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Background: Adequate evidence supports beneficial effects of plant-derived phytochemicals against type 2 diabetes (T2D). Among phytochemicals, dietary flavonoids is one of the superb candidates. The whole studies are carried out in Western populations, so it is needed to investigate the risk of T2D by dietary flavonoid intakes in ethnic origins and other regions to confirm these relations. This study was conducted to investigate whether the daily consumption of total flavonoid and its subclasses can affect the incidence of type 2 diabetes (T2D) in the Iranian population. Methods: Eligible adults ( n =6547) were selected from among participants of the Tehran lipid and glucose study with an average follow-up of 3.0 years. Dietary intakes were assessed using a valid and reliable 168-item semi-quantitative food frequency questionnaire. Multivariate Cox proportional hazard regression models were used to estimate the development of T2D in relation to total intake of flavonoids. Results: This study was conducted on 2882 men and 3665 women, aged 41.3±14.6 and 39.0±13.4 years, respectively. After adjustment for several potential confounders (age, sex, diabetes risk score, physical activity, energy, fiber and total fat intakes), risk of T2D decreased from tertiles 1 to 3 for flavonols (HR (95% CI): 1.00, 0.86 (0.64-1.16), 0.87 (0.63-0.93), P trend =0.01) and isoflavonoids (HR (95% CI): 1.00, 0.84 (0.62-1.13), 0.64 (0.46-0.88), P trend =0.02), whereas non-significant results were found for total flavonoid and other subclasses of flavonoid. Conclusion: These results emphasize the potential protective role of flavonols and isoflavonoids rich food (e.g. apple, tea, soy, and dark chocolate) in the prevention of T2D.

This study aimed to examine the interaction between diet quality indices (DQIs) and smoking on the incidence of hypertension (HTN), stroke, cardiovascular diseases, and all-cause mortality. We prospectively followed 5720 participants and collected dietary data via a validated food frequency questionnaire to calculate DQI-international (DQI-I) and DQI-revised (DQI-R). Considering an interaction analysis, we classified participants based on diet quality (median: higher/lower) and smoking status. Over 9 years of follow-up, higher diet quality scores were associated with a lower risk of stroke and mortality. While current smokers had a higher risk of stroke and mortality but had a lower risk of developing HTN. Compared to the current smokers with lower diet quality, nonsmokers with higher diet quality according to the DQI-I [HR 0.24; 95% CI (0.08, 0.66)], and DQI-R [HR 0.20; 95% CI (0.07, 0.57)] had a lower risk of stroke. Moreover, the lower risk of mortality was more evident in nonsmokers with higher DQI-I [HR 0.40; 95% CI (0.22-0.75)] and DQI-R scores [HR 0.34; 95% CI (0.18-0.63)] compared to nonsmokers with lower diet quality. While higher DQI-I and DQI-R scores were associated with a lower risk of stroke and mortality, this beneficial effect may be negated by smoking., (© 2024. The Author(s).)

We aimed to prospectively assess the association between variety and quantity of fruits and vegetables (FV) and cardiovascular diseases (CVD) incidence and mortality due to the limited evidence. Our analysis included 2,918 adults with a follow-up period of 29,559 person-years. An inverse association was detected between fruit intake and the risk of incidence and mortality from CVD. We found no association between diversity scores of fruits, vegetables, and FV with CVD risk. Subjects with high quantity-high variety, high quantity-low variety, and low quantity-high variety of fruits, vegetables, or FV exhibited no difference in CVD risk compared to the subjects with low quantity-low variety intake. Increasing the variety of FV was associated with increases in the intake of β-carotene, lycopene, lutein, vitamin C, selenium, fibre, fat, and protein after adjustment for the quantity and covariates. We detected an inverse association between fruit intake and the incidence and mortality rates of CVD.

Background: Evidence of possible beneficial effects of dietary diabetes risk reduction score (DDRRS) on reducing the risk of various chronic diseases such as metabolic syndrome (MetS) are limited. This is a prospective, population-based cohort study, which aimed to investigate the relationship of the DDRRS and its components with MetS incident in Iranian adults., Methods: Individuals without MetS (n=3561) were recruited from participants of the Tehran Lipid and Glucose Study (2009-2011) and followed for a mean of 6.01 years. A validated food frequency questionnaire was used to determine the DDRRS using based on eight components, including higher intakes of cereal fiber, nuts, coffee, and polyunsaturated: saturated fat ratio and lower intakes of red or processed meats, sugar-sweetened beverages, trans fatty acids, and low glycemic index. We used the multivariable logistic regression analysis to determine the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across the tertiles of DDRRS., Results: The mean (SD) age of individuals was 38.1(12.6) years at baseline. Median (25-75 interquartile range) DDRRS for all participants was 20(18-22). During the study follow-up, 682(19.1 %) new cases of MetS were reported. Based on the age and sex-adjusted model, participants in highest tertile of DDRRS had lower risk of MetS in compared with the lowest one (OR=0.64;95 %CI:0.52-0.79, P for trend=0.001). In the multivariable adjusted model, after adjustment for all possible confounding variables, the risk of MetS is decreased across tertiles of DDRRS (OR=0.60;95 %CI:0.48-0.75, P for trend=0.001). Also, higher scores of some DDRRS components including red and processed meat, sugar sweetened beverages, and coffee were related to decreased incidence of MetS., Conclusions: The results of this study revealed that greater adherence to DDRRS can be associated with decreased risk of MetS in Iranian adult., (© 2021. The Author(s).)

Background and Aim: Considering the inconsistencies in the cardiovascular effects of dietary acid load and the impact of dietary acidity on the acid-base homeostasis within the body, we aimed to assess the association of dietary acid load and the risk of cardiovascular disease (CVD) in a prospective community-based study., Materials and Methods: Participants (n = 2369) free of CVD at baseline (2006-2008) were included from the Tehran Lipid and Glucose Study (TLGS) and followed up for a mean of 6.7 ± 1.4 years. Dietary intakes of the participants were assessed using a semi-quantitative food frequency questionnaire (FFQ). The dietary acid load was evaluated by Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) scores. Both scores have used the macronutrient and micronutrient data of the Food Frequency Questionnaires. Multivariate Cox proportional hazard regression models were used to estimate the 6-years incident risk of CVDs across tertiles of PRAL and NEAP scores., Results: Mean age and body mass index of participants were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m 2 at baseline. Within 6.7 ± 1.4 years of follow-up, 79 cases of cardiovascular events were reported. NEAP was significantly associated with the incidence of CVDs (HRs = 0.50, CI 0.32-0.96; P for trend = 0.032); however, after adjusting for potential confounders, no significant associations were observed between PRAL and NEAP scores and the risk of CVDs., Conclusions: This study failed to obtain independent associations between dietary acid load and the incidence of CVDs among an Asian population., (© 2021. The Author(s).)

Background & Aims: The aim of this study was to evaluate the association of nut consumption and its various types with metabolic syndrome (MetS) risk and to investigate whether lifestyle factors (physical activity and smoking status) and socioeconomic status (education and occupation) modulate the association of nut consumption and the risk of MetS., Methods: We prospectively studied 1915 participants of the Tehran Lipid and Glucose study, among whom 591 were diagnosed with MetS during 8.9 years of follow-up. Nut consumption and its various types were assessed using a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate Hazard Ratios (HRs) for MetS events across tertiles of nut consumption and its various types. Regarding interaction between nut consumption and physical activity levels, education levels, and smoking status on the risk of MetS, using joint classification, the effect modification of lifestyle factors and socioeconomic status on the association between nut consumption (

Background: There are insufficient data in case of the potential association of habitual dietary L-arginine and the risk of type 2 diabetes mellitus (T2DM) incidence. Here we aimed to examine the potential effect of dietary L-arginine on the T2DM incidence., Methods: For this cohort study, 2139 T2DM-free adults from the participations of Tehran Lipid and Glucose Study (TLGS) were recruited. Follow up period was approximately 5.8 years. Daily intakes of protein and L-arginine were estimated using a validated food frequency questionnaire with 168 food item. Hazard Ratios (HRs) and 95% confidence intervals (CIs), adjusted for sex, age, smoking, diabetes risk score, physical activity levels, and total energy intakes as well as carbohydrate, fiber, fats and lysine, were calculated for L-arginine as both absolute intake and its ratio from total protein., Results: Mean (±SD) age of the participants was 38.9 (±12.6) years and 54.6% were women. Mean (±SD) intake of dietary protein and L-arginine was 77.2 (±22.4) and 4.05 (±1.50) g/d, respectively. An increased risk of T2DM (HR = 2.71, 95% CI = 1.20-6.09) was observed among participants with higher intakes of L-arginine (median intake of > 5.4 vs. 2.69 g/d). Total protein intake and the ratio of L-arginine to total protein intakes were not related to incidence of T2DM in both crude and adjusted models., Conclusion: We found that higher dietary L-arginine levels may increase risk of T2DM and it may have an independent role in T2DM development.

