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OBJECTIVE Emerging evidence points toward a connection between mental health and the gut microbiota and its metabolites (e.g., short-chain fatty acids - SCFAs). It is unknown whether gut microbiota levels are associated with the development of mental health problems (e.g., internalizing or externalizing behaviors) in preschool children. The objective of this study was to evaluate associations between the gut microbiota and internalizing and externalizing behaviors in preschool-aged children. METHODS A community sample of 248 typically developing children (3-5 years) provided a stool sample for gut microbiota and SCFA analysis. Parents reported child internalizing and externalizing behaviors using the Child Behavior Checklist. Associations between child behaviors and gut microbiota measures were analyzed using Spearman correlations followed by an adjustment for multiple testing, with subanalysis conducted in children clinically "at risk" for behavioral problems compared to those who were not using Mann-Whitney U tests. RESULTS There was a correlation between Shannon alpha diversity with internalizing behaviors (rs = -0.134, p = 0.035), and its subscale somatic complaints (rs = -0.144, p = 0.023), while children clinically "at risk" for internalizing problems had decreased alpha diversity (U = 551, p = 0.017). Internalizing behaviors correlated with valerate and isobutyrate (rs = -0.147, p = 0.021; rs = -0.140, p = 0.028, respectively), while the somatic complaints subscale additionally correlated with acetate and butyrate (rs = -0.219, p = 0.001; rs = -0.241, p < 0.001, respectively). These findings were also present in children "at risk" for internalizing problems (U = 569, p = 0.026; U = 571, p = 0.028), and somatic complaints (U = 164, p = 0.004; U = 145, p = 0.001). CONCLUSIONS These analyses reveal novel associations between internalizing behaviors and the gut microbiota in preschool children. Furthermore, a relationship between somatic complaints and acetate and butyrate was identified, indicating that interventions that increase SCFA production warrant future investigation.

Objective This study aimed to investigate effects of hydroxy citric acid (HCA) extracts from Garcinia Cambogia on weight and serum hepcidin level in women with non- alcoholic fatty liver diseases (NAFLD). Design Clinics of Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran Methods This randomized clinical trial was conducted on 40 obese women aged 18–50 years with NAFLD, which were randomly allocated into two groups: “HCA group” (who received low-calorie diet plus six HCA tablets per day) and “Control group" (who received a low-calorie diet only), for eight weeks. Anthropometric parameters, dietary intake, physical activity level, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), high sensivity c-reactive protein (hs-CRP) as well as, plasma level of hepcidin were measured at baseline and at the end of the study. Results There was a significant reduction in dietary intakes in both groups (p Conclusion HCA can improve weight loss in NAFLD patients, while it may not have favorable effects on liver enzymes, hs-CRP and serum hepcidin level. IRCT number: 201503273320N11

PURPOSE: Spexin, a novel 14-amino acid peptide, has multiple physiological functions. The purpose of this paper was to systematically evaluate the current literature on the role of Spexin neuropeptide in obesity and its related comorbidities, food intake and overall metabolic status in human, animal and in vitro studies. METHODS: Multiple databases, including PubMed, EMBASE, ProQuest, Scopus and Google Scholar were searched for English-language papers published since inception until December 2018, that investigated Spexin levels in relation to chronic metabolic diseases, overall metabolism control and feeding-related behaviors.The quality of the included observational studies was assessed by a version of the Newcastle Ottawa Scale (NOS) designed for non-randomized studies and SYRCLE’s assessment tool for animal models. RESULTS: Out of 224 records screened, search results led to a total of 24 related studies (12 human studies (ten cross-sectional studies, one cohort study, and one longitudinal study) and 12 studies in either animals or in vitro).Nine of the included cross-sectional studies and one Longitudinal study had moderate to good study quality, and one cross-sectional and one cohort study had high-quality (or low risk of bias). CONCLUSION: It appears that Spexin has a positive impact on overall metabolic status. As a novel appetite-regulating peptide, Spexin can act as an anorexigenic factor. Information about Spexin is very limited, and well-designed randomized controlled clinical trials are warranted for replicating, validating, and extending the current findings. PROSPERO REGISTRATION NUMBER: CRD42018117198). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40200-020-00636-8) contains supplementary material, which is available to authorized users.

