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Background: Osteoporotic fractures can result in significant health complications and an increased risk of death. Registry studies could provide better treatment options and improve patient outcomes by providing useful information about the disease. The present study describes the protocol for an osteoporosis registry in Iran. Materials and methods: This registry is a prospective multicenter cohort study recruiting patients with osteoporosis from Iran. The inclusion criteria of the study are individuals diagnosed with primary or secondary osteoporosis according to the diagnostic criteria of the study; patients will be identified and recruited from outpatient clinics in this registry. All patients diagnosed with primary or secondary osteoporosis are the target population of the study. Our expected sample size is 1000 participants and the study will continue for at least 2 years. The measurements of the Iranian Osteoporosis Registry include four parts: (i) variables measured by the specific questionnaires package, (ii) bone mineral density (BMD, (iii) clinical examination, and (iv) lab data. The final questionnaire package includes "demographics information", "socioeconomic status", "lifestyle", "reproductive health", "medical history and medication", "Osteoporosis diagnosis gap", "Osteoporosis adherence and treatment gap", "fracture history and fall risk assessment", "FRAX ® tool ", "hospitalization and death outcomes", "low back pain", "hospitalization history", "attitude toward osteoporosis", "osteoporosis awareness", "osteoporosis related-performance", "quality of life (Iranian version of SF12 questionnaire)", and "food frequency questionnaire (FFQ)". Clinical examination of this registry includes anthropometric measurements (including height, weight, body mass index (BMI), waist circumference, hip circumference, and right wrist circumference), and blood pressure. The baseline questionnaires will be filled out right after patients are diagnosed with osteoporosis and then osteoporotic patients will be followed up regularly on a yearly basis. In the follow-up visit, variables that may have changed over time are updated. The main outcomes include registration of fall, fracture, hospitalization, medication adherence, and death. An online web-based user-friendly software is also developed for data collection. Data analysis will be conducted with the collaboration of data-mining experts and epidemiologists at the end of each follow-up. Conclusion: The Iran Osteoporosis Registry will be a valuable source of information regarding osteoporosis outcomes (i.e. fractures, hospitalizations, adherence, and death at the national level), and its results will be very beneficial and practical for policy makers in the field of musculoskeletal diseases. [ABSTRACT FROM AUTHOR]

The aim of the study was to report the burden of type one diabetes mellitus (T1DM) by sex, age, year, and province in Iran over the past 30 years, according to data provided by the global burden of disease (GBD) study. Incidence, prevalence, death, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability due to T1DM by age groups and sex was reported for 31 provinces of Iran from 1990 to 2019 with their 95% uncertainty intervals (UI). In 2019, national age-standardized incidence (11.0 (95% UI: 8.9–13.5)), prevalence (388.9 (306.1–482.1)), death (0.7 (0.6–0.8)), and DALYs (51.7 (40.9–65.1)) rates per 100,000 wre higher than 1990 except for death. Also, the mortality to incidence ratio reduced in all provinces over time particularly after 2014 as well. GBD data analysis showed that age-standardized incidence and prevalence rates of T1DM have increased, the death rate reduced, and DALYs remained unchanged during the past 30 years in Iran and its 31 provinces. death rate reduced and DALYs remained unchanged during the past 30 years in Iran and its 31 provinces. [ABSTRACT FROM AUTHOR]

Background: A considerable amount of research funding goes to diabetes management strategies to improve therapeutic goals and reduce the burden of diabetes. A vast amount of the budget is wasted due to unnecessary studies. A scoping review is a pivotal study to overview the available evidence and avoid research waste. In this review, we will try to find out the scope of available studies on diabetes management interventions, identify associated research gaps, and prioritize future studies. Method: We will carry out a study using Arksey and O'Malley's scoping review framework. We will search the Scopus and PubMed databases from 01/01/2015 till 01/01/2020. Only original articles related to pharmacological and non-pharmacological management interventions will be included. These interventional studies should be conducted on the Iranian population. After data extraction, a descriptive data analysis will be used to present information in different charts or tables. We will evaluate related published articles based on their document type, level of evidence, type of diabetes, subject area, interventions types, main findings and outcomes. Discussion: This study represents the first attempt to sum up available studies related to diabetes management interventions performed in Iran. The results of this study will be useful for all the stakeholders and policy-makers involved in diabetes research. It can help clinicians to be informed about studies on management interventions and can guide scientists eager to diabetes research to choose their future research plans based on diabetes research requirements and gaps. [ABSTRACT FROM AUTHOR]

