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The association between consumption of dairy products and risk of chronic kidney disease (CKD) is under debate. We aimed to determine the potential effects of total and subtypes of dairy intake on the occurrence of CKD.This study was conducted within the Tehran Lipid and Glucose Study (TLGS) on 2416 CKD-free adults. At baseline, consumption of dairy products was estimated using a validated 168-items semiquantitative food frequency questionnaire. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of CKD were calculated in tertile categories of dairy products. Also, the CKD risk was estimated with multivariable Cox regression to substitute total dairy with other dietary protein sources.During 8.4 years of follow-up, the incidence rate of CKD was 21%. The participants' mean (±SD) age was 38 (±13) years and 46% were men. Dietary intakes of total dairy, low-fat dairy, and fermented dairy were not associated with CKD risk. There were significant lower risks of CKD in the highest compared to the lowest tertiles of high-fat dairy (HR = 0.76, 95% CI = 0.60-0.95) and high-fat milk (HR = 0.75, 95% CI = 0.59-0.96). However, no significant associations were found between other categories of dairy products and CKD incidence. Substitutions of total dairy with other dietary protein sources were not associated with CKD risk.In this study, higher intakes of high-fat dairy and high-fat milk were associated with lower risks of CKD. No significant associations were found between other dairy products and CKD. More prospective and clinical trials are needed to clarify the issue.

In the current study, we aimed to assess the effect of dried Ziziphus jujube on blood glucose, lipid profiles, anthropometric indices, and inflammatory factors in type 2 diabetic(T2D) patients.In this randomized controlled clinical trial, 48 patients, aged 30-65 years, were randomly assigned to two intervention(n = 24) and control(n = 24) groups. The subjects in the intervention group received 30 g Ziziphus jujube daily for 12 weeks. At baseline and the end of the 12th week, 10 ml of blood was taken from each patient after a 12- to 14-h overnight fasting. Plasma levels of fasting plasma glucose (FPG), triglycerides(TGs), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), high-sensitivity C-reactive protein(hs-CRP), and interleukin-6(IL-6) were measured. Anthropometric indices were determined.Plasma FPG, TG, TC, and LDL-C decreased significantly up to -11.36%, -13.59%, -7.46%, -7.65% in the Ziziphus jujube group at the end of week 12 compared to baseline, respectively (P 0.05), and this reduction was significant in comparison with the control group (P 0.05). The plasma hs-CRP reduced significantly up to -24.46% in the Ziziphus jujube group at the end of week 12 compared to baseline (P 0.05), however, this reduction was not significant in comparison with the control group (P 0.05). Also, there were no significant differences between the two groups in mean changes of body mass index, plasma HDL-C, and IL-6.The current study showed that daily consumption of Ziziphus jujube may have beneficial effects on the lipid profiles and blood glucose levels in T2D.T his clinical trial was registered at the Iranian registry of clinical trials (IRCT registration number: IRCT20181210041913N1).

In patients with acute intermittent porphyria (AIP), induction of delta aminolevulinic acid synthase 1 (ALAS1) leads to haem precursor accumulation that may cause recurring acute attacks. In a recent phase III trial, givosiran significantly reduced the attack rate in severe AIP patients. Frequent adverse events were injection-site reaction, fatigue, nausea, chronic kidney disease and increased alanine aminotransferase.To describe the efficacy and safety of givosiran based on a personalized medical approach.We conducted a retrospective patient file study in 25 severe AIP patients treated with givosiran in France. We collected data on clinical and biochemical efficacy along with reports of adverse events.Givosiran drastically reduced the attack rate in our cohort, as 96% were attack-free at the time of the study. The sustained efficacy of givosiran in most patients allowed us to personalize dosing frequency. In 42%, givosiran was only given when haem precursor levels were increasing. Our data suggest that givosiran is most effective when given early in the disease course. We confirmed a high prevalence of adverse events. One patient discontinued treatment due to acute pancreatitis. All patients had hyperhomocysteinemia, and all patients with initial homocysteine levels available showed an increase under treatment. In this context, one patient was diagnosed with pulmonary embolism.The sustained effect of givosiran allowed a decrease in dosing frequency without compromising treatment efficacy. The high prevalence of adverse events emphasizes the importance of restricting the treatment to severe AIP and administering the minimum effective dose for each patient.