Background Type 2 diabetes mellitus (T2DM) is related to the gut microbiota with numerous molecular mechanisms. Modulating the gut microbiota by probiotics could be effective in management of T2DM. The aim of the present trial was to evaluate the effect of Lactobacillus casei on glycemic control and serum sirtuin1 (SIRT1) and fetuin-A in patients with T2DM. Methods Forty patients with T2DM (n = 20 for each group) were divided into intervention (probiotic) and placebo groups. The intervention group received a daily capsule containing 108 cfu of L. casei for eight weeks. The patients in placebo group took capsules containing maltodextrin for the same time duration. Anthropometric measurements, dietary intake questionnaires, and blood samples were collected, and the patients were assessed by an endocrinologist at the beginning and at the end of the trial. Results Fasting blood sugar, insulin concentration, and insulin resistance significantly decreased in probiotic group compared with placebo group (-28.32 [-50.23 to -6.41], 0.013; -3.12 [-5.90 to -0.35], 0.028; -32.31 [-55.09 to -9.54], 0.007, respectively). Moreover, HbA1c reduced after intervention, but the reduction was not significant (-0.45 [-0.96 to 0.05], 0.077). In comparison with placebo, the L. casei supplementation significantly increased SIRT1 and decreased fetuin-A levels at the end of the trial (0.52 [0.026 to 1.02], 0.040; -17.56 [-32.54 to -2.58], 0.023, respectively). Conclusion L. casei supplementation affected SIRT1 and fetuin-A levels in a way that improved glycemic response in subjects with T2DM. Affecting the SIRT1 and fetuin-A levels introduces a new known mechanism of probiotic action in diabetes management.

Depression is a common mental disorder in the elderly, and can adversely affect functionality and cognition. Physical illness predisposes the older adults to depression. The current treatment strategies for the management of geriatric depression are not efficient enough, are poorly tolerated, and have undesirable side effects in the patients. This necessitates emerging of new therapeutic options for alleviation of depression in the elderly. One main aspect of most chronic diseases in geriatrics is inflammation. Gut microbiota dysbiosis, which has been frequently reported in the elderly, can lead to endotoxemia and exacerbation of inflammatory status in the body. Restoring gut microbiota balance through application of psychobiotics (i.e., the probiotics and prebiotics) might help ameliorate inflammation, consequently enhancing psychological well-being. Although clinical trials have not come up with much promising results in this regard thus far, more studies with various probiotic strains and prebiotic types are required to draw a conclusion.

The growing elderly population of the world is at greater risk of malnutrition due to physical and psychosocial factors. Since malnutrition contributes substantially to morbidity and mortality, it is essential that valid screening tools be applied to timely diagnose and manage malnutrition in the elderly. Geriatric Nutritional Risk Index (GNRI) is a valid and reliable tool for detecting hospitalized elderly at risk of malnutrition, based on serum albumin and the ratio between the present weight and the ideal body weight of the patient. GNRI has also shown high predictive value in terms of mortality or postoperative complications, in cases other than hospitalized elderly, including hemodialysis, heart diseases, some cancers, and critical limb ischemia. However, it is less useful in overweight patients, is affected by hydration and hormonal status, requires laboratory assays and thus isn’t readily applicable in the community setting, and depends on albumin which is an unspecific indicator of malnutrition.

Background The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. Objective The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. Methods The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. Results Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. Conclusions This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. International Registered Report Identifier (IRRID) DERR1-10.2196/25407

BACKGROUND The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. OBJECTIVE The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. METHODS The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. RESULTS Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. CONCLUSIONS This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25407

Additional file 1: Supplemental Table 1. Affirmative responses to questions of the short questionnaire. Supplemental Table 2. Association between the monthly income per capita and frequency of food groups / items consumption. Supplemental Table 3. Consumption frequency of food groups/ items related to whether subjects could afford to eat balanced meals.

Only a limited number of studies have compared nursing home and community residing elderly in terms of health-related issues. The present study aimed to compare nutritional status and its associated factors between nursing home residents and community-dwelling seniors.In this case-control, age- and gender-matched study in Tabriz (East Azarbaijan, Iran), elderly subjects aged 65 years and older were recruited from nursing homes (n = 76) and community (n = 88). Anthropometric, blood pressure and dietary intake measurements, as well as biochemical assays were performed. Nutritional status (Mini Nutritional Assessment: MNA), cognitive function (Mini Mental State Examination: MMSE) and physical performance (Barthel Index) were assessed and compared between the two settings.Nursing home residents had significantly lower body mass index (BMI), limbs, waist and hip circumferences, and diastolic blood pressure. Caloric and protein intake of the groups were similar, while nursing home residents received lower amounts of many micronutrients and saturated fats and higher polyunsaturated fats. MNA, MMSE and Barthel index scores were significantly different between the groups, all of them in favor of the free living elderly (p 0.001, p 0.001 and p = 0.014, respectively). Laboratory tests revealed significantly lower levels of hemoglobin, folate, fasting blood sugar, insulin, albumin, prealbumin, creatinine and uric acid in the nursing home group; however, mean cell volume (MCV) and HDL-cholesterol were higher in this group.Elderly people living in nursing homes have lower BMI, suffer from many nutritional deficiencies and are predisposed to malnutrition, impaired cognition and deteriorating physical performance, compared to community dwelling seniors.