Background: Mapping the available evidence can be used to inform current diabetes research, identify relevant gaps, and prioritize future research. In this regard, we mapped diabetes research performed in Iran. Method: We searched the Scopus and PubMed databases from 01/01/2015 till 01/01/2020 using keywords such as diabetes and Iran. The included articles were classified according to their document types, level of evidence, and subject areas. Results: The majority of the included articles (53%) were related to diabetes types, followed by complications (28%). Most of the documents were original articles (82%), and reviews were 18% of the publications. Systematic reviews constitute only 6% of the total documents. Observational studies were the most common types of study designs (26%), followed by clinical trials (20%). Moreover, topics on control and management of diabetes were the most prevalent subject areas (58%), and fewer studies were on preventive strategies (6%). In diabetes management studies, less attention has been paid to evaluate psychological (10%), educational (9%), and physical activity-related (7%) interventions. There was a shortage of secondary studies related to physical activity, psychology, diagnostic, and screening-related studies. Conclusion: To fill diabetes research gaps, more investment in cost-effectiveness interventions, such as preventive strategies and behavioral self-management programs, need. Moreover, we need to pay more attention on applied sciences and real world evidence to bridge translational gaps from bench to bedside. In this regard, further data synthesis can be helpful in evaluating the effectiveness of the available studies and avoiding unnecessary investigations. [ABSTRACT FROM AUTHOR]

Purpose: To assess COVID-19-specific diabetes worries, and to determine characteristics of people with high levels of these worries among people with type 2 diabetes (T2D) following the continuation of the pandemic and occurrence of multiple waves of COVID-19 in Iran. Methods: An interviewer-based, cross-sectional study was conducted using 500 T2D people in a diabetes specialty clinic. The questionnaire package comprised five parts: sociodemographic and clinical characteristics, COVID-19-specific worries, diabetes-related distress, feelings of isolation and changes in diabetes-specific behaviors. Clinical history and serum measurements were collected from electronic medical records. Descriptive statistics and logistic regressions were performed in the study. Results: Worries related to COVID-19 pandemic were highly prevalent in T2D people. Around 60% were worried about being severely affected due to diabetes if infected with COVID-19 and being described as a high-risk group for COVID-19, and more than half about being possibly faced with lack of diabetes medications. Logistic regressions demonstrated that being female, higher age, diabetes-related complications, duration of diabetes, insulin use, feeling isolation, diabetes-related distress and having changed self-management behaviors were associated with being more worried about diabetes and COVID-19. Conclusion: Diabetes-related worries relating to the COVID-19 were strongly associated with poorer psychosocial status. Findings emphasize the importance of conveying up-to-date information regarding diabetes and COVID-19 that patients want and need to know, also of providing emotional support associated with COVID-19-specific diabetes worries. [ABSTRACT FROM AUTHOR]

Cancer is the second leading cause of death in the world and the third leading cause of death in Iran. It has been proven that numerous cancer cases are caused by exposure to environmental pollutants. There is a public health concern regarding an increase in exposure to carcinogens across Iran through different sources (air, food, and water) and a lack of research to address this issue. This study aims to gather data on exposure to heavy metals, polycyclic aromatic hydrocarbons (PAHs), and pesticides and their intake routes during the implementation of a national population health survey. This is a cross-sectional study of environmental pollutants in Iran, with a stratified multi-stage random sampling method, which led to 660 nationally representative samples in 132 clusters in three sequential parts. The first will be questionnaires to obtain demographics, assets, food records, air quality, and food frequency. The second will be physical measurements, including anthropometric and body composition. The third will be lab assessments that measure 26 types of environmental pollutants (7 heavy metals, 16 PAHs, and 3 pesticides) in urine, inhaled air, and consumed food and water of the population under study using ICP-MS and GS-MS devices. The results of this study will inform policymakers and the general population regarding the level of threat and will provide evidence for the development of interventional and observatory plans on the reduction of exposures to these pollutants. It could also be used to develop local standards to control contaminants through the three exposure routes. This study protocol will obtain data needed for policymakers to set surveillance systems for these pollutants at the national and provincial level to address the public concerns regarding the contamination of food, air, and water. [ABSTRACT FROM AUTHOR]

