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Sahar Cheshmeh, 1, 2,* Seyed Mostafa Nachvak, 1 Nayebali Rezvani, 3 Amir Saber 1,* 1Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran*These authors contributed equally to this workCorrespondence: Seyed Mostafa NachvakDepartment of Nutritional Sciences, Faculty of Nutritional Sciences and Food Technologies, Kermanshah University of Medical Sciences, Isar Sq., Across from Farabi Hospital, P.O. Box 6719851351, Kermanshah, IranTel +98-8338395885Fax +98-83 37102002Email smnachvak@hotmail.comNayebali RezvaniDepartment of Clinical Biochemistry, Kermanshah University of Medical Sciences, P.O. Box 67148-69914, Kermanshah, IranTel +98-9183391265Email arezvani51@gmail.comPurpose: The study aimed to investigate the effect of breastfeeding, formula feeding and mix feeding (breastfed plus formula-fed) on the expression level of obesity-predisposing genes including fat mass and obesity-associated (FTO), carnitine palmitoyltransferase 1A (CPT1A), and peroxisome proliferator-activated receptor-α (PPAR-α) in 5- to 6-month-old infants.Patients and Methods: A total of 150 infants participated in this case–control study. All subjects were healthy infants aged 5– 6 months that divided into 3 groups: breastfed, formula-fed, and mix-fed. The expression level of FTO, CPT1A, and PPAR-α genes in peripheral blood mononuclear cells (PBMC) was evaluated in each group using reverse transcription-polymerase chain reaction (RT-PCR) method.Results: Our findings showed that the current weight, height, and head circumference of infants in the formula feeding and mix feeding groups were significantly higher than those in the exclusive breastfeeding group. The expression level of FTO and CPT1A genes in formula-fed and mix-fed infants was significantly higher (p< 0.001) than that in breastfed infants, while the expression level of PPAR-α gene was significantly lower (p< 0.05).Conclusion: Breastfeeding showed modulatory effects on the expression level of obesity-predisposing genes and can protect against obesity and subsequent non-communicable diseases. However, more investigations are required to explain the epigenetic effects of breast milk.Keywords: breastfeeding, formula feeding, obesity, FTO, CPT1A, PPAR-α, infants

Elham Ahmadi,1 Hadi Abdollahzad,2,3 Yahya Pasdar,2 Shahab Rezaeian,3 Jalal Moludi,3 Seyed Mostafa Nachvak,2 Roghayeh Mostafai2 1Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Department of Nutrition Sciences, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Hadi AbdollahzadDepartment of Nutrition Sciences, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Isar Sq., Kermanshah P.O. Box 6719851351, IranEmail hadi_nut@yhoo.comBackground: The prevalence of metabolic syndrome (MetS) in recent years has been growing in different societies, which may be due to lifestyle changes including changes in diet, in particular the consumption pattern of edible oils. The purpose of this study was to investigate the relationship between the consumption of animal oils including butter and Kermanshah ghee with MetS and its components in the adult population of Ravansar Non-Communicable Disease (RaNCD) cohort study.Methods: This cross-sectional study was carried out on 5550 adults aged 35– 65 years using baseline data of Ravansar’s prospective study center in Iran. MetS was defined according to the criteria of modified NCEP ATP III for Iranian adults. Relationship between the consumption of butter and Kermanshah ghee and MetS was analyzed by logistic regression model using STATA software.Results: In our study, the frequency of MetS was 31.40%. The mean body mass index and mean age were 27.1± 4.6 kg/m2 and 47.6± 8.2 years. The mean values of consumed butter and Kermanshah ghee were 3.3± 1.8 and 5.1± 2.3 g/day, respectively. After adjusting the confounding variables, the highest to the lowest quintile of butter and Kermanshah ghee consumption showed a reverse correlation with the MetS (OR = 0.7, 95% CI = 0.5– 0.9) and (OR= 0.7, 95% CI=0.6– 0.9), respectively.Conclusion: This study revealed a reverse relationship between milk and Kermanshah ghee consumption with MetS and its components. Therefore, consumption of milk-based oils may be associated with lower cardiovascular risk factors.Keywords: butter, Kermanshah ghee, metabolic syndrome, oil, Ravansar cohort

Seyran Hosseini,1 Amir Nili-Ahmadabadi,2,3 Seyed Mostafa Nachvak,4,5 Dara Dastan,2,6 Shima Moradi,4,5 Hadi Abdollahzad,4,5 Roghayeh Mostafai4,5 1Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 3Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; 4Nutritional Sciences Department, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 5Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 6Department of Pharmacognosy and Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, IranCorrespondence: Seyed Mostafa NachvakNutritional Sciences Department, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranTel +98 83 37102003Fax +98 83 38263048Email smnachvak@hotmail.comDara DastanMedicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, IranTel +98 8138381590Fax +98 8138380031Email d.dastan@umsha.ac.irIntroduction: Pistacia atlantica subsp. kurdica is an important food source and a well-known medicinal plant in the Zagros Mountains of Iran. The present study aimed to investigate the effect of P. atlantica extract and essential oil in streptozotocin-induced diabetic mice.Materials and Methods: Different doses of hydroalcoholic extract and essential oil of P. atlantica subsp. kurdica (50, 100, and 200 mg/kg) were given to streptozotocin-induced diabetic mice in separate groups for three weeks. At the end of treatment, blood samples were collected; then, oxidative stress markers, TNF-α, and lipid profile were determined in its serum samples.Results: Our findings showed that the administration of P. atlantica extract for three consecutive weeks significantly improved the lipid profile, oxidative stress, and inflammation process by reducing lipid peroxidation and increasing total antioxidant capacity.Conclusion: This study showed that P. atlantica subsp. kurdica has antioxidant and blood lipid-lowering effects that can be used as a supplement to improve diabetes complications.Keywords: Pistacia atlantica subsp. kurdica, phytochemical, diabetes, lipid profile, oxidative stress

Hadi Abdollahzad,1 Yahya Pasdar,1 Seyed Mostafa Nachvak,1 Shahab Rezaeian,2 Amir Saber,1 Razieh Nazari1,3 1School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Amir Saber; Razieh NazariDepartment of Nutrition, Faculty of Nutritional Sciences and Food Technologies, Isar Sq., Across from Farabi Hospital, P.O. Box 6719851351, Kermanshah, IranTel +98-83 37102009Fax +98-83 37102002Email amir.saber@kums.ac.ir; roz.sahreh@gmail.comPurpose: The aim of this study was to investigate the association between dietary inflammatory index (DII) and metabolic syndrome (MetS) and its components using data of Ravansar non-communicable diseases (RaNCD) cohort study.Patients and Methods: The present cross-sectional study was performed using the information of 6538 participants in the RaNCD study in Iran. A validated 125-item food frequency questionnaire (FFQ) was used to acquire DII scores. MetS was defined based on national cholesterol education program-adult treatment panel III (NCEP-ATP III) criteria. The association between DII and MetS and its components was investigated by the logistic regression model using STATA software.Results: A significant association was found between DII and MetS (OR trend: 1.08, 95% CI: 1.01– 1.15, P =0.017), triglyceride (TG) (OR trend: 1.06, 95% CI: 1.00– 1.12, P=0.030), fasting blood glucose (FBG) (OR trend: 1.10, 95% CI: 1.01– 1.20, P=0.018) and high density lipoprotein cholesterol (HDL-C) (OR trend: 1.07, 95% CI: 1.02– 1.12, P= 0.005) after adjustment for all covariates. Also, there was a significant relationship between DII score and waist circumference (WC) (OR trend: 1.07, 95% CI: 1.01– 1.14, P=0.016).Conclusion: Higher DII score (a pro-inflammatory diet) had a significant association with the risk of MetS and its components, even after adjustment for different potential confounding factors including socio-demographic data and lifestyle habits. However, further longitudinal investigations with more dietary parameters are needed to elucidate the role of the pro-inflammatory diet in the etiology of MetS.Keywords: dietary inflammatory index, metabolic syndrome, food frequency questionnaire, pro-inflammatory diet

Background: The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a plant-based and anti-inflammatory diet that has the ability to protect and manage cardiovascular and nervous system diseases. Regarding that insomnia and cardiovascular problems are x`common in type 2 diabetes mellitus (T2DM), the present study will assess the effectiveness of the MIND dietary pattern on sleep quality, cardiometabolic indicators, and other psychological indicators., Methods: Forty-four overweight/obese T2DM women with insomnia, aged 30-65 years, will voluntarily participate in this randomized controlled trial and will be randomized to receive either a MIND low-calorie diet (MLCD) or a low-calorie diet (LCD) over a 3-month period. Before and after the study, sleep quality, some biochemical and cardiometabolic indices, cortisol, brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress indicators will be assessed., Discussion: The use of dietary interventions in the management of T2DM complications is practical and safe. This research seeks to investigate the capacity of the MIND diet in the management of insomnia and cardiovascular problems of DM. It is expected that the results of this research will provide new perspectives on using an ideal dietary regimen to treat these health conditions., Trial Registration: IRCT20181111041611N8. Registered on August 7, 2023. https://www.irct.ir/trial/71772., (© 2024. The Author(s).)