Chlorella vulgaris (C. vulgaris) is reported to improve dyslipidemia and hypertension; however, its effect on inflammatory biomarkers and insulin resistance has not been noticed thus far. Non-alcoholic fatty liver disease (NAFLD) as a hepatic symptom of metabolic syndrome is strongly associated with insulin resistance and inflammation.In the current interventional trial, we aimed to study the effects of C. vulgaris supplementation on glucose homeostasis, insulin resistance and inflammatory biomarkers in patients with NAFLD.Seventy NAFLD patients confirmed by ultra-sonographic findings were randomly assigned into intervention group (four 300 mg tablets of C. vulgaris) or placebo group (four 300 mg tablets of placebos) for 8 weeks. Anthropometric measurements, liver enzymes, fasting serum glucose (FSG), insulin, high sensitive C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-α) were assessed and homeostatic model assessment (HOMA) score for insulin resistance was estimated before and after the intervention.Anthropometric measurements decreased significantly in both group (p 0.001). However, mean reduction in weight was significantly higher in C. vulgaris - treated group compared to placebo group. Serum concentrations of liver enzymes, FSG and hs-CRP also significantly decreased and serum insulin concentration and HOMA score increased significantly only in C. vulgaris-treated group (P 0.001, P 0.006 and P 0.025, respectively). Mean change in serum glucose and TNF-α levels were significant between the groups even after adjusting for the serum insulin and baseline values of variables (P = 0.014, P = 0.005, P = 0.014, respectively); between-group differences were not significant for the other variables by the end of study.To our finding, C. vulgaris supplementation could be considered as an adjunctive therapy to decrease weight and improve glycemic status and reducing hs-CRP as well as improving liver function in patients with NAFLD.201202233320N7.

Background: Probiotics are live beneficial microorganisms which may exert hypolipidemic effects through many mechanisms. Lipid profile disturbances are frequently reported in rheumatoid arthritis (RA) patients. The objective of this study was to evaluate the effects of Lactobacillus casei on serum lipids of RA women. Methods: In the present parallel randomized double-blind placebo-controlled clinical trial, 60 RA patients were recruited and divided into 2 groups. They received either a daily capsule containing 108 CFU of L. casei 01, or identical capsules containing maltodextrin, for 8 weeks. Anthropometric parameters, dietary intake and physical activity were assessed at 2 ends of the study. Serum levels of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and triglyceride (TG) were measured. Independent-samples t test and analysis of covariance (ANCOVA) test, and paired t test were used to test between- and within-group differences, respectively. Results: There were no significant between- or within-group differences for demographic and anthropometric parameters, physical activity and dietary intakes, throughout the study. No statistically significant within-group changes were observed for serum lipids in either group; between-group differences were also insignificant by the end of study period (TC: -0.18 [-0.65, 0.29], P = 0.801, HDL-C: -1.66 [-19.28, 15.59], P = 0.663, LDL-C: -2.73 [-19.17, 13.73], P = 0.666, TG: 0.12 [-19.76, 20.00], P = 0.900). Conclusion: Lactobacillus casei 01 could not improve serum lipids in RA patients. Further studies using probiotic foods and different probiotic strains are suggested.

As there is limited and inconsistent evidence in potential role of vitamin D on insulin resistance and matrix metalloproteinases, this study aimed to examine the effect of vitamin D supplementation on glucose homeostasis, insulin resistance, and matrix metalloproteinases in obese subjects with vitamin D deficiency. A total of 44 participants with serum 25-hydroxyvitamin D (25(OH)D) level ≤ 50 nmol/L and body mass index (BMI) 30–40 kg/m2 were randomly allocated into receiving weight reduction diet with either 50 000 IU vitamin D3 pearl (n = 22) or placebo (n = 22) once weekly for 12 weeks. Primary outcomes were changes in fasting serum glucose (FSG), homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and matrix metalloproteinases (MMPs). Secondary outcomes were changes in weight, BMI, 25(OH)D, calcium, phosphorous and parathyroid hormone (PTH). Sun exposure and dietary intakes were also assessed. Serum levels of 25(OH)D3 increased significantly with a simultaneous decrease in serum concentration of PTH in the vitamin D group. Weight, BMI, FSG, and MMP-9 decreased significantly in both groups, and there were significant differences in changes in weight, serum 25(OH)D3, PTH, and MMP-9 levels between the groups. Within- and between-groups analysis revealed no significant differences in serum calcium, phosphorous, serum insulin, HOMA-IR, QUICKI, and MMP-2 after intervention. Our results indicated that improvement in vitamin D status resulted in greater reductions in weight and MMP-9 during weight loss. These preliminary results are sufficient to warrant a bigger study group.