Background: Hypercholesterolemia is a common dyslipidemia that leads to atherosclerosis. It is proved that early stages of atherosclerosis begins in early stages of life. In several studies, widespread prevalence of dyslipidemia in children is reported. So, assessment of lipid profile in children and adolescence is necessary for early diagnosis of dyslipidemia. Laboratory methods for measuring LDL are not available and economical. So, in some laboratories Friedwald method is used to determine LDL level. But, the preciseness of this method is not acceptable. Further, the preciseness of this method was not assayed in children and adolescence. So, it seems that assaying the preciseness of different methods is necessary. Methods: The methodology of this work is on the basis of findings of the Caspian V study. This study was conducted in 30 provinces of Iran during 2015. The population of this work was rural and urban students aged 7–18 years old. The level of total cholesterol (TC), HDL, LDL, and TG were measured using laboratory methods. The average and variances values were determined for each group of data using SPSS. Further, LDL values were calculated with a new formula introduced in this work. A comparison was made between the new formula and the other methods. Results: In the present study, we found that compare to four common formulas, Friedwald was the best equation to estimate LDL-C concentrations in Iranian children and adolescents and the new formula was the next accurate equation. The strongest correlation between Friedwald and the new equation was found for those with 15–18 years old. Conclusion: Considering the cut-off points of TG (100 mg/dL), we observed the strongest correlation between Friedwald equation and direct assay and the weakest one was for Ahmadi formula in subjects with either greater or lower TG concentrations. Furthermore, we found that Anandraja equation had the most sensitivity (89.5%), while the most specificity was dedicated to the new formula (98.9%). [ABSTRACT FROM AUTHOR]

Aim: There is limited evidence regarding the association between the Elderly Dietary Index (EDI) and cardiovascular disease (CVD) risk factors. The aim of the study was to examine how the EDI relates to CVD risk factors in elderly men. Methods: In this cross‐sectional study, we recruited 362 elderly men aged 60 to 80 years old. Diet was measured with a validated and reliable food frequency questionnaire. The EDI assesses adherence to nutritional recommendations for older adults based on the Modified MyPyramid for Older Adults. The EDI includes meat, fish, fruits, vegetables, cereals, legumes, olive oil, bread and dairy products. Anthropometric indices, biochemical markers and blood pressure were measured using standard methods. Multivariate logistic regression assessed relationships between tertiles of EDI scores and CVD risk factors. Results: The mean age and body mass index of participants were 65.43 ± 5.63 years and 25.34 ± 3.17 kg/m2, respectively. After controlling for potential confounders, the EDI was inversely associated with the risk of obesity and overweight (Odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.27, 0.89; P =.004) and was associated with a reduced likelihood of elevated low‐density lipoprotein cholesterol (LDL‐C) concentrations (OR: 0.19, 95% CI: 0.09, 0.41; P < .001). Conclusions: Higher EDI was associated with lower risk of overweight and obesity and high LDL‐C concentrations. However, there was no significant association between EDI and other CVD risk factors in elderly men. [ABSTRACT FROM AUTHOR]

