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The incidence of hypertension (HTN) and consumption of ultra-processed foods are increasing worldwide. However, only a limited amount of research has assessed the causality between ultra-processed foods and the risk of HTN. Therefore, the present study aimed to determine the association between ultra-processed foods and the risk of HTN in a prospective cohort study. In the present study, we included 2399 individuals, aged approximately 19 years, who participated in the Tehran Lipid and Glucose Study (TLGS). The participants had complete dietary data and were free from HTN at baseline. We used the Cox proportional hazards model to determine the association between ultra-processed food intake and the risk of HTN occurrence, reporting the results as the hazard ratio (HR) and 95% confidence interval (95% CI). The mean age of participants was 37.6 years, and we followed them up for an average of 9.21 years. Our results indicated that participants in the highest tertile of ultra-processed foods had a 48% higher risk of HTN development (HR: 1.48; 95% CI: 1.23, 1.79) than those in the lowest tertile. We found a significant association between age and ultra-processed food intake in relation to the risk of HTN. The HR for developing HTN in participants aged <47 years was 1.99 (95% CI: 1.53, 2.58) and in participants aged ≥47 years was 1.26 (95% CI: 0.95, 1.68). Among the ultra-processed food components, consumption of industrial fat products had a positive correlation with the risk of HTN (HR: 1.04; 95% CI: 1.02 to 1.06). Our results suggest that consuming ultra-processed foods is associated with an increased incidence of HTN in adults. This association varied by age and was significant for adults younger than 47 years.

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).)

This study aimed to investigate the interaction of the healthy eating index (HEI) and the dietary approach to stop hypertension (DASH) diet scores with FTO polymorphisms in relation to change in obesity traits. A total of 4480 subjects aged ≥ 18 years were selected from participants of the Tehran lipid and glucose study and followed-up 3 years. Selected polymorphisms (rs1421085, rs1121980, rs8050136) were genotyped and genetic risk score (GRS) was computed. HEI and DASH scores were computed based on dietary data. Changes in body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and visceral adiposity index (VAI) were measured. Higher adherence to both DASH and HEI scores were increased with higher ages. Individuals with high GRS had a lower change in BMI when they had higher adherence to HEI, compared to subjects with lower HEI score (P trend = 0.01). Change in WC in participants in the fourth quartile of HEI score in minor allele carriers of FTO variants was lower compared to the first quartile; conversely, higher adherence to the DASH score by this genotypic group was related to increase in WC. No significant interaction was seen between FTO polymorphisms and both diet scores regarding changes in any of obesity traits. In conclusion, in individuals with high GRS higher adherence to HEI score was associated with lower change in BMI and WC, while higher adherence to DASH diet was associated with higher change in WC, compared to individuals with lower adherence to both scores., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: A metabolically unhealthy phenotype is associated with the risk of cardiometabolic events and can be prevented by adherence to healthy dietary patterns. The present study was designed to investigate the association between high adherence to the Dietary Approaches to Stop Hypertension (DASH), Mediterranean (MeDi), and Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet scores and the incidence of metabolically unhealthy phenotypes in adults across body mass index (BMI) categories., Methods: In this cohort study, 512 subjects with metabolically healthy normal weight (MHNW) at baseline and 787 subjects with metabolically healthy overweight/obesity (MHOW/MHO) at baseline were included. Dietary intake was collected by a validated food frequency questionnaire, and DASH, MeDi, and MIND scores were calculated. The Joint Interim Statement (JIS) criteria were used to define a metabolically unhealthy status., Results: A total of 137 and 388 subjects with metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUOW/MUO) phenotypes, respectively, were observed, over a mean of 5.91 years of follow-up. The Cox proportional hazard regression indicated participants in the third tertile of the DASH score had a lower risk of the MUNW phenotype (HR: 0.59; 95% CI: 0.37-0.92) than those in the lowest tertile. Similarly, the highest adherence to the MeDi and MIND scores was also linked to a 46% (HR: 0.54; 95% CI: 0.36-0.81) and 47% (HR: 0.53; 95% CI: 0.34-0.83) lower risk of the MUNW phenotype, respectively. As well, there was an inverse relationship between the highest adherence to the DASH (HR: 0.66; 95% CI: 0.50-0.86), MeDi (HR: 0.74; 95% CI: 0.58-0.93), and MIND (HR: 0.57; 95% CI: 0.43-0.74) scores and the risk of MUOW/MUO. There was no interaction between age and the three dietary patterns in relation to a metabolically unhealthy phenotype., Conclusion: High compliance with the DASH, MeDi, and MIND scores was associated with a lower risk of MUNW. An inverse relationship between these three dietary patterns and the incidence of the metabolically unhealthy phenotype was also observed in individuals who had MHOW/MHO at baseline., Competing Interests: Conflict of Interest The authors declare no competing interests., (Copyright © 2023 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

The current study aimed to examine the possible association of the dietary index for insulin resistance (DIR) and the lifestyle index for insulin resistance (LIR), determined by dietary components, body mass index, and physical activity, with the risk of cardiometabolic diseases, including insulin resistance (IR), hypertension (HTN), diabetes, and metabolic syndrome (MetS). This prospective cohort study was performed on 2717 individuals aged ≥ 19 years in the framework of the Tehran Lipid-Glucose Study. Data on nutritional intakes were assessed using a validated food frequency questionnaire. Logistic regression models were used to determine the odds ratio and 95% confidence intervals (ORs and 95% CIs) of cardiometabolic diseases across tertiles of DIR and LIR scores. During 3-years of follow-up, the incidence rate of diabetes, IR, HTN, and MetS was 3%, 13%, 13.9%, and 17%, respectively. In the multi-variables model, after controlling all potential confounders, the risk of IR(OR: 1.65, 95% CI 1.01-2.69, P-trend = 0.047), diabetes (OR: 1.95, 95% CI 1.02-3.74, P-trend = 0.058), and HTN(OR: 1.52, 95% CI 1.07-2.15, P-trend = 0.016) was increased across tertiles of DIR score. Also, the risk of IR (OR: 2.85, 95% CI 1.72-4.73, P-trend < 0.001), diabetes(OR: 2.44, 95% CI 1.24-4.78, P-trend = 0.004), HTN(OR: 1.95, 95% CI 1.35-2.81, P-trend < 0.001), and MetS (OR: 2.87, 95% CI 1.96-4.18, P-trend < 0.001) were increased across tertiles of LIR score. Our findings reported that a dietary pattern with a higher DIR score and a lifestyle with a higher LIR score might be related to increased cardiometabolic disorders, including diabetes, HTN, Mets, and IR in Iranian adults., (© 2023. The Author(s).)

