fiber and total energy intake, the OR for depression in the highest compared to the lowest tertile of vitamin D intake was 0.53 (95% confidence interval [CI], 0.24–0.98) (pfor trend: 0.040). Moreover, based on the fully adjusted model, participants in the highest tertile of vitamin D intake had lower odds of stress (OR: 0.49; 95% CI: 0.23–0.93), in comparison to those in the lowest one (pfor trend: 0.021).Originality/valueTo the best of the authors’ knowledge, this is the first study to assess the association of vitamin D intake and risk of psychological disorders, including depression, stress and anxiety in Middle East and North Africa region’s female adolescents.

Background Obesity is considered a major health concern and mounting evidence suggests that the exposure to environmental endocrine disruptors, including Bisphenol-A (BPA), may enhance the risk to develop the disease. Moreover, growing documents propose that the vitamin D may contribute to adipogenic signaling and lipid accumulation during adipocyte differentiation. We focused on the molecular mechanism of vitamin D and BPA in human adipose-derived mesenchymal stem cells (hADMSCs) which vitamin D and BPA may influence adipose tissue development and function. Methods Human adipose-derived mesenchymal stem cells were cultured for 14 days in lipogenic differentiation media containing continuous concentrations of vitamin D plus BPA (0.1 nM or 10 nM). The expression of adipogenic markers including the peroxisome proliferator-activated receptor γ (PPARγ), CCAAT-enhancer-binding protein α (C/EBP α) CCAAT-enhancer-binding protein β (C/EBP β), fatty acid synthase (FASN), lipoprotein lipase (LPL), sterol regulatory element-binding protein-1c (SREBP1c), insulin-induced gene-2 (INSIG2), vitamin D receptor (VDR), estrogen receptor-beta (ER-β), fatty acid-binding protein-4 (FABP4), and glucose transporter-4 (GLUT4) was measured using Quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). Lipid accumulation was visualized with staining with Oil Red O. Results In the morphological assessment of mesenchymal stem cells treated with a concentration of 10 nM vitamin D plus BPA, more lipid accumulations were observed in comparison with the group with 0.1 nM concentration. Treatment of hADMSCs with vitamin D plus BPA (0.1 nM) significantly inhibited the induction of PPARγ, C/EBP β, C/EBP α, and FASN related to adipocyte differentiation and development. However, the exposure of cells to the concentration of 10 nM vitamin D plus BPA induced the expression of these genes associated to the adipogenesis. The remarkable increase in the level of SREBP1c was associated to the suppression of INSIG2 in treated preadipocytes with 10 nM vitamin D plus BPA. Our findings showed that the expression of VDR, ERβ, GLUT4, and FABP4 were upregulated through differentiation with the highest concentrations in 0.1 nM vitamin D plus BPA group for VDR, ERβ, and GLUT4. Conclusions Vitamin D plus BPA at concentration of 10 nM boosted the adipogenesis during the critical stages of adipocytes development, whereas it seems to inhibit this process at concentration of 0.1 nM.

Background The endocrine disruptor Bisphenol-A (BPA), has been involved in dysregulating adipose tissue development and increasing the risk of obesity. The objective of this experiment was to investigate whether treatment of human mesenchymal stem cells with BPA could modulate adipogenesis and adipocyte differentiation. Methods In this experimental study, the human adipose-derived mesenchymal stem cells (hASCs) were cultured for 2 weeks with continuous exposure to 10− 10 M or 10− 8 M concentrations of BPA. The extent of triglyceride accumulation was visualized by Oil Red O staining. To evaluate BPA effect on the expression levels of key adipogenic trascripotion factors and proteins, we used Quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and ELISA. Results The results presented a dose-dependent triglyceride accumulation in treated cells with BPA. Additionally, we observed that BPA induced transcription of the Peroxisome proliferator-activated receptor-gamma (PPARγ), CCAAT-enhancer-binding protein-alpha (C/EBPα), CCAAT-enhancer-binding protein-beta (C/EBPβ), sterol regulatory element-binding protein-1c (SREBP1c), Fatty acid synthase (FASN), and lipoprotein lipase (LPL); BPA suppressed the expression of Fatty acid binding protein-4 (FABP4) and Estrogen receptor-beta (ERβ). Conclusions Our findings supported the hypothesis that BPA enhances adipogenic differentiation thereby may play a role in development of obesity and dysregulation of metabolic homoeostasis.

The relation of some antioxidant nutrients with psychological disorders has been studied previously. The aim of this study was to examine the association between antioxidant vitamin intakes and the risk of depression, anxiety, and stress.This cross-sectional study was conducted on 263 Tehranian female adolescents. Dietary intakes of vitamin E, C, and β-Carotene were determined using a valid and reliable food-frequency questionnaire. Depression, anxiety, and stress scores were characterized by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire. The multivariable logistic regression models were used to determine the odds ratios (ORs) and 95% confidence intervals (95%CIs) of depression, anxiety, and stress across tertiles of antioxidant vitamin intakes.The mean ± SD age of participants was 16.20 ± 0.97 years. Also, the mean ± SD depression, anxiety and stress scores of participants were 9.89 ± 4.15, 8.43 ± 4.39 and 14.00 ± 6.45, respectively. In the fully adjusted model, subjects in the highest tertile of β-Carotene had a lower prevalence of depression (OR:0.46, 95%CI:0.23-0.95), anxiety (OR:0.40, 95%CI:0.20-0.81), and stress (OR:0.35, 95%CI:0.17-0.73) compared to the lowest tertile (P for trend0.05). Moreover, individuals in the top tertile of vitamin E had a lower prevalence of stress, in comparison to the bottom tertile (OR:0.34, 95% CI:0.13-0.89), (P for trend0.05). However, no significant associations were found between the intakes of vitamin E and C and other psychological disorders.In this study, higher intake of β-Carotene was associated with lower prevalence of depression, anxiety and stress. Also, we found an inverse relationship between vitamin E intake and the risk of stress.