Background: Examining dietary approach to stop hypertension (DASH) diet based on other dietary quality indices can be helpful to clarify positive aspects of this healthy dietary pattern. We aimed to examine the association between the DASH diet score and some diet quality indices among Iranian women. Methods: In this cross-sectional study, 304 women aged 20 to 50 years old were recruited. Dietary diversity score (DDS), dietary energy density (DED), adherence to DASH diet, Alternative Healthy Eating Index (AHEI) and mean adequacy ratio (MAR) were examined as suggested by previous articles. Dietary quality indices, anthropometric indices, and dietary intake were categorized based on DASH tertiles. Semi-quantitative food frequency questionnaire with 168 items was used for dietary assessment. Results: There were no significant differences in the demographic characteristics of participants across DASH tertiles (P > 0.05). Participants who adhered more to the DASH diet had lower DED than those with lower adherence (0.99±0.35 vs 1.26±0.30; P = 0.01). Significant differences were observed in the index of DDS across tertiles (P = 0.01), however no differences in nutrient adequacy ratio (NAR) and MAR (0.93) index across the DASH categories were found. Additionally, DDS to DED in the top tertile of the DASH diet was greater than the bottom one (6.7±2.9 vs 4.4±1.9; P = 0.001). Conclusion: The present study indicated that greater adherence to the DASH diet is inversely associated with DED and AHEI. As well as, there was a positive association between the DASH diet and DDS/DED ratio. However, more studies are needed to confirm the results of this study. [ABSTRACT FROM AUTHOR]

Aim: Tendency for taking dietary supplements is dramatically increasing. However, limited studies exist in this regard. We aimed to assess the frequency and determinants of dietary supplement use among a nationally-representative sample of Iranian children and adolescents. Methods: This population-based cross-sectional study (the CASPIAN V) was conducted in students aged 7 to 18 years old in 2015. Multistage, stratified cluster sampling method was used to select participants from thirty provinces in Iran. Data regarding taking vitamin and mineral supplements were collected. Demographic information, anthropometric indices, physical activity, screen time and body image were also evaluated. Multivariate logistic regression model was used for analyses. Results: The prevalence of dietary supplements use was 34.1% and the most popular dietary supplement was Iron (12.9%). Multivariate logistic regression showed that boys (0.84, 95%CI: 0.78, 0.91) and body image perception (OR: 0.84, 95%CI: 0.75, 0.94) used less dietary supplements compared to others. Children aged 11 to 14 years (OR: 1.15, 95%CI: 1.06, 1.26) and those with moderate family socioeconomic status (OR: 1.12, 95%CI: 1.007, 1.25) used more supplement compared to other groups. Moreover, those with higher paternal educational level (OR: 0.77, 95%CI: 0.64, 0.93) used less supplements. However, living area, family size, paternal occupation, children BMI, Intended weight loss, and body image by student did not indicate any significant association. Conclusion: Our findings indicated that about one-third of Iranian children and adolescents used dietary supplements; iron supplements were the most frequent ones. Children aged 11 to 14 years, those with higher educated mothers and moderate family socioeconomic status used more supplements compared to others. However, boys, children with excess weight and those with high-educated parents used less supplements compared to others. More studies are needed to clarify the efficacy and safety of dietary supplements in different age groups in various societies. [ABSTRACT FROM AUTHOR]

Introduction: Limited studies are available regarding the relationship between Food Quality Score (FQS) and cardiovascular disease (CVD) risk factors. Thus, this study was aimed to investigate the association of FQS with CVD risk factors in women. Methods: This cross-sectional study was carried out among 368 women aged 20-50 years who randomly selected from health centers across Tehran, Iran. Dietary intake was collected using a reliable and validated food frequency questionnaire (FFQ). The FQS includes vegetables, fruits, whole grains, yogurt, nuts and legumes, coffee, refined grains, desserts and ice cream, sugar-sweetened beverages, red meats, fried food consumed outside the home, processed meats, potato and potato chips. Standard methods were used to assess blood pressure, biochemical and anthropometric measures. Multivariate logistic regression was used to examine the association between FQS and CVD risk factors. Results: Participant mean age and body mass index (BMI) were 30.7 ± 6.9 years and 24.3 ± 4.0 kg/m2, respectively. After taking potential confounders into account, FQS had no significant association with risk of overweight and obesity [Odds ratio (OR): 1.1, 95% confidence interval (CI): 0.68, 1.8; P = 0.683], diabetes (OR: 0.62, 95% CI: 0.22, 1.74; P = 0.374), metabolic syndrome (OR: 0.36, 95% CI: 0.10, 1.32; P = 0.127), hypercholesterolemia (OR: 0.54, 95% CI: 0.29, 1.01; P = 0.051), or hypertriglyceridemia (OR: 1.63, 95% CI: 0.71, 3.70; P = 0.244). Conclusion: The results showed that FQS was not significantly associated with CVD risk factors among women. Prospective cohort studies are warranted to confirm our findings. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify common barriers to physical activity practice among overweight/obese patients with type 2 diabetes in Iran and their associations with physical activity level. In this cross-sectional study, 146 overweight/obese volunteers with type 2 diabetes were recruited from diabetes clinics in Tabriz, Iran, between July 2012 and March 2013. A Persian version of the long-format International Physical Activity Questionnaire was used to assess physical activity level. A 12-item structured questionnaire was designed to assess physical activity barriers. The validity and reliability of the latter scale were assessed by related measures. An exploratory factor analysis with the principal component analysis extraction method and varimax rotation was performed to extract the underlying factors. Multivariate regression analysis was used to assess the relationship between barriers and physical activity level. About 73% of patients had moderate physical activity. Factor analysis yielded four factors as barriers to physical activity including: (i) negative attitude towards physical activity, (ii) discouragement, (iii) physical problems and (iv) cost/environmental factors. These factors explained about 51% of the total variance. There was a negative relationship between the factor 'physical problems' and physical activity level ( P = 0.024). Overall, there were some barriers to physical activity. Health counsellors should address these barriers to increase the patients' adherence to physical activity recommendations. Physical conditions of the patients must be taken into account. [ABSTRACT FROM AUTHOR]