Background There are no data available regarding the association of dietary diabetes risk reduction score (DDRRS) and risk of cardiovascular disease (CVD) worldwide. We aimed to investigate the association of the DDRRS with the risk of CVD outcomes in a prospective population-based study. Method Individuals without CVD (n=2,195) were recruited from participants of the Tehran Lipid and Glucose Study (2006–2008) and followed for a mean of 6.7 years. The DDRRS was determined on the basis of eight components using a validated 168-item food frequency questionnaire. Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the hazard ratios and 95% confidence interval (CI) of CVD across quartiles of DDRRS. Results The mean ± standard deviation age of participants (44.8% male) was 38.8±13.0 years at baseline. Median DDRRS for all patients was 23 (intequartile range 20–26). During follow-up, 77 (3.5%) new cases of CVD were identified. After adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, energy intake, diabetes, and hypertension, no association was found between DDRRS and risk of CVD (odds ratio, 0.70; 95% CI, 0.36–1.37 [p-value for trend=0.351]). Conclusions The findings of this study showed that higher DDRRS is not associated with risk of CVD events.

Aims There is still controversy on optimal percentage of macronutrient intakes especially carbohydrate on prevention of type 2 diabetes (T2D). The aim of the current study was to evaluate the iso-energetic substitution of dietary macronutrients in relation to incidence of T2D. Methods This prospective study was conducted on 6547 subjects who were followed for 3.0 ± 1.6 years. Dietary intakes were evaluated using a valid and reliable semi-quantitative food frequency questionnaire. Biochemical variables and anthropometrics were evaluated at baseline and follow-up examinations. Multivariate Cox proportional hazard regression models were used to estimate the hazards ratio (HR) of T2D. Results A one unit higher proportion of carbohydrate from whole grain at the expense of carbohydrate from non-whole grain (HR = 0.82, 95% CI = 0.71–0.95), protein (HR = 0.75, 95% CI = 0.60–0.94), total fat (HR = 0.79, 95% CI = 0.67–0.93), saturated fatty acid (HR = 0.79, 95% CI = 0.65–0.96), poly-unsaturated fatty acid (HR = 0.81, 95% CI = 0.68–0.96) and mono-unsaturated fatty acid (HR = 0.75, 95% CI = 0.60–0.94) was associated with decreased risk of T2D. The substitution of protein and fats was not associated with diabetes. Risk of T2D increased from quartiles 1–4 for trans-fatty acid (HR: 1.00, 1.27, 0.95, 1.97, Ptrend = 0.01). Conclusions A higher proportion of carbohydrate from whole grain in replacement of refined grain, and other macronutrients was associated with decreased risk of T2D. Also our study suggests a positive association between trans-fatty acid intake and risk of T2D.