The evidence for a linkage between dietary intake of choline and betaine, a choline metabolism product, and the risk of hypertension (HTN) is limited. The current population-based cohort study was designed to investigate the possible association between dietary intake of choline and betaine with the risk of HTN in adults. This cohort study was conducted on the participants of the Tehran Lipid and Glucose Study (TLGS). Dietary intake of choline and betaine was calculated using the United States Department of Agriculture (USDA) database. Hypertension was diagnosed as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or used drugs to treat hypotension. In this study, 2865 subjects participated and followed-up for a median of 7.4 years. During the follow-up period, 623 patients with hypertension (22.1%) were detected. Our results revealed per every 100 mg increased dietary intake of choline, the risk of developing HTN decreased by 16% (0.84; 95% CI: 0.74 to 0.96, P for trend = 0.009). No significant association was observed between habitual dietary intake of betaine and the risk of HTN (1.10; 95% CI: 0.88 to 1.38, P for trend = 0.21). After stratification based on age, sex, and BMI, each 100 mg per d increase in dietary choline decreased the risk of HTN occurrence in subjects younger than 55 years old by 17% (0.83; 95% CI: 0.71 to 0.96) and men by 21% (0.79; 95% CI: 0.66 to 0.95). The current study's findings provide further support to confirm the protective properties of choline and choline-rich foods against HTN.

Background and Aim: The aim of this study was to investigate the association of dietary insulin index(II), insulin load(IL), glycemic index(GI), and glycemic load(GL) with risk of developing diabetes among the Tehranian adults., Methods: This study was conducted within the framework of the Tehran Lipid and Glucose Study on 1149 subjects, aged ≥30 years, who were followed-up for a mean of 8.04 years. Food frequency questionnaire was used to calculate the dietary GI, GL, II, IL at the baseline. Multivariate Cox proportional hazard regression models, adjusted for the potential confounders, were used to estimate the risk of diabetes based on the dietary indices., Results: Mean age of the study population was 44.8 ± 10.4 years and 46.3% of them were men. During a mean of 8.04 ± 2.1 years of follow-up, 76 (6.6%) new cases of diabetes were identified. The mean ± SD of the II, IL, GI, and GL of the participants were 52.4 ± 6.5, 234.9 ± 88.8, 61.8 ± 7.9, and 200.6 ± 74.5, respectively. After adjusting for age, sex, smoking, physical activity, daily energy intake, and body mass index, higher dietary scores of the II[HR = 1.33 (95%CIs = 1.06-1.68)], IL[HR = 1.70(95%CIs = 1.10-2.60)], GI[HR = 1.28(95%CIs = 1.03-1.60)], and GL[HR = 1.84 (95%CIs = 1.19-2.84)] were found to be associated with the increased risk of diabetes incidence per each ones SD increment in the scores. Considering the tertiles of the dietary scores, the risk of developing diabetes was increased significantly from tertile 1 into 3 of the GL, and after adjusting for all the potential covariates (p-trend = 0.002); the diabetes risk was 3.40 (95%CI:1.48-7.83) in those with highest tertile of GL compared to those in the lowest tertile of GL., Conclusion: Our findings suggest that the diet with high GL, GI, II, and IL can increase the incidence of diabetes. The glycemic and insulin load can strongly predict the risk of diabetes rather than the glycemic index and insulin index., Competing Interests: Conflict of Interest The authors declared there is no conflict of interest., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Current evidence regarding the prognostic relevance of urinary sodium-to-potassium ratio (Na-to-K ratio), as an indicator of diet quality is limited. This study was conducted to investigate whether urinary Na-to-K ratio could be related to habitual dietary patterns, in a general population., Methods: This study was conducted in the framework of the Tehran Lipid and Glucose Study (2014-2017) on 1864 adult men and women. Urinary Na and K concentrations were measured in the morning spot urine samples. Dietary intakes of the participants were assessed using a validated 147-item Food Frequency Questionnaire (FFQ) and major dietary patterns were obtained using principal component analysis. Mediterranean dietary pattern and Dietary Approaches to Stop Hypertension (DASH) score, were also calculated. Multivariable-adjusted linear regression was used to indicate association of dietary patterns and urinary Na-to-K ratio., Results: Mean (± SD) age of participants was 43.7 ± 13.9 years and 47% were men. Mean (± SD) urinary Na, K and the ratio was 139 ± 41.0 and 57.9 ± 18.6 mmol/L, 2.40 ± 0.07, respectively. Higher urinary Na-to-K ratio (> 2.37 vs. < 1.49) was related to lower intakes of vegetables (282 vs. 321 g/day), low-fat dairy (228 vs. 260 g/day) and fruits (440 vs. 370 g/day). Western dietary pattern was related to higher urinary Na-to-K ratio (β = 0.06; 95% CI 0.01, 0.16). Traditional dietary pattern, Mediterranean and DASH diet scores were inversely associated with urinary Na-to-K ratio (β = - 0.14; 95% CI - 0.24, - 0.11, β = - 0.07; 95% CI - 0.09, - 0.01, β = - 0.12; 95% CI - 0.05, - 0.02, respectively)., Conclusions: Spot urinary Na-to-K ratio may be used as a simple and inexpensive method to monitor diet quality in population-based epidemiological studies.

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., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: The link between dietary protein intake and the risk of kidney dysfunction is always a challenging issue. This study aimed to investigate the relationship between total protein, plant protein, and animal protein intake with the risk of incident chronic kidney disease (CKD)., Methods: This study was performed on 1639 adults aged ≥27 years who participated in the Tehran Lipid and Glucose Study. Dietary data were evaluated using a valid and reliable semi-quantitative food frequency questionnaire (FFQ). Total protein content, plant protein, and animal protein of each participant were calculated. Glomerular filtration rate (GFR) less than 60 mL / min / 1.73 m 2 has been considered as the definition of CKD. Odds Ratio (OR) was calculated using logistic regression to show the association between the risk of incident CKD and dietary exposures., Results: After adjusting for age, sex, body mass index, smoking, total energy intake, total fiber intake, dietary fat, physical activity, diabetes, and hypertension, there was no significant association of total protein and animal protein consumptions with the incidence of CKD. After adjustment for confounders, compared with the lowest tertile of plant protein consumption, OR of incident CKD in the highest tertile was 0.29 (95% confidence interval [95% CI] 0.15 to 0.55) with a significant trend (P for trend < 0.001)., Conclusion: The results of this study confirmed an inverse association between plant protein intake and the risk of incident CKD, which demonstrates the protective role of plant-based protein in a diet on kidney function.

We aimed to investigate associations of dietary intakes with unhealthy metabolic phenotype development, in normal weight and overweight/obese adults separately. A total of 1114 individuals, aged ≥19 years, with healthy phenotype in the third examination cycle of Tehran Lipid and Glucose Study were followed until the fifth examination. Dietary intakes were estimated using the food frequency questionnaires, collected during the study. The participants were grouped as normal weight and overweight/obese according to the baseline body mass index (BMI). Unhealthy metabolic status was determined as having more than one component of metabolic syndrome using the Joint Interim Statement. Regardless of BMI, higher intakes of magnesium, dairy products, poultry, apples/pears, citrus fruits, and tea/coffee decreased the risk of developing unhealthy phenotype, while higher intakes of fast foods, organ meats, and potatoes increased the risk. Food intake can influence the transition to unhealthy phenotype in metabolically healthy adults, irrespective of the BMI status.

