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Background: Serum uric acid concentration has been linked with metabolic abnormalities. The available evidence on the association of Sugar‐Sweetened Beverage (SSB) intake with serum uric acid concentrations is conflicting. The present study aimed to summarise earlier findings on the association of SSB consumption with serum uric acid concentrations in adults. Methods: Using relevant keywords, we conducted a search in PubMed (https://pubmed.ncbi.nlm.nih.gov), Scopus (https://www.scopus.com) and Google Scholar (https://scholar.google.com) up to September 2017 for all published papers assessing SSB intake and serum uric acid concentrations. SSBs were defined as the dietary intake of Sugar‐Sweetened Soft Drinks and Fruit Juice (FJ), or as Sugar‐Sweetened Soft Drinks, Diet Soft Drinks and Orange Juice or as Soda and FJ. Results: After excluding non‐relevant papers, five studies, with six effect sizes, remained in our systematic review. All studies included in the current systematic review were of cross‐sectional design that were published between 2007 and 2013. The number of participants ranged from 483 to 14 761 people. Most studies had controlled for age, body mass index, weight and sex. We found that individuals in the highest category of SSB intake had 0.18 mg dL–1 greater concentrations of serum uric acid compared to those in the lowest category (summary effect size: 0.18 mg dL–1; 95% confidence interval = 0.11–0.25). No significant between‐study heterogeneity was found (I2 = 0.0%, P = 0.698). In the sensitivity analysis, we found no particular study influence on the summary effect. There was no evidence of publication bias. Conclusions: We found that SSB consumption was significantly associated with increased serum uric acid concentrations in an adult population. [ABSTRACT FROM AUTHOR]

No previous study has examined the association of an acid-base imbalanced diet to autoimmune bullous disease. The present study aimed to investigate the association between dietary acid load (DAL) as either potential renal acid load (PRAL) and net endogenous acid production (NEAP) intake on the odds of high-severity Pemphigus Vulgaris (PV) disease in adult Iranian patients to fill this gap. A cross-sectional study was conducted on 138 patients, aged 18-65 years with confirmed diagnoses of PV in a referral university center for autoimmune bullous diseases. The dietary intakes of all patients during the last year before enrollment in the study were assessed using a 168-item semi-quantitative food frequency questionnaire. Dietary acid load was calculated based on the PRAL and NEAP scores. To assess PV severity, the pemphigus disease area index (PDAI) score was used. Logistic regression was used to evaluate the association between DAL and PDAI. A positive association was observed between PRAL and PDAI score in the crude (adjusted R 2  = 0.088, B = 6.88, P < 0.0001) and all other adjusted models, as well as the crude model for NEAP (adjusted R 2  = 0.037, B = 4.72, P = 0.013). In terms of adherence to NEAP and PRAL, those in the top tertile of PRAL and NEAP had a higher vulnerability for severe PV in unadjusted (OR = 5.18, 95% (CI) 2.19-12.25) and (OR = 2.48, 95% (CI)  1.08-5.68) respectively. In the present study, we found a significant direct association between DAL and severity of disease in PV patients. Further studies are required to confirm these findings., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Asthma has become the most common chronic condition among children in recent decades. Environmental factors, including food, drive its rise. Sweetened beverages are a staple of children's diets and cause various health issues. Therefore, this research aims to evaluate the association of all types of high fructose beverages with asthma in children., Method: We assessed observational studies published before November 2023, obtained from PubMed, Scopus, and Web of Science. The quality of articles was assessed by using the Newcastle-Ottawa Scale. Studies with a pediatric population under 18 years that indicate the association between all kinds of beverages containing high fructose and asthma and evaluated risk estimates with 95% confidence intervals were included. We also followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)., Results: In the final analysis, we included eleven studies with 164,118 individuals. Twenty-one effect sizes indicated a significant positive association between sugar-sweetened beverages (SSBs) consumption and odds of asthma (OR: 1.28; 95% CI: 1.15-1.42; P value < 0.001). Three effect sizes showed that total excess free fructose (tEFF) intake increases children's asthma odds by 2.7 times (pooled OR: 2.73; 95% CI: 1.30-5.73; P value =0.008). However, five effect sizes in 100% fruit juice failed to show statically association with asthma prevalence in children (pooled OR: 1.43; 95%CI: 0.91-2.23; P value =0.12)., Conclusion: In summary, SSB and tEFF raised asthma probabilities. No relationship was found between fruit juice and asthma in children and adolescents. We need more cohort studies with correct age selection to identify the precise link., (© 2024. The Author(s).)