Background: Despite the favorable effects of well-known dietary patterns in the treatment of hypertension (HTN), such as the Mediterranean (MED) and Dietary Approach to Stop Hypertension (DASH) diets, it is uncertain if adherence to these diets can reduce the risk of HTN, especially in non-Mediterranean populations. Moreover, none of the previous studies evaluated the association between the MED-DASH Intervention for Neurodegenerative Delay (MIND) diet adherence and the incidence of HTN. Therefore, we aimed to assess the association of adherence to these diets with the development of HTN in adults., Methods: This prospective study included 2706 adults free of HTN who were selected from the Tehran Lipid and Glucose Study. The MED, DASH, and MIND diet scores were computed at baseline using dietary information collected with the food frequency questionnaire. Associations between the dietary indices and risk of HTN over a median follow-up of 7.4 years were examined using Cox proportional hazards regression analysis., Results: The baseline mean age of participants was 37.9 ± 12.5 years (age range: 20-79 years), and 52.4% were women. During the 18262 person-years follow-up, 599 incidents of HTN were identified. There was no significant relationship between the dietary scores and the risk of HTN, either as continuous or categorical variables, even after excluding individuals with early/late HTN diagnosis, prehypertension, diabetes, or chronic kidney disease at baseline. A significant interaction was found between body mass index (BMI) and DASH (P-interaction < 0.001). Stratified analyses based on baseline BMI status revealed an inverse association between DASH and HTN risk in individuals with normal-weight (HR = 0.84, 95% CI = 0.71-0.98, P = 0.031), although this association did not reach statistical significance across the tertiles of DASH., Conclusions: In this study, MED, DASH, and MIND showed no significant association with the occurrence of HTN in adults. Further prospective studies on diverse populations are required to assess whether adherence to the MED, DASH, and MIND diets is an effective strategy for reducing the occurrence HTN., (© 2022. The Author(s).)

Inulin is a prebiotic and has beneficial effects on health, such as improving the immune function, lipid profile, and gut microbiota. Some previous studies have assessed the effects of inulin supplementation on cardiometabolic diseases, but the relationship between dietary inulin and these diseases has not been investigated yet. Thus, this survey was designed to assess the potential association between the dietary intake of inulin and the incidence of cardiometabolic diseases, including cardiovascular disease (CVD), hypertension (HTN), chronic kidney disease (CKD), and type 2 diabetes (T2D) among adults. The present prospective cohort study was conducted on participants in the third wave of the Tehran Lipid and Glucose Study (2006-2008) and was followed up until March 2018. The dietary intake of inulin was estimated using a special database that reports values of inulin and oligofructose in grams per 100 g of each food. Cox proportional hazards regression showed that higher consumption of inulin was associated with a lower risk of HTN (HR: 0.79, 95% CI: 0.63 to 0.99) and T2D (HR: 0.94, 95% CI: 0.89 to 1.00). We found no relationship between higher consumption of dietary inulin and the incidence of CKD and CVD in our population. According to our results, it seems inulin from foods had a preventive effect against HTN and T2D, which are major risk factors for cardiovascular and renal events. However, more investigations are warranted.

Aims: This study aimed to investigate the effect of replacing plant proteins with animal proteins in the dietary approaches to stop hypertension (DASH) diet on cardiometabolic risk factors in obese metabolic syndrome participants., Methods: In this double-blind randomized controlled clinical trial, 90 obese patients with metabolic syndrome, aged 30-70 years were randomly allocated into the DASH diet based on plant or animal proteins for 8 weeks. Fasting blood samples were collected to assess the biochemical markers. Also, blood pressure, weight, and waist circumference (WC) were measured at the beginning and end of the trial., Results: The participants in both groups experienced significant reductions in the fasting plasma glucose (FPG), systolic blood pressure (SBP) and diastolic blood pressure (DBP), triglyceride (TG) concentrations, weight and WC. However the reduction in FPG and SBP was higher in the plant-based DASH group, compared to the animal-based DASH group, after adjustment for weight change. No significant changes were found within or between groups with regard to total cholesterol, LDL-C, HDL-C., Conclusions: Substituting plant proteins with animal proteins in the DASH diet improves FPG and SBP in obese individuals with metabolic syndrome, independent of weight change. IRCT registration number: IRCT20090203001640N16., Competing Interests: Declaration of interest The authors declared there is no conflict of interest., (Copyright © 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Childhood hypertension which increases the risk of cardiovascular diseases in adulthood is becoming more prevalent. For the first time in the Middle-East region, this study aimed to assess the long-term effectiveness of a community-based lifestyle intervention on the incidence of hypertension in school-aged children during 16 years of follow-up. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were 2080 children aged 8-18 years with normal blood pressure who were under the coverage of three health care centers selected using multistage cluster random sampling method. One of the health care centers far from the other two was selected for implementing lifestyle intervention (1053 children, 48.2% boys). Triennial examinations were conducted, and survival Cox models were used to assess intervention effects on the incidence of hypertension in boys and girls. Crude incidence rates (per 1000 person-years) of hypertension were 8.11, 3.7, and 5.8 among boys, girls, and the total sample, respectively. Our results showed that HTN has occurred significantly less (P = 0.025) in the intervention group than in the control group, only in female participants. These results remained significant even after adjusting for individuals' and parental characteristics (P = 0.033). Although the risk of hypertension in boys was more than twice that observed in girls, the effectiveness of the recent community-based healthy lifestyle intervention was observed only in girls and not in boys. Further studies are needed to understand gender differences in promoting the effectiveness of similar future programs. The TLGS is registered at Iran Registry for Clinical Trials, a WHO primary registry (http://irct.ir; IRCTID: IRCT138705301058N1)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Milk-protein-derived bioactive peptides (BPs) have been proposed as modulators of different regulatory processes involved in blood pressure regulation. Studies on the long-term effects of BPs on blood pressure have not yet been conducted. We aimed to investigate the association of dairy-originated BPs with the risk of hypertension (HTN) in the Tehran Lipid and Glucose Cohort Study (TLGS). In this cohort study, 4378 subjects with a mean follow-up period of 3.1 years were included in the final analysis. Dietary intake, physical activity, demographic, and anthropometric data and blood pressure measurements were obtained for all participants. Various types of dairy-originated BPs were determined by an in silico method. High intake of total digestion-resistant and bioactive peptides (OR: 1.31, CI 95%: 1.01-1.70), dipeptides (OR: 1.33, CI 95%: 1.03-1.73), peptides with more than seven residues (OR: 1.32, CI 95%: 1.01-1.71), glycosylated residues (OR: 1.39, CI 95%: 1.07-1.80), highly hydrophilic peptides (OR: 1.32, CI 95%: 1.01-1.71), and low hydrophobic peptides (OR: 1.32, CI 95%: 1.01-1.71) was associated with an increased risk of HTN in the adjusted model. In addition, subjects in the higher tertile of anti-HTN peptide (OR: 1.33, CI 95%: 1.02-1.72) and antidiabetic peptide (OR: 1.35, CI 95%: 1.04-1.76) intake had a higher risk of HTN than those in the lower tertile. No significant association emerged between calcium intake from dairy and incident risk of HTN. Our results showed that the intake of some forms of digestion-resistant and BPs, such as anti-HTN peptides, dipeptides, and peptides with more than seven residues, can increase the risk of HTN in the TLGS population., (© 2021. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Objectives: This study aimed to examine the secular trends of dietary food groups and diet quality among adults, overall and by sex, education, and employment status., Methods: This study was conducted within the framework of the Tehran Lipid and Glucose Study. Demographic and anthropometric measurements were gathered using standard questionnaires. In terms of socioeconomic information, participants were divided into two groups according to their educational level and employment status. The regular dietary intakes of participants were gathered with a validated and reliable food frequency questionnaire over the previous year, and Dietary Approaches to Stop Hypertension scores were computed to evaluate diet quality. Generalized estimating equations were used to assess secular trends in food groups within the four phases., Results: From 2006 to 2017, intake of whole grains, legumes, and nuts and seeds increased, and intake of refined grains, dairy products, and solid fats decreased significantly (P for trend < 0.001). Dietary fruit, vegetable, meat, and soft drink intake did not change significantly. According to socioeconomic groups, meat intake decreased significantly among men, uneducated, and unemployed participants, and fruit intake increased in both women and educated participants. Based on a 40-point scale, the Dietary Approaches to Stop Hypertension score increased from 18.1 ± 0.0 in phase1 to 22.7 ± 0.1 in phase 4 of the Tehran Lipid and Glucose Study (P for trend < 0.001)., Conclusions: Over a decade, in addition to improvements in intake of a number of dietary food groups, the estimated overall diet quality of the study population showed a modest improvement. These findings may determine areas for more attention to improve the overall dietary intake of the population., (Copyright © 2021 Elsevier Inc. All rights reserved.)