Background/objectives: There is evidence to support the hypothesis that a diet rich in antioxidants can help safeguard against the development of gestational diabetes mellitus (GDM). This study aimed to investigate the association between dietary total antioxidant capacity (DTAC) during early pregnancy and the risk of GDM., Subjects/methods: We included 1856 pregnant women in their first trimester from the Mothers and their Children's Health (MATCH) prospective cohort study. Prepregnancy dietary intake was assessed using a validated food frequency questionnaire (FFQ) and was used to calculate the DTAC score. Incident GDM was diagnosed based on the American Diabetes Association criteria. We estimated the association between DTAC and GDM using propensity score-based inverse probability weighting (IPW)., Results: Overall, 369 (14.6%) of the pregnant women were identified with GDM. The mean DTAC score and the corresponding standard deviation (SD) was 2.82± (2.56) mmol/100 g, with a range of 0.01 to 18.55. The adjusted risk of GDM decreased by 34% (95% CI = 10%, 52%, p = 0.023) for each DTAC score increase. The results showed that women in the highest quartile of DTAC had a lower risk of developing GDM compared to those in the lowest quartile (adjusted RR: 0.29, 95% CI: 0.12, 0.68, p = 0.005)., Conclusion: DTAC in early pregnancy is significantly associated with a lower risk of GDM. Additional larger cohort studies are needed to validate these findings., (© 2024. The Author(s).)

Background: Sleep is a vital physiological process that plays a crucial role in various aspects of human health and well-being. Regarding the important role of diet on the sleep quality, the present study aimed to assess the association of dietary inflammatory index (DII) with the sleep outcomes and also to provide the potential mechanisms of action., Methods: PubMed, Web of Science and Scopus databases and Google Scholar search engine were systematically searched for relevant studies related to DII and sleep outcomes using appropriate search terms until February 2024., Results: From the initial systematic search of databases, 197 studies were retrieved. However, only 14 of them met the criteria for evaluation. Out of these, eleven studies indicated a significant correlation between higher DII scores and poor overall sleep quality and/or short/long sleep duration or its subscales. On the contrary, four studies did not find any proof of this association., Conclusion: This systematic review indicated that following an anti-inflammatory diet could potentially lead to an improvement in the sleep outcomes. Well-designed clinical trials in the future will be necessary to provide a better understanding and quantification of this association., Competing Interests: The authors declare no competing interests., (©2024 The Author(s).)

Background: Phytochemicals are non-nutritive bioactive compounds with beneficial effects on the metabolism of glucose. This study aimed to clarify the possible causal effect of the pre-pregnancy dietary phytochemical index (DPI) on gestational diabetes mellitus (GDM)., Methods: In this prospective cohort study 1,856 pregnant women aged 18-45 years who were in their first trimester, were recruited and followed up until delivery. The dietary intakes of participants were examined using an interviewer-administered validated 168-item semi-quantitative food frequency questionnaire (FFQ). Inverse probability weighting (IPW) of propensity scores (PS), estimated from the generalized boosted model (GBM) were used to obtain a adjusted risk ratio (aRR) for potential confounders., Results: During the follow-up period, 369 (19.88%) women were diagnosed with GDM. DPI scores ranged from 6.09 to 89.45. There was no association between DPI scores and GDM (aRR: 1.01, 95% confidence interval [CI]: 0.92, 1.08; p trend = 0.922). When comparing DPI quartile 4 (most pro-phytochemical content) to quartile 1 (few phytochemical contents), there was no significant difference between them (aRR: 0.97; 95% CI: 0.75, 1.25; p = 0.852). Also, there was no significant difference between DPI quartile 3 and quartile 1 (aRR: 1.04; 95% CI: 0.81, 1.34; p = 0.741) as well as DPI quartile 2 and quartile 1 (aRR: 0.92; 95% CI: 0.71, 1.21; p = 0.593)., Conclusions: Although this data did not support the association between pre-pregnancy DPI scores and GDM, further cohort studies to ascertain the causal association between them are warranted., (© 2024. The Author(s).)

Background & Aims: Rheumatoid arthritis is a systemic autoimmune disease that causes joint erosion, as well as damage to extra-articular organs. The aim of this study was the investigation of the association between the Mediterranean diet quality index with disease activity in patients with rheumatoid arthritis., Methods: In this cross-sectional study 184 females with rheumatoid arthritis were studied in Kermanshah, Iran. The American College of Rheumatology's 2010 criteria were used to diagnose RA. The biochemical tests including erythrocyte sedimentation rate, C-reactive protein, rheumatoid facto, anti-nuclear antibody titration, antibodies against cyclic citrulline peptide, disease activity score 28 and the food frequency questionnaire was used to assess rheumatoid arthritis activity and the Mediterranean diet quality index, respectively. To compare the dietary intakes of participants across tertiles of Mediterranean diet score, we used Analysis of Variance. Multinomial logistic regression with three adjusted models was used to investigate the association between Mediterranean diet score with disease activity., Results: 184 eligible patients with rheumatoid arthritis participated in this study. The mean age and duration of disease, body mass index, waist circumference and percent body fat did not differ significantly among the tertiles of the Mediterranean diet score (P-value>0.05). Participants in the highest tertile of Mediterranean diet score had significantly greater intakes of fruits, vegetables, fish, legume, nuts and had lowest intake of grains (refrain grain) and red and process meats to white meat ratio (P-value<0.05). There was no significant difference in terms of variables related to disease activity among the tertiles of the Mediterranean score (P-value>0.05). In multi-adjusted models, the odds ratio of Mediterranean diet scores no significant different in the third as compared to the first tertile of Mediterranean diet score (P-value>0.05)., Conclusion: Based on our findings there is no association between the Mediterranean diet score and disease activity of people with rheumatoid arthritis., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Theobromine may have beneficial effects on cardiovascular risk factors. This study aimed to find molecular effects of theobromine on lipid profile, glycemic status, inflammatory factors, and vascular function through a comprehensive assessment of all in vitro and in vivo studies. The search process was started at 18 July 2022. Databases including PubMed, Scopus, and Web of Science were searched to find all articles published up to 18 July 2022. Nineteen studies were included in this study. In vitro studies showed the improving effects of theobromine on inflammatory markers. Of four animal studies assessing the effect of theobromine on inflammatory markers, two reported favorable effects. Among five animal studies assessing the effects of theobromine on lipid profile, three reported improving effects on either triglyceride, total cholesterol, low- or high-density lipoprotein cholesterol. Of the three human studies, two revealed that theobromine had improving effects on lipid profile. A favorable effect of theobromine on augmentation index was also reported in two RCTs. The results for other outcomes were inconclusive. Theobromine may have favorable effects on inflammatory factors, lipid profile, and vascular function markers. However, studies with a longer duration and lower, dietary-relevant doses are required for future confirmation., (© 2023 John Wiley & Sons Ltd.)