Background: This paper presents the protocol of the 4 th round of Iranian Multi-center Osteoporosis Study (IMOS), a national survey with the primary objective of estimating the prevalence of osteoporosis and sarcopenia and their risk factors in a representative sample of urban and rural populations., Methods: The target population of the survey is all individuals ≥ 50 years in Iran. A multi-stage random sampling method has been used in the study. We stratified the 31 provinces of the country into 5 strata based on the distribution of their potential risk factors for osteoporosis and randomly selected one or two provinces from each stratum. Then, we invited 2530 people aged ≥ 50 years recruited in the 8 th National Survey of None Communicable Diseases (NCD) Risk Factors (STEPs-2021) in the selected provinces to participate in IMOS. Body composition measurements including bone mineral density, muscle mass, and fat mass are measured through Dual-energy X-ray Absorptiometry (DXA) method using HOLOGIC (Discovery and Horizon) devices; and Trabecular Bone Score (TBS) is measured on the DXA scans using iNsight software. Anthropometric measurement and physical examinations are made by a trained nurses and other required information are collected through face-to-face interviews made by trained nurses. Laboratory measurements are made in a central lab. The prevalence of osteoporosis and sarcopenia will be estimated after applying sampling design, non-response, and post-stratification weights to the data., Discussion: IMOS will provide valuable information on the prevalence and determinants of osteoporosis and sarcopenia at the national level, and the results can be used in evaluating health system interventions and policymaking in the field of musculoskeletal diseases., (© 2022. The Author(s).)