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: The aim of this study was to investigate the association of dietary patterns with incident hypertension., Materials/methods: This prospective study was conducted on 4793 individuals of Tehran lipid and glucose study participants, aged ≥ 18 years who were followed for a median of 6.3 years from 2008-2011 to 2016-2018. A valid and reliable semi-quantitative food frequency questionnaire was used to assess usual dietary intakes. Anthropometrics and blood pressure were assessed at baseline and during follow up examinations. Dietary patterns were derived using principal component analysis (PCA). Healthy eating index (HEI) and dietary approach to stop hypertension (DASH) score were measured based on dietary recommendations. Time-dependent Cox models adjusting for confounders were used to examine the association between dietary patterns and the risk of hypertension., Results: During follow-up, a total of 727 incident cases of hypertension were identified. The mean ± SD age at baseline was 40.3 ± 13.5 and 37.9 ± 12.1 years in men and women, respectively. Two dietary patterns (the healthy and unhealthy) were extracted by PCA. Compared with participants in the first quartile, a 23% (HR: 1.23; 95%CI 1.00-1.53; P trend: 0.056) increased risk of hypertension was found in the fourth quartile of HEI score. This association was disappeared after further adjustment for confounders. Increasing DASH score, the healthy and unhealthy dietary pattern were not associated with risk of hypertension., Conclusion: Our findings showed that higher adherences to the posteriori- and priori-dietary patterns were not associated with risk of hypertension in this population.

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.

Introduction: To the best of our knowledge, no comprehensive meta-analysis has been carried out to investigate the effect of different approaches of fasting and calorie restriction on blood pressure.  AIM: Thus, the present systematic review and meta-analysis was designed to examine the effect of fasting and energy restricting diets on blood pressure in adult subjects., Methods: We searched PubMed/Medline, Scopus, the Cochrane Library, and Google Scholar up to June 2019. The clinical trials that examined the effects of fasting and energy restricting diets on Blood Pressure was identified using MESH and non-MESH terms., Results: 23 studies, including a total of 1397 participants, reported SBP and DBP as an outcome measure. Overall results from the random-effects model indicated that fasting and energy restricting administration elicited significant changes in SBP (weight mean difference (WMD): - 1.88 mmHg, 95% CI - 2.50, - 1.25) and DBP (WMD - 1.32 mmHg, 95% CI - 1.81, - 0.84, p = 0.000). Subgroup analyses displayed that intervention duration ≤ 12 weeks more effectively reduced SBP (WMD: -3.26 mmHg) and DBP (WMD - 1.32 mmHg). In addition, these analyses showed that fasting regimens (WMD - 3.26 mmHg) more effectively reduced SBP than energy restricting diets (WMD - 1.09 mmHg)., Conclusion: The principal finding of this study was that fasting and energy restricting diets elicited, overall, significant reductions in SBP and DBP. Subsequent subgroup analyses revealed that intervention duration ≤ 12 weeks and fasting regimens more effectively reduced SBP and DBP.

The current study aimed at investigating the association between Dietary Approach to Stop Hypertension (DASH) diet and odds of obesity phenotypes, is a cross sectional study conducted on 3218 Iranian overweight or obese participants (BMI >25 kg/m 2 ), aged ≥20 years, who participated in the fourth phase (2009-2011) of the Tehran Lipid and Glucose Study. Using a valid and reliable food-frequency questionnaire, DASH diet scores between 8 and 40 points were determined. Obesity phenotypes including metabolic unhealthy obesity (MUHO) and metabolic healthy obesity (MHO) were defined using criteria of the Joint International statement(JIS) for metabolic syndrome. Multivariable logistic regression was used to determine the odds ratio (OR) for obesity phenotypes according to the tertiles of the DASH diet. Mean ± SD age of participants (43.5% male) was 39.2 ± 9.5 years and median (25-75 interquartile range) DASH diet score was 24 (21-27); percentages of MHO and MUHO subjects were 33.4 and 66.6%, respectively. In the multivariable adjusted model, after controlling for age, sex, BMI, physical activity, smoking status, socioeconomic status, and energy intake, participants in the highest tertile of DASH diet had lower odds of MUHO (OR:0.79;95%CI:0.64-0.98), in comparison to those in the lowest one (P for trend = 0.040). Our findings indicate that adherence to DASH diet may be favourable in prevention of metabolic abnormalities in overweight and obese individuals.

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.

Aim: This study was conducted to investigate whether serum NO metabolites (NO x ) could predict the occurrence of type 2 diabetes (T2DM), hypertension (HTN) and metabolic syndrome (MetS). Methods: We measured serum NO x concentrations in the Tehran Lipid and Glucose Study participants (aged ≥19 years) and followed them for a median of 7.7 years for the incidence of outcomes. To determine the appropriate cut-off points of serum NO x for predicting clinical events, a random sampling method (50:50 ratio) was used for the population and for analysis, receiver operator characteristic curve was used. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence intervals (95% CIs) of T2DM, HTN and MetS in response to serum NO x values. Results: The optimal cut-off points of serum NO x levels for predicting T2DM, HTN and MetS were 26.5, 25.5 and 25.5 µmol/L, respectively. Participants with serum NO x levels ≥25.5 µmol/L had increased risk of MetS (HR = 1.31, 95% CI = 1.01-1.72). No evidence was found for any association of serum NO x with incidence of T2DM and HTN (HR = 1.03, 95% CI = 0.83-1.77 and HR = 1.09, 95% CI = 0.88-1.35). Conclusion: In this prospective population-based investigation, a higher circulating NO x was associated with development of MetS.

