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A bankruptcy approach is proposed for resolving trans-boundary rivers conflicts in which the total water demand or claim of the riparian parties is more than the available water. Bankruptcy solution methods can allocate the available water to the conflicting parties with respect to their claims. Four bankruptcy rules are used here to allocate the available water to the riparian parties. Given the non-uniform spatial and temporal distribution of water across river basins, bankruptcy optimization models are proposed to allocate water based on these rules with respect to time sensitivity of water deliveries during the planning horizon. Once allocation solutions are developed, their acceptability and stability must be evaluated. Thus, a new stability index method is developed for evaluating the acceptability of bankruptcy solutions. To show how the bankruptcy framework can be helpful in practice, the suggested methods are applied to a real-world tarns-boundary river system with eight riparians under various hydrologic regimes. Stability analysis based on the proposed stability index method suggests that the acceptability of allocation rules is sensitive to hydrologic conditions and demand values. This finding has an important policy implication suggesting that fixed allocation rules and trans-boundary treaties may not be reliable for securing cooperation over trans-boundary water resources as they are vulnerable to changing socio-economic and climatic conditions as well as hydrologic non-stationarity. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress and inflammation play critical roles in the pathogenesis of many chronic diseases. Dark chocolate (DC)/cocoa, as a rich source of polyphenols like flavonoids, has anti-inflammatory and antioxidant properties that may confer health benefits, but findings in this context are inconsistent., Objective: This systematic review and dose-response meta-analysis aimed to provide a comprehensive overview of the controlled trials (CTs) that have examined the effects of DC/cocoa on oxidative stress and inflammation biomarkers in adults., Search Methods: Databases including PubMed, Web of Science, and Scopus, were searched for relevant studies through April 2024., Selection Criteria: Studies assessed C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), nitric oxide (NO), P-selectin, E-selectin and thiobarbituric acid reactive substances (TBARS) in adults were included., Data Analysis: Based on the random-effects model, we calculated WMDs, SMDs and 95 % confidence intervals (CIs). Sensitivity, sub-group, meta-regression and dose-response analyses were also conducted., Results: Thirty-three eligible CTs with 1379 participants were included. All studies reported the intervention types (cocoa powder, beverages and chocolate bars) and dosage. However, sixteen studies didn't do/report testing for purity and potency by independent groups. Also, none of the studies mentioned the risk of contamination with heavy metals. Another limitation was the lack of blinding assessment in studies. DC/cocoa significantly reduced MDA (SMD: -0.69, 95 %CI: -1.17, -0.2, p = 0.005) and increased NO levels (SMD: 2.43, 95 %CI: 1.11,3.75, p < 0.001); However, it has no significant effects on the other outcomes. Greater anti-inflammatory effects occurred at higher flavonoid doses (>450 mg/day) and for shorter durations (≤4 weeks) in the non-healthy participants. Non-linear dose-response relationships between cocoa dosage and CRP level and also between flavonoid dosage and IL-6 level were observed. Based on the GRADE evaluation, just CRP and MDA results were considered as high certainty evidence and the other outcomes results were categorized as very low to moderate certainty., Conclusions: DC/cocoa may improve systemic oxidative status and inflammation in adults. However, further studies should be performed to determine its benefits., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Alcohol use is associated with a wide spectrum of neurological disorders, including cognitive dysfunction and dementia. Likewise, the high prevalence of cognitive dysfunction and dementia specifies the urgent need to identify modifiable risk factors. Because findings on alcohol and cognitive dysfunction and dementia have been inconsistent, the present dose-response meta-analysis of cohort and case control studies was conducted to evaluate the available evidence., Method and Materials: A systematic search was conducted on PubMed/MEDLINE, Scopus, Embase, and PsychInfo databases and Google Scholar up to April, 2023. In the dose-response meta-analysis, a restricted cubic spline regression model was conducted to evaluate a possible non-linear relation between alcohol intake and the outcomes. Random-effects model was used to perform the meta-analysis and evaluate heterogeneity. Egger's test and a funnel plot were used to assess small study effects. Subgroup analyses were carried out to explore possible sources of heterogeneity., Results: Seventeen eligible studies comprising 80,680 total persons with 4929 cases for dementia and 13,530 total persons with 1579 cases for cognitive dysfunction were included for dose-response analysis. When compared to the reference group of 0 g/day of alcohol intake, the dose-response meta-analysis revealed a significant non-linear (J-shaped) association between alcohol intake and the risk of each of cognitive dysfunction, (lower dose range: 1-30.5 g/day, RR: 0.97; 95 % CI 0.95-0.99; higher dose range: >30.5 g/day, RR: 1.07; 95 % CI 1.01-1.15) and dementia (lower dose range: 1-17.5 g/day, RR: 0.92; 95 % CI 0.88-0.96, higher dose range: >17.5 g/day, RR: 1.23; 95 % CI 1.09-1.35). The lowest risk was achieved at approximately 30 g/day of alcohol for cognitive