Background: Based on data regarding nutrition transition in the Middle East and North Africa, this study aim to investigate the general structure and secular trend of dietary patterns reported from the Tehran Lipid and Glucose Study (TLGS) and adherence to these dietary patterns among Iranian population from 2006 till 2017., Methods: We investigated on four examination waves of TLGS, including wave 1 (2006-2008), wave 2 (2009-2011), wave 3 (2012-2014), and wave 4 (2015-2017), using a validated and reliable food frequency questionnaire. Generalized Estimating Equations was used to assess secular trends in anthropometric, biochemical, and dietary variables across the study period. To identify general structure and secular trend of dietary patterns during each waves, principle component analysis (PCA) and K-mean cluster analysis were used, respectively., Results: After adjusting for potential confounders including age, sex, body mass index, and total energy intake, the carbohydrate and protein intake gradually increased and the total fat intake decreased during study period (P-value< 0.001), although total energy intake remained stable. During the study period, participants consumed noticeably less refined grains, solid fat, dairy products, and simple sugars. Snack and dessert consumption increased and meat intakes showed no significant changes during a decade (all P-values< 0.001). Three dietary patterns extracted using PCA, included: Healthy dietary pattern characterized by higher intakes of vegetable, fruit, dairy products, liquid oil, nuts and seeds, and honey and jam; Western dietary pattern featured by refined grain, solid fat, meat, snack and dessert, potato, and soft drink, and the Mixed dietary pattern, highlighted by tea and coffee, and simple sugar. Based on cluster analysis, 27.8% of participants in wave 4 followed a Western dietary pattern, and 34.1% followed the Mixed dietary pattern. The Healthy dietary pattern was stable among the study population during the last decade., Conclusions: The structure and the type of foods that participants preferred to eat changed since 2006, a new secular trend in dietary patterns, including a stability of Healthy dietary pattern, a decline of the Western dietary pattern and an increase in the Mixed dietary pattern was obsereved in our investigation.

Background: The present study aimed to assess the relation between nutrient patterns and changes in adult anthropometric and cardiometabolic factors., Methods: This study was conducted on 1637 adults participating in the Tehran Lipid and Glucose Study (2005-2008), who were free of cardiovascular diseases and cancer and had completed dietary data. They were followed to the next survey (2008-2011). Dietary intakes were collected and nutrient patterns were obtained. Three year changes in anthropometric and cardiometabolic factors were measured., Results: Five nutrient patterns were extracted. The first pattern was characterized by "plant protein, thiamine, niacin, and minerals including phosphorus, zinc, copper, magnesium, manganese, and selenium". Animal protein, lactose, vitamin D, riboflavine, pantothenic acid, vitamin B12, calcium, phosphorus, and zinc" were loaded in the second pattern. The third and fourth patterns were characterized by "vitamin K, fiber, calcium, iron, manganese, and potassium", and "high correlation with starch, thiamine and folate, and negative correlation with mono and poly unsaturated fatty acids and vitamin E", respectively. The fifth pattern was high in Fructose, vitamins A, C, pyridoxine, and potassium. There was no association between nutrient patterns and 3-year changes in blood pressure and fasting blood glucose; whereas, per each quartile increment of the fifth pattern adjusted for potential confounders, triglyceride change was decreased [β = - 3.66, 95% CI (- 6.57, - 0.57); P for trend = 0.014]., Conclusion: Present study indicates that nutrient patterns may have an association with cardiometabolic factors, particularly a pattern rich in fructose, vitamins A, C, pyridoxine, and potassium which decreases triglyceride level.

Introduction: Data shows that interactions between dietary factors and genetic variants can modulate the association of polymorphisms such as the Melanocortin-4 receptor (MC4R) gene with obesity. Considering the limited data available on this topic we aimed to investigate interactions between dietary patterns (DPs) and MC4R polymorphisms in relation to obesity phenotypes., Methods: This cohort study was performed in the framework of Tehran Lipid and Glucose Study; for eligible participants in this study (n=3850), the median follow-up was 4 years. DPs were determined using factor analysis. The genotypes of polymorphisms (17782313rs and 12970134rs) were identified and their interaction with DPs were assessed in relation to incidence of obesity phenotypes including central obesity, general obesity and visceral adiposity dysfunction., Results: The mean age of participants (62.5% females) were 37.0±13.7 years. Two main DPs (healthy and unhealthy) were extracted. C-allele carriers of rs17782313 in higher quartiles of the healthy DP score had a significant decrease in the incidence of general obesity, compared to those who had the TT genotype (HR=0.61, 95% CI=0.42-0.89, P interaction=0.01). For rs12970134 A-allele carriers, subjects in the second compared to the first quartile of the healthy DP score, had a significant decrease in the incidence of general obesity (HR=0.68, 95% CI=0.46-0.99). There were no significant interaction between DPs and MC4R variants in relation to other obesity phenotypes., Conclusion: Our results indicate that the healthy DP could interact with rs17782313 in relation to incidence of general obesity., (Copyright © 2020 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to investigate the association of total proline intake, proline of various food sources, and substitution analysis for proline of food sources with blood pressure (BP) and 3.1-year incidence of hypertension in the framework of the Tehran Lipid and Glucose Study. The cohort consisted of 4287 participants (41.9% male), aged ≥ 20-70 years. In fully-adjusted model, individuals in the highest tertile for proline intake had an increased risk of incident hypertension than those in the lowest one (OR: 1.45; 95%CI: 1.06-1.97; p for trend: .017). Replacing proline of cheese and legumes source with that of yogurt, poultry, milk, and red meat source was associated with significant negative β coefficient for BP. The present study indicated that high dietary intakes of proline may increase the risk of incident hypertension. Also, substituting proline intake of cheese and legumes by those of proline intake of meats and milk is associated with a lower risk of high BP.

This study was designed to investigate prospective associations between dietary habitual intakes of flavonoids and carotenoids and the development of an unhealthy metabolic phenotype. In this study 1114 adults, who had a healthy metabolic phenotype in the third examination cycle (2005-2008) participated. Dietary intakes of flavonoids and carotenoids were estimated using valid food frequency questionnaires evaluated during the study. Joint Scientific Statement criteria were used to define a metabolic unhealthy phenotype as meeting at least two criteria. During a median follow-up of 5.4 years, one standard deviation increase in total flavonoids reduced the risk of developing an unhealthy phenotype by 50% (95% CIs: 0.42-0.59), and inverse associations were observed for individual classes except anthocyanins, being the strongest for flavan-3-ols. Among carotenoid classes, a significant inverse association was only observed between lutein + zeaxanthin (HRs: 0.87, 95% CIs: 0.77-0.98) and the occurrence of an unhealthy phenotype. When data were stratified by baseline BMI, total flavonoids and individual classes of flavan-3-ols, flavonols, and flavones among both normal weight and overweight/obese individuals, isoflavones in those with excess weight and anthocyanins in normal weight individuals were inversely associated with the development of an unhealthy phenotype. Total carotenoids, β-carotene and lutein + zeaxanthin were significantly associated with the lower likelihood of the occurrence of an unhealthy phenotype, only among normal weight individuals. Higher intakes of flavonoids and their individual classes may contribute to the lower risk of a metabolic unhealthy phenotype in both normal weight and overweight/obese adults. Flavonoids may have more favorable metabolic health effects than carotenoids.

Objective: 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)., Methods: 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., Results: 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 trend <0.001) 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 trend <0.001). 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., Conclusions: 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., (Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Dietary intakes are suggested to affect age at menopause but associations between dietary factors and ovarian reserve reduction have not yet been investigated. We aimed to examine dietary intakes in relation to the rate of decline in anti-Mullerian hormone (AMH), an indicator of ovarian reserve, in a generally healthy cohort of women., Methods: This prospective investigation was conducted among 227 eumenorrheic women, aged 20-50 years, from the Tehran Lipid and Glucose study, who were followed over a mean of 16 years. AMH was measured twice, at baseline and the 5th follow-up examination cycle, and yearly rate of decline in AMH was calculated. Rapid decline in AMH was defined as the annual percent change AMH > 5.9%/year based on tertile 3 of the variable. Average usual dietary intakes were estimated using the food frequency questionnaires administered at the second, third, and the fourth follow-up examinations. After adjusting for potential covariates, the association between dietary factors and both risk of rapid decline in AMH and also annual percent decline of AMH (as a continuous variable) were examined using logistic regression and the Spearman correlation, respectively., Results: The baseline age of the participants and the median rate of decline in AMH were 37.2 years and was 5.7% yearly, respectively. The odds of rapid decline in AMH was reduced by 47% for dairy products (95% CIs = 0.36, 0.79; p = 0.002), 38% for milk (95% CIs = 0.41, 0.93; p = 0.020), and 36% for fermented dairy (95% CIs = 0.45, 0.93, p = 0.018) per one standard deviation (SD) increase in their dietary intakes. The odds of rapid decline in AMH was significantly reduced with higher intakes of fat, carbohydrate, protein, and calcium intakes from dairy sources, lactose and galactose. Annual rate of AMH decline was inversely correlated with dairy products, milk, fermented dairy, fruits, dairy carbohydrate, dairy fat, dairy protein, total calcium and dairy calcium, lactose and galactose, and positively correlated with organ meats., Conclusion: Dairy foods consumption may reduce the rate of AMH decline in regularly menstruating women. Life style modification in terms of dietary advice may be considered as a preventive strategy for reduction in the rate of ovarian reserve loss.

