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Abstract Migraine, a complex disorder, is characterized by recurrent headache episodes. The production of melatonin in the pineal gland, which is crucial for controlling circadian rhythms and sleep–wake cycles, is altered in various conditions, including neurological disorders such as migraine. Recent studies underscore the significance of serum melatonin levels in patients with chronic and episodic migraine, the focus of this study. This case‒control study, conducted from September 2017 to June 2020 in Tehran, Iran, selected potential participants aged 18–65 years from a headache clinic at Sina Hospital (affiliated with Tehran University of Medical Sciences). Both episodic migraine and chronic migraine were diagnosed following the diagnostic criteria in the International Classification of Headache Disorders’ third edition. Melatonin levels were measured according to the instructions of the ELISA kits. There were significant differences in the frequency of headache days and the duration of abortive medication usage between the two groups (P value

Abstract Introduction By studying the dietary habits of patients with bacterial vaginosis (BV) and the controls, we aim to find out whether the dietary intakes of phytochemicals could reduce the odds of BV. To the best of our knowledge, no study has ever examined the matter before. Therefore, we decided to conduct this secondary analysis of case-control study to examine the association between dietary phytochemicals and BV. Method This case-control study was conducted at the gynecological clinic of Imam Hossein Hospital using a convenience sampling method from November 2020 to June 2021. To diagnose BV, all participants underwent examination by a gynecologist, assessing the presence of 3 or 4 criteria from the Amsel criteria. A validated semi-quantitative food frequency questionnaire was used. The phytochemical index was determined using McCarty’s method. To assess the association between dietary phytochemical intake and the odds of BV, binary logistic regression was utilized. Results After adjusting for potential confounders, the association between phytochemical index and BV remained significant (odds ratio (OR) = 0.349, 95% confidence interval (CI): 0.176–0.695, p-value = 0.003). Furthermore, each unit increase in fat intake was associated with higher odds of BV (OR = 1.008, 95% CI: 1.002–1.014, p-value = 0.006), and a positive family history of BV continued to show significantly increased odds of BV (OR = 3.442, 95% CI: 2.068–5.728, p-value

Summary: Background: Hyperemesis gravidarum (HG) is the most widespread reason for admission to the hospital during the first half of pregnancy. HG etiology is not clear in many cases. However, maternal body composition and pre-pregnancy diet are suggested as possible factors. This hospital-based case-control study aims to determine the link between the Mediterranean diet score (MDS) and pre-pregnancy anthropometric indicators with Hyperemesis gravidarum. Methods: A total of 45 women with incident HG and 126 controls were entered into this case-control study between April 2020 and June 2021. A repeatable and accurate 168-item semi-quantitative food frequency questionnaire was used to define the MDS. The association between MDS and HG odds was examined through adjustment by possible confounders by the estimation of multivariate regression models. Results: The median (interquartile range) pre-pregnancy body mass index of participants was 22.7 (21.7–25.9) and 22.9 (21.4–25) Kg/m2 in cases and controls, respectively (P=0.284). The adjusted analyses found that the MDS was associated with a 25% reduced odds of HG (odds ratio (OR): 0.75, 95% confidence interval (95%CI): 0.24–0.91). Body mass index and waist circumference before pregnancy were not significantly associated with HG odds in both regression models. Conclusions: The odds of HG during pregnancy are lower in women with a higher MDS before pregnancy. Also, a high intake of fruits and nuts, vegetables, legumes, and fish before pregnancy is liked with a lower HG odds.

Abstract Vitamin D is a fat-soluble steroid hormone that was initially known only for regulating calcium and phosphorus levels and maintaining bone health. However, it was later discovered that many organs express vitamin D metabolizing enzymes and have a ligand for vitamin D, which regulates the expression of an extensive assortment of genes. As a result, vitamin D is indispensable for the proper function of organs, and its deficiency is believed to be a critical factor in symptoms and disorders such as cardiovascular diseases, autoimmune diseases, and cancers. The significance of vitamin D in reproductive tissues was recognized later, and studies have revealed its crucial role in male and female fertility, as well as proper reproductive function during pregnancy. Vitamin D deficiency has been identified as a risk factor for infertility, gonadal cancers, pregnancy complications, polycystic ovary syndrome, and endometriosis. However, data investigating the association between vitamin D levels and reproductive disorders, including endometriosis, have encountered inconsistencies. Therefore, the present study aims to review existing research on the effect of vitamin D on proper reproductive function, and the role of deficiency in reproductive diseases and specifically focuses on endometriosis.