Background: Since obesity and diabetes are prevalent worldwide, identifying the factors affecting these two conditions can effectively alter them. We decided to investigate the expression of obesity and diabetes genes in infants with birth weights lower than 2500 g in comparison with infants with normal birth weights., Methods: 215 healthy infants between the ages of 5-6 months were used in the current case-control research, which was conducted at health and treatment facilities in Kermanshah. Infants who were healthy were chosen for the research after their weight and height were measured and compared to the WHO diagram to ensure that they were well-grown and in good health. There were 137 infants in the control group and 78 infants in the case group. All newborns had 5 cc of blood drawn intravenously. To assess the expression of the genes MC4R, MTNR1B, PTEN, ACACB, PPAR-γ, PPAR-α, NRXN3, NTRK2, PCSK1, A2BP1, TMEM18, LXR, BDNF, TCF7L2, FTO and CPT1A, blood samples were gathered in EDTA-coated vials. Chi-square, Mann-Whitney U, and Spearman analyses were used to examine the data., Results: A significant inverse correlation between birth weight and obesity and diabetes genes, including MTNR1B, NTRK2, PCSK1, and PTEN genes (r= -0.221, -0.235, -0.246, and - 0.418, respectively). In addition, the LBW infant's expression level was significantly up-regulated than the normal-weight infants (P = 0.001, 0.007, 0.001, and < 0.001, respectively). The expression level of the PPAR-a gene had a significantly positive correlation with birth weight (r = 0.19, P = 0.005). The expression level of the PPAR-a gene in the normal-weight infants was significantly up-regulated than the LBW infants (P = 0.049)., Conclusion: The expression levels of MTNR1B, NTRK2, PCSK1, and PTEN genes were up-regulated in the LBW infants; however, the expression level of PPAR-a gene was significantly down-regulated in the LBW infants compared to the infants with normal birth weight., (© 2023. The Author(s).)

Objective: l-Carnitine has been suggested as a potential nutrient that alleviates the oxidative and inflammatory damages of coronary artery disease (CAD), but the results of the previous studies of the importance of this supplementation remains unclear. This study attempts to evaluate the effects of l-carnitine (LC) supplementation on oxidative stress and inflammatory biomarkers in patients with CAD., Methods: A double-blind, randomised, placebo-trial was conducted on 75 CAD subjects. Patients were randomly assigned to receive LC (1000 mg/day) or placebo capsules over 3 months. Sera high-sensitivity C-reactive protein (hs-CRP), myeloperoxidase (MPO), nitrotyrosine (NT) and total antioxidant capacity (TAC) were assayed., Results: A significant increase in serum TAC and a significant decrease in MPO, NT, and hs-CRP levels were detected following 12 weeks of LC supplementation, compared to the placebo., Conclusions: These results suggest that LC supplementation may exert beneficial effect on cardiovascular health through attenuate oxidative and inflammatory markers in CAD patients.

Ginger and its derivatives have been shown to be effective in the prevention and treatment of cancer. We undertook a systematic review to answer the question of whether ginger has a role in modifying the biomarkers of cancer in cell culture conditions and on colorectal cancer in randomized clinical trials. We performed a comprehensive search of the literature from Scopus, Embase, Web of Science, PubMed, Cochrane central register of controlled trials, and Cochrane database of systematic reviews. At first, all 12 papers studied the effect of ginger or its derivatives on cell culture conditions. The results of cell culture studies show that ginger has a powerful role in inducing apoptosis. In the second part, five studies of clinical trials were analyzed. By analyzing antitumor markers of clinical trials, ginger increased some anticancer markers but performed poorly in inducing some anticancer markers. This systematic review showed that the consumption of ginger extract has the potential to prevent and treat colorectal cancer but this ability is weak., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Diabetes mellitus (DM) and obesity are common illnesses characterized by glucose metabolism issues and excessive weight gain. Breastfeeding is the best way to feed a newborn up to 6 months old and it has been shown to reduce the risk of diabetes and obesity later in life due to its nutritional properties. The purpose of this study was to investigate the effects of breastfeeding, formula feeding, and formula-plus breastfeeding (mix-feeding) on the anthropometric indices, metabolic variables, and the expression level of obesity and diabetes-predisposing genes of healthy infants. A total of 150 healthy infants were enrolled in this cross-sectional study. All infants (aged 24 months) were divided into three groups based on the type of feeding, breastfeeding, formula feeding, and mix-feeding. The anthropometric indices, glycemic indexes, lipid profile, and the expression levels of acetyl-coenzyme A carboxylase beta (ACACB), brain-derived neurotrophic factor (BDNF), liver X receptor α (LXR-α), peroxisome proliferator-activated receptor γ (PPAR-γ), and phosphatase and tensin homolog (PTEN) genes were measured in all infants using reverse transcription-polymerase chain reaction (RT-PCR) method. The anthropometric indices including weight, height, head circumference, insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were lower in the breastfeeding infants in comparison to other groups. As well, the expression level of the ACACB gene was significantly downregulated in breastfeeding infants, while the PPAR-γ gene was significantly upregulated, but the expression levels of LXR- α, PTEN and BDNF did not change significantly across groups. Breastfeeding compared to formula feeding had positive effects on anthropometric indices, metabolic variables, and diabetes-predisposing genes., (© 2022 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Aim: Rheumatoid arthritis is an inflammatory illness characterized by persistent and systemic inflammation. There is just a little amount of research on nutrition and RA progression. The goal of this research is to see whether there's a link between main eating trends and RA activity., Methods: In Kermanshah, Iran, 183 individuals with RA were studied in cross-sectional research. The American College of Rheumatology's 2010 criteria were used to diagnose RA. The disease activity score 28 and nutritional information from a reliable 147-item food frequency questionnaire were used to assess RA activity. Factor analysis was used to extract dietary patterns., Results: The researchers discovered three main eating trends, which they named. Individuals in the highest tertile of a high protein anti-inflammatory dietary pattern that emphasizes consumption of dairy products, red meats, white meats, vegetables oils, condiments, vegetables and fruits as well as low in salts and refined grain had lower DAS-28 scores than those in the first tertiles (T3 = 2.09 ± 0.14 vs. T1 = 3.75 ± 0.13; P-value = 0.001) after controlling for potential confounders. Patients in the top tertile of the low fiber dietary pattern had higher DAS-28 scores than those in the bottom tertile (T3 = 3.40 ± 0.15 vs. T1 = 2.95 ± 0.15; P-value = 0.036) than those in the bottom tertile., Conclusion: This research found an inverse connection between RA activity and adopting a high-protein anti-inflammatory dietary pattern. Furthermore, adopting a low-fiber dietary pattern may be linked to increased RA disease activity. To confirm such a relationship, further research is needed in the future., Competing Interests: Conflict of Interest The authors have declared no conflict of interest., (Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: Diet plays an important role in regulating inflammation, which is a hallmark of rheumatoid arthritis (RA). Our aim was to investigate the association between the Dietary Inflammatory Index (DII) scores and RA activity., Methods: This cross-sectional study was conducted on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall inflammatory potential of the diet was extracted from a validated 168-item food frequency questioner (FFQ) using the DII. RA disease activity was assessed using Disease Activity Score 28 (DAS-28) scores. Logistic regression and one-way ANOVA/ ANCOVA were conducted., Results: Individuals in the highest DII quartile had the significantly higher odds of positive C-reactive protein than those in the lowest quartile of the DII scores (OR 4.5, 95% CI 1.16 - 17.41, P = 0.029). A statistically significant downward linear trend in fat-free mass and weight were observed with increasing the DII quartiles (P = 0.003, P = 0.019, respectively). Patients in the highest DII quartile had higher DAS-28 scores than those in the first quartile (Mean difference: 1.16, 95% CI 0.51 - 1.81, P < 0.001) and second quartile of the DII scores (Mean difference: 1.0, 95% CI 0.34 - 1.65, P < 0.001)., Conclusion: Our results indicated that reducing inflammation through diet might be one of the therapeutic strategies to control and reduce the disease activity in RA patients., (© 2022. The Author(s).)