Purpose To the best of our knowledge, the studies on determining adherence to the Mediterranean dietary pattern (MDP) in Iran as a non-Mediterranean country are scarce. Thus, the aim of the study is to determine the adherence to the MDP in a sample of female adolescents who are residents of Tehran, Iran. Design/methodology/approach In this cross-sectional study, 263 female adolescents aged 15-18 years were studied. Information on socio-demographic, lifestyle and anthropometric variables were obtained using a structured questionnaire. Also, dietary intakes were determined using a validated 168-item food frequency questionnaire. Adherence to MDP was characterized using Mediterranean-style dietary pattern score (MSDPS). Findings Typically, the mean ± SD MSDPS was low in the present study (15.9 ± 5.6). The mean ± SD age and body mass index of the study population was 16.2 ± 0.9 years and 22.2 ± 4.1 kg/m2, respectively. In this study, the maximum MSDPS was 34.3, which was only one-third of maximum possible score (100). Multiple linear regression analyses showed that higher MSDPS scores were positively associated with age (standardized β = 0.1; p = 0.006), higher energy intake (standardized β = 0.2; p < 0.001) and marginally higher physical activity (standardized β = 0.1; p = 0.079). Originality/value Understanding low adherence to MDP in Tehranian female adolescents can provide basic knowledge to launch systematic programmes for gravitation toward MDP.

BACKGROUND: Few studies have shown the protective effects of Mediterranean Dietary Pattern (MDP) in psychological disorders. OBJECTIVE: This cross-sectional study was designed to determine the association between adherence to MDP and depression, anxiety and stress among female adolescents aged 16.20±0.97 in Tehran, Iran. METHODS: Data from 263 participants were analyzed. Adherence to MDP was determined using Mediterranean-Style Dietary Pattern Score (MSDPS). Depression, anxiety and stress scores were characterized by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire. RESULTS: Multivariable logistic regression was used to determine the prevalence of depression, anxiety, and stress across quintiles of MSDPS. After adjustment for age, the odds ratio (OR) for depression in the highest quintile of MSDPS was 0.44 (95% confidence interval [95%CI], 0.19–0.95), (P for trend = 0.009) compared to the lowest quintile. After additional adjustment for BMI, energy intake, physical activity, ethnicity, parents education level and total family income, subjects in the highest quintile had a 59% lower prevalence of depression compared to those in the lowest quintile of MSDPS (OR = 0.41;95% CI, 0.17–0.97), (P for trend = 0.010). However, the MSDPS was not significantly associated with the presence of anxiety and stress. CONCLUSION: Adherence to MDP is associated with a reduced presence of depressive symptoms in female adolescents.

Background Adherence to a Mediterranean dietary pattern (MDP) has been reported to decrease chronic diseases. Objective The aim of the present study was to determine the association between nutrition knowledge (NK) and adherence to MDP in Iranian female adolescents. Subjects This cross-sectional study was conducted on 297 female adolescents aged 15–18 years. Methods The participants were interviewed using a valid and structured questionnaire to collect information on socio-demographic, lifestyle and anthropometric variables. Dietary intakes were assessed using a validated 168-item Food Frequency Questionnaire (FFQ). Adherence to MDP was measured by the Mediterranean-Style Dietary Pattern Score (MSDPS). Each participant’s NK was determined using a 20-item NK questionnaire. Results The mean ± standard deviation (SD) age and body mass index (BMI) of participants were 16.1 ± 0.9 years and 22.3 ± 4.6 kg/m2, respectively. The median [interquartile range (IQR)] of the NK score and the MSDPS were 80.0 (68.0–87.0) and 15.2 (11.9–19.5), respectively. The odds ratio (OR) of higher adherence to MDP in the highest tertile of the NK score was 2.19 [95% confidence interval (CI): 1.22–3.95; p for trend = 0.009], compared to the lowest tertile after adjusting for age and energy intake. In a multivariable-adjusted model, after further adjustment for BMI, mother’s/father’s education level, mother’s/father’s employment status, parent’s marital status and physical activity, the subjects in the highest tertile of the NK score had higher adherence to MDP compared with those in the lowest tertile (OR = 2.05; 95% CI, 1.09–3.83; p for trend = 0.013). Conclusion Our findings support the hypothesis that a higher NK score is significantly associated with a higher MDP adherence score in Iranian female adolescents.

Background: The relation between dietary inflammation and risk of depression has not been widely explored. We examined the association between the inflammatory effect of the diet and the odds of depression among Iranian female adolescents. Methods: Using a stratified cluster sampling technique, 300 female adolescents aged 15–18 years were recruited from schools in Tehran between years 2014–2015. Depression was assessed using the Depression, Anxiety and Stress Scale (DASS)- a 21-point scale. The dietary inflammatory index (DII®) was used to evaluate the inflammatory potential of the diet. Dietary intake was assessed using a validated food frequency questionnaire. In addition to descriptive statistics, multivariable linear and logistic regression were used to calculate confounder-adjusted beta estimates and odds ratios. Results: In total, 88 females (30%) had at least a moderate level of depressive symptoms (DASS > 6). Females with the most pro-inflammatory diet had higher DASS depression score (β = 1.67; 95% CI = 0.03, 3.31) and were at 3.96 (95% CI = 1.12, 13.97) times higher odds of having at least moderate depressive symptoms, compared to females with the least anti-inflammatory diets. Conclusion: These data suggest that Iranian adolescent females eating a pro-inflammatory diet, as indicated by higher DII scores, had greater odds of having at least moderate depressive symptoms.