Background: The optimal dietary pattern for reducing the extent of metabolic syndrome (MetS) has not been well established yet. The aim of this study was to evaluate dietary patterns and adherence to WHO healthy diet in children and adolescents and their associations with MetS., Methods: Subjects of this cohort study were selected from among children and adolescents of the Tehran Lipid and Glucose Study participants, aged 6-18 years (n = 424). Dietary measurements were collected using a valid and reliable food frequency questionnaire. MetS was defined as the existence of at least 3 risk factors according to the Cook criteria. Diet was assessed based on dietary components of the WHO healthy diet. Dietary patterns were defined by principal component analysis., Results: The mean ± SD age of participants (42% boys and 57% girls) was 13.5 ± 3.7 years. The most consistency with the WHO healthy diet was observed for cholesterol, free sugar and protein consumption in both genders, and the least was for n-3 poly-unsaturated fatty acid, trans-fatty acid and salt. Intake of SFA up to 12% of energy intake (third quartile) reduced the risk of MetS, compared to the first quartile. Subjects in the third quartile of n-6 poly-unsaturated fatty acid intake (6.2% of energy) showed the lowest odds ratio of MetS compared to the first quartile (OR: 0.18, CI: 0.04-0.66). In the adjusted model, the risk of MetS reduced across quartiles of MUFA intake by 60% (OR: 1, 0.40, 0.40, 0.42; P trend = 0.05). No significant trends were observed in the risk of MetS components across quartiles of the WHO healthy diet components. Three major dietary patterns were identified, the healthy, unhealthy and cereal/meat. An increased risk of MetS was observed in the highest quartile of unhealthy dietary pattern score compared to the lowest quartile (OR: 1, 0.81, 0.93, 2.49; P trend = 0.03)., Conclusions: Our results demonstrated that the majority of our population did not meet some components of WHO healthy diet recommendations. The quality and quantity of fatty acid intakes were associated with risk of MetS. Adherence to unhealthy dietary pattern was associated with two-fold increase in MetS risk.

Background: Abnormal levels of liver enzymes, particularly aminotransferases, are prognostic features of non-alcoholic fatty liver disease (NAFLD). Considering the important role of dietary intakes in development of NAFLD, we aimed to determine possible association of unhealthy foods (fast foods, soft drinks, sweet and salty snacks) consumption with elevated levels of aminotransferases., Methods: This cross-sectional study was conducted within the framework of sixth phase of the Tehran Lipid and Glucose Study (2014-2017), on 187 adult men and 249 adult women (19-70 y). Usual intakes of unhealthy foods (kcal/week) were measured using a validated semi-quantitative 147-items food frequency questionnaire. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) were measured. Multivariable logistic regression models were used to estimate the odds of elevated aminotransferases in each tertile of energy-dense unhealthy foods., Results: Mean age of participants was 44.44 ± 15.09 years, 43% of participants were men. Higher consumption of fast foods (> 11.39% kcal/week) was associated with elevated ALT to AST ratio (OR: 3.27; 95% CI: 1.90-5.63) and elevated ALT (OR: 2.74; 95% CI: 1.57-4.76). Also, each 1 SD increased energy intakes from fast foods was related to increased chance of having elevated ALT and ALT to AST ratio by 35% (OR: 1.35; 95% CI: 1.08-1.68, OR: 1.35; 95% CI: 1.10-1.66, respectively). There was no significant association between consumption of soft drinks, sweet or salty snacks and elevated aminotransferases., Conclusions: Higher intakes of energy from fast foods seems to be associated with an elevated serum levels of ALT and ALT to AST ratio, as indicators of development of NAFLD.

Objective: Dietary total antioxidant capacity (DTAC) has been hypothesized as being involved in health promotion and disease prevention. However, data about the association of the DTAC (as estimated by ferric reducing antioxidant power) with diabetes chronic complications are scarce. Therefore, the aim of this study was to determine the associations between the DTAC and chronic kidney disease (CKD) risk in subjects with type 2 diabetic., Methods: The present case-control study consisted of 210 (102 cases and 108 controls) patients with type 2 diabetic who were participants of the phase 5 Tehran Lipid and Glucose Study and were classified based on their CKD status. DTAC was estimated based on the ferric reducing antioxidant power of selected foods. Dietary intake, sociodemographic data, medical history, and anthropometric measurements were collected from participants using a validated questionnaire., Results: The mean DTAC value, as well as total calorie intake, did not show significant differences between cases and controls., Conclusion: No significant association was found between DTAC and CKD in patients with type 2 diabetic. Further studies are needed to confirm the effects of DTAC on the risk of CKD., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Gene-diet interactions may have an important role in the disparities between the lipid responses of individuals to diet. This study aimed to investigate whether polymorphisms (rs5882 and rs3764261) in the cholesteryl ester transfer protein (CETP) gene modify the association of diet with changes in serum lipid profiles., Subjects/methods: A total of 4700 individuals aged ≥18 years were selected from among participants of the Tehran Lipid and Glucose Study. After 3.6 years of follow-up, changes in serum lipid profiles were evaluated. Usual dietary intake was assessed using a validated food frequency questionnaire. DNA samples were genotyped with HumanOmniExpress-24-v1-0 bead chips (containing 649,932 SNP loci)., Results: No significant interaction was found between CETP polymorphisms and dietary patterns in changing lipid profiles. Mean changes of total cholesterol (TC) decreased in higher quartiles of fish intake in A allele carriers (Q1:8.02, Q4:5.58, P trend  = 0.01) compared to the CC genotype (Q1:3.65, Q4:8.93, P trend  = 0.11) (P i  = 0.02). There are ascending trends of changes in triglyceride (TG) concentrations across quartiles of total fat, monounsaturated and saturated fat consumption in G allele carriers of rs5882 compared to the AA genotype. There was a declining trend for mean changes in TG concentrations across quartiles of carbohydrate intake in G allele carriers of rs5882 compared to the AA genotype (P i  = 0.01)., Conclusions: Our data demonstrated that minor allele carriers of rs5882 had a better TG value than AA homozygote individuals when consuming a low fat and high carbohydrate diet. Fish intake modifies the association of rs3764261with TC concentrations.

In the current study, we investigated the association between dietary amino acid ratios and the 3-year incidence of hypertension, conducted in the framework of the Tehran Lipid and Glucose Study with 4287 adults(41.9% men), aged 20-70 y. Dietary intakes of amino acids were assessed using a valid and reliable food frequency questionnaire and reported as percentage of protein. Then amino acid ratios including Leu.Ser/Thr.Trp, Leu/Trp, Leu/Thr, and Ser/Thr were calculated. We identified 429(10%) cases of hypertension during 3.1 y of follow up. The adjusted OR of the highest quartile of dietary Leu.Ser/Thr.Trp intake was 1.48 (95%CI:1.04-2.09, P for trend:0.02) compared with the lowest one. Furthermore, the OR of hypertension in the highest, compared with the lowest quartile of the leu/Thr ratio(2.19 vs 2.02) was 1.46(1.01-2.12), P for trend = 0.07. Our findings suggest that high dietary intakes of Leu.Ser/Thr.Trp ratio were associated with higher risk of incident hypertension and BP levels.

Background/objectives: Type 2 diabetes (T2D) is fast increasing in recent decades. Limited prospective studies are available on Mediterranean diet protective effect against T2D development. We assessed longitudinal association of the Mediterranean diet with T2D risk in Iranian men and women., Subjects/methods: Diet was measured using a 168-item food frequency questionnaire in 2139 adults (free of T2D), aged 20-70 years. All individuals, based on the traditional Mediterranean diet score (MDS), received scores between 0 and 8 points. Multivariate hazard ratio (HR) and 95% confidence interval (CI) were reported for the association of T2D and the MDS, with adjustment of diabetes risk score (DRS) and dietary energy intakes., Results: During follow-up, a total of 143 events occurred. Individuals who had higher intakes of fish/sea foods, legumes, nuts, and monounsaturated fatty acids (MUFAs) to saturated fatty acids (SFAs) ratio had a decreased risk of T2D. After adjustment for confounders, an inverse association was found between adherence to the MDS and T2D (HR = 0.48; 95% CI 0.27-0.83)., Conclusions: Our findings demonstrated an inverse association between the Mediterranean diet score and incidence of T2D.