Background: The study investigates substituting non-nutritive sweeteners (NNS) for sugar to address health concerns related to excess sugar intake. It specifically examines how stevia affects insulin and blood glucose levels. The systematic review and meta-analysis aim to evaluate stevia's impact on glycemic indices., Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines, including 26 studies with 1439 participants. The PROSPERO registration number for this research is CRD42023414411. We systematically searched PubMed (MEDLINE), Scopus, Web of Science, and Google Scholar. Additionally, we thoroughly reviewed the reference lists of the articles we extracted and relevant reviews. Two evaluators independently carried out screening, quality assessment, and data extraction. The GRADE (grading of recommendations, assessment, development, and evaluation) approach was utilized to evaluate the certainty of the evidence., Results: Stevia consumption was associated with significantly reducing blood glucose levels (WMD: -3.84; 95 % CI: -7.15, -0.53; P = 0.02, low certainty), especially in individuals with higher BMI, diabetes, and hypertension. Dose-response analysis revealed a decrease in blood glucose for ≥3342 mg/day of stevia consumption. Stevia consumption has been shown to reduce blood glucose levels within 1-4 months, as evidenced by dose-response analysis (less than 120 days) and subgroup analysis (more than four weeks). However, stevia did not significantly affect insulin concentration or HbA1C levels (very low and low certainty, respectively)., Conclusions: Low certainty evidence showed that stevia improved blood glucose control, especially when consumed for less than 120 days. However, more randomized trials with higher stevia dosages are required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Background: Majority of earlier studies have assessed the association between individual healthy eating index-2010 (HEI-2010) and the odds of breast cancer (BC). However, no study has been conducted on the effect of compliance with HEI-2010 and the odds of BC in the Iranian population with a large sample size. Therefore, we aimed to investigate the relationship between the HEI-2010 and the odds of BC in the Iranian population., Method: This population-based case-control study included 350 newly diagnosed cases of BC and 700 healthy controls randomly selected from adult women. HEI-2010 was examined using validated questionnaires. The adherence to HEI-2010 among the participants was divided into four categories. The general characteristics of the participants in the quartiles of the HEI score for categorical variables and continuous variables were evaluated using chi-square and one-way analysis of variance, respectively. Also, using logistic regression analysis, dietary intakes were evaluated in HEI score quartiles. Also, confounding variables were adjusted in different models., Result: People with the highest HEI score had 60% lower odds of BC (OR: 0.40; 95% CI: 0.27, 0.57) than those with the lowest score among post-menopause women. After controlling for age and energy intake, individuals with the highest HEI score were 78% less likely to have BC compared with those with the lowest score (OR: 0.22; 95% CI: 0.14, 0.33). Adjustments for other potential confounders including demographic factors made the association stronger (OR: 0.21; 95% CI: 0.13, 0.32). This association remained significant even after taking BMI into model (OR: 0.27; 95% CI: 0.17, 0.43)., Conclusion: Finally, in this study we found an association between HEI-2010 and odds of breast cancer. This association was particularly seen in postmenopausal women. No significant association was found between adherence to HEI-2010 and odds of BC among pre-menopausal., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ebrahimpour-Koujan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global metabolic problem which can lead to irreversible liver fibrosis. It has been shown that vitamin D and its receptors contribute to fibrogenic pathways in the liver. However, the effect of vitamin D supplementation on liver fibrosis related factors have not been examined. This double blinded placebo controlled clinical trial was designed to investigate the effects on vitamin D supplementation on serum levels of VDR, fibrogenic factors and fibrogenic MicroRNAs in MASLD patients., Methods: Forty six MASLD patients after block matching for sex and BMI were randomly assigned to receive 4000 IU/d vitamin D or placebo for 12 weeks. Weight, height and waist circumference were measured. Serum fibrogenic microRNAs, laminin, collagen type IV, hyaluronic acid, vitamin D, VDR, PTH, blood fasting glucose, serum fasting insulin, lipid profile, ALT and AST were determined at the baseline and at the end of the trial. Insulin resistance and insulin sensitivity were calculated using the HOMA-IR and QUICKI equation., Results: Supplementation with vitamin D for 12 weeks led to the significant increases in serum 25(OH) vitamin D, VDR and HDL-C compared to placebo (P < 0.001, P = 0.008 and P < 0.001). There were significant decreases in ALT, AST, FBS and LDL-C levels in the vitamin D group as compared to the placebo (P < 0.05). Laminin and hyaluronic acid concentrations were significantly decreased in the vitamin D group as compared to the placebo group, by -10.6 and - 28.7 ng/mL, respectively. Supplementation with vitamin D for 12 weeks resulted in a significant lower MiR-21 and MiR-122 gene expressions compared to the placebo group (P = 0.01 and P < 0.001, respectively)., Discussion: As the first randomized controlled trial on the effect of vitamin D supplementation on serum levels of VDR, fibrogenic factors and fibrogenic MicroRNAs in MASLD patients, we found a significant reduction in some liver fibrogenic factors, in liver transaminases and corresponding changes in some fibrosis-related MiRs and some metabolic factors. Further clinical trials with larger sample sizes and direct measures of liver fibrosis are needed to confirm these findings., Trial Registration Number: (available at: http://www.irct.ir , identifier: IRCT201405251485N13), Registration date: 14-03-2017., (© 2024. The Author(s).)

Carotenoids appear to have anticancer effects. Prospective evidence for the relation between serum carotenoids and breast cancer is controversial. The present systematic review and meta-analysis aimed to investigate the link between circulating carotenoids and the risk of breast cancer. We performed a systematic search of PubMed, Scopus, and Web of Science up to 30 November, 2022. Prospective studies on adults aged ≥18 y that have reported risk estimates for the association between circulating carotenoids and breast cancer risk were considered. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for combining studies' risk estimates. Dose-response relations were explored through a 1-stage random-effects model. Fifteen publications (17 nested case-control studies and 1 cohort study) with 20,188 participants and 7608 cases were included. We observed an inverse association between the highest level of circulating total carotenoids (relative risk [RR]: 0.76; 95% confidence interval [CI]: 0.62, 0.93; n = 8), α-carotene (RR: 0.77; 95% CI: 0.68, 0.87; n = 13), β-carotene (RR: 0.80; 95% CI: 0.65, 0.98; n = 15), β-cryptoxanthin (RR: 0.85; 95% CI: 0.74, 0.96; n = 11), lycopene (RR: 0.86; 95% CI: 0.76, 0.98; n = 13), and lutein (RR: 0.70; 95% CI: 0.52, 0.93; n = 6) and the risk of breast cancer compared with the lowest level. Additionally, each 10 μg/dL of total carotenoids, α-carotene, β-carotene, and β-cryptoxanthin was associated with 2%, 22%, 4%, and 10% lower risk of breast cancer, respectively. This relationship was stronger at lower levels of total carotenoids and β-cryptoxanthin. The certainty of evidence was rated from very low to low. Most studies were performed among Western nations, which should be acknowledged for extrapolation of findings. Total circulating carotenoids, α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein seem to be related to a decreased risk of breast cancer. Our findings could have practical importance for public health. This study was registered at PROSPERO as CRD42023434983., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Evidence on the association between following healthy eating and the severity of pemphigus vulgaris (PV) is scarce. Therefore, the aim of this cross-sectional study aimed to investigate the relationship between adherence to the alternative healthy eating index (AHEI) and the severity of Pemphigus vulgaris disease in adults., Methods: In this hospital-based cross-sectional study, a total of 138 pemphigus vulgaris cases were studied, of which 108 had pemphigus disease area index (PDAI) ≤15, and 30 had PDAI>15. Dietary intakes were assessed using a valid 168-item food frequency questionnaire (FFQ). To calculate the AHEI, the data received from the diet were used. The subjects of this index received a score of 1-10. The final AHEI was calculated by summing the component scores., Results: After adjusting for age and sex, we found that individuals with the highest AHEI score were 72% less likely to have increased PV severity compared with those with the lowest score (OR: 0.28; 95% CI: 0.08-0.92, P trend = 0.020). Further control for another potential confounder, intake energy, made the association stronger (OR: 0.24; 95% CI: 0.06-0.88, P trend = 0.017). Also, after controlling the body mass index (BMI) confounding factor, it maintained its strong relationship (OR: 0.24; 95% CI: 0.06-0.88, P trend = 0.016)., Conclusion: The evidence of our study shows that following the healthy eating index is associated with a reduction in the severity of pemphigus vulgaris. Prospective cohort studies are needed to confirm these findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Fallah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Research on the effects of zinc supplementation on lipid profiles in people with type 2 diabetes mellitus (T2DM) has been inconsistent. This systematic review and meta-analysis was performed to summarize the current data on the effects of zinc supplementation on lipid profiles in patients with T2DM. Three online databases including PubMed, Scopus, and Web of Science were searched to find relevant studies published until September 2022. The exposure was zinc supplementation, and the outcomes were low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and total cholesterol (TC). Fourteen randomized clinical trials consisting of 1067 patients were included in the statistical analysis. Significant improvement was observed in all 4 lipid profile components. Following zinc supplementation, a significant decrease was observed in TC (weighted mean difference [WMD]: -16.16; 95% confidence interval [CI]: -26.43, -5.89; P = 0.002), LDL (WMD: -6.18; 95% CI: -9.35, -3.02; P < 0.001), and TG (WMD: -13.08; 95% CI: -21.83, -4.34; P = 0.003). After analyzing 13 studies reporting HDL, a significant increase was seen (WMD: 3.76; 95% CI: 1.30, 6.22; P = 0.003). In a nonlinear dose-response analysis, a significant inverse association was observed between <12 wk zinc supplementation and TC, LDL, and TG (TC: WMD: -5, P nonlinearity < 0.001; LDL: WMD: -5, P nonlinearity = 0.07, TG: WMD: -16.5, P nonlinearity = 0.006). Nonlinear dose-response analysis shows that the optimum elemental zinc dosage for the best response to the supplementation for TC, LDL, and TG are 120, 100, and 140 mg/d, respectively (TC: WMD: -5, P nonlinearity < 0.001; LDL: WMD: -10, P nonlinearity = 0.006, TG: WMD: -50, P nonlinearity = 0.031). In conclusion, we found significant changes in all 4 components of the lipid profile through zinc supplementation in T2DM patients. Based on our findings, zinc supplementation may have profound favorable consequences on the lipid profile of T2DM patients, especially in the zinc-deficient group., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