Background: Dietary amino acids have been associated with blood pressure (BP) in previous studies; we conducted this study to examine the association between dietary branched chain amino acids (BCAAs) and the incidence of hypertension among participants of the Tehran Lipid and Glucose Study (TLGS)., Methods: Analyses were conducted on 4,288 participants aged 20-70 years, who were free of hypertension at baseline (2008- 2011) and were followed for 3 years (2011-2014) to ascertain incident hypertension. Dietary intakes of BCAAs including, valine, leucine, and isoleucine were collected at baseline using the food frequency questionnaire (FFQ). Odds ratio (OR) of hypertension were determined by logistic regression across quartiles of BCAAs, adjusted for sex, age, smoking status, physical activity, body mass index (BMI), diabetes, and some dietary factors., Results: The mean ± standard deviation for age and BMI of participants (41.9% men) were 39.7 ± 12.8 years and 26.9 ± 4.6 kg/ m2 , respectively. The median intakes of total BCAAs, valine, leucine, and isoleucine was 17.9, 5.5, 7.8, and 4.5 percentage of total amino acids intake, respectively. We documented 429 (10%) hypertension incident cases. The multivariable adjusted OR for the highest vs lowest quartiles of BCAAs was 1.54 (95% confidence interval (CI):1.03-2.32; P for trend = 0.05); furthermore, the OR (95% CI) of hypertension for the highest vs the lowest quartile of valine was 1.61 (1.10-2.36; P for trend = 0.009) in the fully adjusted model. However, we found no significant association between leucine and isoleucine with incidence of hypertension., Conclusion: Findings indicated that higher BCAA intake, in particular valine, is associated with higher risk of incident hypertension., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Considering the fact that subjects with dysglycemia, dyslipidemia or high blood pressure are at high risk for chronic kidney disease (CKD), long-term adherence to the Dietary Approaches to Stop Hypertension (DASH)-style diet may contribute to the prevention of CKD. This study, examined the association between adherence to the low-sodium DASH-style diet and incident CKD among high-risk adults over 3 years of follow-up., Methods: In this prospective cohort study (followed up for 3 years, 2012-15), we selected 1100 subjects with dysglycemia, 2715 with dyslipidemia and 2089 with high blood pressure, all of whom were free of CKD at baseline (2009-11) in a subgroup of the Tehran Lipid and Glucose Study. The low-sodium DASH-style diet was designed based on eight foods and nutrients using a food frequency questionnaire. Estimated glomerular filtration rate (eGFR) was calculated and CKD was defined as eGFR <60 mL/min/1.73 m2., Results: After 3 years of follow-up, among subjects with dysglycemia, dyslipidemia or high blood pressure, the rate of incident CKD was ∼16%. In multivariable-adjusted analyses for participants in the highest compared with the lowest quartile of the low-sodium DASH-style diet score, the odds ratio was 0.58 [95% confidence interval (CI) 0.36-0.92] for subjects with dysglycemia, 0.64 (95% CI 0.48-0.87) for subjects with dyslipidemia and 0.62 (95% CI 0.44-0.87) for subjects with high blood pressure., Conclusions: Higher adherence to the low-sodium DASH-style diet might be associated with a lower risk of incident CKD among high-risk adults, highlighting the importance of adherence to the low-sodium DASH-style diet in substantially reducing both the occurrence of CKD and the burden imposed by it in the future.

Background: Current evidence available on the association between Dietary Approach to Stop Hypertension (DASH) diet and cardiovascular risk in adolescents is controversial., Objective: The aim of the present study was to assess the association between DASH diet and cardiovascular risk factors after 3 years of follow-up among Tehranian adolescents., Methods: A population-based cohort study was conducted on 628 subjects, aged 10-18 years, selected from among participants of the Tehran Lipid and Glucose Study. The DASH score was determined on the basis of eight components using a valid and reliable food-frequency questionnaire at baseline. Anthropometric and lipid profile data were measured at baseline and after a 3-year follow-up., Results: Mean (SD) age of the study population (46.6% men) was 14.1 (2.5) years. After adjustment for potential confounding variables, including sex, age, physical activity and total calorie intake, the risk of general obesity (OR = 0.26, 95%CI: 0.15-0.76) and central obesity (OR = 0.32, 95%CI: 0.14-0.84) in the highest quintile of DASH score were significantly lower than in subjects in the lowest quintile. However, DASH score was not associated with risk of incident dyslipidaemia in our study (OR = 0.81, 95%CI: 0.30-1.82). The higher DASH score was inversely associated with 3-year changes in body mass index and waist circumference during the study period (P for trend <0.05). However, there was no significant association between the higher score of this diet with 3-year changes in lipid profiles., Conclusion: Adherence to the DASH diet was associated with decreased risk of central and general obesity, whereas higher DASH diet score was not associated with risk of dyslipidaemia in adolescents., (© 2018 World Obesity Federation.)

Objective: There is an interaction between dietary sodium/potassium intake in the pathogenesis of hypertension (HTN) and cardiovascular disease (CVD). The aim of this study was to investigate the association of dietary sodium to potassium (Na/K) ratio and the risk of HTN and CVD in a general population of Iranian adults., Methods: In this prospective cohort study, adults men and women with complete baseline data were selected from among participants of the Tehran Lipid and Glucose Study and were followed up for 6.3 years for incidence of HTN and CVD outcomes. Dietary sodium and potassium were assessed using a valid and reliable 168-item food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between dietary sodium, potassium and their ratio and risk of outcomes., Results: During the study follow-up, 291 (15.1%) and 79 (5.0%) new cases of HTN and CVD were identified, respectively. No significant association was observed between usual intakes of sodium, potassium and dietary Na/K ratio with the incidence of HTN. There was no significant association between dietary intakes of sodium and potassium per se and the risk of CVD, whereas when dietary sodium to potassium ratio was considered as exposure in the fully-adjusted Cox regression model, and participants in the highest compared to lowest tertile had a significantly increased risk of CVD (HR = 2.19, 95% CI = 1.16-4.14)., Conclusions: Our findings suggest that high dietary Na/K ratio could contribute to increased risk of CVD events.