Objectives: The reference values to determine vitamin A and D deficiency may vary based on ethnicity, age, and region of residence. The aim of this study was to determine the reference interval of circulating vitamin A and D levels among Iranian children and adolescents based on sex, age, and region of residence., Methods: This nationwide cross-sectional study was performed with 2596 students 7 to 18 y of age from the CASPIAN-V (Childhood and Adolescence Surveillance and Prevention of Adult Non- communicable disease) study. A parametric method was used to define the age-specific reference values by obtaining smooth centile curves and explicit formulae for the centile estimates and SD scores for both sexes and regions of residence., Results: Significant differences were found between the residents of rural and urban regions in terms of serum 25-hydroxyvitamin D [25(OH)D] and retinol concentration (P < 0.05). Boys (27 ± 8 versus 26.04 ± 10, P = 0.009). Children ages 7 to 12 y had higher serum 25(OH)D concentration than 13- to 18-y-old adolescents (26.96 ± 8 versus 26.04 ± 10, P = 0.007). The estimated reference interval for circulating 25(OH)D levels corresponding to the range between the 5th and 95th percentiles were 11.45 to 48.40 ng/mL in boys and 9.51 to 47.69 ng/mL in girls. Estimated reference intervals for serum retinol concentration among boys and girls corresponding to the 5th and 95th percentiles were 0.58 to 3.38 and 0.58 to 4.52, respectively. There were significant variations in both retinol and 25(OH)D concentrations across different age groups., Conclusion: This study established the reference intervals for circulating 25(OH)D and retinol levels in Iranian adolescents and children in different age groups based on sex and region., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background and Aim: Ramadan fasting is a religious fasting of Muslims and has many effects on health and disease. This study aim was to analyze Ramadan fasting research output during the past five years and identify research gaps in this field., Materials and Methods: A systematic search was performed in Web of Science, pubmed, Scopus, EMBASE and Cochrane databases by appropriate keywords. Documents published between January 2015 and January 2020 with English language were included. After removing duplicates, remained documents were screened and classified., Results: Finally, after screening, 393 documents remained and were classified. Of these documents, 53 were review article and 338 original articles. More than 96% of studies were clinical study while basic science studies were too limited. Among the study topics, diabetes mellitus with 31% was the most common topic followed by metabolic disorders and nutrition, respectively., Conclusion: Ramadan fasting is an important religious issue that needs more attention. Research should be directed to clinical and basic studies in different health and disease conditions other than nutrition and metabolic disorders., Competing Interests: Declaration of competing interest The authors have no conflict of interest to report., (Copyright © 2021. Published by Elsevier Ltd.)

Purpose: High dietary acid load (DAL) may have an influence on anthropometric indices. Given that there was no study on the association between DAL and anthropometric indices children and adolescents, the current study was aimed to examine the association between DAL and anthropometric indices in Iranian children and adolescents., Methods: Students aged 6-18 years were recruited using a multi-stage, cluster sampling method from 30 provinces of Iran. Dietary intake was assessed through a validated food frequency questionnaire. Height (Ht), weight (Wt), neck circumference (NC), waist circumference (WC), wrist circumference, and hip circumference (HC) were measured. WC-to-HC ratio (WHR), WC-to-Ht ratio (WHtR), body mass index (BMI) z-score, tri-ponderal mass index (TMI), and parental BMI were computed. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were used to estimate DAL. The association between DAL and anthropometric indices was evaluated using linear regression models., Results: In total, 5326 students (46.92% girls), with mean (standard deviations (SD)) age of 12.50 (3.14) years participated in the study (response rate: 98.13%). After adjusting for confounders, there was a significant association between NEAP and NC (P < 0.05). Also, an inverse association was observed between PRAL and NEAP with parental BMI (P < 0.05)., Conclusion: Our findings showed a direct association between diet-induced acid load and NC and an inverse association between DAL indices and parental BMI. More well-designed clinical studies are warranted to confirm our results and the underlying mechanisms., Level of Evidence: Level V, cross-sectional descriptive study.

Background: Vitamin D deficiency (VDD) is recognized as a global pandemic. Identification, any association between VDD and subjective health complaints (SHC), can be helpful to realize critical mechanisms and improve psychological and somatic symptoms. Given few studies published on this issue and the importance of its clarification, the main objective of this study was to examine the association between VDD and the SHC in children and adolescents., Methods: In this national cross-sectional study, 2596 Iranian children and adolescents aged 8-18 years were included. Data on SHC, anthropometric indices, physical activity, and serum levels of vitamin D were collected. Logistic regression models (crude, adjusted) were applied to examine the association between the VDD and the SHC. Statistical analysis was performed using STATA version 11. P-values< 0.05 were considered as statistically significant., Results: Serum levels of vitamin D in approximately 70% of Iranian children and adolescents were lower than 30 ng/mL. Among the SHC, irritability (40.9%) and feeling anxiety (33.7%) were the most prevalent ones. Multiple complaints in students with the VDD was 2.5 times greater than those with sufficient vitamin D concentrations (p <  0.001). Compared to the reference group, the strongest association was found between vitamin D status and difficulties in getting to sleep (OR: 2.5, 95%CI: 1.18, 3.53, p <  0.001)., Conclusion: VDD was observed in the considerable percentage of the study population. There were no significant differences between the two gender groups. In addition, there were significant associations between vitamin D status and most of the somatic and psychological symptoms, particularly for getting to sleep. It seems national interventional programs for vitamin D supplementation or food fortifications can be helpful.