Background: It has been shown that dysbiosis might have a role in developing of chronic inflammation and depression. In this study, we are interested in exploring of anti-inflammatory and anti-depressant effects of Lactobacillus Rhamnosus G (LGG), a probiotic strain, alone or in combination with a prebiotic, Inulin, in patients with coronary artery disease (CAD)., Methods: This randomized, double-blind clinical trial was held on 96 patients with CAD. Patients were randomly allocated into four different groups: LGG [a capsule/day, contained 1.9 × 10 9 colony-forming unit of Lactobacillus Rhamnosus G], inulin (15 g/day), co-supplemented (LGG and inulin), and placebo. Participants consumed the supplements for two months. Beck Depression Inventory (BDI), MacNew questionnaire and Spielberger state-trait anxiety inventory (STAI-Y) were used to assess depression, quality of life and anxiety, respectively. Serum levels of C-reactive protein (hs-CRP), lipopolysaccharide (LPS), tumor necrosis factor (TNF)-α, and Interleukin (IL)-10 were also measured., Results: Probiotic-Inulin Co-supplementation significantly decreased BDI (-11.52 ± 0+3.20 vs. +2.97 ± 0.39, P  = 0.001), STAI-state (-17.63 ± 3.22 vs. -0.60 ± 0.33, P  = 0.021), and STAI-trait (-24.31 ± 7.41 vs. -1.45 ± 0.66, P  = 0.020) scores, hs-CRP (-1.69 ± 0+66 vs. +0.82 ± 0.39 mg/dL, P  = 0.020), LPS (-22.02 ± 5.40 vs. +0.31 ± 0.18 (EU/L), P  = 0.047), and TNF-α (-25.05 ± 7.41 vs. +0.79 ± 0.71 (ng/L), P  = 0.032) in comparison to placebo., Conclusion: Co-supplementation of probiotics and inulin in CAD subjects for eight weeks had beneficial effects on depression, anxiety, and inflammatory biomarkers. Adding inulin to probiotic supplements improved psychological outcomes and inflammatory biomarkers more effectively than two supplements separately. Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20180712040438N4..

Energy restriction and manipulation of macronutrient composition of the diet are the main approaches that are used by people who aim to lose weight. When such strategies are employed, appetite and endocrine regulators of satiety, such as gut peptides, all are deeply affected. The gut microbiota-brain axis controls energy homeostasis in humans by affecting central satiety and gut peptides. The purpose of this study was to evaluate if the synergistic effect of probiotics and vitamin D in yogurt matrix can modulate this effect. In the double-blind, randomized, placebo-controlled trial, 140 obese adults were randomly allocated into four groups: 1) regular yogurt plus low-calorie diet; 2) PY plus low-calorie diet; 3) vitamin D-fortified yogurt plus low-calorie diet, and 4) probiotic and vitamin D co-fortified yogurt plus low-calorie diet. All groups were encouraged to increase their physical activity. Glucagon-like peptide-1 (GLP-1), peptide Tyrosin-Tysrosin (PYY), ghrelin, anthropometric variables, insulin, fasting blood sugar (FBS), insulin resistance/sensitivity, 1,25(OH) 2 D 3 , dietary intake, and physical activity were measured before and after 10 weeks. The difference between groups for GLP-1 after 10 weeks was significant after adjusting for baseline GLP-1 and protein intake as confounders. PY showed the largest effect size (ES) on GLP-1 ( p  = 14.2) and FBS ( p  = 14) compared with others. Pairwise comparison of yogurts effect sizes on GLP-1 showed a significant difference in group 1 vs. group 2 ( p  = .001), group 1 vs. group 3 ( p  = .003), and group 1 vs. group 4 ( p  = .048). Vitamin D-fortified yogurt had the largest effect size on the serum level of vitamin D and it showed a significant difference with RY ( p  = .018) and PY ( p  = .002). Consumption of vitamin D-fortified yogurt and PY could be regarded as a promising approach during calorie restriction., Competing Interests: The authors declare no conflict of interest in this study., (© 2022 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Despite strategies based on social distancing, the coronavirus disease 2019 (COVID-19) expands globally, and so far, many attempts have been made to achieve effective treatment for patients with COVID-19. This disease infects the lower respiratory tract and may lead to severe acute respiratory syndrome coronavirus (SARS-CoV). COVID-19 also can cause gastrointestinal infections. Therefore, COVID-19 patients with gastrointestinal symptoms are more likely to be complicated by SARS-CoV. In this disease, acquired immune responses are impaired, and uncontrolled inflammatory responses result in cytokine storms, leading to acute lung injury and thrombus formation. Probiotics are living microorganisms that contribute to the health of the host if administered in appropriate doses. Aim: This study aimed to provide evidence to show the importance of gut dysbiosis in viral disease, especially COVID-19. Therefore, we have focused on the impact of probiotics consumption on preventing severe symptoms of the disease. Methods: We have entirely searched SCOPUS, PubMed, and Google Scholar databases to collect evidence regarding the relationship between probiotics and viral infections to expand this relationship to the COVID-19. Results: It has been shown that probiotics directly counteract SARS-CoV in the gastrointestinal and respiratory tracts. Moreover, probiotics suppress severe immune responses and prevent cytokine storms to inhibit pathologic inflammatory conditions in the body via modulation of immune responses. Conclusion: According to available evidence based on their antiviral and respiratory activities, using probiotics might be an adjuvant therapy to reduce the burden and severity of this disease.

Background: Indices, based on anthropometrics with or without non-anthropometric components, are predictive of cardio-metabolic outcomes. Fat mass index (FMI) is similar to BMI except measured fat mass replaces body weight. The visceral adiposity index (VAI) combines anthropometric measures with lipid measurements TG/HDL. The relationship of these indices to incident type 2 diabetes (T2DM) has not been established. Therefore, we have evaluated the predictive power and optimal cut-off points of FMI, and VAI with T2DM in a cross-sectional population study., Methods: These population-based cross-sectional study comprised 8411 adults aged 35-65 years using data from the Ravansar Non-Communicable Diseases (RaNCD) cohort. VAI and FMI were defined as previously published. Optimal cut-off points for association with incident T2DM were determined from receiver-operating curves (ROC)., Results: The optimal cut-off point for VAI was 4.86 (AUC: 0.673; 95% CI: 0.65-0.69) and FMI 9.3 (AUC: 0.57; 95% CI: 0.55-0.59), and for T2DM in our study population. The odds ratios (OR) for T2DM were nearly identical, for VAI 1.098 (95% CI: 1.08-1.11) and for FMI 1.08 (95% CI: 1.05-1.10)., Conclusions: In the current population study, VAI and FMI were weakly associated with T2DM. Therefore, it seems that anthropometric measures are unlikely to be strong mediators of T2DM compared to historical and other factors in the population studied., Competing Interests: All authors declare that they have no conflicts of interests., (© 2022 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Metabolic syndrome is overwhelmingly increasing and is a significant risk factor for cardiovascular disorder, so effective treatment strategies are considered high priority. This study aimed to determine the effects of synbiotic supplementation on metabolic factors in patients with metabolic syndrome., Methods: In this triple-blind, randomized, placebo-controlled, clinical trial, 108 participants were divided into two groups to receive synbiotic supplementation or placebo for 12 weeks. All participants were also educated about maintaining a healthy lifestyle and consuming low-calorie nutritious meals, along with dietary intake and physical activity monitoring. Anthropometric measures, blood pressure, glycemic indices, lipid profile, hepatic enzymes, and hs-CRP were evaluated at the baseline and end of the trial., Results: Synbiotic supplementation significantly reduces fasting blood glucose (FBG) levels in the intervention group versus placebo group [-14.69 ± 15.11 mg/dl vs. -8.23 ± 7.90 mg/dl; p =0.007], but there was no difference between groups in other metabolic factors., Conclusions: These findings suggest that synbiotic supplementation while following a healthy lifestyle and nutrition improved FBG in patients with metabolic syndrome., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Fatemeh Rahimi et al.)