Recent studies investigated the relation between amino acids and blood pressure. Our aim was to examine the association between intake of aromatic amino acids (AAAs) and risk of hypertension. A total of 4288 individuals, aged 20-70 years, participants of the Tehran Lipid and Glucose Study, who were free of hypertension at baseline (2008-2011), were followed for 3 years (2011-2014). Average intakes of AAAs including phenylalanine, tyrosine, and tryptophan were collected using a valid and reliable food frequency questionnaire at baseline. Adjusted logistic regression models were used to report odds ratio (OR) of hypertension across quartiles of AAAs. At the end of follow-up, 429 (10%) hypertension cases were ascertained. The adjusted OR of hypertension for percentage of AAAs from total protein intakes was 1.63 (95% confidence interval, 1.06-2.50; P for trend: .03) when comparing the highest quartile to the lowest. Furthermore, in the adjusted analyses, a statistically significant positive relationship was observed between the highest versus the lowest quartile intake of phenylalanine (OR = 1.66; 95% confidence interval, 1.14-2.47; P for trend: .03). However, there was no significant association of tyrosine and tryptophan intakes with hypertension risk. Our data suggest that AAAs may increase the risk of incident hypertension., (Copyright © 2017 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Beetroot is considered a complementary treatment for hypertension because of its high content of inorganic NO 3 This systematic review and meta-analysis aimed to clarify several aspects of beetroot juice supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP). We searched PubMed, Scopus, and Embase databases, and the reference lists of previous reviews. Randomized clinical trials that investigated the effects of beetroot juice on resting blood pressure in humans were recruited for quality assessment, meta-analyses, subgroup analyses, and meta-regressions; of these, 22 were conducted between 2009 and 2017 and included a total of 47 intervention ( n = 650) and 43 control ( n = 598) groups. Overall, SBP (-3.55 mm Hg; 95% CI: -4.55, -2.54 mm Hg) and DBP (-1.32 mm Hg; 95% CI: -1.97, -0.68 mm Hg) were significantly lower in the beetroot juice-supplemented groups than in the control groups. The mean difference of SBP was larger between beetroot juice-supplemented and control groups in the longer than in the shorter (≥14 compared with <14 d) study durations (-5.11 compared with -2.67 mm Hg) and the highest compared with the lowest (500 compared with 70 and 140 mL/d) doses of beetroot juice (-4.78 compared with -2.37 mm Hg). A positive correlation was observed between beetroot juice doses and the mean differences of blood pressures. In contrast, a smaller effect size of blood pressures was observed after supplementation with higher NO 3 (milligrams per 100 mL beetroot juice). A weak effect size was observed in a meta-analysis of trials that used NO 3 -depleted beetroot juice as a placebo compared with other interventions (-3.09 compared with -4.51 mm Hg for SBP and -0.81 compared with -2.01 mm Hg for DBP). Our results demonstrate the blood pressure-lowering effects of beetroot juice and highlight its potential NO 3 -independent effects., Competing Interests: Author disclosures: ZB, PM, AK, FA, and AG, no conflicts of interest., (© 2017 American Society for Nutrition.)

Objectives: This study investigated the association between habitual consumption of allium vegetables (garlic and onion) and the incidence of cardiovascular disease (CVD) outcomes, hypertension (HTN), chronic kidney disease (CKD), and type 2 diabetes (T2D)., Methods: Adult men and women, participated in the Tehran Lipid and Glucose Study (2006-2008 to 2012-2014), were recruited. Habitual dietary intakes were assessed using a validated semiquantitative food frequency questionnaire. Demographics, anthropometrics, blood pressure, and biochemical variables were evaluated at baseline and during follow-up examinations. Multivariate Cox proportional hazard regression models adjusted for potential confounders were used to estimate the development of CVD outcomes, HTN, CKD, and T2D in relation to allium vegetable intakes., Results: Mean age of participants (44.2% men) was 40.3 ± 14.3 years, at baseline. During an average of 6 years of follow-up, the incidence rate of CVD outcomes, HTN, CKD, and T2D were 3.3, 15.5, 17.9, and 6.7%, respectively. A higher habitual intake of allium vegetables was associated with a 64% reduced risk of CVD outcomes (hazard ratio = 0.36, 95% confidence interval, CI = 0.18-0.71; P for trend = 0.011), 32% lower incidence of CKD (hazard ratio = 0.69, 95% CI = 0.46-0.98; P for trend = 0.11), and 26% decreased HTN development (hazard ratio = 0.74, 95% CI = 0.54-1.00; P for trend = 0.06). No significant association was observed between allium vegetable intakes and the risk of T2D. Allium vegetable intake was related to 6 years' changes of triglyceride levels (β = -0.81, P = 0.01) and creatinine clearance (β = 0.56, P = 0.01)., Conclusion: Data of the current study support the available mechanistic findings regarding cardiorenal protective properties of allium vegetables.

Background: This study was conducted to examine the association of adherence to the Dietary Approaches to Stop Hypertension (DASH)-style diet with incident chronic kidney disease (CKD) among an Iranian population., Methods: We followed-up 1630 participants (50.5% women, mean age: 42.8 years) of the Tehran Lipid and Glucose Study for 6.1 years, who were initially free of CKD. Baseline diet was assessed using a valid and reliable 168-item food frequency questionnaire. A DASH-style diet, based on scoring eight components (fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed meats, sweetened beverages and sodium) was used. 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 m2. Odds ratio (OR) using multivariable logistic regression was reported for the association of incident CKD with DASH-style diet score., Results: The incidence of CKD among those in the top quintile of the DASH-style diet was 30%, 18% lower than those in the bottom quintile. After controlling for age, sex, smoking, total energy intake, body mass index, eGFR, triglycerides, physical activity, hypertension and diabetes, adherence to the DASH-style diet was found to be inversely associated with incident CKD (OR: 0.41; 95% confidence interval: 0.24-0.70). In addition, higher scores of fruits, whole grains, nuts and legumes, sweetened beverages and sodium were inversely associated with incidence of CKD., Conclusion: Results revealed that after 6.1 years of follow-up, adherence to the DASH-style diet was associated with a lower risk of incident CKD among adults., (© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

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.

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: 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 of the potential properties of nitrate-rich foods against development of hypertension (HTN) and vascular disease. In this study, we investigated the association of nitrate-containing vegetables (NCVs) with risk of HTN after 3 years of follow-up., Methods: This prospective study was conducted on 1546 non-hypertensive subjects, aged 20-70 years. Blood pressure was measured at baseline and after 3 years and HTN was defined by the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. Dietary intake was collected using a validated semi-quantitative food frequency questionnaire (FFQ). NCVs and high-, medium- and low-NCV subcategories were defined, and the odds of HTN after 3 years according to tertiles of NCV and NCV-category intake were estimated by logistic regression and adjusted for potential variables., Results: Mean age of participants was 38.0 ± 12.0 years at baseline and 57.0 % were women. Mean dietary intake of energy-adjusted NCV was 298.0 ± 177.3 g/day. After adjustment for total energy intake, fiber, sodium, potassium and processed meat, a significant inverse association was observed between NCV and the risk of HTN in the highest tertile category (odds ratio 0.63, 95 % confidence interval: 0.41-0.98, p for trend = 0.05). There was no significant association of 3 year risk of HTN across tertiles of low nitrate-, medium nitrate- and high-nitrate vegetables., Conclusion: Higher dietary nitrate intake from vegetables sources may have a protective effect against development of HTN.