Abstract Background Although studies have reported an inverse association between fruits, vegetables, and fiber consumption and all-cause and cause-specific mortality, the issue remains incompletely defined in the Middle Eastern population. Aims The current study aimed to investigate the association between dietary fiber, fruit, and vegetable intake and all-cause and cause-specific mortality. Methods A total of 48632 participants (mean age = 52years), 57.5% (n = 27974) women and 42.5% (n = 20658) men, were recruited from an ongoing large-scale prospective cohort study (the Golestan Cohort Study (GCS)), in the north of Iran. Using a validated semi-quantitative 116-item food questionnaire, dietary intakes were collected. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) of all-cause and cause-specific mortality were reported. Results After approximately 14 years of follow-up, 10,774 deaths were recorded. In the fully adjusted model, compared to those in the lowest quintile of intake, those in the second and third quintiles of dietary fiber intake had a 7%-10% reduction in risk of all-cause mortality, and a 15%-17% reduction in the risk of mortality from other causes. Increasing consumption of fruits was also associated with a decreased risk of mortality for all-cause mortality by 9%-11%, and all cancer by 15–20%. Further, those in the third and fourth quintiles of vegetables intake had 11%-12% lower risk for CVD mortality. Discussion The results from the GCS further support the current recommendations on following a healthy diet containing proper amounts of fiber, vegetables, and fruits, as health-protective dietary items. Conclusions Higher intake of dietary fiber, fruits, and vegetables has the potential to reduce both overall and cause-specific mortality rates. However, additional cohort studies with larger sample size and long-term follow-up durations are required to establish these findings.

Abstract Background: Changing the dietary pattern may be an alternative treatment for bacterial vaginosis, the prevalent vaginal infection in women. Methods: One hundred and forty-three bacterial vaginosis-affected women diagnosed by Amsel criteria and 151 healthy controls aged 18 to 45 entered the current case-control research. To calculate the alternative healthy eating index and dietary acid load score, food consumption was recorded with an accurate and precise food frequency questionnaire. The dietary acid load was measured by potential renal acid load (PRAL) and net endogenous acid production (NEAP) indices. Using logistic regression models, the association between the alternative healthy eating index and dietary acid load score with bacterial vaginosis was investigated. Results: The last tertile of the alternative healthy eating index had a 75% decreased odds of experiencing bacterial vaginosis in the adjusted model (adjusted odds ratio (aOR) = 0.25, 95% confidence interval (CI) = 0.12–0.53, P for trend = 0.001). Besides, vegetables (aOR = 0.34, 95% CI = 0.17–0.69, P for trend = 0.003), nuts and legumes (aOR = 0.44, 95% CI = 0.23–0.87, P for trend = 0.028), and meats (aOR = 0.31, 95% CI = 0.16–0.60, P for trend = 0.001) intake was linked to a decreased bacterial vaginosis odds. However, sugar-sweetened beverages and fruit juice (aOR = 3.47, 95% CI = 1.68–7.17, P for trend

Introduction: Polycystic ovary syndrome is a major cause of anovulation and infertility in women that is associated with chronic diseases such as obesity, insulin resistance, diabetes, cardiovascular disease, and fatty liver disease. This systematic review was performed aimed to determine the effects of ketogenic diet on the outcomes of polycystic ovary syndrome.Methods: In this systematic review, the keywords of “polycystic ovary syndrome”, “ketogenic diet”, “low carbohydrate diet”, and “clinical trials” were searched in databases of Medline, PubMed, Science Direct, Magiran, ISD, ISC and Cochrane in English and Persian language without time restrictions. Then, the articles relevant to the study's aim were reviewed.Results: In this research, 4 studies were examined. The results showed that following a ketogenic diet in patients with polycystic ovary syndrome may reduce the risk of cardiovascular diseases in these patients by lowering weight and body mass index, blood pressure, serum total cholesterol, and triglycerides.Conclusion: Long-term adherence to a ketogenic diet may result in weight loss, improved insulin resistance, and serum lipid profile disorders in patients with polycystic ovary syndrome. Clinical trials are suggested to evaluate the effects of ketogenic diet on these metabolic and endocrine factors in PCOS women.