Gastroesophageal reflux disease (GERD) is a chronic condition which has a high global prevalence. Dietary intake is considered to be a contributing factor for GERD. However, scientific evidence about the effect of diet on the risk of GERD is controversial. This systematic review was conducted to address this issue. A comprehensive structured search was performed using the MEDLINE, Scopus, and Web of Science databases up to August 2020, in accordance with the PRISMA statement. No restrictions were set in terms of language, time of publication, or study location. Study selection and data abstraction was conducted independently by two authors, and risk of bias was assessed using a modified Quality in Prognosis Studies Tool. Eligible studies evaluating the impact of food and dietary pattern on GERD were included in qualitative data synthesis. After excluding duplicate, irrelevant, and low quality studies, 25 studies were identified for inclusion: 5 case-control studies, 14 cross-sectional studies, and 6 prospective studies. This review indicates that high-fat diets, carbonated beverages, citrus products, and spicy, salty, and fried foods are associated with risk of GERD., Competing Interests: AUTHOR DISCLOSURE STATEMENT The authors declare no conflict of interest., (Copyright © 2021 by The Korean Society of Food Science and Nutrition.)

Grilling is one of the most traditional ways of cooking foods, especially meat, which can produce a number of carcinogenic compounds. This study was to identify the pattern of kebab consumption and its PAHs among a selection of the Iranian population. Kebab consumption pattern were assessed using a validated questionnaire. A sample of three types of popular kebabs, including Koobideh (minced meat), Barg (crushed meat pieces), and Juje (chopped chicken pieces), was collected from each restaurant and then transferred to a laboratory to measure PAHs. The median benzo[a]pyrene concentrations (7.85 μg/kg) and the sum of benzo[a]pyrene, chrysene, benzo[a]anthracene, and benzo[b]fluoranthene concentrations (15.74 μg/kg) were higher than the maximum level imposed by the Commission of the European Communities. A significant relationship between Barg kebab prepared with charcoal and the amounts of anthracene, benzo[a]anthracene, dibenzo[a,h]pyrene, and benzo[g,h,i]perylene was found. The highest PAHs produced in samples prepared with charcoal was dibenzo[a,h]pyrene.

Background: Emerging evidence indicates that propolis as a novel potential antioxidant has unique benefits. This study aimed to evaluate the effect of propolis on oxidative stress, inflammation, body composition, and athletic performance in healthy active subjects., Methods: This clinical trial was conducted on 54 male military cadets. Eligible subjects were randomly allocated to receive a single dose of 450 mg propolis twice daily for four weeks or a matching placebo containing microcrystalline cellulose. Cooper 12-min run test and running-based anaerobic sprint test were performed to measure aerobic and anaerobic performance. Blood samples were obtained immediately after Cooper's test to evaluate oxidative stress and inflammation status. Fat mass and fat-free mass were analyzed using bioelectrical impedance., Results: Mean changes in fat mass, fat-free mass, anaerobic powers, fatigue index, and VO 2 max did not differ significantly between the two groups after the adjustment for baseline values (P-value>0.05). A significant change was observed in plasma levels of IL-6 (-1.43 ± 0.11pg/mL), total oxidant status (-3.9 ± 0.2µmol/L), total antioxidant capacity (164 ± 12 µmol/L), malondialdehyde (-0.52 ± 0.03µmol/L), oxidative stress index (-0.45 ± 0.04), and glutathione (48.72±2µmol/L) in the propolis group compared with the placebo group after the adjustment for baseline values and weight changes (P-value<0.05). Although IL-10 concentrations had no significant changes in both groups, the ratio of IL-6/IL-10 significantly reduced in the propolis group compared with the placebo group (-0.174 ± 0.015 versus. 0.051 ± 0.014; P-value: 0.041)., Conclusions: Our results indicated that propolis might have beneficial effects on oxidative stress and inflammation following intense activities in healthy male subjects., Competing Interests: The authors have declared no conflict of interest., (© 2021 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Non-alcoholic fatty liver disease (NAFLD) is a significant public health problem globally and the most notable chronic liver disease in Asian countries. Various dietary supplements have been assessed as potential methods to alleviate the metabolic damages related to NAFLD, but the results of these works have been equivocal. This study aimed to evaluate the effects of probiotic yogurt fortified with vitamin D (Pro-YFD) on glycemic and anthropometric indices in patients with NAFLD. One hundred and four NAFLD patients of both sexes were randomly allocated to 2 groups: group A (Pro-YFD) and group B (unfortified yogurt). The intervention period was 3 months. Fasting blood samples were obtained for measuring fasting blood sugar (FBS) and insulin level. Food intake was measured using a validated food frequency questionnaire. Body composition was estimated by bio-impedance. Eighty-eight patients completed the study. The mean serum level of 25(OH)D 3 was elevated significantly (p < 0.001), while insulin level decreased significantly (p < 0.003) in group A at the end of the study. FBS levels showed no significant differences between the groups at the end of the trial. Also, there were no significant changes in diet caloric intake, physical activity, or anthropometric indices in the 2 groups during the interventions. Pro-YFD in the diets of patients with NAFLD may attenuate insulin resistance and improve serum level of 25(OH)D 3 ., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests., (Copyright © 2021. The Korean Society of Clinical Nutrition.)

A healthy diet has long been indicated to be protective against Alzheimer's diseases (AD). We carried out a systematic review and meta-analysis of published observational studies to explore the relationship between healthy and unhealthy diets and risk of ADs. We screened PubMed, Scopus, Web of Sciences, Google Scholar, Science Direct, and Embase, and screened manually to identify relevant articles published in English and non-English until Jun 2020. We classified the studied dietary patterns into two groups: healthy and unhealthy diets. The pooled weighted mean difference and 95% confidence interval (95% CI) was used to analyze the data using a random-effects model. The data were extracted manually and the preferred reporting items for systematic review and meta-analysis checklist was used to appraise the risk of bias and quality of data. Of the 1,813 articles identified, 21 met the inclusion criteria and were included in the quantitative analysis. A healthy diet was related to a lower risk of AD [odds ratio (OR): 0.45, 95% CI: 0.23 to 0.86, I 2 =99.7%; n=17 studies]. Moreover, high adherence to an unhealthy diet was not associated with increased risk of AD (OR: 0.99, 95% CI: 0.98 to 0.99, I 2 =0.0%; n=6 studies). However, the etiology of AD is uncertain and it is difficult draw conclusions about dietary healthy patterns. We concluded that adherence to a healthy diet is associated with a lower risk of AD, but were unable to find evidence that an unhealthy diet increases the risk of AD., Competing Interests: AUTHOR DISCLOSURE STATEMENT The authors declare no conflict of interest., (Copyright © 2020 by The Korean Society of Food Science and Nutrition. All rights Reserved.)