Background/objective: The epidemiological association of phytochemical-rich foods with the risk of hypertension is unclear. This study aimed to determine the association of dietary phytochemical index (PI) with the occurrence of hypertension (HTN) after 3 years of follow-up in Tehranian adults., Subjects/methods: This prospective study was conducted on 1546 nonhypertensive subjects, aged 20-70 years. Dietary intake was collected by validated semiquantitative food frequency questionnaire (FFQ). Dietary PI was calculated as (dietary energy derived from phytochemical-rich foods (kcal)/total daily energy intake (kcal)) × 100. Blood pressure was measured at baseline and after 3 years of follow-up and HTN was defined by Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. The odds of HTN after 3 years in each quartile category of dietary PI were estimated by logistic regression model and adjusted for potential variables., Results: The mean age of participants was 38.0±12.0 years and 43% were male. The mean dietary PI was 29.1±11.8. After 3 years of follow-up, 265 (17.1%) new cases of HTN were identified. No significant changes were observed in the systolic and diastolic blood pressure across quartile categories of dietary PI. After adjustment for confounders, the odds (95% confidence interval) of HTN across quartiles of dietary PI were 1.00, 0.97 (0.62-1.38), 0.69 (0.45-1.07) and 0.52 (0.32-0.84) (P for trend=0.004)., Conclusions: Consumption of phytochemical-rich foods may prevent the development of HTN. Further investigations are, however, recommended.

Objectives: Data on secular trends in adolescent obesity and dyslipidemia are limited. Data on obesity status collected during 3 surveys were used to evaluate these trends in obesity and dyslipidemia among Tehranian adolescents and to assess the likelihood of risk factors for cardiovascular disease., Methods: We analyzed data for adolescents (age 10 to 19 years) from 3 cross-sectional surveys of the Tehran Lipid and Glucose Study: 1999-2001 (n = 3010, 47.2% males), 2002-2005 (n = 1107, 48.4% males), and 2006-2008 (n = 1090, 46.6% males). Overweight and abdominal obesity were defined using Iranian body mass index (BMI) percentiles, International Obesity Task Force (IOTF) criteria, and Iranian waist circumference (WC) charts. Hypertension was defined by using the National Heart, Lung, and Blood Institute's recommended cut points, and dyslipidemia was defined according to the recent recommendations of the American Heart Association., Results: The overall adjusted prevalences of "at risk for overweight" and overweight changed from 13% and 8% (using Iranian cutoffs), respectively, and 14.8% and 4.7% (using IOTF criteria) in 1999-2001 to 19% and 15% (Iranian cutoffs) and 23.0% and 9.2% (IOTF criteria) in 2006-2008 (P < 0.01 for all comparisons). The prevalence of abdominal obesity increased in males from 14.5% in 1999-2001 to 33.3% in 2006-2008 (P < 0.001). Almost half the adolescents had low high-density lipoprotein cholesterol (HDL-C) in the 3 surveys. In all surveys, as BMI and WC increased, multivariate age- and sex-adjusted odds ratios of low HDL-C and high triglyceride levels significantly increased. Overweight was associated with a greater likelihood of these risk factors, as compared with increased WC., Conclusions: Overweight and abdominal obesity are increasing in Tehranian adolescents, and these increases are accompanied by abnormalities in levels of serum triglyceride and HDL-C.

Background: It has been suggested that health professionals may discard measurement of hip circumference from public health screening efforts. Before discarding the hip circumference in epidemiological surveys, it is important to consider whether any important information is likely to be lost., Objective: To evaluate the relationship between hip circumference and metabolic risk factors in an urban adult population of Tehranian women., Design: In this population-based cross-sectional study, a representative sample of 5720 women aged 18-74 years, were included. Demographic data was collected; anthropometric indices and blood pressure were measured according to standard protocol. Hypertension was defined based on Joint National Committee VI (JNC VI). Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose (FPG) > or =126 mg/dl or 2-h plasma glucose (2hPG) > or =200 mg/dl. Lipid disorders and components of metabolic syndrome were considered based on Adult Treatment Panel III (ATP III)., Results: Mean age of women was 39.9+/-14.6 years. Mean body mass index, waist-to-hip ratio, waist and hip circumferences for subjects were 27.1+/-5.1 kg/m2, 0.83+/-0.08, 86.5+/-13.1 cm and 103.5+/-9.8 cm, respectively. Higher hip circumference was associated with lower levels of serum total- and LDL-cholesterol, serum triglyceride, fasting plasma glucose, 2-h plasma glucose, systolic and diastolic blood pressure. Subjects in the top quintile of hip circumference had higher values of serum HDL-cholesterol concentration compared to those in the lower category. After adjustment for potential confounding variables and anthropometric measures associated with higher hip circumference, a significant decreasing trend was observed for odds of having high LDL-cholesterol (odds ratios among quintiles: 1.00, 0.98, 0.97, 0.95, 0.84, respectively, P for trend=0.04), diabetes (1.00, 0.68, 0.58, 0.45, 0.42, P for trend=0.01), hypertension (1.00, 0.96, 0.82, 0.78, 0.70, P for trend 0.02), low serum HDL-cholesterol (1.00, 1.03, 0.86, 0.82, 0.56, P for trend=0.04), elevated blood pressure (1.00, 0.99, 0.82, 0.70, 0.61, P for trend=0.01) and abnormal glucose homeostasis (1.00, 0.69, 0.66, 0.54, 0.48, P for trend=0.01) among hip circumference quintile categories. Individuals in the upper category of hip circumference had lower odds of having hypercholestrolemia (0.86 vs. 1.00) and high serum triglyceride levels (0.74 vs. 1.00) compared to those in the lowest category., Conclusion: Hip circumference is independently and inversely associated with metabolic risk factors. This study underscores the importance of continuing to measure hip circumference in epidemiologic surveys in Tehranian adult women.

Objective: To determine the effects of a Dietary Approaches to Stop Hypertension (DASH) eating plan on metabolic risks in patients with the metabolic syndrome., Research Design and Methods: This was a randomized controlled outpatient trial conducted on 116 patients with the metabolic syndrome. Three diets were prescribed for 6 months: a control diet, a weight-reducing diet emphasizing healthy food choices, and the DASH diet with reduced calories and increased consumption of fruit, vegetables, low-fat dairy, and whole grains and lower in saturated fat, total fat, and cholesterol and restricted to 2,400 mg Na. The main outcome measures were the components of the metabolic syndrome., Results: Relative to the control diet, the DASH diet resulted in higher HDL cholesterol (7 and 10 mg/dl), lower triglycerides (-18 and -14 mg/dl), systolic blood pressure (SBP) (-12 and -11 mmHg), diastolic blood pressure (-6 and -7 mmHg), weight (-16 and -14 kg), fasting blood glucose (FBG) (-15 and -8 mg/dl), and weight (-16 and -15 kg), among men and women, respectively (all P < 0.001). The net reduction in triglycerides (-17 and -18 mg/dl), SBP (-11 and -11 mmHg), diastolic blood pressure (-5 and -6 mmHg), and FBG (-4 and -6 mg/dl), weight (-16 and -15 kg), and increase in HDL (5 and 10 mg/dl) among men and women, respectively, was higher in the DASH group (all P < 0.05). The weight-reducing diet resulted in significant change in triglycerides (-13 and -10 mg/dl), SBP (-6 and -6 mmHg), and weight (-13 and -12 kg) among men and women, respectively (all P < 0.05)., Conclusions: The DASH diet can likely reduce most of the metabolic risks in both men and women; the related mechanisms need further study.