Background: Among multiple factors that affect the etiology of polycystic ovary syndrome (PCOS), diet hasan important contribution. Chronic oxidative stress has also been implicated in the development of PCOS. Thepresent study is an attempt to evaluate dietary total antioxidant capacity (TAC) and its relationship with odds ofPCOS in Iran.Materials and Methods: The study was carried out as a case-control study in hospital outpatient clinics, Tehran,Iran. Totally, 310 female participants with a history of PCOS and 602 age-matched controls took part in thisstudy between June 2015 and December 2018. A reproducible and valid 168-item semi-quantitative food frequencyinventory was utilized to determine the entire antioxidants of the usual diet in order to calculate dietaryTAC. The relationship of dietary TAC with odds of PCOS were assessed adjusting for potential confoundersthrough an estimation of two multivariable conditional regression models. The first tertile was presented as areference category.Results: In a fully adjusted model, the highest tertile of dietary TAC was associated with a reduced odds ofPCOS [odds ratio (OR): 0.81, 95% confidence interval (95% CI): 0.59, 0.96, P for trend: 0.038). In addition,PCOS odds decreased in the highest tertile of α-tocopherol intake (OR: 0.73, 95% CI: 0.56, 0.88, P for trend:0.023). The adjusted ORs in the highest tertile of vitamin C, β-carotene and magnesium were 0.79 (95% CI:0.83-0.97), 0.81 (95% CI: 0.67-0.98) and 0.91 (95% CI: 0.55-0.9 8) respectively, with a significant trend.Conclusion: Our results provide evidence that there was a relationship between high TAC diets and lower odds ofPCOS.

Abstract Bacterial vaginosis (BV) is a predominant vaginal disturbance that affects about 25% of childbearing-aged women. Dietary consumption may have a crucial role in vaginal flora imbalances. This study was a hospital-based case–control study. In total, 144 incident BV cases and 151 healthy participants were recruited from the gynecology clinic in Tehran, Iran, between November 2020 and June 2021. Participants' typical diets were collected by a food frequency questionnaire. Vaginal flora was characterized based on the Amsel criteria. Factor analysis was used to pinpoint the principal dietary patterns. For logistic regression, the first tertile was assumed as a reference. Five principal dietary patterns emerged and were nominated as "Healthy diet," "Unhealthy diet," "Ovo-vegetarian diet," "Pseudo-Mediterranean diet," and "Western diet." The "Unhealthy diet" pattern were positively associated with BV (adjusted odds ratio (aOR) = 3.35; 95% confidence interval (CI) 1.41, 7.94; ptrend: 0.006), while adherence to the "Ovo-vegetarian diet" pattern was associated with a reduced odds of BV (aOR = 0.16; 95% CI 0.07, 0.34; ptrend

Abstract Background Bacterial vaginosis, BV, is a common inflammatory vaginal dysbiosis. The Mediterranean diet, MD, containing foods rich in antioxidant compounds, is shown to be beneficial for inflammatory conditions. This study aimed to investigate the association between MD adherence and dietary total antioxidant capacity (DTAC) with BV. Methods This case–control study was conducted on 143 BV-affected and 151 healthy individuals aged between 15 and 45 years. The Amsel criteria were used to detect newly diagnosed patients with BV by a gynecologist. The 168-item food frequency questionnaire (FFQ) was used to record participants' dietary intakes in the last year. The reported data in the FFQ was used to measure adherence to the MD by calculating the Medi-Lite score and to measure the DTAC by calculating ferric-reducing antioxidant power, FRAP, based on the related databases. Logistic regression models were used to determine the association between Medi-Lite and DTAC and BV odds. Results The highest tertile of Medi-Lite score was associated with a reduced odds of BV in the crude model (Odds Ratio, OR: 0.49, 95% Confidence Interval, 95% CI 0.25, 0.96, P for trend: 0.023). This significant inverse association was not observed in the last model adjusted for age, body mass index (kg/m2), waist circumferences (cm), cigarette smoking, frequency of pregnancy, and physical activity (MET/h/d). In crude and adjusted odels, BV odds decreased in the highest tertile of vegetable (adjusted OR, aOR: 0.32, 95% CI 0.16, 0.63, P for trend: 0.001), fish (aOR: 0.46, 95% CI 0.25, 0.84, P for trend: 0.009), legumes (aOR: 0.26, 95% CI 0.14, 0.50, P for trend

Introduction: Greenhouse gas (GHG) emissions have caused environmental effects. Food production is one of the sources of GHGs. This study aimed to suggest dietary scenarios for decreasing GHG emissions. Materials and Methods: GHG emissions in the target population of Urmia city, Northwest Iran, were investigated using a modeling approach. Three dietary scenarios were modeled and analyzed to evaluate and compare GHG emissions. The objectives and decision variables of the three scenarios included minimizing the carbon footprint and intake of food items, respectively. In the first scenario, the amount of energy intake was equal to baseline energy intake. The second scenario maintained the same energy intake constraint as the first scenario and made further alterations by considering the number of serving sizes suggested by the food pyramid for each food group. The third scenario was mostly based on this model by accounting for dietary reference intake for macronutrients, micronutrients, and energy. Results: There was about 72% and 55.67% reduction in carbon dioxide equivalent (CO2 eq) production in the first and second scenarios rather than the baseline diet of 4072.10 g CO2 eq, respectively. In the final scenario, the CO2 eq emissions were less than half of the baseline diet. Conclusion: The study showed that a healthy diet with a higher proportion of vegetables, fruit, legumes, nuts, and dairy, and a lower share of red and white meat, egg, grains, fat and oil, and sweets can reduce CO2 eq emissions.