Background Adequate supplies of food and food security (FS) are the fundamental aspects of human societies, and considered one of the pivotal factors of individual and social health. The aim of the present study was to assess the applicability of the short questionnaire for screening food insecurity (FI) and to evaluate the prevalence of FI in northwest of Iran. Methods In this study, 550 subjects aged ≥16 years were studied. Three-day dietary records and a short questionnaire were applied to estimate the prevalence of FI in terms of hunger and hidden hunger. The sensitivity, specificity and accuracy of the short questionnaire were assessed. Moreover, the association between the results of the short questionnaire and the criteria that were theoretically related to FI were examined. Data were presented as mean (SD), median (min-max) for the numeric normal and non-normal variables, respectively, and frequency (percent) for categorical variables. The between-group comparisons of variables were done using independent samples t test. P values less than 0.05 were considered statistically significant. Results The prevalence of hunger and hidden hunger was 30.8 and 46.0%, respectively. Overall, 23.2% of the subjects were classified as “food secure”. The sensitivity, specificity and accuracy of the short questionnaire in determining hunger were 92.8% (95% CI: 87.3–95.9), 84.2% (95% CI: 79.3–89.3), and 87% (95% CI: 84–90.2), respectively. These values for hidden hunger were 21.6% (95% CI: 15.7–29.9), 92.3% (95% CI: 88.7–99.4), and 53.4% (95% CI: 47.9–59.8), respectively. Our study showed a statistically significant association between FI and socio-economic status. FI significantly enhanced the risk of underweight, while it markedly reduced the risk of overweight and obesity. The average frequency of monthly consumption of meat, dairy products, fruits, vegetables, and rice was significantly lower in food insecure group, while the median frequency of bread consumption was markedly higher in food insecure group. The participants of insecure group were less likely to consume fruits, vegetables, dairy products, rice and meat. Conclusions FI was frequent in North-west of Iran. The findings indicated that the short questionnaire was a simple, low-cost and practical tool for screening FI in terms of hunger. Trial registration IR.TBZMED.REC.1397.400.

Background and aims Spexin (SPX) is a novel peptide recently discovered as an important regulatory adipokine in obesity and related metabolic diseases. The aim of the current study was to determine the potential role of Circulating levels of SPX in obese children and explore its relationships with obesity-related risk factors, and its potential role in preventing obesity. Methods and results Forty-five obese children and 45 normal-weight children of similar age and sex, with mean age of 13.73 (2.68) were recruited in this Study. Weight and height, blood pressure, resting metabolic rate (RMR), physical activity level, stress, anxiety and depression, appetite status, daily energy intake, pubertal stage, serum Spexin, Interleukin-10 (IL-10), IL-1β, high-sensitivity C-reactive protein (hs-CRP), fasting glucose, insulin and lipid profile, were measure during standard techniques. Median (IQR) of Spexin levels were significantly lower in obese vs. normal-weight children [120.70 (77.7) pg/mL vs.145 (186.7)pg/mL; P = 0.03]. Based on the tertiles of the serum Spexin levels, a protective independent effect was observed for the highest tertile of serum Spexin concentrations. Crude OR (CI): 0.33 (0.11–0.95), P-trend = 0.04. Model 1 OR (CI): 0.20 (0.05–0.73), P- trend = 0.01, Model 2 OR (CI): 0.22 (0.05–0.86), P -trend = 0.03. Serum Spexin concentration was significantly associated with IL-10, IL-1β, fasting Insulin and HOMA-IR (P Conclusion The lower circulating levels of Spexin in obese children compared to their normal-weight peers, the protective independent effect found for the highest tertile of serum Spexin, and its association with glucose metabolism and immune function observed in our study, suggest a potential role for this novel peptide in childhood obesity and its related metabolic disorders.

Major depressive disorder (MDD) is a common psychiatric disorder, closely associated with obesity. This study aimed to assess the effects of prebiotics combined with calorie restriction on clinical and metabolic response in obese women with MDD.In an 8-week double-blind placebo-controlled randomized clinical trial, 62 obese women with MDD were equally allocated into either prebiotic (10 g/day Inulin) or placebo (10 g/day Maltodextrin) group. In addition, all the participants were also prescribed a 25% calorie-restricted diet (registration ID: IRCT20100209003320N15). Depression was assessed by Hamilton depression rating scale (HDRS) and Beck depression inventory (BDI-II) pre- and post-intervention. Anthropometric measures, fasting serum levels of glucose, insulin and lipid profile were assessed, and dietary assessments were performed pre- and post-intervention. Insulin resistance was estimated by homeostasis model assessment of insulin resistance (HOMA-IR).45 patients completed the trial. There were no significant between-group differences for MDD symptoms and other study outcomes, post-intervention. Weight, waist and hip circumferences, systolic blood pressure, and HDRS score significantly decreased in both groups, while fat mass and total cholesterol (TC) declined only in the prebiotic arm. Those who had ≥1.9 kg weight loss showed significantly improved HDRS score, compared to women with1.9 kg weight reduction, irrespective of the supplement they took.Although prebiotic supplementation had some beneficial metabolic effects, calorie restriction and weight loss seem to play a more important role in improving depressive symptoms among obese women with MDD.