Background and Objective: Hypertension in long time can cause cardiovascular disorders and increase chance of stroke. This study was done to determine the association between some dietary factors and risk of hypertension. Methods: This cross-sectional study was conducted on the fourth phase (2008-11) of Tehran lipid and glucose study (TLGS). In this study 6089 subjects (2807 males and 3282 females), aged 19-70 years, were participated and dietary, demographic, anthropometric and blood pressure of each subject were collected. Dietary intake was assessed using a validated and reliable food frequency questionnaire with 147-items. Odds ratio for hypertension according to quartiles of dietary factors was determined using logistic regression with adjustment for confounder variables. Results: The rate of hypertension was 29.8%. Mean of weight, body mass index, waist circumference, prevalence of abdominal obesity and alliteration in the hypertensive subjects were significantly higher than normotensive subjects (P

Abstract Background The potential effects of dietary oxalate (Ox) intake on cardio-renal function have remained unestablished. We evaluated the effect of usual Ox intake and its interaction with dietary calcium (Ca) on incident hypertension (HTN) and chronic kidney disease (CKD). Methods Adult men and women, free of HTN and CKD at baseline (2006–2008), were recruited. Dietary intakes were assessed using a validated food frequency questionnaire, and the outcomes were documented up to 2014–2017. Multivariate Cox proportional hazard regression models were used to estimate the development of HTN and CKD in relation to Ox intakes. Repeated-measures generalized estimating equation (GEE) linear regression models were used to assess possible effect of Ox-intake on the estimated glomerular filtration rate (eGFR) and blood pressure levels over eight years. Results Dietary Ox intakes were positively associated with incident CKD (HR = 2.59, 95% CI = 1.46–4.64) and HTN (HR = 1.79, 95% CI = 1.05–3.04). Compared to high-Ca consumers, subjects who had lower Ca intakes ( 220 vs.

Abstract Background The aim of this study was to investigate the association of dietary patterns with incident hypertension. Materials/methods This prospective study was conducted on 4793 individuals of Tehran lipid and glucose study participants, aged ≥ 18 years who were followed for a median of 6.3 years from 2008–2011 to 2016–2018. A valid and reliable semi-quantitative food frequency questionnaire was used to assess usual dietary intakes. Anthropometrics and blood pressure were assessed at baseline and during follow up examinations. Dietary patterns were derived using principal component analysis (PCA). Healthy eating index (HEI) and dietary approach to stop hypertension (DASH) score were measured based on dietary recommendations. Time-dependent Cox models adjusting for confounders were used to examine the association between dietary patterns and the risk of hypertension. Results During follow-up, a total of 727 incident cases of hypertension were identified. The mean ± SD age at baseline was 40.3 ± 13.5 and 37.9 ± 12.1 years in men and women, respectively. Two dietary patterns (the healthy and unhealthy) were extracted by PCA. Compared with participants in the first quartile, a 23% (HR: 1.23; 95%CI 1.00–1.53; P trend: 0.056) increased risk of hypertension was found in the fourth quartile of HEI score. This association was disappeared after further adjustment for confounders. Increasing DASH score, the healthy and unhealthy dietary pattern were not associated with risk of hypertension. Conclusion Our findings showed that higher adherences to the posteriori- and priori-dietary patterns were not associated with risk of hypertension in this population.

Abstract Red beetroot (Beta vulgaris), as a naturally occurring root vegetable and a rich source of phytochemicals and bioactive compounds, is known for its beneficial roles in the improvement of several clinical and pathologic outcome. Chronic and acute beetroot juice supplementation, as a cost-effective strategy, is proposed to hold promises in controlling diabetes and insulin hemostasis, blood pressure and vascular function, renal health and the possible effect on microbiome abundance. The secondary outcome and physiological response of microbiome abundance modulation included the non- significant fluctuation of systolic and diastolic blood pressures. Also, some studies have suggested a reno-protective property of beetroot juice that is associated with the reduction of mortality rate and favorable changes in kidney’s functional parameters among patients with renal disorders. Similarly, it is shown that the persistent consumption of beetroot juice effectively postpones the postprandial glycemic response and decreases the blood glucose peak. The significant blood pressure lowering effect has been seen among normotensive subjects, which tend to be more considerable among hypertensive individuals and progressive among overweight adults. Within this context, this review aims to provide a comprehensive overview on the therapeutic applications of beetroot juice in metabolic disorders and theirs underlying mechanisms. Despite the inconsistencies in the set of results from the reviewed studies, there is no doubt that further contributing factors must be investigated more deeply in future studies.

Objective: There is an interaction between dietary sodium/potassium intake in the pathogenesis of hypertension (HTN) and cardiovascular disease (CVD). The aim of this study was to investigate the association of dietary sodium to potassium (Na/K) ratio and the risk of HTN and CVD in a general population of Iranian adults. Methods: In this prospective cohort study, adults men and women with complete baseline data were selected from among participants of the Tehran Lipid and Glucose Study and were followed up for 6.3 years for incidence of HTN and CVD outcomes. Dietary sodium and potassium were assessed using a valid and reliable 168-item food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between dietary sodium, potassium and their ratio and risk of outcomes. Results: During the study follow-up, 291 (15.1%) and 79 (5.0%) new cases of HTN and CVD were identified, respectively. No significant association was observed between usual intakes of sodium, potassium and dietary Na/K ratio with the incidence of HTN. There was no significant association between dietary intakes of sodium and potassium per se and the risk of CVD, whereas when dietary sodium to potassium ratio was considered as exposure in the fully-adjusted Cox regression model, and participants in the highest compared to lowest tertile had a significantly increased risk of CVD (HR = 2.19, 95% CI = 1.16–4.14). Conclusions: Our findings suggest that high dietary Na/K ratio could contribute to increased risk of CVD events.