Background and Objective: This randomized crossover clinical trial investigated the effects of substituting legumes for meat consumption in the therapeutic lifestyle change (TLC) diet on leptin and adiponectin concentrations among type 2 diabetic patients., Material and Methods: Thirty-one type 2 diabetic patients (24 women, age: 58.1±6.0 years) were randomly assigned to groups designated to consume a legume-free TLC diet or a legume-based TLC diet for 8 weeks. Both diets were similar except for the replacement of two servings of red meat with legumes 3 days per week in the legume-based TLC group. Leptin and adiponectin concentrations were measured at baseline and after the 8-week intervention., Results: The legume-based TLC diet significantly increased adiponectin concentrations in comparison with the legume-free TLC diet. There was no significant change in leptin concentrations after both intervention diets., Conclusions: Legumes increased serum adiponectin concentrations in type 2 diabetic patients. Registration number: IRCT201202251640N7., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: We aimed to investigate the association of dietary total antioxidant capacity (TAC) with incidence of CKD in subjects with dysglycemia., Methods: We followed-up 1179 subjects aged ≥30 years with dysglycemia from the Tehran Lipid and Glucose Study (TLGS) for 3 years, who were initially free of CKD. Dietary intakes of TAC, vitamin C, vitamin E, and β-carotene were assessed by a food-frequency questionnaire at the baseline. Dietary TAC was estimated using the oxygen radical absorbance capacity method. Estimated glomerular filtration rate (eGFR) was calculated, using the Modification of Diet in Renal Disease Study equation and CKD was defined as eGFR <60 mL/min/1.73 m 2 . Odds ratios (ORs) using multivariable logistic regression were reported for the association of incident CKD with dietary TAC., Results: A total of 197 (16.7%) cases of incident CKD were recorded after 3 years of follow-up. After adjustment for age, sex, smoking, physical activity, body mass index, hypertension, and total energy intake, the top tertile of dietary TAC compared to the bottom was associated with 39% [95% confidence interval (CI) = 0.40-0.93] lower risk of incident CKD (P for trend = 0.025). Furthermore, the highest tertile of vitamin C intake compared to the lowest risk of incident CKD was decreased (OR 0.60; 95% CI 0.38-0.93, P trend 0.023). Intakes of vitamin E and β-carotene were not significantly associated with incident CKD risk., Conclusion: Our findings suggest that diets high in TAC are associated with a lower risk of incident CKD among subjects with hyperglycemia after 3 years of follow-up.

Background: The purpose of the present study was to investigate the longitudinal association of total polyphenol and its main four subclasses intake with metabolic syndrome (MetS) and its components., Methods: The present prospective study was conducted on 1265 Tehranian adults, aged 19-74 years. Usual dietary intake was evaluated using a validated food-frequency questionnaire. MetS was defined using NCEP ATP III guidelines. Intakes of total polyphenol and its four main subclasses, including flavonoids, phenolic acids, stilbenes, and lignans, were estimated using Phenol-Explorer database., Results: Median (interquartile range [IQR]) of total polyphenol intake and its subclasses, including flavonoids, phenolic acids, lignans, and stilbenes, was 1422 (967-2137), 69.5 (45.5-99.8), 75.7 (52.2-115), 3.8 (1.9-6.9), and 0.2 (0.1-0.5) mg/day, respectively. After adjustment for confounding factors, participants in the highest tertile of flavonoid intake had 31% lower risk of developing MetS (odds ratio [OR] 0.69; 95% CI 0.48-0.98) and 36% lower risk of hypertriglyceridemia (OR 0.64; 95% CI 0.48-0.99) during 6 years of follow-up. Total polyphenol intake and other subclasses of polyphenol were not associated with MetS and its components., Conclusion: Higher intake of flavonoids was inversely associated with risk of developing MetS and hypertriglyceridemia in a Tehranian population.

Aim: Studies suggest that fatty acid intake may be an important determinant of type 2 diabetes mellitus (T2DM). This study aims to prospectively examine the association between fatty acid quantity and quality with risk of T2DM in adults., Methods: In this community-based prospective sample, 2139 adults, free of T2DM, aged 20-70y-old were followed for a median of 5.8 y. Diet information was collected with the use of a validated questionnaire at baseline. Cox regression and 95% confidence intervals (CI), adjusted for age, diabetes risk score (DRS), and dietary intakes of energy, fiber and magnesium, were used to evaluate the association of fatty acid intakes with incident T2DM., Results: During follow-up, we identified 143 incident T2D cases. In multivariable analyses, when extreme quintiles were compared, cholesterol (HR = 0.40; 95% CI: 0.20-0.82; P-trend, 0.02), monounsaturated fatty acids (HR = 0.30; 95% CI: 0.13-0.70; P-trend, 0.02), polyunsaturated fatty acids (HR = 0.45; 95% CI: 0.24-0.93 P-trend = 0.04) and ω-3 fatty acids (HR = 0.55; 95% CI: 0.31-0.88; P-trend = 0.02) were associated with T2DM. The ratio of ω-6 to total ω-3 intake was associated with a higher risk of T2D (HR = 1.65; 95% CI: 1.05-2.86; P-trend, 0.04). We also found positive associations between the ratios of total fat to ω-3 (HR = 1.65; 95% CI: 1.02-2.46; P-trend = 0.05)., Conclusions: Our findings indicate that diets with high cholesterol, monounsaturated, polyunsaturated and ω-3 fatty acids are associated with a lower risk of T2DM. Also the ratios of ω-6/ω-3 and total fat/ω-3 were positively associated with T2DM., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The relationship of CCND2 gene variation, rs11063069 with metabolic syndrome (MetS) modulates by dietary factors but enough data are not available on this issue. So, the hypothesis, which assumes that dietary factors modulate the relationship of CCND2 polymorphisms with the risk of MetS was investigated in our study. Subjects of this nested case-control study were selected from participants of the Tehran Lipid and Glucose Study. Each case (n=974) was pair-matched individually with a control by age, sex and the follow-up duration. Dietary patterns were determined using factor analysis. CCND2 rs11063069 was genotyped by the ARMS-polymerase chain reaction analysis. Two dietary patterns were extracted: the healthy dietary pattern (HDP) and the Western dietary pattern; among G allele carriers, being in the highest quartiles of HDP score decreased risk of MetS (OR, Q1:3.01 [1.95-6.15], Q4:0.88 [0.39-1.78], P trend=.001), compared with those in the lowest quartile. In addition, the consumption of some vegetables, red-yellow vegetable (tomatoes, squash and carrots) and fruits by G allele carriers could decrease the risk of high fasting plasma glucose (P interaction=.003), low HDL-C (P interaction=.03) and high blood pressure (P interaction=.01) respectively. No significant interaction was observed in this study between nutrients (macronutrients, zinc, magnesium and iron) and CCND2 rs11063069 in relation to MetS or its components in this study. Our findings showed that by promoting adherence to HDP and increasing intake of some vegetables and fruits, the risk of MetS or its components reduced in G allele carriers; these associations were not observed in the AA genotype group., (Copyright © 2017. Published by Elsevier Inc.)

The purpose of this study was primarily to evaluate the association of total fibre intake with the risk of incident chronic kidney disease (CKD). We also evaluated the association of dietary fibre from fruits, vegetables, cereals and legumes with the incidence of CKD in a population-based prospective study. We followed up 1630 participants of the Tehran Lipid and Glucose Study for 6·1 years, who were initially free of CKD. Baseline diet was assessed by a valid and reliable FFQ. Estimated glomerular filtration rate (eGFR) was calculated, using the Modification of Diet in Renal Disease Study equation, and CKD was defined as eGFR <60 ml/min per 1·73 m2. OR using multivariable logistic regression was reported for the association of incident CKD with tertiles of dietary fibre intake. After adjustment for age, sex, smoking, total energy intake, physical activity, diabetes and using angiotensin-converting-enzyme inhibitor, the OR for subjects in the highest compared with the lowest tertile of total fibre intake was 0·47 (95 % CI 0·27, 0·86). In addition, for every 5 g/d increase in total fibre intake, the risk of incident CKD decreased by 11 %. After adjusting for potential confounders, OR for participants in the highest compared with the lowest tertile of fibre from vegetables was 0·63 (95 % CI 0·43, 0·93) and from legumes it was 0·68 (95 % CI 0·47, 0·98). We observed inverse associations between total fibre intake and risk of incident CKD, which demonstrate that high fibre intake, mainly from legumes and vegetables, may reduce the occurrence of CKD.

The objective of this study was to investigate whether a diet rich in legumes are associated with oxidative stress among type 2 diabetic patients. In a randomized, controlled, crossover clinical trial, 31 type 2 diabetic patients were randomly assigned to receive 2 diets, each for a period of 8 weeks: (1) The legume-free therapeutic lifestyle change (TLC) diet and (2) the legume-based TLC diet. Both diets were similar except that 2 servings of red meat were replaced by different types of legumes 3 days per week in the legume-based TLC diet. Oxidative stress biomarkers were measured at baseline and after 8 weeks. Compared to the legume-free TLC diet, the legume-based TLC diet significantly decreased malondialdehyde (-0.22 versus -0.68 μmol/l; P=0.002), oxidized-LDL (-0.9 versus -2.3 mU/l; P=0.05) and increased nitric oxide (0.40 versus 0.96 mM/l; P=0.03) and catalase activity (1.2 versus 2.1 Iu/ml; P=0.05).