dysfunction and 15 g/day for dementia. The J-shape association remained with subgroups defined by age (≤65; >65 years) or study duration (<10; ≥10 years) for dementia, and within age >65 and duration <10 years for cognitive dysfunction., Conclusion: We observed a J-shape association between alcohol consumption and both cognitive dysfunction and dementia, with light-to-moderate alcohol intake being associated with a reduced risk in adults. Further studies are needed to clarify more specifically the association between alcohol consumption and six domains of cognitive dysfunction based on diagnostic and statistical manual of mental disorders (DSM) criteria., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Caffeine is commonly used as an ergogenic aid to increase strength and endurance in athletes. The results of meta-analyses in this regard are still conflicting. Therefore, the current umbrella meta -analysis was conducted to determine the effects of caffeine supplementation on muscle strength and endurance as a clear and final conclusion., Methods: Relevant studies were searched in international databases including PubMed, Scopus, and Web of Science until August 15, 2022. Meta-analysis studies examining the effects of caffeine supplementation on muscle strength and endurance were included in this study. Random effects model was used to perform meta-analysis. Additional analyses including subgroup and sensitivity analyzes were performed., Findings: In general, 9 meta-analyses were included in the study. The results showed that caffeine supplementation led to a significant increase in muscle strength (SMD = 0.18, 95 % CI: 0.14, 0.21; p < 0.001) and muscle endurance (SMD = 0.30, 95 % CI 0.21, 0.38; p < 0.001)., Conclusion: Meta -analysis showed the significant effects of caffeine consumption on muscle strength and muscle endurance. Due to the lack of evidence, further studies are needed in the women's population., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Cancer-related complications pose significant challenges in the management and treatment of patients with malignancies. Several meta-analyses have indicated improving effects of probiotics on cancer complications, while some studies have reported contentious findings. The purpose of the present study was to evaluate the efficacy of probiotics in addressing cancer complications, including diarrhea, mucositis, and infections, following chemotherapy, radiotherapy, and surgery. Relevant studies were searched in the PubMed, Scopus, Embase and Web of Science databases and Google Scholar up to September 2023. All meta-analyses addressing the effects of probiotics on all cancer treatments-induced complications including infection, diarrhea and oral mucositis were included. The pooled results were calculated using a random-effects model. Analyses of subgroups, sensitivity and publication bias were also conducted. The results revealed that the probiotics supplementation was effective on reduction of total cancer complications (OR:0.53; 95% CI: 0.44, 0.62, p  < 0.001; I 2 =79.0%, p  < 0.001), total infection rate (OR:0.47; 95%CI: 0.41, 0.52, p  < 0.001; I 2 = 48.8%, p  < 0.001); diarrhea (OR:0.50; 95%CI: 0.44, 0.57, p  < 0.001; I 2 =44.4%, p  = 0.023) and severe diarrhea (OR: 0.4; 95%CI: 0.27, 0.56, p  < 0.001; I 2 =31.3%, p  = 0.178), oral mucositis (OR: 0.76; 95%CI: 0.58, 0.94, p  < 0.001; I 2 =95.5%, p  < 0.001) and severe oral mucositis (OR:0.65, 95%CI: 0.58, 0.72  p  < 0.001; I 2 =22.1%, p  = 0.274). Multi strain probiotic (OR:0.49; 95%CI: 0.32, 0.65, p  < 0.001; I 2 =90.7%, p  < 0.001) were more efficacious than single strain (OR:0.73; 95%CI: 0.66, 0.81, p  < 0.001; I 2 =0.00%, p  = 0.786). The findings of the current umbrella meta-analysis provide strong evidence that probiotic supplementation can reduce cancer complications.

The literature regarding the role of probiotics in critically ill patients who have undergone mechanical ventilation (MV) is unclear; therefore, this umbrella systematic review and meta-analysis was carried out to clarify the effects of probiotics on the clinical outcomes of mechanically ventilated patients. The Scopus, PubMed/Medline, ISI Web of Science, and Google Scholar online databases were searched up to February 2023. All meta-analyses evaluating the impact of probiotics in patients under MV were considered eligible. The assessment of multiple systematic reviews (AMSTAR) questionnaire was used to evaluate the quality of the studies. Data were pooled using the random-effects approach. Thirty meta-analyses and nine clinical outcomes were re-analyzed. Probiotics significantly decreased ventilator-associated pneumonia (VAP) incidence, nosocomial infections, intensive care unit (ICU) length of stay, hospital length of stay, ICU mortality, hospital mortality, MV duration, duration of antibiotic use, and diarrhea. The obtained results of the current umbrella meta-analysis indicate that probiotic administration could be considered an adjunct therapy for critically ill patients; however, no specific probiotic treatment regimen can be recommended due to the diverse probiotics used in the included meta-analyses. The following microorganisms were used at various doses and combinations throughout the studies: Lacticaseibacillus casei , Lactiplantibacillus plantarum , L. acidophilus , L. delbrueckii , L. bulgaricus , Bifidobacterium longum , B. breve , B. salivarius , Pediococcus pentosaceus , Lactococcus raffinolactis , B. infantis , B. bifidum , Streptococcus thermophilus , Ligilactobacillus salivarius , L. lactis , B. lactis , Saccharomyces boulardii , L. rhamnosus GG, L. johnsonii , L. casei , S. faecalis , Clostridium butyricum , Bacillus mesentericus , L. sporogenes , S. boulardii , L. paracasei , B. subtilis , and Enterococcus faecium .