It has been suggested that vitamin C is involved in suppressing stress oxidation signaling in vitiligo disease. However, the effect of vitamin C supplementation on stress oxidative factors has not been investigated in vitiligo subjects. This study was designed to examine the effects on vitamin C supplementation on serum levels of stress oxidative factors and regimentation in vitiligo patients. Forty-four vitiligo patients will be recruited in this study. After block matching for sex and number of phototherapy sessions, they will be randomly assigned to receive 1000 mg/d vitamin C or placebo for 8 weeks. The weight, height, and waist circumference of participants will be measured. Determination of serum stress oxidative indices (CAT, SOD, GPX, MDA, TOS, TAC) will be done at study baseline and at the end of the trial. Also, the regimentation will be determined using the VASI score. This is the first randomized controlled trial that will determine the effect of vitamin C supplementation on serum levels of stress oxidative indices and regimentation in vitiligo patients. The results of this trial will provide clinical evidence on the effectiveness of vitamin C supplementation in controlling oxidative stress in vitiligo patients. Trial registration number: This study is registered in the Iranian Registry of Clinical Trials website (available at http://www.irct.ir , identifier: IRCT20230123057193N1), Registration date: 2023/04/17., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Zinc deficiency is one of the most important micronutrient deficiencies in children that can affect the children's growth pattern. In this regard, different studies were conducted to assess the effect of zinc supplementation on growth patterns in healthy children. To the best of our knowledge, no systematic review has summarized the results of these studies. So, in the present study, we systematically reviewed the result of the studies that assessed the effect of zinc supplementation on anthropometric parameters in healthy, over 2-year-old children., Methods: A systematic search was carried out in PubMed, Scopus, and Web of Science from inception to November 2021. Data were pooled using the random-effects method and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI)., Results: The pooled results of eight studies, including 1586 participants, showed that zinc supplementation significantly increases height [(WMD): 0.9, 95% CI: (0.27, 1.52), p < 0.001], weight [(WMD): 0.51, 95% CI: (0.06, 0.97), p < 0.001], height for age (HAZ) [(WMD): 0.07, 95% CI: (0.03, 0.10), p < 0.001]. Also, meta-regression analysis did not reveal any significant association between dose and duration of intervention and anthropometric parameters., Conclusion: The present study demonstrates the beneficial effects of zinc supplementation on weight, height, and HAZ., (© 2023. BioMed Central Ltd., part of Springer Nature.)

We aimed to summarize the associations between food sources of fructose and cardiovascular diseases (CVD), cancer, and all-cause mortality risk using a systematic review and meta-analysis. We searched PubMed, Scopus, and Web of Science up to November 2020. We included cohort studies that investigated the relationship between mortality risk (all-cause, CVD, specific CVD, and total and site-specific cancers) and intake of ≥1 food source of fructose (fruit, fruit juice, breakfast cereals, sugar-sweetened beverages (SSBs), sweets, and yogurt) in general adult population. Summary hazard ratios and 95% CIs were estimated using a random-effects model for linear and nonlinear relationships. Findings indicated that each 100 g/d increase in fruit intake was associated with 8-13% lower risk of CVDs, stroke, gastrointestinal, and lung cancer mortality. For all-cause mortality, there was a beneficial relationship up to 200 g/d fruit, and then plateaued. For ischemic heart disease and cancer mortality, there was a beneficial relationship up to 300 g/d followed by a slight increase. Ingestion of breakfast cereals and sweets was also associated with lower risk of all-cause mortality. For yogurt, a non-linear marginal decrease in all-cause mortality was found. Ingestion of each 200 g/d yogurt was associated with a 14% lower risk of CVD mortality. Every 60 g/d increase in sweet intake was linked to a 5% lower risk of all-cause mortality. Contrariwise, every 250 g/d increase in SSBs intake was associated with 7-10% higher risk of all-cause and CVD mortality. In conclusion, beneficial associations were found between fruit, breakfast cereals, sweets, and yogurt with all-cause and/or CVD mortality risk. Fruit intake had also an inverse link with cancer mortality. Conversely, SSBs had a harmful relationship with all-cause and CVD mortality.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2000361 . Registry number: CRD42019144956.