The current study aimed to investigate the association between dietary amino acid patterns and incidence of hypertension, using principal components factor analyses. This study was conducted within the framework of Tehran Lipid and Glucose Study on 4288 adults, who were free of hypertension at baseline (2008-2011) and were followed for three years (2011-2014). Principal component factor analyses were conducted based on eight amino acid groups and three amino acid patterns were extracted. The first pattern was characterized by branched chain, aromatic, and alcoholic amino acids, and proline. Acidic amino acids and proline were highly loaded in the second pattern and the third was characterized by sulphuric and small amino acids. Adjusted odds ratio of the highest quartile of the first pattern was 1.83 (95%CI: 1.21-2.77, P for trend = 0.002) compared to the lowest one. The first pattern had high positive correlation with dietary intakes of animal protein and dairy, but was negatively correlated with plant protein, fruit, and vegetable. There was no significant association for the second and third patterns. Findings indicate that the dietary amino acid pattern, rich in branched chain, aromatic, and alcoholic amino acids, and proline could increase the risk of hypertension.

Introduction: There is inconsistent evidence regarding the potential role of L-arginine intake on kidney function. This study investigated the association of dietary L-arginine intake and the risk of chronic kidney disease (CKD) in adults., Materials and Methods: We evaluated 1780 men and women participated in the Tehran Lipid and Glucose Study, followed for a median of 6.3 years. Dietary intakes of total L-arginine as well as animal- and plant-derived L-arginine were assessed using the validated semi-quantitative food frequency questionnaire, at baseline. Demographics, anthropometrics, and biochemical variables were evaluated at baseline and again after a 3-year and a 6-year follow-up. The incidence of CKD was assessed across tertiles of L-arginine and its categories using multivariable logistic regression models., Results: The mean dietary intakes of total, plant-derived, and animal-derived L-arginine were 4.1 ± 1.5 g/d, 1.8 ± 0.9 g/d, and 2.1 ± 0.8 g/d, respectively. In the fully-adjusted logistic regression model, the highest compared to the lowest intakes of animal-derived L-arginine (2.57 g/d versus 1.05 g/d) increased the risk of CKD (relative risk, 1.54; 95% confidence interval, 1.06 to 2.14, P = .02 for trend). Animal-derived L-arginine was negatively associated with changes of estimated glomerular filtration rate and creatinine clearance rate during the follow-up. There was no significant association between total or plant-derived L-arginine intakes and the risk of CKD after 6.3 years of follow-up., Conclusions: Our findings suggested an adverse effect of higher intakes of L-arginine from animal sources that could be a dietary risk factor for development of kidney disease.

The relationship between fructose and cardiovascular disease (CVD) remains controversial. In this study, we aimed to assess possible association of dietary intakes of fructose with the risk of CVD events in a prospective population-based study. Participants without CVD ( n = 2369) were recruited from the Tehran Lipid and Glucose Study and followed a mean of 6.7 years. Dietary data were collected using a validated 168 item semi-quantitative food frequency questionnaire. Dietary total fructose (TF) intake was calculated by sum of natural fructose (NF) in fruits and vegetables and added fructose (AF) in commercial foods. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the risk of CVD across tertiles of dietary fructose. Linear regression models were used to indicate association of fructose intakes with changes of CVD risk factors over the study period. The mean age of participants (43.5% men) was 38.1 ± 13.3 years at baseline. During an average of 6.7 ± 1.4 years of follow-up, 79 participants experienced CVD outcomes. The mean daily intake of TF was 6.4 ± 3.7% of total energy (3.6 ± 2.0 from AF and 2.7 ± 1.8 from NF). Higher consumption of TF (≥7.4% vs. <4.5% of total energy) was accompanied with an increased risk of CVD (HR = 1.81, 95% CI = 1.04-3.15); higher energy intake from AF was also related to incidence of CVD (HR = 1.80, 95% CI = 1.04-3.12), whereas NF was not associated with the risk of CVD outcomes. Both AF and TF were also related to changes of systolic and diastolic blood pressures, waist circumference, serum insulin and creatinine levels, as well as HDL-C. Our data provides further evidence regarding undesirable effects of fructose intake in relation to risk of CVD events., Competing Interests: The authors had no conflict of interest.

Ovarian aging is thought to be influenced by environmental factors, including nutrition. The aim of this study was to systematically review current evidence on the associations between nutritional factors, ovarian reserve, and age at menopause. PubMed and Scopus were structurally searched until May 2016. Original studies, with either observational or interventional designs, that examined the associations of nutritional factors (serum or dietary nutrients, food groups, and/or dietary patterns) with different ovarian reserve markers and/or timing of menopause were considered eligible. Twenty-six studies met the inclusion criteria: 17 studies on ovarian reserve markers and 9 studies on menopausal age. Significant diversity was observed in nutritional factors examined across studies. In the study of nutritional factors, associations of serum 25-hydroxyvitamin D [25(OH)D] concentration and intakes of soy or soy products with ovarian reserve have been the most investigated. For associations with menopausal age, intakes of total fat, fiber, and soy products have been mainly examined. Significant associations with ovarian reserve markers were found in 4 of 7 studies on serum 25(OH)D, 2 of 6 studies on soy or soy products, 1 of 2 studies on fiber intake, 1 study on serum zinc and copper concentrations, and 1 study on serum antioxidant concentrations. Studies on nutritional factors and menopausal age provided inconsistent findings, some of which suggested modest associations. Although there is some promising evidence on the influential role of nutrition in ovarian aging, a limited number of studies, heterogeneous in their design and study of nutritional factors, makes it difficult to draw definite conclusions. To better understand this issue, examination of associations of dietary intakes or dietary patterns with more precise markers of ovarian reserve, such as anti-mullerian hormone and antral follicle count, with age at menopause is needed. In addition, to explore whether nutritional factors alter the process of ovarian aging, an examination of changes in ovarian reserve markers should be considered., Competing Interests: Author disclosures: NM, PM, FRT, and FA, no conflicts of interest., (© 2017 American Society for Nutrition.)

There are conflicting data on the impact of zinc transporter 8 (ZNT8) gene variations on the metabolic syndrome (MetS). Hence, the effects of the interaction between rs13266634 and dietary factors on the risk of MetS were investigated in this study. Subjects of this nested case-control study were selected from the participants in Tehran Lipid and Glucose Study. Each of the cases (n = 817) was individually matched with a control. Dietary patterns were determined using factor analysis. The ZNT8 rs13266634 were genotyped by the Tetra-refractory mutation system-polymerase chain reaction analysis. Two dietary patterns were extracted. There were no significant interactions between the ZNT8 SNP and the dietary patterns on the risk of MetS or its components. An interaction was observed between rs13266634 and the omega-3 fatty acid intakes on the risk of MetS in subjects with the CC genotype (P interaction < 0.01). Zinc modified the association of the ZNT8 variant with high fasting blood sugar (P interaction = 0.05) in CC genotype carriers. An interaction was also observed between rs13266634 and salty snacks at the risk of abdominal obesity (P interaction < 0.05). Our findings suggest an interaction between omega-3 fatty acids, zinc, salty snacks and rs13266634, which may affect the risk of MetS or its components.

Background and Objectives: The aim of this study was to investigate the relationship between major dietary patterns and the risk of insulin resistance (IR) among an urban Iranian population., Methods and Study Design: In this longitudinal study, 802 adult men and women were studied within the framework of Tehran Lipid and Glucose Study. Fasting serum insulin and glucose were measured at baseline and again after a 3-year of followup. The usual dietary intakes were assessed using a validated 168 item semi-quantitative food frequency questionnaire and major dietary patterns were obtained using principal component analysis. Logistic regression models were used to estimate the occurrence of IR across tertiles of dietary patterns with adjustment for potential confounding variables., Results: Mean age of participants was 39.0±11.2 years and 45.5% were men. Three major dietary patterns including the Western, traditional and healthy were extracted, which explained 25.3% of total variance in food intake. The healthy dietary pattern, loaded heavily on intake of vegetable oils, fresh and dried fruits, low-fat dairy, nuts and seeds, was accompanied with a reduced risk of insulin resistance by 51% (OR=0.49, 95% CI=0.30-0.81), and 81% (OR=0.19, 95% CI=0.10-0.36), in the second and third tertile, respectively (p trend=0.001). In the presence of all dietary pattern scores in the logistic regression model, a 45% reduced risk of IR was observed per 1 unit increase in healthy dietary pattern score., Conclusion: These findings confirmed the protective effect of a plant-based, low-fat dietary pattern against the development of insulin resistance as a main risk factor of type 2 diabetes and metabolic disorders.