Aims: This systematic review and meta-analysis aims to evaluate the effectiveness of chia seeds in improving glycemic status, including fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and insulin., Methods: A comprehensive literature search was conducted on PubMed, Scopus, Web of Science, Cochrane, and Google Scholar up to January 2024. Randomized controlled trials (RCTs) assessing the effect of chia seeds on FBG, HbA1c, and/or insulin that meet our eligibility criteria were included. Version 2 of the Cochrane risk-of-bias tool (RoB2) was used to assess the quality of the included studies. Data were extracted and analyzed using a random-effects model and reported as weighted mean differences (WMD) with 95 % confidence intervals (CI). Subgroup and sensitivity analyses were also performed. The registration number was CRD42023441766., Results: Out of 341 articles retrieved from the initial search, 8 RCTs (with 10 arms) involving 362 participants were included in the meta-analysis. The results showed that chia consumption had no significant effect on FBG (WMD: 0.79 %; 95 % CI: -0.97 to 2.55; p = 0.38), HbA1c (WMD: -0.12 %; 95 % CI: -0.27 to 0.02; p = 0.09), and insulin (WMD:1.23 %; 95 % CI: -1.77 to 4.22; p = 0.42)., Conclusions: Chia seed consumption shows no significant impact on FBG, HbA1c, and insulin levels. This study is limited by the small number of studies in the meta-analysis and the significant heterogeneity among them, necessitating further research with larger sample sizes., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest regarding the publication of this paper. All authors have disclosed any potential conflicts of interest for the previous two years, and no conflicts were identified., (Copyright © 2024 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Osteoarthritis (OA) is one of the most prevalent degenerative joint diseases. Several meta-analyses have shown that curcumin could improve the function of the knee and alleviate pain in OA, while some meta-analyses demonstrate controversial results. Hence, we assessed curcumin's effects on knee OA in an umbrella meta-analysis. PubMed, Scopus, Embase, and Web of Science databases were employed to find English-language meta-analyses of randomized controlled trials investigating the effect of curcumin supplementation on OA outcomes up to September 2023. The visual analog scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, function, and stiffness scales were analyzed. Effect sizes and 95% confidence intervals were utilized to obtain the overall effect size. A random-effects model was applied to perform the meta-analysis. Heterogeneity was determined by I 2 statistics and the Cochrane Q-test. The pooled effect of the 11 included meta-analyses showed that curcumin could significantly decrease the VAS score (weighted mean difference [WMD] and standardized mean difference [SMD]), WOMAC-total (SMD and WMD), WOMAC-Function (SMD and WMD), WOMAC-Pain (SMD), and WOMAC-Stiffness scores (SMD) (p ≤ 0.001, ≤0.001, ≤0.001, 0.007, ≤0.001, 0.002, ≤0.001, ≤0.001, respectively). The results strongly support curcuminoid supplementation in relieving pain, improving joint mobility and stiffness, and shortening medication usage of OA patients., (© 2024 John Wiley & Sons Ltd.)

Objectives: Several meta-analyses have suggested the beneficial effect of vitamin D on patients infected with severe acute respiratory syndrome coronavirus-2. This umbrella meta-analysis aims to evaluate influence of vitamin D supplementation on clinical outcomes and the mortality rate of COVID-19 patients., Design: Present study was designed as an umbrella meta-analysis. The following international databases were systematically searched till March 2023: Web of Science, PubMed, Scopus, and Embase., Settings: Random-effects model was employed to perform meta-analysis. Using AMSTAR critical evaluation tools, the methodological quality of the included meta-analyses was evaluated., Participants: Adult patients suffering from COVID-19 were studied., Results: Overall, 13 meta-analyses summarising data from 4 randomised controlled trial and 9 observational studies were identified in this umbrella review. Our findings revealed that vitamin D supplementation and status significantly reduced mortality of COVID-19 [Interventional studies: (ES = 0·42; 95 % CI: 0·10, 0·75, P < 0·001; I 2 = 20·4 %, P = 0·285) and observational studies (ES = 1·99; 95 % CI: 1·37, 2·62, P < 0·001; I 2 = 00·0 %, P = 0·944). Also, vitamin D deficiency increased the risk of infection and disease severity among patients., Conclusion: Overall, vitamin D status is a critical factor influencing the mortality rate, disease severity, admission to intensive care unit and being detached from mechanical ventilation. It is vital to monitor the vitamin D status in all patients with critical conditions including COVID patients.