Research on the effects of fish oil on clinical symptoms and psychosocial functioning in people with psychosis has been inconsistent. We conducted this systematic review and meta-analysis to summarize the available data on the effects of oral intake of fish oil on psychological functioning in patients with psychosis. Three online databases including PubMed, Scopus, and Web of Science were searched to identify relevant studies published by April 2021. The exposure was oral fish-oil supplementation. The Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Global Assessment of Functioning (GAF) were our outcome measures. Seventeen randomized clinical trials involving 1390 patients were included. No change in PANSS was observed following oral fish-oil intake [weighted mean difference (WMD): -0.87; 95% CI: -16.99, 15.26; P = 0.92]. In a nonlinear dose-response analysis, a significant inverse association was observed between <10 wk of fish-oil supplementation and PANSS (WMD: -10; P-nonlinearity = 0.02). Although analysis of 4 studies showed a nonsignificant reduction in BPRS after fish-oil intake (WMD: -2.990; 95% CI: -6.42, 0.44; P = 0.08), a nonlinear dose-response analysis revealed significant inverse associations between dose (>2200 mg/d) and duration of fish-oil supplementation (<15 wk) with BPRS score (WMD: -8; P-nonlinearity = 0.04). Combined effect sizes from 6 randomized clinical trials showed significant increases in GAF after oral administration of fish oil (WMD: 6.66; 95% CI: 3.39, 9.93; P < 0.001). In conclusion, we did not find any significant changes in PANSS and BPRS scores following fish-oil supplementation. Nevertheless, oral fish-oil intake significantly contributed to improvement in GAF scores. This is the first meta-analysis to examine the effects of fish oil on the psychological functioning scores of PANSS, BPRS, and GAF simultaneously., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Despite earlier meta-analyses on the association between adherence to a Mediterranean diet (MD) and risk of diabetes, there is no comprehensive and updated study assessing this issue. Furthermore, no earlier study has examined the nonlinear dose-response relation between consumption of an MD and risk of diabetes. The current systematic review and meta-analysis was conducted to investigate the linear and nonlinear dose-response relation between MD and incidence of diabetes. Using relevant keywords, electronic searches for prospective studies were conducted in ISI Web of Science, PubMed, and Scopus until January 2022. The reported HRs or ORs in the primary studies were regarded as RRs. The overall effect was calculated using a random-effects model that accounts for between-study variability. The potential nonlinear dose-response associations were tested using a 2-stage hierarchical regression model. Based on 16 prospective studies (with 17 effect sizes), we found that the greatest adherence to the MD was significantly associated with a reduced risk of diabetes (pooled RR: 0.83; 95% CI: 0.77, 0.90; I2 = 79%, P ≤ 0.001). Based on linear dose-response analysis, each 1-score increase in the Mediterranean diet score was associated with a 3% decreased risk of diabetes (HR = 0.97; 95% CI: 0.96, 0.98; P < 0.001). A nonlinear relation (P-nonlinearity = 0.001) was also observed between MD score and risk of type 2 diabetes. Even modest adherence to the MD was linked to a decreased incidence of type 2 diabetes. The protocol is also registered in the International Prospective Register Of Systematic Reviews (PROSPERO) database (https://www.crd.york.ac.uk/PROSPERO/; registration ID: CRD 42021265332)., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: The evidence on the association between adherence to a healthy lifestyle and risk of glioma are scarce. This is particularly relevant to Middle Eastern countries where lifestyle factors including dietary intakes, physical activity and environmental contributors are different from other parts of the world. The aim of this case-control study was, therefore, investigating the association between adherence to a healthy lifestyle and odds of glioma among adults., Methods: Totally, 128 newly diagnosed glioma cases and 256 age- and sex-matched controls were recruited in this hospital-based case-control study. Dietary intakes were examined by the use of a 126-item validated FFQ. International Physical Activity Questionnaire (IPAQ) was used for measuring physical activity of participants. To construct a healthy lifestyle score (HLS), data from dietary intakes, physical activity and BMI were used. Subjects in the low risk categories of the mentioned components received the score of 1, otherwise they received the score of 0. The final HLS was computed through summing up the scores of components., Results: After adjustment for age and sex, we found that individuals with the highest HLS score were 55% less likely to have glioma compared with those with the lowest score (OR: 0.45; 95% CI: 0.22, 0.92). Additional controlling for other potential confounders made the association stronger (OR: 0.28; 95%CI: 0.12, 0.66). In terms of individual components of healthy lifestyle score, subjects with a healthy diet had 54% lower odds of glioma than those with a non-healthy diet (OR: 0.46; 95%CI: 0.26, 0.80). No significant associations were seen between physical activity level or BMI status and glioma., Conclusion: We found evidence indicating that adherence to a healthy lifestyle, in particular a healthy diet, was associated with a lower odds of glioma. Prospective cohort studies are needed to confirm these findings., (© 2022. The Author(s).)

No information is available from Middle Eastern countries linking dietary calcium intake and odds of breast cancer., Objective: This study was conducted to investigate the association between dietary calcium intake and odds of having breast cancer among Iranian women., In this population-based case-control study, 350 newly diagnosed breast cancer cases were recruited and 700 age-matched subjects were enrolled as controls. Dietary intakes were examined by the use of a 106-item validated FFQ. Total dietary calcium intake of each participant was computed by summing up calcium intake from all foods and dishes. The quartile cutoff points of energy-adjusted calcium intake was obtained in the control group. These cutoff points were used to classify all study participants into quartiles in terms of dietary calcium intake., After adjustment for age and energy intake, we found that individuals in second quartile of calcium intake were 43% less likely to have breast cancer compared with those in the bottom quartile (OR: 0.57; 95% CI: 0.38-0.86). This significant association disappeared after further controlling for other potential confounders including dietary factors and BMI (OR: 0.91; 95% CI: 0.57-1.45). When the analyses were done by menopausal status, premenopausal women with the greatest calcium intake were 60% less likely to have breast malignancy than those with the lowest intake (OR: 0.40; 95% CI: 0.16-0.99). Adjustment for potential confounders did not substantially influence this finding (OR: 0.32; 95% CI: 0.11-0.95). The association remained significant even after additional controlling for dietary covariates (OR: 021; 95% CI: 0.06-0.72) and BMI (OR: 0.21; 95% CI: 0.04-0.93). No significant association was found between dietary calcium intakes and odds of breast cancer in postmenopausal women., Dietary calcium intake was protectively associated with odds of breast cancer in premenopausal women, but not in postmenopausal women. Further prospective investigations are needed to confirm these findings.