Vitamin D deficiency can be regarded as one of the overgrowing health problem in all of the world. Evidence from a clinical trial suggested a role for probiotic bacteria in increasing vitamin D. However, probiotic's effect is strain specific and this effect should be confirmed about different strains. The objective was to determine if yogurt fortification with probiotic bacteria, Lactobillus acidophilus La-B5, Bifidobacterium lactis Bb-12 either alone or in combination with vitamin D can be a complementary treatment for vitamin D deficiency . The end-points were vitamin D, cardio metabolic lipid profile, anthropometric indices (weight, height, waist, hip, fat mass, lean body mass) and dietary intake. A 10-week parallel-group, double-blind, randomized and controlled trial was conducted on 140 obese men and women. The participants were randomly allocated to receive 100 grams either 1) plain low-fat yogurt or 2) probiotic yogurt or 3) vitamin D-fortified yogurt or 4) probiotic and vitamin D cofortified yogurt. All groups received low-calorie diet. Vitamin D increased significantly in group 4 ( p  = .008), group 3 ( p  = .001) and group 1 ( p  = .012 with no difference between groups. Vitamin D-fortified yogurt had the most effect size and showed a significant difference versus plain ( p  = .018) and probiotic yogurt ( p  = .002). Regarding lipid profile, there were no significant differences between groups. Data from this study does not support the hypothesis that yogurt fortified with probiotic bacteria, Lactobillus acidophilus La-5 and Bifidobacterium lactis Bb-12 either alone or in combination with vitamin D might impose any increasing effect on serum level of vitamin D in comparison with vitamin D-fortified yogurt., Competing Interests: The authors declare that they do not have any conflict of interest., (© 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Oxidative stress, defined as an imbalance between pro-oxidants and neutralizing antioxidants within the body, is a growing public health concern. Oxidative stress is involved in the progression of nearly all chronic diseases. Melatonin has been suggested to reduce oxidative stress by its potential radical scavenging properties., Objective: To determine the efficacy and safety of melatonin as a therapy for the improvement of oxidative stress parameters in randomized controlled trials., Methods: A systematic database search using Scopus, PubMed/Medline, EMBASE, Web of Science, the Cochrane Controlled Register of Trials and clinicaltrials.gov (https://clinicaltrials.gov) for studies published up to July 2020 was conducted. We included studies which investigated the effect of supplemental melatonin compared to placebo on oxidative stress parameters in unhealthy patients. Quantitative data synthesis was conducted using a random-effects model with standard mean difference (SMD) and 95 % confidence intervals (CI). Cochrane's Q and I 2 values were used to evaluate heterogeneity., Results: A total of 12 randomized controlled trials (RCTs) were eligible. The meta-analysis indicated an association between melatonin intake and a significant increase in total antioxidant capacity (TAC) (SMD: 0.76; 95 % CI: 0.30, 1.21; I 2 = 80.1 %), glutathione (GSH) levels (SMD: 0.57; 95 % CI: 0.32, 0.83; I 2 = 15.1 %), superoxide dismutase (SOD) (SMD: 1.38; 95 % CI: 0.13, 2.62; I 2 = 86.9 %), glutathione peroxidase (GPx) (SMD: 1.36; 95 % CI: 0.46, 2.30; I 2 = 89.3 %), glutathione reductase (GR) (SMD: 1.21; 95 % CI: 0.65, 1.77; I 2 = 00.0 %) activities, and a significant reduction in malondialdehyde (MDA) levels (SMD: -0.79; 95 % CI: -1.19, -0.39; I 2 = 73.1 %). Melatonin intake was not shown to significantly affect nitric oxide (NO) levels (SMD: -0.24; 95 % CI: -0.61, 0.14; I 2 = 00.0 %) or catalase (CAT) activity (SMD: -1.38; 95 % CI: -1.42, 4.18; I 2 = 96.6 %)., Conclusion: Melatonin intake was shown to have a significant impact on improving Oxidative stress parameters. However, future research through large, well-designed randomized controlled trials are required to determine the effect of melatonin on oxidative stress parameters in different age groups and different disease types., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Soy products and isoflavones intake have been shown to exert antioxidant effects. There are several randomized control trials (RCTs) that evaluated the effect of soy products intake on oxidative stress (OS) parameters. The aim of the present systematic review and meta-analysis was to summarize the results of RCTs evaluating the effect of soy products and isoflavones intake on OS parameters. Randomized trials that assessed the effect of soy products and isoflavones intake on OS parameters in adults were identified through searching in electronic databases: Cochrane clinical trial center, Embase, PubMed, Scopus, and Web of Sciences up to April 2020. Random effects model was used to calculate the effects sizes of soy intake on OS parameters. Twenty-four trials with 1,852 participants were eligible and were included in the meta-analysis which measured OS parameters. Soy intake compared to control group significantly reduced MDA levels (SMD: -0.53; 95% CI: -0.86, -0.19; I 2  = 88.3%), increased GSH levels (SMD: 0.51; 95% CI: 0.13, 0.88; I 2  = 72.4%), SOD activity (SMD: 0.53; 95% CI: 0.08, 0.99; I 2  = 84.1%), TAC (SMD: 0.54; 95% CI: 0.27, 0.82; I 2  = 49.3%) and TRAP (SMD: 1.74; 95% CI: 0.82, 2.65; I 2  = 81.3%) significantly compared to control group. Soy products and isoflavones intake are effective in improving OS parameters in adults compared with controls; thus, it could be a valuable advise to control OS progress in chronic diseases., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: Children with autism spectrum disorders (ASD) have lower serum vitamin D and higher serotonin and interleukin (IL)-6 levels compared with healthy children. The aim of this study was to evaluate the effect of vitamin D on core symptoms and serum levels of serotonin and IL-6 in these children., Methods: This parallel randomized double-blind, placebo-controlled trial was conducted with 43 children with ASD (7 girls and 36 boys; 8.91 ± 2.87 y of age). Children were randomly allocated to receive either vitamin D drop (300 IU/kg up to a maximum of 6000 IU daily) or placebo for 15 wk. Serum levels of 25-hydroxyvitamin (OH)D, IL-6, and serotonin were measured at baseline and at the end of the trial. Also, the severity of autism and the social and individual maturity of the children were measured by the Childhood Autism Rating Scale (CARS), the Autism Treatment Assessment Checklist (ATEC), and Aberrant Behavior Checklist-Community (ABC-C) questionnaires before and after intervention. Randomization and allocation to groups were done using computer-generated numbers., Results: More than 86% of patients had vitamin D deficiency at the beginning of the study. Serum levels of 25(OH)D increased significantly in the vitamin D group (P = 0.001). The clinical symptoms of autism measured by CARS and ATEC scales were alleviated significantly (P = 0.021 and P = 0.020, respectively); however, the serum levels of serotonin and IL-6 and the scale of ABC-C remained without a significant change., Conclusion: These findings suggest that vitamin D supplementation may improve ASD symptoms; however, more studies with longer duration are indispensable to confirm our results., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Although several studies have examined the link between different food groups intake and stunting among children, no study, to our knowledge, was done on exceptional children. The aim of this study was assessed the association of dietary intake and stunting in Iranian exceptional children., Methods: This cross-sectional study was conducted on 470 exceptional children (226 mentally retarded, 182 deaf and 62 blind children), aged 5-15 years. Height was measured using standard tool. Stunting was defined as height-for-age z-score of <-1. A validated dietary habit questionnaire was applied to assess dietary intakes., Results: Mean age of children was 10.02 ± 2.04 years. Stunting was prevalent among 50.6% of children. Compared with children in the lowest category of dairy consumption, those in the highest category had lower odds of stunting. This association remained significant even after adjusting for covariates (OR: 0.50, 95% CI: 0.29-0.87). In addition, moderate consumption of egg (1-3 time/wk) was inversely associated with stunting either before or after controlling for potential confounders (OR: 0.36, 95% CI: 0.21-0.64). Such finding was also seen among mentally retarded children (OR: 0.38, 95% CI: 0.16-0.89). No other significant association was seen between intakes of other food groups (including meat, fruits and vegetables) and stunting., Conclusions: We found that higher intake of dairy products and egg was associated with lower risk of stunting. However, intakes of other food groups including meat, fruits and vegetables were not significantly related to stunting.

Type 2 diabetes mellitus (T2DM) is a serious public health problem accompanies with several complications. This study was conducted to evaluate the effects of chromium picolinate (CrPic) supplementation on the glycemic status and lipid profile in patients with T2DM. The patients with T2DM (n = 52) were randomly allocated into 2 groups. One group received 400 µg CrPic per day and the other group took placebo; the intervention duration was 8 weeks. Anthropometric indices and metabolic factors were measured at the beginning, and at end of the study. The patients were recommended not to change their normal diet, life style and medication. No significant changes were observed for weight, body mass index, and fasting blood glucose (FBG) in both groups; while intra-groups changes in homeostatic model assessment for insulin resistance (HOMA-IR) value was significant (p < 0.05). Results of analysis of covariance showed that there were significance differences between groups in total cholesterol, low density lipoprotein cholesterol and HOMA-IR at the end of the intervention adjusting for baseline levels (p = 0.035, 0.030 and < 0.001, respectively). In this study, oral supplementation with 400 µg CrPic for eight weeks did not alter FBG concentration as well as anthropometric parameters in individuals with T2DM. However, the modest beneficial effects of chromium supplementation on insulin resistance as indicated by HOMA-IR and lipid profile were found., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests., (Copyright © 2020. The Korean Society of Clinical Nutrition.)