The results of meta-analyses investigating the role of folate on depression are conflicting. The aim of this umbrella meta-analysis was to obtain an overall effect and give a concise and resolving conclusion. International scientific databases including PubMed, Scopus, and Web of Science were searched up to Oct 2023. All observational and interventional meta-analyses investigating the role of folate in depression were included in the study. Random-effects model was employed to obtain pooled results. I 2 statistics and Cochrane Q test were used to assess the between-study heterogeneity. The quality of included meta-analyses was evaluated using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR2) questionnaire. Overall 11 studies were included, of which 8 studies went under quantitative evaluation. The results indicated that folate supplementation significantly relieved depression symptoms [(SMD: -0.42; 95% CI: -0.57, -0.27, p  < .001; I 2  = 0.0%, p-heterogeneity = 0.554) (WMD: -3.20; 95% CI: -4.00, -2.41, p  < .001, I 2  = 14.8%, p-heterogeneity = 0.318)] with low levels of heterogeneity. Also, based on observational studies, folate insufficiency significantly increased the odds ratio of depression by 35% (OR:1.35; 95% CI: 1.27, 1.42, p  < .001, I 2  = 8.7%, p -heterogeneity = 0.350). The findings support the fact that folate supplementation could be suggested as an efficacious and adjuvant agent in the alleviation of depression symptoms along with routine medications., Competing Interests: None., (© 2024 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Improving the performance of surface-piercing propellers is achieved by investigating the influential factors. In this study, Artificial Neural Network is used to identify nonlinear models for estimating various phenomena. Non-Dominated Sorting Genetic Algorithm II is considered as an optimization tool. In this study, in order to optimize the position parameters, including the immersion ratio, angle of attack, and yaw angle, data from experimental tests at the HYDROTECH center of IUST were collected as the initial data field for the generation of training data by the artificial neural network, then experimental tests were implemented in the position of the Non-Dominated Sorting Genetic Algorithm II proposed as the output, and the results were compared. The Artificial Neural Network results showed that the mean error of the trained verified and test data is 7.5e-5, 1e-4, and 1e-4, respectively. Comparing the experimental and optimization results, the thrust coefficient showed a relative error of 9.7%, while the torque coefficient showed a relative error of 7.5%, this algorithm can be used as a cost-effective, time-saving method for a similar problem., (© 2024. The Author(s).)

According to published meta-analyses, vitamin D exerts different beneficial effects in preventing and controlling risk factors associated with noncommunicable chronic diseases; however, the results are still conflicting. The purpose of this umbrella meta-analysis was to investigate the effect of vitamin D supplementation on low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol (TC), and triglyceride (TG) as components of the lipid profile. PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews were systematically searched for meta-analyses of randomized controlled trials. The umbrella meta-analysis followed the PRISMA guidelines. The random-effects model was employed to estimate the overall effect size (ES). Overall, 25 meta-analyses were included. In the standardized mean difference analysis, vitamin D significantly decreased TG (ES: -0.15; 95% CI: -0.23, -0.08; P ≤ 0.001) and TC levels (ES: -0.17; 95% CI: -0.23, -0.11; P ≤ 0.001) and increased HDL levels (ES: 0.08; 95% CI: 0.01, 0.15; P = 0.025). In the weighted mean difference analysis, vitamin D significantly decreased only TG levels (ES: -4.63 mg/dL; 95% CI: -7.70, -1.57; P = 0.003). The present study supports that vitamin D supplementation could be considered a beneficial adjuvant therapy in managing lipid profile levels, especially in individuals with vitamin D deficiency. This systematic review was registered in PROSPERO as CRD42022306334., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Studies have shown that vitamin E as an antioxidant protects omega-3 fatty acids (FAs) from oxidation. Several studies have evaluated the effect of omega-3 FAs and vitamin E co-supplementation on obesity indices; however, the results are inconsistent. The present systematic review and meta-analysis was conducted to address the role of omega-3 FAs plus vitamin E on obesity indices. Methods: Cochrane Library, PubMed, Scopus, Embase, and Web of Science databases were searched up to February 2022. Among all of the qualified studies, 10 articles were selected. The effect size was presented as weighted mean difference (WMD) and 95% confidence interval (CI). Fixed-effects model was employed to perform meta-analysis. Subgroup analysis and publication bias assessment were carried out. Results: There was no significant impact of combined omega-3 FAs and vitamin E supplementation on BW and BMI; however, it should be noted that the intervention has an increasing impact when supplementation duration was >8 weeks and in individuals with type 2 diabetes mellitus, >50 years old, and BMI>25 kg/m Conclusion: There was no significant impact of combined omega-3 FAs and vitamin E supplementation on BW and BMI; however, it should be noted that the intervention has an increasing impact when supplementation duration was >8 weeks and in individuals with type 2 diabetes mellitus, >50 years old, and BMI>25 kg/m 2 .