Summary Background & aims This study aimed to determine the prospective relationship between the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice and metabolic syndrome (MetS) and to investigate whether weight change can modify this association in a representative sample of the population of Tehran, Iran. Methods In this 8.9-year follow-up study, the consumption of SSBs and 100% fruit juice by 1915 individuals, who participated in Tehran Lipid and Glucose Study (TLGS), was examined using a validated food frequency questionnaire. The MetS was defined according to the Joint Interim Statement. Participants were categorized as those who lost weight (≥-2%), those with weight stability (−1.9%–1.9%), and those who gained weight (≥2%). The Cox regression model was used to determine the relationship between the consumption of SSBs and 100% fruit juice and the risk of MetS and weight gain ≥2%. Also, the modifying effect of weight change including weight loss, weight stability and weight gain on the relationship between SSBs and 100% fruit juice consumption and the incidence of MetS was assessed. Results There was no significant association between the consumption of SSBs and the risk of MetS in the crude model; however, after adjustments for confounders, a significant positive association was found between the consumption of SSBs and the risk of MetS (HR: 1.33; 95% CI: 1.07–1.66). Also, no significant association was observed between the consumption of 100% fruit juice and the risk of MetS in the crude model. However, after adjustments for the potential confounders, 100% fruit juice was inversely associated with the MetS risk (HR: 0.78; 95% CI: 0.63–0.95). The consumption of SSBs and 100% fruit juice was positively associated with weight gain (≥2% during the follow-up). Nevertheless, after adjustments for lifestyle and dietary factors, there was no significant association between the consumption of SSBs and weight gain. On the other hand, the consumption of 100% fruit juice was positively associated with the increased risk of weight gain (HR: 1.41; 95% CI: 1.20–1.65). Among participants with weight loss, the first, second and third tertiles of 100% fruit juice reduced the risk of MetS by 29% (HR: 0.71; 95% CI: 0.51–0.99), 47% (HR: 0.53; 95% CI: 0.37–0.75) and 35% (HR: 0.65; 95% CI: 0.46–0.92), respectively. Conclusion Although 100% fruit juice reduced the risk of MetS, its consumption must be limited due to its positive effect on weight gain. On the other hand, the consumption of 100% fruit juice reduced the risk of MetS, depending on the individual's weight change. Also, high consumption of SSBs was associated with the incidence of MetS.

Background and aims Dietary macronutrient composition plays an important role in the prevention of cardiovascular disease (CVD). This study aimed at assessing the iso-energetic substitution of dietary macronutrients in relation to the incidence of CVD. Materials and results This prospective study was conducted on 5102 individuals of Tehran lipid and glucose study participants, aged 20–70 years who were followed for 5.3 years. A valid and reliable semi-quantitative food frequency questionnaire was used to assess dietary intakes. The hazard ratio of CVD for each 5% of energy from macronutrients at the expense of another macronutrient was calculated using the substitution model. During follow-up, a total of 206 CVD outcomes were identified. Mean age of participants (44.2% men) was 47.0 ± 12 and 45.6 ± 11 for men and women, respectively. Substituting 5% of energy from all types of macronutrients by 5% percentage of energy from combined saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) was associated with a decrease in the risk of CVD by almost 20%. Higher energy intake from total-, starchy-, and nonstarchy carbohydrates replaced by other macronutrients was not significantly associated with the risk of CVD. Each 5% of energy from animal protein (HR: 1.09 and CI: 1.02–1.16) independently increased the risk of CVD in the adjusted Cox proportional hazard regression analyses. Conclusion Higher percentage of energy from animal protein independently increased the risk of CVD, replacement of SFA and MUFA together with other macronutrients was inversely associated with CVD risk.

Background and aims Studies indicated that the risk of cardiovascular disease (CVD) in association to greater adherence to low-carbohydrate diet (LCD) differs in various populations. In this study, we aimed to assess the association of LCD score with the risk of CVD events in a prospective population-based study. Methods and results CVD-free participants (n = 2188) were recruited from the Tehran Lipid and Glucose Study (2006–2008) and followed for a mean of 6.7 years. Using a valid and reliable 168 item semi-quantitative food frequency questionnaire, the LCD score was determined based on the percentage of energy as carbohydrate, protein, and fat, which ranged from 0 to 12. Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the hazard ratios (HRs) and 95% confidence interval (CI) of CVD across tertiles of LCD score in women and men. Mean ± SD age of participants (44.8% male) was 38.8 ± 13.0 years, and median (25–75, interquartile range) of the LCD score was 6 (4–8) at baseline. During follow-up, 77 (3.5%) new cases of CVD were identified. After adjustment for sex, age, body mass index, physical activity, smoking, energy intake, diabetes, and hypertension, there was no association between the LCD score and risk of CVD outcomes in all participants (HR = 0.93; 95% CI: 0.86–1.02) and women (HR = 1.13; 95% CI: 0.94–1.36); however, the LCD score was associated with an 11% reduced incidence of CVD events in men (HR = 0.89; 95% CI: 0.80–0.98), (P for trend: 0.028). Conclusion Findings showed that higher adherence to LCD may be associated with a lower risk of CVD outcomes in men but not in women.