Objectives: This study aimed to assess the effect of CoQ10 supplementation on serum matrix metalloproteinases (MMPs) and clinical parameters in rheumatoid arthritis (RA) patients., Method: In this randomized, double-blind, placebo-controlled trial, 54 RA patients who fulfilled the eligibility criteria (18-56 years, diagnosed at least 6 months ago, with DAS-28 > 3.2) were randomly assigned into two groups to receive 100 mg/day CoQ10 (n = 27) or placebo (n = 27) for 2 months. Serum MMP-1 and MMP-3 levels and clinical status using disease activity score in 28 joints (DAS-28) were assessed before and after supplementation. Data were analyzed using χ2, independent sample t test, paired t test, Wilcoxon, Mann-Whitney, and analysis of covariance., Results: A significant reduction was observed in both CoQ10 and placebo groups in the medians of serum MMP-1 (0.2 to 0.16, P < 0.001), (0.18 to 0.15, P = 0.001); swollen joint count (2 to 0, P < 0.001), (2 to 0, P = 0.009); and the means of DAS-28 (5.01 ± 1.21 to 2.34 ± 0.68, P < 0.001), (4.88 ± 0.96 to 4.04 ± 1.36, P = 0.009) respectively. Serum MMP-3 level increased significantly in placebo group (2.26 to 2.57, P = 0.020), and the MMP-3 changes between groups were significant (P = 0.027). Furthermore, significant reductions were only observed in ESR, pain score, and tender joint count in CoQ10 group compared with baseline (P = 0.001, P < 0.001, and P < 0.001, respectively). Significant differences were observed between two groups in DAS-28, pain score, and swollen and tender joint count after the intervention (P < 0.001, P < 0.001, and P = 0.012 and P < 0.001, respectively)., Conclusions: It seems that CoQ10 may provide a new complementary approach for RA patients.Key Points• CoQ10 supplementation in RA patients attenuated serum MMP-3 level.• CoQ10 supplementation in RA patients improved clinical outcomes and ameliorated disease severity.• CoQ10 may provide a new complementary approach for patients with RA.

Objective: Evidence has suggested that Spirulina supplementation may affect anthropometric indices. Therefore, a systematic review and meta-analysis was performed to summarize published randomized clinical trials which assess the effect of Spirulina supplementation on obesity., Setting: Pertinent studies were identified using Embase, Scopus, ISI Web of Science, PubMed and Cochrane library databases up to May 2019. Mean Differences (MD) were pooled using a random-effects model. Heterogeneity, sensitivity analysis and publication bias were reported using standard methods., Results: Results of 5 studies (7 treatment arms) showed a significant reduction in weight (MD: -1.56 Kg, 95% CI: -1.98 to -1.14) after Spirulina supplementation. Subgroup analysis based on health status revealed that weight change in obese subjects (MD: -2.06 Kg, 95% CI: -2.45 to -1.68) was greater than overweight participants (MD: -1.28 Kg, 95% CI: -1.62 to -0.93) following Spirulina supplementation. Also, pooled analysis showed that Spirulina supplementation led to a significant reduction in body fat percent (MD: -1.02, 95% CI: -1.49 to -0.54) and waist circumference (MD: -1.40, 95% CI: -1.40 to -1.39), but not in body mass index and waist to hip ratio., Conclusion: Spirulina supplementation significantly reduces body weight, especially in obese individuals., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: We conducted a systematic review and dose-response meta-analysis of prospective studies to summarize findings on the associations between intakes of soy, soy isoflavones, and soy protein and risk of mortality from all causes, cancers, and cardiovascular diseases., Methods: Online databases were systematically searched to identify relevant articles published earlier than May 2018. We applied restricted cubic splines using random-effects analysis to assess dose-response associations. Between-study heterogeneity was assessed by I 2 value and Cochrane Q test. Potential publication bias was assessed by visual inspection of funnel plots and Begg regression test., Results: In total, 23 prospective studies with an overall sample size of 330,826 participants were included in the current systematic review and the meta-analysis. Soy/soy products consumption was inversely associated with deaths from cancers (pooled relative risk 0.88, 95% CI 0.79 to 0.99; P=0.03; I 2 =47.1%, 95% CI 0.0% to 75.4%) and cardiovascular diseases (pooled effect size: 0.85, 95% CI 0.72 to 0.99; P=0.04; I 2 =50.0%, 95% CI 0.0% to 77.6%). Such significant associations were also observed for all-cause mortality in some subgroups of the included studies, particularly those with higher quality. In addition, higher intake of soy was associated with decreased risk of mortality from gastric, colorectal, and lung cancers as well as ischemic cardiovascular diseases. Participants in the highest category of dietary soy isoflavones intake had a 10% lower risk of all-cause mortality compared with those in the lowest category. We also found that a 10-mg/day increase in intake of soy isoflavones was associated with 7% and 9% decreased risk of mortality from all cancers and also breast cancer respectively. Furthermore, a 12% reduction in breast cancer death was indicated for each 5-g/day increase in consumption of soy protein. However, intake of soy protein was not significantly associated with all-cause and cardiovascular diseases mortality., Conclusions: Soy and its isoflavones may favorably influence risk of mortality. In addition, soy protein intake was associated with a decreased risk in the mortality of breast cancer. Our findings may support the current recommendations to increase intake of soy for greater longevity., (Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: There are different equations for estimating Resting Energy Expenditure (REE). However, these equations were mainly developed based on populations of western countries., Aim: The present study was conducted to determine the validity of REE predictive equations in adults with central obesity., Methods: This study was conducted with 129 adults with central obesity aged 35-65 years, a sub-sample from a large cohort study (Western Iran), Kurdish population. REE was measured by indirect calorimetry (IC) and REE predictive equations. Data were analysed using Pearson correlation, paired t-test, concordance correlation coefficient (CCC), mean squared deviation (MSD), level of agreement (LOA) and Bland-Altman plot., Results: All REE predictive equations had low CCC and high LOA. Although there was no statistically significant difference in the REE measured with IC and the REE predicted with the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), FAO/WHO/UNU (Height), Muller and revised Harris-Benedict equations ( P = 0.874, 0.113, 0.619, 0.143 and P = 0.121), other equations had statistically significant differences with IC ( P <0.001). In addition, the highest correlation was found between the IC (r = 0.682). The least difference was related to the FAO/WHO/UNU equation, with an agreement limit of -507.96 to 500.79 Kcal/day, with a 95% confidence interval., Conclusions: The results of this study showed that the FAO/WHO/UNU, Muller, revised Harris-Benedict equations and Mifflin St Jeor equations are relatively acceptable for estimating REE. However, these prediction equations are not good at predicting REE; more precise equations are needed to apply for different ethnic groups.

Background/objectives: Changes in food consumption patterns during Ramadan may cause metabolic changes, but these have not been well studied. We aimed to determine food intake, glucose homeostasis, lipid profiles, and body composition before, during, and after Ramadan fasting., Methods: 160 healthy men were enrolled and investigated at three times (before, at the end of, and 1 month after Ramadan). Body composition was estimated by bio-impedance. Fasting blood samples were obtained for measuring fasting blood sugar (FBS), lipid profiles and insulin level. Insulin resistance (IR) was identified by the homeostatic model assessment (HOMA) of peripheral IR. Food intake was measured using a validated food frequency questionnaire before and during Ramadan. Statistical analysis was performed by SPSS 16 and P < 0.05 considered the level of significance., Results: Anthropometric parameters such as body weight, body mass index, and body fat percentage (BFP) as well as FBS and circulating triglycerides were all decreased significantly at the end of Ramadan compared with the same indices measured prior to Ramadan (all P < 0.001). In contrast, at the end of Ramadan, HOMA-IR was significantly elevated (P < 0.001). One month after Ramadan, these traits had all started to return to their pre-Ramadan levels, but were still disrupted. Food intake of all food groups except carbohydrates were decreased during Ramadan., Conclusion: Ramadan fasting may lead to both positive and negative health effects such as a decrease in FBS, weight, BFP, and increase in LDL and IR in healthy adults. However, these effects were all transitory.