Purpose: The results of meta-analyses regarding the effect of vitamin D on blood pressure are conflicting. The present umbrella meta-analysis was conducted to provide definite and conclusive results., Methods: Systematically, Scopus, EMBASE, PubMed, and Web of Science databases and Google Scholar were searched for relevant literature published up to July 2022. All meta-analyses of clinical trials addressing the effect of vitamin D on blood pressure were included. Random effects analysis was performed to obtain the overall effect size based on the standardized mean differences (SMDs) and weighted mean differences (WMDs) separately. The quality of included meta-analyses was assessed by using the Measurement Tool for Assessing Multiple Systematic Reviews 2 questionnaire., Findings: Overall, 21 meta-analyses were enrolled in the umbrella review. The results indicated that systolic blood pressure was significantly reduced after the intervention based on WMD effect size analysis (ES WMD  = -0.69 mm Hg; 95% CI, -1.35 to -0.04 [P < 0.038]; I 2  = 46.7%, P = 0.021); however, no considerable impact was observed based on analysis of SMD effect sizes (ES SMD  = -0.05 mm Hg; 95% CI, -0.24 to 0.14; P = 0.615). Also, vitamin D supplementation indicated a significant improvement in diastolic blood pressure based on WMD effect sizes (ES WMD  = -0.66 mm Hg; 95% CI, -1.05 to -0.27 [P < 0.001]; I 2 = 56.4%, P = 0.004) but not SMD analysis (ES SMD  = -0.04 mm Hg; 95% CI, -0.13 to 0.04 [P = 0.328]; I 2  = 53.4%, P = 0.057)., Implications: Based on obtained evidence, vitamin D could be considered an efficient adjuvant for improving blood pressure., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The present study aimed to assess the effect of propolis supplementation on oxidative status, a key contributor to the etiology of many chronic diseases. A systematic search of multiple databases, including Web of Science, SCOPUS, Embase, PubMed, and Google Scholar, was conducted from inception to October 2022 to identify articles examining the effect of propolis on glutathione (GSH), glutathione peroxidase (GPX), total antioxidant capacity (TAC), superoxide dismutase (SOD), and malondialdehyde (MDA) levels. The quality of the included studies was evaluated using the Cochrane Collaboration tool. A total of nine studies were included in the final analysis, and a random-effects model was used to pool the estimated effects. Results showed that propolis supplementation significantly increased the levels of GSH (SMD = 3.16; 95% CI: 1.15, 5.18; I 2  = 97.2%), GPX (SMD = 0.56; 95% CI: 0.07, 1.05; p = 0.025; I 2  = 62.3%), and TAC (SMD = 3.26; 95% CI: 0.89, 5.62; I 2  = 97.8%, p < 0.001). However, the effect of propolis on SOD was not significant (SMD = 0.05; 95% CI: -0.25, 0.34; I 2  = 0.0%). Although the MDA concentration was not significantly decreased overall (SMD = -0.85, 95% CI: -1.70, 0.09; I 2  = 93.3%), a significant decrease in MDA levels was observed at doses ≥1000 mg/day (SMD = -1.90; 95% CI: -2.97, -0.82; I 2  = 86.4) and supplementation durations of less than 11 weeks (SMD = -1.56; 95% CI: -2.60, -0.51; I 2  = 90.4). These results suggest that propolis is a safe supplement with a beneficial effect on GSH, GPX, and TAC levels and may be an effective adjunctive therapy for diseases where oxidative stress is a key factor in the etiology. However, further high-quality studies are necessary to make more precise and comprehensive recommendations given the limited number of studies, clinical diversity, and other limitations., (© 2023 John Wiley & Sons Ltd.)

Background and aims : The purpose of this umbrella meta-analysis was to quantitatively summarize meta-analyses of randomized controlled trial (RCT) studies regarding the effects of probiotic supplementation on Helicobacter pylori ( H. pylori ) eradication. Methods : A thorough search of the electronic databases including PubMed, Web of Science, Embase, Scopus, and Google Scholar was carried out from the inception up to May 2022. For the evaluation of overall effect sizes, the pooled relative risk (RR) or odds ratio (OR) and their corresponding 95% confidence intervals (CI) were calculated. The random-effects model was used for the meta-analysis. Results : Overall, 18 eligible studies (47 278 participants in total) were included in the study. The findings revealed that probiotics have a beneficial impact on H. pylori eradication (pooled ES RR : 1.13; 95% CI: 1.11, 1.14, p < 0.01, and ES OR = 1.86, 95% CI: 1.70, 2.03, p < 0.01). Greater effects on H. pylori eradication were observed when higher doses (>10 × 10 10 CFU) and mixed strains were supplemented. Conclusion : The present umbrella meta-analysis suggests that supplementation with probiotics may be considered as an efficient approach to ameliorate H. pylori complications, particularly probiotics with higher CFUs and mixed strains.