The aim of the present study was to investigate the association of different meat intake and substitution of them with risk of incident chronic kidney disease (CKD).At the baseline, habitual dietary intakes of 4881 participants of the Tehran Lipid and Glucose Study who were free of CKD were assessed by a valid and reliable food-frequency questionnaire. Logistic regression, adjusted for age, sex, smoking, total energy intake, triglycerides, body mass index, physical activity, hypertension, and diabetes, was used to assess the relationship between major protein sources of food (total red meat, unprocessed red meat, and processed red meat) and incident CKD. Odds ratios (ORs) and 95% confidence intervals (CIs) for the CKD were estimated for substituting one serving of total red meat with one serving of low-fat dairy, nuts, whole grains, and legumes.The mean ± standard deviation age of participants was 40.1 ± 12.8 years. After adjustment for confounders, compared with the lowest quartile of total red meat intake, OR of incident CKD in the highest quartile was 1.73 (95% CI: 1.33 to 2.24; P for trend0.001) in the final model. OR for participants in the highest compared with that in the lowest quartile of processed red meat was 1.99 (95% CI: 2.54 to 2.56; P for trend0.001). In the substitution analyses, replacing 1 serving of total red meat and processed meat with 1 serving of low-fat dairy, nuts, whole grains, and legumes was associated with a lower risk of incident CKD.Higher consumption of total red meat and processed meat was associated with increased risk of incident CKD. Furthermore, substitution of total red and processed meat in the diet with other sources of dietary protein was associated with lower CKD risk.

Dietary phytochemical index (DPI) is an inexpensive method for estimating the amounts of phytochemicals in foods. No study has investigated the association between DPI and non-alcoholic fatty liver disease (NAFLD). Our study aimed to compare DPI in patients with NAFLD and the control group.This is a case-control study of 250 subjects with NAFLD and 450 healthy subjects attending the Metabolic Liver Disease Research Center as a referral center affiliated to Isfahan University of Medical Sciences. DPI was calculated based on data collected from a 168-item validated food frequency questionnaire. Sociodemographic data, physical activity, and anthropometric measures such as body weight, height, and waist circumference were determined.In the final adjusted model, the odds ratio (OR) of NAFLD across the DPI tertiles decreased significantly (OR = 0.55, 95 %CI = 0.31-0.95) (P-trend = 0.03). The highest vs. lowest tertiles of vegetable and olives PI were significantly associated with a lower risk of NAFLD (OR and 95 % CI = 0.26 (0.14-0.47); OR and 95 % CI = 0.51 (0.29-0.90), p for trend 0.001, respectively), however, there was no significant relation between other PI components and NAFLD.This case-control study suggested that a higher PI score is associated with a reduced chance of NAFLD after adjusting for confounding variables. In addition, the highest tertile of vegetable and olives PI was significantly associated with a lower risk of NAFLD.

Background Scrotal ultrasound helps in the rapid diagnosis of complete testicular torsion and assessment of alternative causes of acute scrotal pain. Early detection of torsion of the testis and reperfusion, either manually or surgically, is paramount to preserving testicular viability. Manual detorsion also offers immediate symptom relief by alleviating ischemia. Bedside ultrasound performed by a trained emergency physician (EP) can significantly reduce the time to diagnosis and reperfusion by means of performing an ultrasound-guided manual detorsion in the emergency department (ED). Case Report We report two cases of ultrasound-guided manual detorsion of testis that were performed successfully by EPs in the ED. After manual detorsion, both patients underwent nonemergent orchidopexy and recovered well after surgery. Why Should an Emergency Physician Be Aware of This? Manual testicular detorsion is a simple, safe, and effective maneuver that can be performed in the ED by EPs. Bedside ultrasound is helpful in confirming the diagnosis of complete torsion of the testicle (no blood flow) and successful reperfusion after manual detorsion. We recommend EPs be trained to perform scrotal ultrasound and manual detorsion of a torted testicle. We strongly emphasize that manual detorsion of the testes is not a substitute for definitive surgical management and should only be used as a temporary measure for reperfusion to allow more time to organize the logistics of surgery, which can be critical in remote settings.