Background & Aims: Unhealthy snacks contain high amounts of calories, simple sugars, fat, cholesterol, salt, additives, and conservatives. Increased consumption of these unhealthy snacks is one of the underlying factors for the prevalence of overweight, obesity, and metabolic disorders. In this study, we investigated the effects of unhealthy snacks on diet and the risk of metabolic syndrome after 3-years of follow-up in Tehranian adults. Methods: This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study, between 2006-2008 and 2009-2011, on men and women in Tehran, Iran. Dietary intakes of participants were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline and 3 years later. Multiple logistic regression models with adjustment for confounding factors were used to estimate the occurrence of metabolic syndrome (MetS) in each quartile of unhealthy snacks. Results: The mean age of participants was 37.8 ± 12.3 years, and the mean of body mass index was 26.0 ± 4.5 kg/m2 . Moreover, 39% of the participants were male. Daily energy intake, dietary energy density, and total fat and sodium intake were higher in the fourth quartile of unhealthy snacks consumption. There was a significant decreasing trend in dietary intake of carbohydrate, calcium, zinc, selenium, and fiber parallel to increase in consumption of energy-dense snacks. Participants who were in the highest quartile of energy intake from unhealthy snacks consumed less whole grains, vegetables, and dairy products. After adjustment for potential confounders, the risk of metabolic syndrome had a significant positive association with salty snacks consumption, and a non-significant positive association with consumption of candies, chocolate, and soft drinks. Conclusion:Increased daily energy intake from unhealthy snacks could be a risk factor for the occurrence of metabolic syndrome.

Inorganic nitrate (NO3) due to its potential endogenous conversion to nitric oxide (NO), is suggested as a compensatory fuel for disrupted NO pathways in the case of pathological stats during pregnancy. Dietary NO3-rich supplement in the NO-deficient pregnant women is now suggested as a more appealing choice with fewer off-target effects which can attenuate hypertension and preeclampsia, improve placental blood flow and subsequently enhance maternal and neonatal health. There is also an increasing public interest and common health claims regarding beneficial effects of NO3-rich dietary supplements like beetroot byproducts in pregnant women. Conversely, NO3-rich dietary supplementation during pregnancy may be accompanied with a wide range of unexpected maternal and fatal adverse outcomes such as methemoglobinemia, alteration in embryonic cells and malignant transformation, as well as thyroid disorders. In conclusion, use of dietary inorganic NO3 as a common supplement during pregnancy is currently on a long way from bench to bedside. [ABSTRACT FROM AUTHOR]

Background Phytochemicals are natural non-nutritive bioactive compounds found in fruits, vegetables, whole grains, nuts and legumes, as well as other plant foods. In the present study, we assessed the dietary phytochemical index (PI) in relation to cardiometabolic risk factors among Iranian adults. Methods This cross-sectional study was conducted within the framework of third phase of Tehran Lipid and Glucose Study 2006-2008. For the present study, 2567 subjects aged 19-70 years (1129 men and 1438 women) were selected randomly. Dietary data were collected using a validated semi-quantitative food frequency questionnaire with 168 food items. The PI was calculated based on daily energy derived from phytochemical-rich foods. The odds ratios of abdominal obesity, impaired fasting glucose, hypertriglyceridaemia, low high-density lipoprotein-cholesterol and hypertension were assessed across PI quartile categories. Results The mean (SD) age of participants was 39.4 (13.2) years. Participants in the upper quartile of PI were older, and had a lower weight and waist circumference. The mean (SD) of the PI was 17.3 (5.6), 25.5 (6.4), 32.7 (8.3) and 42.8 (10.5) in the first, second, third and fourth quartiles, respectively. Compared with those in the lower quartile of PI, participants in the upper quartiles had a 66% lower risk of abdominal obesity [95% confidence interval ( CI) = 0.23-0.51] and a 36% lower risk of hypertriglyceridaemia (95% CI, 0.47-0.86), after adjustment for potential confounders. Conclusions Higher intakes of phytochemical-rich foods are associated with a lower risk of abdominal obesity and hypertriglyceridaemia as the main cardiometabolic risk factors. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to assess the potential effects of long-term intake of caffeine and habitual consumption of coffee and tea on the occurrence of cardio-renal events among an Iranian population with low coffee and high tea consumption. Methods Adult participants of the Tehran Lipid and Glucose Study (2006–2008 to 2012–2014) who met the study inclusion criteria, were recruited. Habitual dietary intakes were assessed using a validated food frequency questionnaire. Demographics, anthropometrics, blood pressure, and biochemical variables were evaluated at baseline and during follow-up examinations. Multivariate Cox proportional hazard and logistic regression models adjusted for potential confounders were used to estimate the risk of cardiovascular disease (CVD), hypertension (HTN) and chronic kidney disease (CKD). Results During median 6 years of follow-up, the incidence rate of CVD outcomes, HTN, and CKD were 3.3%, 15.5%, and 17.9%, respectively. The risk of CVD was increased more than two-fold in the highest tertile of tea consumption (HR = 2.44, 95% confidence interval, CI = 1.40–4.27; P for trend = 0.001), and caffeine intakes (HR = 2.22, 95% CI = 1.23–4.01; P for trend = 0.005). A 42% lower incidence of CVD was observed in coffee drinkers, compared to non-drinkers (HR = 0.58, 95% CI = 0.36–0.93; P for trend = 0.023). No significant association was observed between tea, coffee or caffeine intakes and the risk of HTN or CKD. Conclusions Findings of our study support previous data regarding the protective effects of coffee on CVD. Contrary to the previous studies, we found that higher intakes of tea and caffeine, mainly originated from tea in our population, may increase risk of CVD events. It may be related to the type of tea and its preparation methods, additives or artificial colors in tea consumed in Iran, and sweets or sugar that mostly consumed accompanied by tea. Also, genetic variants of the liver enzymes may modify the association of dietary caffeine sources and incidence of CVD. Further prospective studies with incorporation of different population with different dietary habits and genetic backgrounds are needed to clarify the contradictions.

Background: Elevated blood pressure is still one of the major risk factors for diseases and disabilities and also a public health challenge worldwide. In the present longitudinal study, we aimed to evaluate the association between risk of hypertension and dietary advanced glycation end products (AGEs) as a recently discussed potential risk factor. Materials and Methods: Dietary assessment of 1775 participants in the third phase of Tehran lipid and glucose study to obtain dietary intake of AGEs was performed using a validated semi-quantitative food frequency questionnaire, and they were followed up for a mean duration of approximately 6 years. To determine the incidence of hypertension across quartiles of AGEs intake, logistic regression models with adjustment for potential confounding variables were used. All statistical analyses were conducted using SPSS, and P < 0.05 was considered statistically significant. Results: Higher hypertension occurrence risk was generally attributed to higher AGEs intake quartiles after adjusting for age in men (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.11–1.52, P = 0.038) and additional adjustment for smoking, drugs, and physical activity in women (OR = 1.38%–95% CI = 1.09–1.42, P = 0.042). Moreover, across the increasing trend of dietary AGEs intake, the percentage of fat intake increased and that of carbohydrate significantly decreased (P < 0.0001). Conclusion: In conclusion, it is highly recommended to limit dietary AGEs consumption to prevent and manage hypertension and its complications.

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.