Autism spectrum disorders (ASDs) are associated with specific dietary habits, including limited food selection and gastrointestinal problems, resulting in an altered gut microbiota. Autistic patients have an elevated abundance of certain gut bacteria associated with increased oxidative stress in the gastrointestinal tract. Probiotic supplementation has been shown to decrease oxidative stress in a simulated gut model, but the antioxidant effects of probiotics on the oxidative stress of the gut in autistic patients have not been directly studied. However, it is speculated that probiotic supplementation may help decrease oxidative stress in the gastrointestinal tract of autistic patients due to their specific dietary habits altering the microbiota. PubMed, Scopus and Web of Science databases and Google Scholar were searched up to May 2023. This systematic-narrative review aims to present the latest evidence regarding the changes in eating habits of autistic children which may further increase the gut microbiota induced oxidative stress. Additionally, this review will assess the available literature on the effects of probiotic supplementation on oxidative stress parameters., Competing Interests: Conflict of interest Authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Several meta-analyses reported glycemic-lowering effects of cinnamon, while others reported conflicting findings. In the present study, we aimed to perform an umbrella meta-analysis of previous interventional meta-analyses on the effects of cinnamon on glycemic control in patients with type 2 diabetes (T2D) or with polycystic ovary syndrome (PCOS)., Methods: Relevant studies were searched in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar up to June 2022. Meta-analyses of randomized clinical trials (RCTs) investigating the effects of cinnamon on glycemic indices including fasting plasma glucose (FPG), homeostatic model assessment for insulin resistance (HOMA-IR), insulin, and hemoglobin A1C (HbA1c) were included. Random-effects models were used to perform the umbrella meta-analysis and pool the weighted mean difference (WMD) or standardized mean difference (SMD) and their 95% confidence intervals (CI)., Results: Overall, 11 meta-analyses of RCTs were included. Cinnamon supplementation was effective in reducing serum FPG (WMD: -10.93 mg/dL; 95%CI: -16.22, -5.65; SMD: -0.86; 95%CI: -1.19, -0.52), insulin (WMD: -2.01 IU/mL; 95%CI: -3.96, -0.07; SMD: -0.61; 95%CI: -0.93, -0.30), HOMA-IR levels (WMD: -0.61; 95%CI: -0.91, -0.31; SMD: -0.78; 95%CI: -1.26, -0.30), and HbA1c (WMD: -0.10%; 95%CI: -0.17, -0.03)., Conclusion: Cinnamon can be used as an anti-diabetic agent and an add-on treatment to control glycemic indices among patients with T2D or PCOS., (© 2023. The Author(s).)

Background: Insulin-like growth factor-1 (IGF-1) secretion is thought to be induced by a semi-essential amino acid called arginine (Arg). Existing research on the effect of Arg on IGF-1 levels has provided conflicting results. This systematic review and meta-analysis investigated the efficacy of acute and chronic Arg supplementation on IGF-1 levels., Methods: PubMed, Web of Science, and Scopus were systematically searched until November 2022. The meta-analysis was performed using random- and fixed-effects models. Sensitivity and subgroup analyses were also carried out. Publication bias was assessed using Begg's test., Results: Nine studies were included in this meta-analysis. Chronic Arg supplementation did not significantly change IGF-1 levels (SMD = 0.13 ng/ml; %95 CI: -0.21, 0.46; p = 0.457). Furthermore, the IGF-1 level was not significantly affected by acute Arg supplementation (SMD = 0.10 ng/mL; CI: -0.42, 0.62; p = 0.713). The meta-analysis results did not change following subgroup analyses based on the duration, dosage, age, placebo, and study population., Conclusion: In conclusion, there was no significant effect of Arg supplementation on IGF-1 concentration. The meta-analyses revealed no acute or chronic Arg supplementation impact on IGF-1 levels., Competing Interests: Conflict of interest The authors report there are no competing interests to declare., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background and Aim: Several studies have been conducted to evaluate the effect of N-acetylecysteine (NAC) supplementation on antioxidant status, while no dose-response meta-analysis summarized the efficacy of NAC supplementation., Methods: The systematic search of literatures was conducted on Scopus, PubMed, Embase, Web of Science electronic databases. Controlled clinical trials investigating the effects of NAC on antioxidant biomarkers were included in the current meta-analysis. Random-effect model was used to perform meta-analysis. Heterogeneity was examined using I 2 index. Subgroup analysis was carried out to find the possible sources of heterogeneity. Dose-response analysis was performed to find the non-linear relationships between effect size and independent variables., Results: Overall, 26 eligible studies were included in the review. NAC supplementation significantly increased TAC (SMD = 0.77 μmol/L; 95% CI: 0.38, 1.16; p < 0.001), GSH (SMD = 0.80 nmol/ml; 95% CI:0.25, 1.34; p = 0.004) and CAT (SMD = -0.57 IU/L; 95% CI:-1.13, -0.02; p = 0.042) levels. However, no significant improving effect was observed in terms of GR (SMD = 0.25 IU/g; 95% CI:-0.14, 0.63; p = 0.210), SOD (SMD = 0.14 U/ml; 95% CI:-0.20, 0.49; p = 0.414) and GPx (SMD = 0.19 IU/g; 95% CI:-0.48, 0.86; p = 0.576) levels. Furthermore, dose-response analysis show that NAC supplementation in participants with mean age up to 30 years had more robust effect on increasing GSH levels., Conclusion: We found a significant effect of NAC supplementation on TAC, GSH, CAT in adults. Overall, NAC could be considered as a potent agent in enhancing antioxidant capacity., Competing Interests: Declaration of competing interest None., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Purpose: Dyslipidemia is considered as a known risk factor for cardiovascular disease. Yet various trials with wide ranges of doses and durations have reported contradictory results. We undertook this meta-analysis of randomized