Translocation of microbiome-derived lipopolysaccharide (LPS) to the bloodstream (metabolic endotoxaemia) is associated with a significantly increased risk of cardiovascular diseases (CVD); however, the direction of this association is not fully understood. It has been revealed by some studies that alterations in the intestinal microbiota (dysbiosis) lead to increased intestinal permeability and translocation of LPS to the blood circulation. LPS may trigger toll-like receptor 4- (TLR-4) mediated inflammatory responses; this could lead to a chronic low-grade pro-inflammatory condition named metabolic endotoxaemia (ME), which is typically observed in CVD patients. ME is promoted by increased intestinal permeability. Moreover, dysbiosis leads to production of trimethylamine-N-oxide (TMAO), a gut bacterial metabolite suggested as a new risk factor in CVD development. Probiotics, extensively reviewed for decades, are live microorganisms which, when taken in adequate amounts, have beneficial effects on the host metabolism. Prebiotics are a type of dietary fibre that act as nourishment for the good bacteria in the gut and decrease the population of pathogen bacteria that produce greater amounts of endotoxins. Although an association has been postulated between ME and CVD, the results of studies investigating the role of antibiotic therapy in preventing the disease have been inconsistent. In this review, we discuss how prebiotics and probiotics modulate gut microbiota and consequently might help with prevention and/or treatment of CVD associated with ME.

Objective Diabetes mellitus is a prevalent endocrine disorder worldwide. Citrulline is an α-amino acid, which is abundant in watermelon, and a precursor of arginine and nitric oxide. Decreased bioavailability of nitric oxide is associated with insulin resistance. The present systematic review focused on the existing evidence of citrulline and watermelon extract effects on metabolic and inflammatory parameters in diabetes mellitus. Methods A systematic search of the databases PubMed, Scopus, EMBASE, ProQuest and Google Scholar was conducted for relevant papers published from inception until October 2018. All clinical trials, animal and in vitro studies published in the English language that assessed the role of citrulline and watermelon extract on diabetes mellitus, were eligible. Studies providing inadequate information were excluded. Results Out of 1262 articles we found, only eight articles met the inclusion criteria for analysis. In three studies an increase in the synthesis of nitric oxide was reported with citrulline and watermelon extract supplementation. Four studies showed a significant reduction in blood glucose after supplementation with watermelon extract, and two studies reported a decrease in a number of inflammatory biomarkers following citrulline supplementation. Although citrulline intake caused a significant reduction in HOMA-IR in one study, inconsistent results were revealed on the effects of citrulline and watermelon extract on insulin levels and lipid profile. Conclusion Citrulline and watermelon extract could improve nitric oxide synthesis, glycaemic status and inflammation in diabetes mellitus. However, further studies are required to shed light on the underlying mechanisms.

Summary Background & aims Depression is a major debilitating health problem with high global prevalence. Gut microbiota dysbiosis might be implicated in pathophysiology of depression. Hence, probiotics, prebiotics and synbiotics (psychobiotics) have been administered in clinical trials in attempt to relieve depressive symptoms. This update systematic review aimed to evaluate the current body of research concerning the effects of psychobiotics on depression. Methods PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed in this review. Search was performed in MEDLINE, ProQuest, EMBASE, PsycNET, and Scopus databases for randomized clinical trials which assessed the effects of psychobiotics on depressive symptoms among adults, and were published in English language, since inception until September 2018. Results Out of 3374 records screened, 32 articles met the study criteria; only seven studies reported significant anti-depressant effects of psychobiotics. Some probiotic strains showed beneficial effects on depressive symptoms; the results were inconsistent, though. Few studies investigated the effects of prebiotics or synbiotics on depression, and did not come up with much promising results The overall risk of bias was judged to be unclear across the included studies, and major confounding factors were not considered in their design. Conclusion Since probiotics may affect depression in strain-specific manner, the current evidence is not sufficient to either support or decline anti-depressant effects of probiotics; results of studies on prebiotics and synbiotics are not conclusive, either. More well-designed studies with emphasis on specific probiotic strains, inter-individual gut microbiota variations, and depression subtypes are warranted. PROSPERO registration number CRD42018107356.