Background: Most information on the association of dietary fat intake and gastro-esophageal reflux disorder (GERD) came from developed countries, where lifestyle and other dietary components might be different from those in developing countries. This cross-sectional study was, therefore, conducted to investigate the association between dietary fat intake and odds of having GERD in a large group of Iranian population., Study Design: This cross-sectional study was done among 3362 adult population in Isfahan, Iran. Dietary intakes were collected by the use of a validated semi-quantitative food frequency questionnaire., Methods: Assessment of GERD was done using a validated self-administered questionnaire examining the frequency of heartburn in the last 3 months. Individuals with the presence of heartburn symptoms sometimes, often or always during the last 3 months were defined as having GERD., Results: Participants in the top category of dietary fat intake had higher daily intakes of energy, macronutrients and micronutrients. Dietary intakes of all food groups were also significantly higher among those in the top quintile as compared with those in the bottom category of dietary fat intake ( P < 0.001 for all). There were no significant associations between dietary fat intake and incidence of GERD in general population. Crude and multivariable-adjusted models revealed no significant associations between dietary fat intake and having GERD in either gender., Conclusions: We found no significant association between dietary fat intake and odds of having GERD in this population. Further studies, in particular of prospective designs, are warranted to clarify this association., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Background: Stomach cancer (SC) is one of the most common cancers in the world. Dietary risk factors of SC are not fully understood. This study aimed to investigate the association between macronutrient intakes and the risk of SC., Study Design: A hospital-based case-control study. ., Methods: The data were obtained from a hospital-based case-control study conducted at the Cancer Institute of Iran from 2010 to 2012. Patients were 40 years or older and were diagnosed with SC in less than one year with no history of any cancers. On the other hand, the controls were healthy subjects who were caregivers or visitors of the patients. Demographic characteristics were collected using a structured questionnaire through face to face interviews by trained interviewers. Dietary data were obtained using a validated Diet History Questionnaire. The age and gender-adjusted odds ratios (ORs), as well as the adjusted ORs of age, gender, energy, education, smoking, and body mass index, were reported for continuous and tertiles of intakes., Results: Totally, 207 SC patients and 217 controls participated in this study. In the full adjusted model, after comparing the highest tertiles to the lowest ones, the intake of sucrose (OR: 2.94; 95% CI: 1.66-5.19; P-trend<0.001), protein (OR: 2.04; 95% CI: 1.17-3.55; P-trend=0.011), cholesterol (OR: 2.22; 95% CI: 1.28-3.85; P-trend=0.005), and percent of calories from protein (OR: 3.09; 95% CI: 1.69-5.61; P-trend<1.001) showed a positive significant association with SC. Moreover, a significantly negative association was found between the percent of calories obtained from carbohydrates and SC (OR: 0. 57; 95% CI: 0.33-0.98; P-trend=0.015)., Conclusion: The findings in this study showed that macronutrient intakes might be associated with the etiology of SC in Iran.

Background: Dietary intakes are important for development and prevention of chronic disease. The Food Frequency Questionnaire (FFQ) has been suggested as an acceptable feasible method for assessing the association of dietary intake and disease. However, FFQs are sensitive to dietary habits and culture and should be valid in the study population., Aims: We investigated the validity of the Diet History Questionnaire (DHQ) and the Food Frequency Questionnaire in healthy Iranians., Methods: Participants were healthy relatives of cancer patients in the Cancer Institute of Iran. They participated in face-to-face interviews. We took telephone based 24-hour recalls every 2 months over a 1-year period. Assuming the mean intakes of 24-hour recalls as the gold standard, we estimated Pearson correlation coefficients to measure the reliability of the FFQ and the DHQ. We investigated how the FFQ or DHQ categorized individuals in different intake groups comparing with the 24-hour recalls., Results: Overall, 102 subjects took part in our study. Deattenuated Spearman correlations were ≥ 0.5 for energy, carbohydrate, protein, carotene, niacin, folate, vitamin B 12 , biotin, vitamin C, iron, zinc and selenium in both DHQ and FFQ. Level of agreement with 24-hour recall in classifying individuals into different categories of intakes ranged from 0.81 for riboflavin and carotene to 0.92 for carbohydrate and zinc in the DHQ and from 0.75 for riboflavin to 0.96 for carbohydrate in the FFQ., Conclusions: Both DHQ and FFQ were valid in assessing most nutrient intakes and classifying individuals in different categories of intakes in the Iranian population., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Findings on the effects of probiotics on salivary cytokines and immunoglobulines have been conflicting. We aimed to perform a systematic review and meta-analysis on clinical trials that examined the effects of oral intake and local administration of probiotics on salivary cytokines and immunoglobulines in adults. We searched PubMed, MEDLINE, SCOPUS, EMBASE, and Google Scholar up to April 2020 for all relevant published papers assessing probiotic intakes and salivary cytokines and immunoglobulines. We included all randomized clinical trials that investigated the effect of oral probiotic supplementation or lozenges tablets on inflammatory biomarkers in adults. Studies that reported their effect sizes as mean ± SD or mean ± SEM were included. After excluding non-relevant papers, 8 studies remained in this review. Combining findings from 3 studies with 4 effect sizes, we found no significant reduction in salivary IgA concentrations after oral probiotic supplementation [weighted mean difference (WMD): -0.26; 95% CI: (-0.86, 0.35)]. A significant increase in salivary IL-1β concentrations reached after local probiotic supplementation (WMD: 28.21; 95% CI: 18.42, 38.01); however, no significant changes in salivary IL-6 concentrations after local probiotic supplementation was found (WMD: 0.36; 95% CI: -0.85, 1.56). We observed a significant increase in salivary IL-8 concentrations after local probiotic supplementation (WMD: 31.82; 95% CI: 27.56, 36.08). In case of salivary IL-10 concentrations after local probiotic administration, no significant reduction was seen (WMD: -0.02; 95% CI: -0.10, 0.06). we found that oral and local administrations of probiotics might influence some of salivary cytokines. However, additional clinical trials are required to examine these effects on further pro- and anti-inflammatory cytokines and immunoglobulines.