Examining the trend of anthropometric indices in children and adolescents in each region can be highly beneficial in providing effective strategies to improve the status of their growth. This study was conducted with the aim of determining the trend of anthropometric indices in students from primary to high school in the west of Iran. Data were collected using a demographic questionnaire and health certificates for anthropometric information of primary school students, and current anthropometric measurements with scale for high school students. Then, all of the data were analyzed in AnthroPlus and SPSS software. Of the 731 students, 350 were female and 381 were male. Mean height Z-score to age showed a significant reduction from primary to high school (from +0.0386 to -0.27416), and mean body mass index Z-score to age showed a significant increase (from -0.3916 to +0.1826). Prevalence of stunting and overweight/obesity in high school was 1.4 and 2.5 times higher than primary school, respectively, but the prevalence of wasting reduced by 2.3 fold. Girls were more affected by the increased trend of obesity and stunting compared to boys. Nutritional transition was evident in students. Healthcare policy-makers should design and implement a comprehensive health strategy to deal with this situation, especially in girls., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests.

A precision instrument is required to assess the nutritional status. This study was conducted on comparison of 3 nutritional questionnaires to determine energy intake (EI) accuracy in adults in Ravansar Non-Communicable Chronic Disease (RaNCD) cohort study. This cross-sectional study was conducted on 118 of participant's RaNCD. EI was evaluated with 3 questionnaires including food frequency questionnaire (FFQ), 24-hours recall (24HR), and food habits questionnaire (FHQ). Resting metabolic rate (RMR) was measured using indirect calorimetry. We used EI/RMR cut off to evaluate EI reporting status. The mean ± standard deviation of age in men and women were 44.1 ± 6.5 and 43.7 ± 5.25 respectively and 50.8% of participants were men. Among 3 EI estimating questionnaires, FFQ was more accurate than 2 other questionnaires (67.8%). We observed that implausible reporters of 24HR were likely overweight (p < 0.005) but we did not observe a significant difference between EI reporting of FFQ and FHQ with participants' body composition. Our finding showed that EI underreporting of 24HR and FHQ were high. Under reporters were seemed to be overweight. Therefore, these results suggested that among 3 nutritional questionnaires the FFQ was an appropriate approach to determine EI in this population due to plausible EI reporting was higher than 2 other nutritional questionnaires (24HR and FHQ)., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests.

Background: Prostate cancer is one of the most common types of cancer with a high mortality rate. The current study was conducted to investigate the relationship between dietary patterns and prostate cancer risk among Iranian men. Methods: This case-control study was conducted in Kermanshah province in western Iran in November 2016. Fifty patients with prostate cancer were selected as cases and 150 healthy men matched for age and body mass index (BMI) were selected as controls. Dietary intake data were collected by a semi-quantitative food frequency questionnaire (FFQ). Food items were grouped according to the similarity of nutrient profiles. The main dietary patterns were identified by factor analysis. Results: After adjustment for potential confounders, a healthy dietary pattern was associated with decreased risk of prostate cancer (highest versus lowest tertile OR:0.24; 95% CI: 0.07-0.81;trend p: 0.025). An unhealthy dietary pattern was related to increased risk of prostate cancer(highest versus lowest tertile OR:3.4; 95% CI: 1.09-10.32; trend p: 0.037). Conclusion: This study shows that an unhealthy dietary pattern was associated with increased risk of prostate cancer. However, a healthy dietary pattern was associated with decreased risk of prostate cancer.

Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests.

The incidence of atherosclerosis is increasing rapidly all over the world. Inflammatory processes have outstanding role in coronary artery disease (CAD) etiology and other atherosclerosis manifestations. Recently attentions have been increased about gut microbiota in many fields of medicine especially in inflammatory diseases like atherosclerosis. Ineffectiveness in gut barrier functions and subsequent metabolic endotoxemia (caused by rise in plasma lipopolysaccharide levels) is associated with low-grade chronic inflammation i.e. a recognized feature of atherosclerosis. Furthermore, the role of trimethylamine-N-oxide (TMAO), a gut bacterial metabolite has been suggested in atherosclerosis development. On the other hand, the effectiveness of gut microbiota modulation that results in TMAO reduction has been investigated. Moreover, considerable evidence supports a role for the endocannabinoid system (ECS) in atherosclerosis pathology which affects gut microbiota, but their effects on atherosclerosis are controversial. Therefore, we presented some evidence about the relationship between gut microbiota and ECS in atherosclerosis. We also presented evidences that gut microbiota modulation by pre/probiotics can have significant influence on the ECS.

Background: Epidemiologic studies indicated that dietary pattern plays a determinant role in cancer incidence. They also indicated that 1/3 of cancers are associated to foods. Diet contains different carcinogenic agents: naturally occurring chemicals, synthetic components and compounds produced during cooking such as kebab. This traditional food is one of the most popular foods in the Middle East, particularly in Iran. Red meat, especially lamb or veal, is the most common meat used in preparation of kebab. Since kebab is considered as a food containing carcinogenic compounds, so the purpose of this study was to assess the consumption pattern of kebab in a sample of Iranian adults and its relationship with demographic characteristics. Materials and Methods: This cross-sectional study was conducted between March and April 2015 on 705 Iranian adults who were living in Kermanshah province in the west of Iran. Subjects were selected randomly from different districts of Kermanshah. Data were collected through a questionnaire survey which had been designed by academic members of Department of Nutrition at Kermanshah University of Medical Sciences. Data analysis was performed using SPSS Version 20. The results were expressed as mean ± SD. Student's t-test, ANOVA and chi-square tests were performed to compare the study groups. The normality of data was assessed using the Kolmogorov-Smirnov test. All results were analyzed using a significance level of P <0.05. Results: The results indicated that nearly 60% of subjects have a high tendency to consume kebab. The average of kebab consumption among the participants in this study was 4 times per month. Nearly, 85% of study participants tended to consume kebab with a large amount of salt. The chi-square test determined the significant difference between education and tendency to consume kebab; individuals with higher level of education had more tendency to consume kebab than those having lower level of education (p=0.021). In this study, 93.9% of participants used charcoal, a cooking fuel, to prepare kebab. Conclusion: The results of this study point out that the study participants, regardless of socio-economic status, consume high amounts of kebab, and thus this unhealthy eating habit will increase the risk of carcinogenesis. Therefore, the immediate attention of Public Health Officials is required.

Dietary diversity score (DDS) is known as an indicator of food quality. Dietary diversity can promote health status. The aim of this study was determined DDS and its related factors in Kermanshah University of Medical Sciences (KUMS) employees. This cross-sectional study was conducted on 190 employees of KUMS in 2015. According to the population of KUMS centers which were selected randomly (Paramedical, Public Health faculties, Imam Reza Hospital and province health center), subjects were selected by convenience sampling method. Food frequency questionnaire (FFQ) was used to calculate DDS. Foods were divided into 5 main groups: grains, vegetables, fruits, meat, and dairy products. The main groups had 23 subgroups. Total DDS divided to 4 quartiles: less than 3.0, 3.0-5.5, 5.6-8.5, and more than 8.5. Anthropometric parameters including: weight, height, waist circumference (WC), and hip circumference were measured. Data were analyzed by Kolmogorov-Smirnov test, χ 2 test, and analysis of variance (ANOVA) test with SPSS 20 software (IBM Corp., Chicago, IL, USA). The mean ± standard deviation of DDS and body mass index (BMI) were 5.68 ± 1.73 and 25.1 ± 3.42 kg/m 2 , respectively. The average of the waist-to-hip ratio (WHR) in men and women was 0.92 ± 0.04 and 0.86 ± 0.06, respectively. There was statistically significant difference between DDS and self-reported economic status (p < 0.022). No significant difference was observed between DDS and BMI or WC. However, significant negative correlation was observed between DDS and WHR in men (p < 0.019). This study showed that DDS had a negative correlation with the WHR. Therefore, dietary diversity may improve health status by effect on fat distribution in body., Competing Interests: Conflict of Interest: The authors have declared no conflict of interest.