Tools, called 'diet/dietary quality indices', evaluate the level of adherence to a specified pattern or a set of recommendations in populations. Yet, there are no review studies providing unanimous comprehensive results of dietary indices on obesity. We reviewed observational studies, focusing on the association of diet quality indices with general obesity or abdominal obesity in adults. We systematically conducted a search in all English language publications available on MEDLINE, ISI Web of Science and Embase between January 1990 and January 2016. Among the wide variety of indices and weight-derived variables, studies with dietary-guideline-based indices and mean changes for weight gain or OR for general obesity and abdominal obesity were selected. From a total of 479 articles, thirty-four studies were selected for the current review, ten of which had prospective designs and twenty-six had cross-sectional designs. Associations of weight status with the original Healthy Eating Index (HEI) and other versions of the HEI including alternative HEI, HEI-2005 and HEI-05 were examined in thirteen studies, with ten studies revealing significant associations. The HEI was a better general obesity predictor in men than in women. Diet scores lacked efficacy in assessing overall diet quality and demonstrated no significant findings in developing countries, in comparison with US populations. In addition, indices based on dietary diversity scores were directly associated with weight gain. Despite the insufficient evidence to draw definitive conclusions about the relation between dietary indices and obesity, HEI was found to be inversely associated with obesity and diversity-based indices were positively associated with obesity.

Background and Aim: The association of habitual intakes of dietary nitrate (NO₃ - ) and nitrite (NO₂ - ) with blood pressure and renal function is not clear. Here, we investigated a potential effect of dietary NO₃ - and NO₂ - on the occurrence of hypertension (HTN) and chronic kidney disease (CKD)., Methods: A total of 2799 Iranian adults aged ≥20 years, participating in the Tehran Lipid and Glucose Study (TLGS), were included and followed for a median of 5.8 years. Dietary intakes of NO₃ - and NO₂ - were estimated using a semi-quantitative food frequency questionnaire. Demographics, anthropometrics, blood pressure and biochemical variables were evaluated at baseline and during follow-up examinations. To identify the odds ratio (OR) and 95% confidence interval (CI) of HTN and CKD across tertile categories of residual energy-adjusted NO₃ - and NO₂ - intakes, multivariate logistic regression models were used., Results: Dietary intake of NO₃ - had no significant association with the risk of HTN or CKD. Compared to the lowest tertile category (median intake < 6.04 mg/day), the highest intake (median intake ≥ 12.7 mg/day) of dietary NO₂ - was accompanied with a significant reduced risk of HTN, in the fully adjusted model (OR = 0.58, 95% CI = 0.33-0.98; p for trend = 0.054). The highest compared to the lowest tertile of dietary NO₂ - was also accompanied with a reduced risk of CKD (OR = 0.50, 95% CI = 0.24-0.89, p for trend = 0.07)., Conclusion: Our findings indicated that higher intakes of NO₂ - might be an independent dietary protective factor against the development of HTN and CKD, which are major risk factors for adverse cardiovascular events., Competing Interests: The authors have no conflict of interest.

We aimed to investigate associations of the dietary inflammatory index (DII) with glucose-insulin homeostasis markers, and the risk of glucose intolerance. This cross-sectional study included 2975 adults from the Tehran Lipid and Glucose Study. Fasting plasma glucose (FPG), 2-h post-load glucose (2h-PG), and fasting serum insulin were measured. Homeostatic model assessment of insulin resistance index (HOMA-IR) and β-cell function (HOMA-B), and the quantitative insulin sensitivity check index (QUICKI) were calculated. Glucose tolerance abnormalities included impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes (T2DM). DII scores were positively associated with 2h-PG (β = 0.04; p = 0.05). There was no significant linear trend across quartiles of DII for adjusted means of glucose-insulin homeostasis markers. Participants in the highest quartile of DII score tended to have higher FPG compared to those in the second quartile of DII score (5.46 vs. 5.38 mmol/L, p = 0.07) and higher fasting insulin and HOMA-IR compared to those in the lowest quartile (8.52 vs. 8.12 µU/mL for fasting insulin, p = 0.07; 2.06 vs. 1.96 for HOMA-IR, p = 0.08). No significant associations were observed between DII and risk of IFG, IGT, T2DM, and insulin resistance. Among glucose-insulin homeostasis markers, DII had a positive weak association only with 2h-PG., Competing Interests: The authors declare no conflicts of interest.

Background & Aims: Visceral adiposity index (VAI), an indicator of visceral adiposity, has been found to be associated with cardiometabolic disturbances in women with polycystic ovary syndrome (PCOS). The association of dietary intakes with VAI, and subsequently cardiometabolic variables is still unclear. The aims of this study were to identify a dietary pattern associated with VAI and to investigate whether this pattern is associated with cardiometabolic variables in PCOS women., Methods: The study was conducted on 53 PCOS women, aged 18-45 years, diagnosed according to National Institutes of Health (NIH) criteria, and 167 age-matched normo-ovulatory women who were recruited from the Tehran Lipid and Glucose Study. Reduced rank regression was applied to determine a dietary pattern that explains the maximum variation of the VAI. Associations between the dietary pattern and cardiometabolic profiles were investigated using linear and logistic regression, adjusted for age and BMI., Results: A VAI dietary pattern was identified characterized by high consumption of fried vegetables, vegetable oils (except olive oil), salty snacks, legumes, eggs, fast foods and low consumption of traditional sweets, high and low fat dairy, cruciferous vegetables, sugars and honey. A one standard deviation (SD) increase in dietary pattern score was significantly associated with higher triglycerides (TGs) (βcontrol = 0.22, p = 0.003; βcase = 0.48, p = 0.001) and TGs/HDL-C ratio (βcontrol = 0.23, p = 0.002; βcase = 0.52, p = 0.001) in both groups. After adjusting for age and BMI, a 1-SD increase in dietary pattern score was associated with increased risk of VAD in PCOS (OR 2.77; 95% CI 1.15, 6.66) and control groups (OR 2.41; 95% CI 1.41-4.12). In the control group, the risk of hypercholesterolemia, hypertriglyceridemia, high LDL-C, low HDL-C, hyperglycemia and IGT + IFG increased significantly per 1-SD increase in dietary pattern score, which all remained significant after adjusting for age and BMI, except for the risk of high LDL-C. Among the cardiometabolic abnormalities, only the risk of hypertriglyceridemia was significantly associated with dietary pattern score in women with PCOS, which lost its significance after adjusting for age and BMI., Conclusion: The VAI dietary pattern affects most cardiometabolic variables in controls, but to a lesser extent in PCOS women. Our study suggests that relationships between diet and cardiometabolic risk profiles may be modified by PCOS status., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: To evaluate the longitudinal association between dietary advanced glycation end products (AGEs) and risk of chronic kidney disease (CKD) in a population-based study., Design and Setting: In a longitudinal design study, participants were evaluated after approximately 3 years. Daily consumption of carboxymethyl lysine, a major type of dietary AGEs, was determined using a validated semiquantitative food frequency questionnaire. Estimated glomerular filtration rate in this study was calculated by the Modification of Diet in Renal Disease formula. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2) based on the national kidney foundation guidelines., Subjects: A total of 1,692 participants, free of baseline CKD with complete follow-up data, out of 3,462 subjects, age ≥27 years of the third phase of Tehran Lipid and Glucose Study., Main Outcome Measures: The association between dietary AGEs and CKD was assessed using the multivariate logistic regression models., Results: The mean age of participants was 43.4 ± 11.4 years. The mean dietary intake of energy-adjusted AGEs was 8,336 ± 1,532 kU/day. By increasing trend of AGE consumption, the percentage of fat intake increased (P < .001), whereas the percentage of carbohydrates and total fiber intake decreased (P < .001). Longitudinal analysis indicated that compared to the first quartile category of AGE intakes from fat, in participants of the fourth quartile category, the risk of CKD increased (odds ratio: 2.02; 95% confidence interval: 1.16-3.54). The odds of CKD had increasing trends across increasing categories of AGE intakes from fat (P for trend <.05)., Conclusion: Higher consumption of AGEs through dietary fat was associated with higher risk of CKD incidence., (Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the association of major dietary patterns with the risk of impaired glucose and insulin homeostasis during a 3-year follow-up., Design: Fasting serum insulin (FSI), fasting (FSG) and 2 h serum glucose (2h-SG) were measured at baseline and again after 3 years. Dietary intakes were evaluated using a validated 168-item semi-quantitative FFQ and major dietary patterns were obtained using principal component analysis. Logistic regression models were used to estimate the occurrence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), pre-diabetes (IGT/IFG), β-cell dysfunction and hyperinsulinaemia across tertiles of dietary patterns, with adjustment for potential confounding variables., Setting: Tehran Lipid and Glucose Study., Subjects: Iranian men and women (n 904)., Results: Mean age of participants was 38·7 (sd 11·3) years and 44·6 % were men. Major dietary patterns were Western, traditional and healthy, which explained 25·2 % of total variance in food intake. There was a positive association between Western and traditional scores with 3-year change in 2h-SG, while the healthy pattern was negatively related to 3-year changes in FSG, 2h-SG, FSI and homeostasis model assessment of insulin resistance. Highest compared with the lowest tertile of the Western dietary pattern was accompanied by a higher risk for development of IGT (OR=3·09; 95 % CI 1·28, 7·50); a higher score on the healthy dietary pattern was associated with a significantly reduced risk of hyperinsulinaemia (OR=0·53; 95 % CI 0·28, 0·94)., Conclusions: Our findings showed that adherence to a Western dietary pattern may be a risk factor for the development of IGT, while a healthy dietary pattern may prevent hyperinsulinaemia.