Purpose: Stroke is one of the most common conditions causing death. There have been few studies examining the effects of alpha lipoic acid (ALA) on stroke patients. In this regard, the present randomized controlled clinical trial was conducted to examine the effects of ALA supplementation on serum albumin, and inflammatory and oxidative stress markers in stroke patients. Methods: The present paralleled randomized controlled clinical trial involved 42 stroke patients who were over 40 years and under enteral feeding. The participants were randomly assigned into two groups and finally 40 patients completed the study. Patients in alpha lipoic acid group (n=19) took 1200 mg ALA supplement daily along with their meal, and participants in control group (n=21) underwent the routine hospital diet for 3 weeks. Fasting blood samples were obtained and albumin, oxidative stress, and inflammatory indices were assessed at baseline, as well as at the end of the trial. Results: After 3 weeks, treatment of patients with ALA led to a significant decrease in tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) levels ( P =0.01) compared to baseline. But serum levels of albumin, total antioxidant capacity (TAC), malondialdehyde (MDA), highsensitivity C-reactive protein (hs-CRP), IL-6 and TNF-α did not change significantly vs. control group ( P >0.05). Conclusion: ALA did not significantly change the serum levels of albumin and inflammatory as well as antioxidant capacity indices in stroke patients compared with the control group. More clinical trials with large sample sizes and long duration are needed to clarify the effects of ALA on these patients., (© 2020 The Authors.)

Objectives: The present study was aimed to investigate the effect of alpha-tocopherol supplementation on biomarkers of endothelial function (Intercellular Adhesion Molecule 1 and Vascular Cell Adhesion Protein 1) and inflammatory markers (Interleukin 6 and high-sensitivity C-reactive protein) among the hemodialysis patients., Methods: To conduct this randomized, double-blinded, and placebo-controlled clinical trial, 49 hemodialysis patients, aged 20-60 years, were recruited and randomly divided into the intervention and control groups. The intervention group (n = 25) received 600 IU alpha-tocopherol soft gels (200 IU three times daily), while the controls (n = 24) consumed the identical placebo soft gels for 10 weeks. At the baseline and end of the study, 7 ml pre-dialysis blood samples were taken from all participants to measure their serum concentrations of ICAM-1, VCAM-1, IL-6, and hs-CRP., Results: Alpha-tocopherol supplementation reduced the serum levels of ICAM-1 and VCAM-1 significantly (-140.67 ± 57.25 ng/ml vs. -15.97 ± 79.19 ng/ml, P = 0.001 for ICAM-1 and --6.79 ± 4.76 ng/ml vs. 1.02 ± 3.22 ng/ml, P = 0.019 for VCAM-1). However, no significant difference was observed between the two groups regarding the serum levels of hs-CRP (-0.15 ± 0.19 mg/l vs. 0.02 ± 0.12 mg/l; P = 0.32) and IL-6 (-0.03 ± 0.1 pg/ml vs. - 0.06 ± 0.11 pg/ml; P = 0.65)., Conclusions: Our results showed that 10 weeks of supplementation with 600 IU alpha-tocopherol improved ICAM-1 and VCAM-1 levels, but did not have any effect on the serum concentration of IL-6 and hs-CRP in hemodialysis patients. Further studies are required to confirm these findings., Competing Interests: Declaration of Competing Interest All authors declared that they have no personal or financial conflicts of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Although several studies have investigated the association between Internet use and odds of overweight and obesity, results are inconsistent. This systematic review and meta-analysis was performed to summarize evidence on the association between Internet use and odds of overweight and obesity. A systematic literature search was conducted in PubMed/Medline, Web of Science, Scopus, and Google Scholar up to February 2019 to identify relevant publications. Finally, 9 cross-sectional studies were considered in this systematic review and meta-analysis. Combining 11 effect sizes from 9 studies, we found a significant, positive association between the highest Internet use, compared to the lowest (ranged from ≥5 h/d to no use among studies), and odds of overweight and obesity (OR: 1.47; 95% CI: 1.21-1.78; I2, 69.6%; P < 0.001), such that Internet users had 47% greater odds of being overweight or obese. We also observed a significant, positive association between the highest Internet use, compared to the lowest (ranged from ≥5 h/d to no use among studies), and overweight/obesity (OR: 1.15; 95% CI: 1.06-1.25; I2, 0.0%; P = 0.426), obesity (OR: 2.58; 95% CI: 1.88-3.54; I2, 0.0%; P = 0.637), and overweight (OR: 1.38; 95% CI: 1.16-1.64; I2, 13.1%; P = 0.330). A linear dose-response meta-analysis revealed that each additional 1 h/d of Internet use was associated with 8% increased odds of overweight and obesity (OR: 1.08; 95% CI: 1.05-1.11; I2, 3.8%; P = 0.403). Findings of this systematic review and meta-analysis indicated that Internet use was positively associated with increased odds of being overweight and obese., (Copyright © American Society for Nutrition 2019.)

Background: Majority of earlier studies have assessed the association between individual lifestyle factors and the risk of breast cancer (BC); however, limited information is available linking the whole lifestyle factors to BC. We aimed to examine the association between combined lifestyle score (diet, physical activity (PA) and smoking) and risk of BC in Iranian population., Methods: This population-based case-control study included 350 newly diagnosed cases of BC and 700 healthy controls randomly selected from adult women. Dietary intakes, PA and smoking status of study participants were examined using validated questionnaires. The lifestyle risk factors examined in this study included cigarette smoking, physical inactivity, and Healthy Eating Index-2010 (HEI-2010). The lifestyle score ranged from zero (non-healthy) to 3 (most healthy) points. Logistic regression models were fitted to investigate the association between combined lifestyle scores and odds of BC., Results: Mean age and body mass index (BMI) of study participants were 62.4 years and 24.3 kg/m 2 , respectively. In the whole study population, individuals with the highest healthy lifestyle score (HLS) were 0.38 times less likely to have BC than those with the lowest score (OR: 0.62; 95% CI: 0.40, 0.93, P trend  = 0.01). The analysis by menopausal status showed that postmenopausal women with the highest HLS had 44% lower odds of BC compared with those with the lowest score (OR: 0.56; 95% CI: 0.36, 0.88, P trend  = 0.004). Such association was not seen in premenopausal women. After analyzing each component of HLS, we found that individuals with the highest HEI score were 46% less likely to have BC than those with the lowest score (OR: 0.54; 95% CI: 0.35, 0.82, P trend  <  0.001). No other significant associations were found between PA and smoking and risk of BC., Conclusions: Significant inverse associations were found between HLS and HEI with BC especially among postmenopausal women. Prospective studies are required to confirm these findings.