The aim of the present study was to investigate whether circulating levels of spexin is related to metabolic syndrome, some dietary intakes (Total energyintake, Macronutrient intakes) and body composition in children.90 children were recruited in the present cross sectional study. Anthropometric measures, body composition, blood pressure, dietary intakes, resting metabolic rate, physical activity level, appetite status, pubertal stage, serum spexin, fasting blood glucose, high-sensitivity C-reactive protein, insulin and lipid profile were measured using standard techniques.14 children met the criteria for metabolic syndrome. Median (IQR) of spexin levels were significantly lower in children with high fat mass and children with higher systolic blood pressure (SBP), compared to children with normal fat mass and normal SBP: (P 0.05). A protective independent effect was detected for the highest tertile of serum spexin on metabolic syndrome in adjusted models; Crude OR (CI): 0.23 (0.04-1.2), P-trend = 0.08; Model 1: OR (CI): 0.15(0.02-1.01), P-trend = 0.05; Model 2: OR (CI): 0.10 (0.01-0.90), P-trend = 0.03. There was a significant negative association between spexin and total dietary fat intake (r= - 0.21; P 0.04).This findings can further highlight the importance of the relationship between spexin, adipose tissue and adipose tissue metabolism.

ObjectiveWe aimed to compare the pregnancy status of the pregnant women and birth status of their newborns, socioeconomic status, and access to health services, between high- and low-damage areas in Heris, affected by the Varzaghan Earthquake, 2012.MethodsThe study was conducted on pregnant women at any trimester of pregnancy (with complete medical profiles in local health centers) in August 2012 (time of the earthquake) who lived in Heris and delivered up to March 2013. Data were obtained on pregnancy- and infant-related variables, housing, socioeconomic status, and access to health services, including food supplies, before and after the earthquake.ResultsFamily income and mothers’ education were lower in highly damaged areas. Among these women, underweight at first trimester of pregnancy was higher, and weight gain during the last trimester was lower, compared with low-damage regions. Preterm delivery was higher in low-damage areas. Birth indices of the infants were not significantly different between the 2 areas; however, in highly damaged areas, moderate malnutrition was more prevalent among children under 1 year (weight-for-age) and under 2 years (height-for-age).ConclusionsSocioeconomic status of mothers was lower in highly damaged areas and might have played a role in their own and newborns’ health status. (Disaster Med Public Health Preparedness. 2019;13: 511-518)

Background: Several mechanisms have been suggested to explain the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and its progression, one of which is increased oxidative stress. Objectives: This study aimed to evaluate the effect of alpha-lipoic acid (ALA) supplementation on anthropometric indices, dietary intake and oxidative stress-related parameters in obese patients with NAFLD. Methods: In this double-blind, placebo-controlled trial, 50 NAFLD patients were assigned to two groups of receiving 1200 mg ALA (two 600 mg capsules of ALA) and placebo (two 600 mg capsules of placebo) for 12 weeks. Serum liver enzymes, malondialdehyde (MDA) level, total antioxidant status (TAS), and the activities of copper-zinc superoxide dismutase (Cu/Zn-SOD) and glutathione peroxidase (GSH-Px) were assessed at baseline and after 12 weeks of intervention. Results: Serum concentrations of liver enzymes decreased significantly in the ALA group (P < 0.05 for all), while a noticeable decline was observed for alanine aminotransferase (ALT) in the placebo group (32.5 ± 18.9 vs. 25.9 ± 11.2; P = 0.034). Nonetheless, there were no significant differences between the study groups concerning serum liver enzymes concentrations post-intervention. Although ALA supplementation significantly reduced the serum concentration of MDA (2.52 ± 0.35 vs. 2.77 ± 0.49; P < 0.040) and increased serum TAS (1.73 ± 0.55 vs. 1.52 ± 0.34; P < 0.048), other oxidative stress-related parameters such as Cu/Zn-SOD and GSH-Px activities were not affected. Conclusions: These findings suggest that daily supplementation of 1200 mg alpha-lipoic acid (ALA) for 12 weeks improves oxidative stress markers in patients with nonalcoholic fatty liver disease (NAFLD) and it could be considered as adjunctive therapy for the prevention of NAFLD progression.

Background: Adequate iodine intake by women in child-bearing age affects fetus neurodevelopment during pregnancy. A majority of previous studies has investigated iodine status among children, and there is limited data on female adolescents who are more exposed to consequences of iodine deficiency (ID) in their near-future pregnancies; thus, we aimed to assess iodine status, and knowledge on iodine deficiency disorders (IDDs) among adolescent school girls (14-19 years old) in Shahriar, Iran. Methods: This cross-sectional study was conducted among 223 female students selected through multi-stage cluster sampling from 12 schools. Iodine and creatinine concentrations were measured in casual urine samples. Iodine content of household salts was also assessed.Data on intake of salt and iodine-rich food sources were collected applying a food frequency questionnaire (FFQ), and knowledge about iodine and IDDs were assessed by a questionnaire. Results: Median and Mean (95% CI) concentrations of urinary iodine and creatinine were 129 µg/L, 137.62 µg/L (95% CI: 126.28, 148.95) and 1.72 g/L, 1.86 g/L (95% CI: 0.55-3.17),respectively. The frequency of mild, moderate and severe ID were 22.4%, 14.3% and 0%,respectively; 43.5% had adequate, and 3.1% had excessive urinary iodine levels. Mean saltiodine concentration was 21.69 (SD=10.56) ppm. Mean knowledge score was 12.7 (SD=3.44).About half of the students had a poor (25.1%) or fair (24.2%) knowledge about iodine deficiency.Adjusting for the confounders, no significant positive association was found between knowledge about iodine-rich food sources and goitrogens with urinary iodine excretion. Conclusion: Adolescent girls in Shahriar had relatively poor knowledge of iodine, and about one third of them suffered from ID.