Objective: Acid-base status, which can be affected by dietary acid load (DAL), has been associated with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS). Given the limited published literature on DAL, the aim of this study was to examine the association between DAL and risk factors for CVD and prevalence of MetS in young women., Methods: This was a cross-sectional study conducted with 371 women (20-50 y of age). Dietary intake was assessed using a food frequency questionnaire. DAL was evaluated through potential renal acid load (PRAL) and net endogenous acid production (NEAP). The associations between DAL (both PRAL and NEAP) with categories of biochemical factors (fasting blood sugar, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol), anthropometric parameters (body mass index and waist circumference) and the prevalence of MetS based on the National Cholesterol Education Program's Adult Treatment Panel III) were assessed using binary logistic regression in crude and adjusted models., Results: The median values of PRAL and NEAP were 8.93 and 46.77 mEq/d, respectively. After adjustment for several covariates, a significant positive association was observed between PRAL and serum triglyceride levels (odds ratio [OR], 4.28; 95% CI, 1.67-10.99; P = 0.002). Moreover, there were positive associations between NEAP with overweight and obesity (body mass index ≥25 kg/m 2 ; OR, 3.07; 95% CI, 1.92-4.93; P = 0.0001), waist circumference (OR, 2.27; 95% CI, 1.37-3.75; P = 0.001), and serum triglyceride levels (OR, 4.92; 95% CI, 1.87-12.92; P = 0.001)., Conclusion: Compared with women with a low DAL score, women with a higher DAL score had higher weight, waist circumference, and triglyceride concentrations., (Copyright © 2019. Published by Elsevier Inc.)

Background: The use of traditional and complementary medicine (T&CM) is increasing in both developed and developing countries. The school of Persian medicine (PM) in Iran is a comprehensive medical school that is rich in history and has its own special principles, elements, philosophy, and diagnostic and treatment options. Many complementary therapy modalities are also popular and in demand among patients and physicians. The aim of this paper is to provide logic for the policymakers in Iranian medical education to make changes in medical education curricula, particularly on integrating T&CM., Methods: We reviewed the global experience in teaching T&CM to medical students, and highlighting the strengths of PM, described why it is necessary to integrate T&CM into general medicine curricula in Iran., Results: PM is a traditional system of medicine that dates back about 7000 years. Although there are few studies about the safety and effectiveness of PM, research into it has recently been accelerated. There is a suitable opportunity for integrating T&CM with conventional medicine. Physicians should be familiar with T&CM to avoid any contraindications, interactions, and unwanted effects., Conclusion: Traditional medicine is part of Iran's heritage and, thus, needs special attention. Familiarization of physicians with T&CM can help them choose the best treatment options for their patients. To integrate T&CM into the medical education curricula of Iran, a two-credit course has been proposed for implementation across the country., (Copyright © 2019 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.)

Given the limited research on dietary insulin load (DIL), we examined DIL in relation to cardiovascular risk factors and inflammatory biomarkers in elderly men. For the present cross-sectional study, we recruited 357 elderly men. Dietary intake was assessed using FFQ. DIL was estimated by multiplying the insulin index of each food by its energy content and frequency of consumption and then summing the final value of all food items. After adjustment for covariates, a significant positive association was observed between high DIL with fasting blood sugar (FBS) levels (OR: 7·52; 95 % CI 3·38, 16·75; P=0·0001) and high-sensitive C-reactive protein (hs-CRP) (OR: 3·03; 95 % CI 1·54, 5·94; P=0·001). However, there was no association between high DIL and BMI (OR: 1·43; 95 % CI 0·75, 2·75; P=0·27), serum TAG level (OR: 0·82; 95 % CI 0·26, 2·59; P=0·73), HDL-cholesterol (OR: 2·03; 95 % CI 0·79, 5·23; P=0·13) and fibrinogen (OR: 1·57; 95 % CI 0·80, 3·06; P=0·18). Overall, elderly men with high DIL had higher FBS and hs-CRP levels than those with low DIL. Future studies are needed to clarify the association between DIL and other cardiovascular risk factors in both men and women.