Introduction: Bacterial vaginosis is the most common vaginal infection in women of childbearing age. Identifying nutritional risk factors as a potential therapeutic target can be important. This study was performed with aim to determine the relationship between the consumption of ultra-processed foods and bacterial vaginosis. Methods: This case-control study was performed in 2020 on 144 women with bacterial vaginosis and 151 healthy women aged 15-45 years referred to the gynecology clinic of Imam Hossein Hospital in Tehran. Bacterial vaginosis was diagnosed using the Amsel criteria and participants were divided into case and control groups based on it. Food intake of participants during 1 last year was collected using a valid semi-quantitative food frequency questionnaire with 168 food items. Ultra-processed foods were classified according to the NOVA classification system. A logistic regression test was used to investigate the association between the consumption of ultra-processed foods with bacterial vaginosis, and then the odds ratio was calculated. P< 0.05 was considered significant. Results: After adjusting for confounding variables, it was seen that participants in the upper tertile of intakes of the ultra-processed foods (OR=2.13, CI: 1.19-3.8, P=0.004), processed meats and fast foods (OR=2.27, CI: 1.23-4.2, P=0.008), oils and sauces (OR=2.47, CI: 1.34-4.54, P=0.004) and sweets (OR=2.82, CI: 1.5-5.3 P=0.001) were significantly more likely to be suffering from bacterial vaginosis than the group in first tertile. Conclusion: There was a direct relationship between the intake of ultra-processed foods, processed meats and fast foods, oils and sauces and sweets with bacterial vaginosis.

Background As the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran. Methods Patients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model. Results The median (interquartile range) age of patients was 60 years (44–74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019). Conclusions: Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.

This study aimed to investigate the association between dietary acid load (DAL) and multiple sclerosis (MS), through the potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores. In a hospital-based case–control study of 109 patients with MS and 130 healthy individuals, a validated 168-item semi-quantitative food frequency questionnaire and a logistic regression model were used to evaluate the association between the DAL and MS. After adjusting for age (years), gender (male/female), body mass index (Kg/m2), and total calories (Kcal), the MS odds were 92% lower for those in the highest tertile of total plant-based protein (OR: 0.08, 95%CI: 0.03, 0.23; p-value < 0.001) and about four times higher for those in the highest tertile of the PRAL (OR: 4.16, 95%CI: 1.94, 8.91; p-value < 0.001) and NEAP scores (OR: 3.57, 95%CI: 1.69, 7.53; p-value < 0.001), compared to those in the lowest tertile. After further adjusting for sodium, saturated fatty acid, and fiber intake, the results remained significant for total plant-based protein intake (OR: 0.07, 95%CI: 0.01, 0.38; p-value = 0.002). In conclusion, a higher NEAP or PRAL score may be associated with increased odds of MS, while a higher intake of plant-based protein instead of animal-based protein may be protective.

Background. Inconsistent findings have been reported for associations between dietary indices and bacterial vaginosis (BV). The aim of this study was to examine the association of dietary glycemic index (DGI), glycemic load (DGL), insulin index (DII), and insulin load (DIL) with BV among Iranian women. Methods. The current case-control study consisted of 144 new cases of BV and 151 controls. The diagnosis of BV was made based on the Amsel criterion in hospital clinics in Tehran, Iran, from November 2020 until June 2021. DGI, DGL, DII, and DIL were calculated from a validated semiquantitative food frequency questionnaire. The association between dietary carbohydrate indices and odds of BV were assessed adjusting for potential confounders through an estimation of two multivariate regression models. Results. The multivariate adjusted odds ratio (OR) comparing the highest tertile of dietary DGI and DGL with the lower tertile was 2.99 (95% confidence interval (CI): 1.47–6.81; Ptrend=0.003) and 4.01 (95% CI: 1.22–5.91; Ptrend=0.029), respectively. In a fully adjusted model, the top tertile of dietary fiber compared to the bottom was associated with 88% (95% CI: 0.14-0.33) lower odds of BV (Ptrend