Background/objective: Dietary recommendations for the consumption of spicy foods in uninvestigated heartburn are still under debate. We examine the association between spicy food consumption and the prevalence of uninvestigated heartburn in a large sample of Iranian adults., Methods: This cross-sectional study was conducted among 4,633 Iranian adults living in Isfahan (2,046 men, 2,587 women) in 2010. The average daily intake of spicy foods was estimated using a dietary habit questionnaire. Uninvestigated heartburn was defined, using a validated Rome III questionnaire, as the presence of heartburn sometimes, often or always during the last 3 months., Results: Uninvestigated heartburn was prevalent in 23.8% (n = 1,103) of participants. After controlling for potential confounders, including dietary behaviors and body mass index, men consuming spicy foods ≥10 times/week were 2.63 times more likely to have uninvestigated heartburn (95% CI:1.28-5.36) compared with those who never consumed spicy foods. Also, those men with the highest consumption of spicy foods were 3 times more likely to experience heartburn frequently (95% CI 1.44-6.39) compared with men with the lowest intake. No overall significant associations were found between the consumption of spicy foods and uninvestigated heartburn, including the frequency and severity of heartburn, in women. When the analysis was restricted to those with uninvestigated heartburn, no significant associations were found between consumption of spicy foods and frequency of heartburn either in men or women., Conclusion: The present findings suggest that high consumption of spicy foods was associated with a greater risk of uninvestigated heartburn in men, but not in women. Further studies, particularly of a prospective nature, are needed to confirm our findings, as well as underlying mechanisms., (© 2019 S. Karger AG, Basel.)

Background: Findings on the association of sugar sweetened beverages (SSB) and fructose intakes with gout and hyperuricemia have been conflicting. Objective: We aimed to perform a systematic review and meta-analysis on studies that examined the association of SSB and fructose consumption with gout and hyperuricemia in adults. Methods: We searched PubMed, Scopus and Google Scholar up to Aug 2017 for all relevant published papers assessing SSB and fructose intakes and risk of gout and hyperuricemia. After excluding non-relevant papers, 10 studies remained in our systematic. Meta-analysis on SSB consumption and risk of gout was done on three effect sizes from cohort studies and five effect sizes from case-control studies. For risk of hyperuricemia, the meta-analysis was done on six effect sizes from cross-sectional studies. All analyses were performed on ORs or RRs. Results: We found an overall significant positive association between SSB consumption and risk of gout in both cohort (summary effect size: 1.35; 95% CI: 1.18-1.55) and case-control studies (summary effect size: 1.33; 95% CI: 1.06-1.66). Meta-analysis on cross-sectional studies revealed that SSB consumption was associated with 35% greater odds of hyperuricemia (summary effect size: 1.35; 95% CI: 1.19-1.52). No evidence of between-study heterogeneity as well as publication bias was found. Although the studies on fructose intake and risk of gout and hyperuricemia were included in our systematic review, we did not perform met-analysis on these studies due to insufficient number of publications. Conclusion: We found that SSB consumption was significantly associated with increased risk of gout and hyperuricemia in adult population. Further studies are needed to examine the association between dietary fructose intake and risk of gout and hyepruricemia.

Background: Although individual macronutrients were studied in relation to mental health, no information exist about the association between adherence to low carbohydrate diet and psychological disorders. This study was conducted to investigate the association between adherence to a low carbohydrate diet and prevalence of psychological disorders among Iranian adults., Methods: In this cross-sectional study on 3362 adult men and women, dietary intakes were examined by the use of a validated semi-quantitative food frequency questionnaire. Low carbohydrate diet (LCD) score was computed for each participant based on deciles of percentages of energy from macronutrients. Then the scores of carbohydrate, protein and fat intake for each participant were summed up to achieve the overall LCD score, which ranged from 3 (highest carbohydrate intake and lowest fat and protein intakes) to 30 (lowest carbohydrate intake and highest fat and protein intakes). Anxiety, depression, and psychological distress were assessed by validated Iranian versions of the Hospital Anxiety and Depression Scale and General Health Questionnaire-12., Results: Prevalence of depression, anxiety and psychological distress in the whole population were 28.0, 13.3 and 22.6%, respectively. No significant differences were observed in the distribution of depression, anxiety and psychological distress across different quartiles of LCD score. After controlling for potential confounders, no significant association was seen between LCD score and prevalence of depression (OR for the highest vs. the lowest quartile of LCD score: (1.15; 95% CI: 0.93, 1.39). Consumption of LCD was not also associated with increased risk of anxiety (0.82; 95% CI: 0.59, 1.14) and psychological distress (0.92; 95% CI: 0.72, 1.16). These associations did not alter when the analyses were done stratified by gender or BMI status., Conclusion: Adherence to the low carbohydrate diet, which contains high amount of fat and proteins but low amounts of carbohydrates, was not associated with increased odds of psychological disorders including depression, anxiety and psychological distress. Given the cross-sectional nature of the study which cannot reflect causal relationships, longitudinal studies, focusing on types of macronutrients, are required to clarify this association.