controlled trials (RCTs) to determine whether omega-3 supplementation can affect lipid profile in children and adolescents., Methods: Cochrane Library, Embase, PubMed, and Scopus databases were searched up to March 2021. Meta-analysis was performed using random-effect method. Effect size was expressed as weighted mean difference (WMD) and 95% confidence interval (CI). Heterogeneity was assessed using the I 2 index. In order to identification of potential sources of heterogeneity, predefined subgroup and meta-regression analysis was conducted., Results: A total of 14 RCTs with 15 data sets were included. Based on the combination of effect sizes, there was a significant reduction in TG levels (WMD: -15.71 mg/dl, 95% CI: -25.76 to -5.65, P=0.002), with remarkable heterogeneity (I 2 =88.3%, P<0.001). However, subgroup analysis revealed that omega-3 supplementation significantly decreased TG only in studies conducted on participants ≤13 years old (WMD=-25.09, 95% CI: -43.29 to -6.90, P=0.007), (I 2 =84.6%, P<0.001) and those with hypertriglyceridemia (WMD=-28.26, 95% CI: -39.12 to -17.41, P<0.001), (I 2 =0.0%, P=0.934). Omega-3 supplementation had no significant effect on total cholesterol, HDL, and LDL levels. Also, results of nonlinear analysis showed significant effect of treatment duration on HDL status (P non-linearity =0.047)., Conclusion: Omega-3 supplementation may significantly reduce TG levels in younger children and those with hypertriglyceridemia. Also, based on the HDL-related results, clinical trials with longer duration of intervention are recommended in this population., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Aims: Several meta-analyses have revealed that probiotics could lower blood pressure (BP), but the findings were inconsistent. In this regard, an umbrella meta-analysis was carried out to provide a more accurate estimate of the overall impacts of probiotics supplementation on BP., Data Synthesis: We searched the following international databases till November 2021: PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. A random-effects model was applied to evaluate the effects of probiotics on BP. Sensitivity analysis was performed by using the leave-one-out method. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence. Pooled effect size of 14 meta-analyses with 15,494 participants indicated significant decreases in both systolic (Weighted mean difference (WMD) = -1.96 mmHg; 95% confidence interval (CI): -2.78, -1.14, p < 0.001, and standardized mean difference (SMD) = -2.62; 95% CI: -4.96, -0.28, p < 0.001) and diastolic BP (WMD = -1.28 mmHg; 95% CI: -1.76, -0.79, p < 0.001, and SMD = -0.60 mmHg; 95% CI: -1.08, -0.12, p = 0.014) following probiotics supplementation. Greater effects on SBP were revealed in trials with a mean age of >50 years and the duration of intervention ≤10 weeks. DBP was also more reduced in studies with a dosage of ≥10 10 colony forming unit (CFU), and SBP was decreased in patients with hypertension or diabetes analyzing WMD., Conclusion: The present umbrella meta-analysis suggests probiotics supplementation to improve BP and claims that probiotics could be used as a complementary therapy for controlling high BP., Prospero Id: CRD42022306560., Competing Interests: Declaration of competing interest No conflict of interest to declare., (Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Payingspecial attention to the development indicators of medical tourism (MT) can lead to the further development of this industry and tourists' satisfaction., Objective: This study aimed to investigate MT development indicators in Yazd Reproductive Sciences Research Institute, Yazd, Iran in 2021., Materials and Methods: In this cross-sectional study, 430 medical tourists referred to the Yazd Reproductive Sciences Institute, Yazd, Iran in 2021 were studied. A researcher-made questionnaire with 46 questions and 10 dimensions was used in both internal and external environments to collect data. The Spearman correlation coefficient was also used to assess the correlation between the quantitative factors., Results: The reliability and validity of the scale were confirmed. The mean ± SD of the advertising and marketing index scored was lower than the other internal environmental indices (15.05 ± 2.16). Also, the economic factors and tourism infrastructure were lower than the other external environmental factors (9.8 ± 1.99, 8.53 ± 2.11, respectively)., Conclusion: Given the importance of MT, top managers and relevant authorities should pay close attention to the criteria of advertising, marketing, and tourism infrastructure. MT demand can be improved by increasing the importance of advertising, implementing realistic advertising strategies, and developing adequate urban infrastructure and services., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2022 Shafii et al.)

Several meta-analysis studies have revealed improving effects of probiotics on lipid profile, while some studies have reported controversial findings. The purpose of present study was to evaluate the efficacy of probiotics on blood lipids. Relevant studies were searched in the international databases, including PubMed, Scopus, EMBASE, Web of Science, and Cochrane Central Library up to August 2021. The pooled results were calculated with the use of a random-effects model to assess the effects of probiotics on blood lipids. Overall, 38 meta-analyses were inclueded in the study. The results indicated that the probiotics supplementation was effective on reduction of total cholesterol (TC) (ES= -0.46 mg/dL; 95% CI: -0.61, -0.30, p < 0.001; I 2 = 83.8%, p < 0.001), triglycerides (TG) (ES= -0.13 mg/dl; 95% CI: -0.23, -0.04, p = 0.006; I 2 = 74.7%, p < 0.001), and low-density lipoprotein cholesterol (LDL-C)levels (ES= -0.29 mg/dL; 95% CI: -0.40, -0.19, p < 0.001; I 2 = 77.8%, p < 0.001). There was no significant effect of probiotics on high-density lipoprotein cholesterol (HDL-C) levels (ES= 0.02 mg/dl; 95% CI: -0.04, 0.08, p = 0.519; I 2 = 72.5%, p= <0.001). The results of present umbrella meta-analysis strongly support supplementation with probiotics as an influential intervention for improving lipid profile.