BACKGROUND & AIMS Low serum 25-hydroxyvitamin D (25OHD) is common in obese people. Obesity is associated with a state of low-grade inflammation (meta-inflammation). There is an increasing evidence indicating that vitamin D has anti-adipogenic activity and immunoregulatory effect. This study aimed to assess the effect of vitamin D supplementation on meta-inflammation and fat mass in obese subjects with vitamin D deficiency. MATERIALS AND METHODS In this double-blind placebo-controlled randomized clinical trial, 44 obese subjects with vitamin D deficiency (25OHD

Older people are more likely to develop nutritional problems and timely diagnosis of malnutrition is crucial to prevent hazardous consequences following poor nutrition. To evaluate the efficacy of Geriatric Nutritional Risk Index (GNRI) to assess nutritional status among non-hospitalized elderly, compared to mini nutritional assessment (MNA) among Iranian seniors. One hundred and sixty-four subjects, aged ≥ 65 years old were recruited to our cross-sectional study from various districts of Tabriz (Tabriz, Iran). Anthropometric and biochemical measurements were performed, short- and long-form MNAs and GNRI were assessed in our study subjects. Sensitivity, specificity and predictive values of the three indices, agreement between them, and their correlation with anthropometric and biochemical parameters were evaluated. Receiver-operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off point for GNRI in our study population. GNRI had lower sensitivity (50, 57%), but optimal specificity (94, 93%) and lower negative predictive value (NPV; 68, 71%) compared to MNA-LF and MNA-SF, respectively. We found a moderate agreement between GNRI and MNA-SF (K = 0.52) and MNA-LF (K = 0.46) scores. Significant correlations were observed between re-categorized MNAs as well as GNRI scores, and age, weight, MAC, CC, WC, albumin, and pre-albumin. The cut-off point of 110.33 was obtained for GNRI, according to the ROC curve. Although GNRI may not be an efficient tool for screening malnutrition due to its lower sensitivity, it is moderately correlated with MNAs and also more useful when limited funding needs to target the truly malnourished seniors.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease in which the gut microbiota is altered. Probiotics are microorganisms that can normalize gut microbiota; thus, they may help to alleviate RA symptoms. The objective of the present clinical trial was to assess the effects of probiotic supplementation on disease activity and inflammatory cytokines in patients with RA.Forty-six patients with RA were assigned into two groups in this randomized, double-blind, placebo-controlled clinical trial. The patients in the probiotic group received a daily capsule that contained a minimum of 10(8) colony-forming units of Lactobacillus casei 01 for 8 wk. The placebo group took capsules filled with maltodextrin for the same time period. Questionnaires, anthropometric measurements, and fasting blood samples were collected, and the participants were assessed by a rheumatologist at baseline and at the end of the trial.Disease activity score was significantly decreased by the intervention, and there was a significant difference between the two groups at the end of the study (P0.01). Three of the assessed serum proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-12) significantly decreased in the probiotic group (P0.05); however, serum levels of interleukin-1 β were not significantly affected by the probiotic (P = 0.22). The serum level of regulatory cytokine (interleukin-10) was increased by the supplementation (P0.05). The proportion of interleukin-10 to interleukin-12 was significantly increased in the probiotic group as well.L. casei 01 supplementation improved the disease activity and inflammatory status of patients with RA. Further studies are warranted to confirm these results, and such confirmation may lead to the introduction of probiotics as adjunctive therapy for this population.