Background: Observational studies that investigated the association between adherence to low carbohydrate diet and odds of glioma are sparse. This is particularly relevant in developing countries where dietary carbohydrate intake is very high., Objective: This study was, therefore, conducted to investigate the association between adherence to low carbohydrate dietary pattern and odds of glioma among Iranian adults., Methods: In this hospital-based case-control study, 128 newly diagnosed glioma cases were recruited and 256 age- and sex-matched subjects were enrolled as controls. Dietary intakes were examined by the use of a 126-item validated FFQ. Low carbohydrate diet (LCD) score was computed for each participant based on deciles of percentages of energy from carbohydrates, proteins, and fats. Individuals in the lowest decile of carbohydrate consumption received 10 points. Participants in second decile received 9 points and so on down to participants in the highest decile received 1 points. For fat and protein intakes, the points assigned to deciles were reversed; such that those in the highest decile received 10 points and those in the lowest decile received 1 point. We then summed all points of the three macronutrients to achieve the overall diet score, which ranged from 3 (highest carbohydrate intake and lowest fat and protein intakes) to 30 (lowest carbohydrate intake and highest fat and protein intakes). The higher the score, the greater adherence to the LCD dietary pattern., Results: After adjustment for age and sex, we found that individuals in top tertile of LCD score were 60% less likely to have glioma compared with those in the bottom tertile (OR: 0.40; 95% CI: 0.23, 0.67). Additional controlling for other potential confounders made the association slightly attenuated (OR: 0.49; 95%CI: 0.26, 0.93). Further adjustment for dietary nutrient intakes strengthened the association (OR: 0.32; 95%CI: 0.12, 0.81). After additional controlling for BMI, we found that adherence to LCD was protectively associated with reduced odds of glioma (OR: 0.32; 95%CI: 0.12, 0.81)., Discussion: We found an inverse association between adherence to LCD and odds of glioma among Iranian population. Prospective cohort studies are needed to confirm these findings., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: This study described validity of Diet History Questionnaire (DHQ) for assessing energy and nutrient intake among Iranian population., Methods: A group of experienced nutritionists translated the DHQ to Farsi language and modified it based on Iranian food habits and cooking methods. We recruited 244 healthy adults with a mean age of 42.83 ± 0.75 yrs. from healthy individuals who were friends or relatives of patients in the Cancer Institute of Iran from April 2011 to February 2012. We used the DHQ to assess dietary intakes through interviews as well as at least four 24-h recalls one in every season. Reliability was estimated by comparing data of DHQ with mean intake from 24-hour recalls using deattenuated and energy-adjusted Spearman correlation coefficients. We classified dietary intakes of two methods into three groups to probe if DHQ correctly allocates subjects into different intake groups compared to reference method. The results are reported as percent of disagreement, adjacent agreement, and complete agreement., Results: Deattenuated spearman correlation ranged from 0.18 for vitamin B 12 and fat to 0.60 for sugar. It ranged from 0.13 for pantothenic acid to 0.60 for sugar in men and from 0.07 for fat to 0.58 for sugar in females. The complete agreement of methods ranged from 51% for selenium to 36% for carotene in the entire sample, from 50% for energy to 31% for niacin in males and from 49% for sugar to 27% for vitamin B 12 in females., Conclusion: The DHQ is a valid tool for assessing most nutrients intake among Iranian population. In addition, it is a proper instrument in categorizing individuals based on their dietary intakes., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: It has been suggested that vitamin D and its receptors involve in suppressing fibrogenic signaling in non-alcoholic fatty liver disease (NAFLD). However, the effect of vitamin D supplementation on fibrogenic factors has not been investigated in NAFLD individuals with steatohepatitis. This study was designed to examine the effects on vitamin D supplementation on serum levels of vitamin D receptor (VDR), fibrogenic factors, and fibrogenic microRNAs (MiR) in NAFLD patients., Methods: Forty-six NAFLD patients will be recruited in this study. After block matching for sex and BMI, they will be randomly assigned to receive 4000 IU/day vitamin D or placebo for 12 weeks. Weight, height, and waist circumference will be measured. Determination of serum fibrogenic MiRs, laminin, collagen type IV, hyaluronic acid, vitamin D, VDR, calcium, blood glucose, serum insulin, lipid profile, liver markers (ALT, AST, total, direct, and indirect bilirubin) will be done at study baseline and at the end of the trial. Insulin resistance and insulin sensitivity will be determined using the HOMA-IR and QUICKI equation., Discussion: This is the first randomized controlled trial that will determine the effect of vitamin D supplementation on serum levels of VDR, fibrogenic factors, and fibrogenic MiRs in NAFLD patients. The results of this trial will provide clinical evidence on the effectiveness of vitamin D supplementation in controlling liver fibrosis in NAFLD patients., Trial Registration: Iranian Registry of Clinical Trials, IRCT201405251485N13 . Registered on 14 March 2017.

Objective: This randomized clinical trial was conducted to evaluate the effects of silymarin supplementation on glycemic indices and serum lipid profile in type 2 diabetes mellitus (T2DM) patients., Methods: 40 T2DM patients (twenty male and twenty female), 25-50 years of age and on stable medication, were recruited for the present paralleled, randomized, triple-blinded, placebo-controlled clinical trial. The participants were randomly assigned to the silymarin or placebo groups, in which the patients either received 140 mg of silymarin, thrice daily (n = 20) or placebo (n = 20) for 45 days. Anthropometric and dietary intake data were collected at the baseline and end of the trial. Fasting blood samples were collected, and glycemic indices and lipid profile were determined at baseline, as well as the end of the study., Results: Silymarin supplementation led to significant reduction in fasting blood sugar, serum insulin, homeostatic model assessment for insulin resistance, serum triglyceride and triglyceride to high-density lipoprotein cholesterol ratio as compared to the placebo, by 11.01, 14.35, 25.92, 23.7 and 27.67% respectively. There was significant increase in high-density lipoprotein cholesterol levels and quantitative insulin sensitivity check index in the silymarin group as compared to the placebo group, by 6.88 and 5.64% respectively, (p < 0.05). Total cholesterol and low-density lipoprotein cholesterol concentrations significantly decreased in the silymarin group as compared to the baseline, by 7.93 (p = 0.001) and 7.15% (p = 0.02), respectively., Conclusion: Silymarin supplementation may improve the glycemic indices and lipid profiles of T2DM patients. More studies are needed to validate the adjunct use of silymarin for metabolic control of T2DM patients., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Aim: Diabetes is a serious metabolic disorder and oxidative stress and inflammation contribute to its pathogenesis and complications. Since Silybum marianum (L.) Gaertn. (silymarin) extract is an antioxidant with anti-inflammatory properties, this randomized clinical trial was conducted to evaluate the effects of silymarin supplementation on oxidative stress indices and hs-CRP in type 2 diabetes mellitus patients., Methods: For the present paralleled, randomized, triple-blinded, placebo-controlled clinical trial, 40 type 2 diabetes patients aged 25-50 yr old and on stable medication were recruited from the Iranian Diabetes Society and endocrinology clinics in East Azarbayjan (Tabriz, Iran) and randomly assigned into two groups. Patients in the silymarin treatment group received 140 mg, thrice daily of dried extracts of Silybum marianum (n = 20) and those in the placebo group (n = 20) received identical placebos for 45 days. Data pertaining to height, weight, waist circumference and BMI, as well as food consumption, were collected at base line and at the conclusion of the study. Fasting blood samples were obtained and antioxidant indices and hs-CRP were assessed at baseline, as well as at the end of the trial., Results: All 40 patients completed the study and did not report any adverse effects or symptoms with the silymarin supplementation. Silymarin supplementation significantly increased superoxide dismutase (SOD), glutathione peroxidase (GPX) activity and total antioxidant capacity (TAC) compared to patients taking the placebo, by 12.85%, 30.32% and 8.43%, respectively (p < 0.05). There was a significant reduction in hs-CRP levels by 26.83% (p < 0.05) in the silymarin group compared to the placebo group. Malondialdehyde (MDA) concentration significantly decreased by 12.01% (p < 0.05) in the silymarin group compared to the baseline., Conclusions: Silymarin supplementation improves some antioxidant indices (SOD, GPX and TAC) and decrease hs-CRP levels in T2DM patients., (Copyright © 2015. Published by Elsevier GmbH.)