Obesity has become a public health problem in adolescents and could be a risk factor for both short-term and long-term health consequences. This study aimed to evaluate the relationship of Dietary Guidelines for Americans Adherence Index (DGAI), Healthy Eating Index-2005 (HEI-2005) and Healthy Eating Index-2010 (HEI-2010) with risk of obesity associated phenotypes in Tehranian adolescents. This cross-sectional study was conducted within the framework of the Tehran Lipid and Glucose Study, on 722 adolescents, aged 10-19 years. Usual dietary intakes were assessed by a food frequency questionnaire, and diet quality scores were obtained based on DGAI, HEI-2005 and HEI-2010. General obesity and cardio metabolic risk factors were defined according to the Centers of Disease Control and Prevention and de'Ferranti cut-offs, respectively. After adjusting for age, sex, energy intake and physical activity, compared to those in the lowest quartile, participants in the highest quartile of HEI-2010 had lower risk of general obesity (OR: 0.62; 95% CI: 0.38-0.93; Ptrend = 0.03) and central obesity (OR: 0.63; 95% CI: 0.44-0.95; Ptrend = 0.04). No association was observed between different types of obesity and scores of other diet quality indices. In conclusions, considering the role of HEI-2010 in decreasing the risk of obesity, these findings suggest that HEI-2010 may be useful for assessing diet-related progress in obesity prevention efforts.

Objectives: Dietary factors play an important role in the development of hypertension (HTN). In this study, we aimed to determine the possible effect of protein foods group and its subgroups on risk of HTN after 3-year follow-up in Iranian adults., Design: Prospective study in framework of the Tehran Lipid and Glucose Study., Subjects: A total of 1,152 healthy adults, aged 20 to 84 years participated and were followed-up for 3 years., Main Outcome Measure: Usual dietary intake was assessed using a 168-item validate semiquantitative food frequency questionnaire at baseline and again after 3 years. Protein foods group was considered as the sum of meats, poultry, seafood, eggs, beans and peas, nuts, and seeds. Blood pressure was measured at baseline and after 3 years, and HTN was diagnosed by the seventh report of Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VII). To assess the odds ratio of HTN in each tertile of protein foods group and its subgroup, a multivariate logistic regression adjusted for potential confounding variables was used., Results: Mean age of participants was 36.0 ± 11.2 years, and mean intake of protein foods group was 855 ± 343 g/week (range 70.5-3,450 g/week). After 3 years of follow-up, the incidence of HTN was 12.5%. There was no significant association between dietary intakes of the protein foods group, meats, poultry, seafood, beans and peas, and nuts and seeds and the occurrence of HTN over 3 years. However, 3-year incidence of HTN was significantly decreased in the highest tertile of eggs in compared with the lowest (odds ratio: 0.54; 95% confidence interval: 0.32-0.91; P for trend = .02)., Conclusion: Our findings indicated that egg consumption could have favorable effect against development of HTN., (Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to evaluate possible effects of food fortification practices on vitamin D intake in adults., Design and Setting: This was designed as a cross-sectional, population-based study., Subjects: We investigated vitamin D intake in a population-based sample of 5224 adults, using a validated food frequency questionnaire. A theoretical model was conducted to evaluate the hypothetical effects of dairy product fortification., Results: Dairy had the highest mean of vitamin D intake among food groups. If all types of milk were fortified by vitamin D (42 IU/100 grams of milk), the mean intake of vitamin D would reach 132 ± 148 (92(180)) IU/day. If both milk and yogurt were fortified to 42 IU/100 g and 89 IU/100 g, respectively, the average mean vitamin D intake from foods in this population would increase from 84 ± 88 IU/day to 308 ± 240 IU/day. As the fortification level increased, the proportions of young people with more than the recommended daily allowance (RDA) of vitamin D increased from 1.1% to 77.4% in men and from 1.4% to 80% in women, but none of them achieved the tolerable upper intake level (UL) of vitamin D., Conclusion: The proposed fortification scenario would provide enough vitamin D intakes by RDA in a population aged between 18 and 50 years (about 80% of the population), with none of them achieving ULs.

Objective: To assess the association of adherence to Dietary Approaches to Stop Hypertension (DASH)-style diet with development of metabolic syndrome (MetS) in children and adolescents., Study Design: Dietary data were collected using a valid and reliable food frequency questionnaire among 425 healthy subjects, aged 6-18 years. MetS was defined as the presence of at least 3 of the following according to the Cook criteria: waist circumference ≥90th percentile for sex and age according to national reference curves; systolic blood pressure and/or diastolic blood pressure ≥90th percentile for sex, age, and height; fasting plasma glucose ≥100 mg/dL; triglycerides ≥110 mg/dL; and high-density lipoprotein cholesterol <40 mg/dL. The DASH-style diet score was assessed based on 8 components: high intakes of whole grain, vegetables, fruits, nuts, legumes; moderate amounts of low-fat dairy products; and low intake of red and processed meat, sweetened beverages, and sodium. Multivariable logistic regression models were used to estimate the OR and 95% CI after 3.6 years of follow-up for developing MetS in each quartile of DASH score after adjustment for baseline confounders., Results: Mean ± SD for age and DASH score were 13.6 ± 3.7 years and 24.1 ± 4.3, respectively, at baseline. The OR (95% CI) of developing MetS in the highest, compared with the lowest, quartile of DASH score was 0.36 (0.14-0.94) with a linear decreasing trend (P for trend = .023). Also, incidence of hypertension, high fasting plasma glucose, and abdominal obesity decreased with higher adherence to DASH diet (P < .05 for all)., Conclusions: Our findings indicate the relationship of adherence to DASH-style diet with MetS and some of its components in both children and adolescents., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: There is growing evidence regarding the potential properties of nitrate-rich foods in development of chronic diseases. In this study, we investigated the association of nitrate-containing vegetables (NCVs) and the risk of chronic kidney disease (CKD)., Methods: We evaluated 1546 eligible adult participants of the Tehran Lipid and Glucose Study (TLGS), at baseline (2006-2008) and again after 3 years (2009-2011). Dietary intake was collected using the validated semi-quantitative food frequency questionnaire. Nitrate-containing vegetables and its categories including high-, medium-, and low-nitrate vegetables were defined. Estimated glomerular filtration rate (eGFR) and CKD were defined. Association between NCVs and CKD in the cross-sectional phase and the predictability of NCVs consumption in CKD occurrence were assessed using multivariable logistic regression models with adjustment for potential confounders., Results: Mean dietary intake of energy-adjusted NCVs was 298.0 ± 177.3 g/day. Highest compared to the lowest tertile of NCVs was accompanied with a significantly lower mean eGFR (76.6 vs. 83.3, mL/min/1.73 m(2), p < 0.001) and a higher prevalence of CKD (21.7 vs. 9.9%, p < 0.001). At baseline, higher intake of high-NCVs was associated with a 48% higher chance of having CKD (OR = 1.48, 95% CI = 1.05-2.13). After 3 years of follow-up, there was no significant association between consumption of total NCVs and its categories with the occurrence of CKD., Conclusion: Considering the lack of association between high-NCVs intakes and the risk of CKD in prospective analysis, additional research is recommended to clarify possible effect of nitrate intakes from vegetables on kidney function.