Bacterial vaginosis (BV) is a common cause of genital discomfort in women in reproductive ages, which causes many complications. Bacterial vaginosis is usually treated by metronidazole and clindamycin. However, this protocol does not prevent its recurrence, which is a main complaint of the patients. The number of lactobacilli in the vagina of women with BV is significantly lower than that in healthy women. Hence, efforts have been made to normalize vaginal flora by oral or vaginal administration of lactobacilli. The objective of the present study was to review clinical evidences available regarding the efficacy of probiotics in the prevention and treatment of BV.Published randomized controlled trials were searched in PubMed, Science Direct, and the Cochrane Database between 1990 and 2011. Search terms included bacterial vaginosis, urinary tract infection, lactobacillus, and probiotics.Orally consumed probiotics are believed to ascend to the vaginal tract after they are excreted from the rectum; vaginal administration allows for direct replacement of the probiotics for unhealthy vaginal microbiota and occupation of specific adhesion sites at the epithelial surface of the urinary tract, which consequently results in maintenance of a low pH and production of antimicrobial substances like acids and hydrogen peroxide. Receiving Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14 at a dose of at least 10 CFU/day for 2 months has been shown to present the patients with better results.Although the results of different studies are controversial, most studies have been in favor of the probiotics in the prevention or treatment of BV, and no adverse effects have been reported. Therefore, it may be helpful to recommend daily consumption of probiotic products to improve public health among women.

Gut microbiota has been shown to affect many populations' health. Probiotics, prebiotics, and synbiotics have been found to balance the gut microbiota toward healthy microbes resulting in enhanced health for consumers. The goal of this study was to survey the publication rate on pro-, pre-, and synbiotics and determine the contribution from different countries to these fields. All data were obtained from Medline and Web of Science. No time limit was applied in Medline, and in the Web of Science, citation was restricted to the years 1993-2011. The software package of Dr. Biglu was used to extract the desired information. The results indicated a growing rate in the publishing of the mentioned fields in both developed and developing countries, which is predicted to increase in the upcoming years as well. It is suggested that investing more in these fields can help countries improve public health and cut down disease-related costs.

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that causes great pain and disability and increasing oxidative stress in patients. The objective of the present study was to evaluate the effects of probiotics-live microorganisms with many health benefits, including antioxidant properties-on oxidative stress indices of patients with RA. This study is a secondary analysis from a previously published study Methods: In a randomized double-blind placebo-controlled clinical trial, 46 patients with RA were assigned to one of two groups; patients in the probiotic group received a daily capsule containing 10(8) colony forming units (CFUs) of Lactobacillus casei 01 (L. casei 01), while those in the placebo group took identical capsules containing maltodextrin, for 8 weeks. In the baseline and at the end of the study, anxiety, physical activity levels, and dietary intakes were assessed. Anthropometric parameters, serum malondialdehyde (MDA), total antioxidant capacity (TAC), erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activities were measured.There was no significant difference between the two groups for demographic characteristics, anthropometric parameters, physical activity, anxiety levels, or dietary intakes, throughout the course of the study. No significant within- and between-group differences were observed for MDA, TAC, or CAT. SOD activity decreased only in the probiotic group and GPx activity decreased in both study groups (p0.05); however, no significant between-group difference was found for these enzymes activities at the end of the study (p0.05).No significant effect of L. casei 01 supplementation was observed on the oxidative status of patients with RA, compared to placebo.

Probiotics are live bacteria which have frequently been reported to be beneficial in preventing a wide range of diseases as well as playing a major role in treating the existing ailments. Thus far, a variety of probiotic products have been developed which can be categorized into two groups: probiotic foods and supplements. Both foods and supplements have been able to confer the health benefits claimed for them. However, it is not known which one can be clinically more efficient, and to the best of our knowledge, until now no research has been conducted to investigate this issue. The present review aims to discuss this matter, based on the evidence available in the literature. To do so, articles indexed in PubMed and ScienceDirect between 2000 and 2011 were reviewed. The articles included the clinical trials in which either foods or supplements were used to administer the probiotics to either patients suffering from different diseases or healthy subjects. Although both foods and supplements seem to have been efficient carriers for the beneficial bacteria, to generally promote public health in communities, probiotic foods appear to be preferred to probiotic supplements.

Aim The present study aimed at investigating the effects of Lactobacillus casei 01 supplementation on symptoms and inflammatory biomarkers of rheumatoid arthritis (RA) in women. Method In this randomized double-blind clinical trial, female patients with established RA for more than 1 year, 20–80 years of age and body mass index (BMI) lower than 40, who followed stable medication for 3 months prior to the supplementation, were randomly allocated to receive either one capsule containing 108 colony forming units (CFU) of L. casei 01, or a placebo for 8 weeks; allocation was stratified by BMI and menopausal status. Disease activity score-28 (DAS28) was calculated, European League Against Rheumatism (EULAR) response was evaluated and the cytokines, interleukin (IL)-1β, IL-6, IL-10, IL-12 and tumor necrosis factor (TNF)-α were measured. Results Thirty patients were recruited in each group; 22 and 24 patients were analyzed in the probiotic and placebo groups, respectively. L. casei 01 supplementation decreased serum high-sensitivity C-reactive protein (hs-CRP) levels, tender and swollen joint counts, global health (GH) score and DAS28 (P