Growing evidence has suggested that the consumption of probiotics can decrease depressive symptoms. However, even the results of meta-analyses are conflicting. In this regard, we performed an umbrella meta-analysis and proposed the decisive impacts of probiotics on depressive symptoms. The following international databases were searched up to July 2021: PubMed/Medline, Web of Science, Scopus, EMBASE, and Google Scholar. Meta-analyses investigating the impact of supplementation of probiotics on depression symptoms in adults were included. According to the studies, random-effects model was used to perform the analysis. Subgroup analysis was performed by dosage of probiotics, duration of supplementation and total sample size. Publication bias was assessed using Egger's, Begg's and visual inspection of funnel plot. Ten meta-analyses ( n  = 8886 participants) were included in study. The pooled data indicated that probiotic supplementation significantly reduced depression symptoms (ES= -1.41; 95% CI: -2.53, -0.30, p  = 0.016; I 2 = 99.4, p = <0.001). Subgroup analysis of studies with intervention duration >8 weeks and dosage >10 × 10 9 CFU demonstrated a more robust effect of probiotics on decreasing depression symptoms. There was also significant between-study heterogeneity in which dosage was identified as source of it. The results of present umbrella meta-analysis suggest administration of probiotics for relieving depression symptoms for >8 weeks with dosage of >10 × 10 9 CFU.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2051164.

Meta-analyses of interventional and observational studies investigating the efficacy and the relationship between vitamin D and depression provided inconsistent results. The current umbrella meta-analysis was conducted to assess the available evidence and provide a conclusive outcome in this regard. The following international databases were systematically searched till March 2022: PubMed, Scopus, Embase, Web of Science, and Google Scholar. Random-effects model was carried out to calculate the pooled point estimates and their respective 95 % confidence intervals (CI). Ten meta-analyses of randomised controlled trials (RCTs) revealed significant reduction in depression symptoms comparing participants on vitmain D supplements to those on placebo (Pooled standardised mean difference: - 0.40; 95 % CI: - 0.60, - 0.21, p < 0.01: I 2 = 89.1 %, p < 0.01). Four meta-analyses of cohort studies (with one having two subgroups) revealed that participants with lower levels of serum vitamin D were at increased odds of depression than those with higher levels of serum vitamin D (Pooled odds ratio: 1.60; 95 % CI: 1.08, 2.36, p < 0.01; I 2 = 91.3 %, p < 0.01). The present umbrella meta-analysis confirms the potential benefits of vitamin D supplementation and higher serum vitamin D levels in reducing the development and symptoms of depression., Competing Interests: Declaration of Interest The authors declare that there is no conflict of interests., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Metabolic syndrome (MetS) is a cluster of metabolic disorders with a heavy disease burden. Fenugreek was reported to be effective in some components of MetS. Therefore, a comprehensive review and meta-analysis of randomized controlled trials was conducted to study the effects of fenugreek on MetS indices. From the beginning until August 2022, PubMed, Embase, Scopus, and Web of science were searched. Data were analyzed using the random-effect model, and presented as weighted mean difference (WMD) and associated 95 % confidence interval (CI). This meta-analysis comprised from a total of 29 eligible RCTs with 31 arms measuring fasting plasma glucose (FPG), Triglyceride (TG), high-density lipoprotein (HDL), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The results indicated significant improving effects of fenugreek on FPG (WMD: -16.75 mg/dL; 95 % CI: -23.36, -10.15; P < 0.001), TG (-20.12 mg/dL; 95 % CI: -34.238, -5.994; P < 0.001), HDL (WMD: 3.55 mg/dL; 95 % CI: 1.98, 5.12; P < 0.001), WC (WMD: -2.51; 95 % CI: -3.78, -1.24; P < 0.001) and SBP (WMD: -3.45 mmHg; 95 % CI: -6.38, -0.52; P = 0.021); However the effect on DBP (WMD: 3.17; 95 % CI: -5.40, 11.73; P = 0.469) and BMI (WMD: -0.40 kg/m2; 95 % CI: -1.114, 0.324; P = 0.281) was not significant. Administration of fenugreek can meaningfully reduce FPG, TG, WC, and SBP and increase HDL. The overall results support possible protective and therapeutic effects of fenugreek on MetS parameters., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2022. Published by Elsevier Ltd.)

Method: This meta-analysis aims to evaluate the effectiveness of probiotics in reducing inflammatory biomarkers and the length of intensive care unit (ICU) stays. PubMed-Medline, SCOPUS, Embase, and Google Scholar databases up to July 2021 were searched. The meta-analysis was carried out using random-effect analysis. To determine the sources of heterogeneity, subgroup analyses were performed. In case of the presence of publication bias, trim and fill analysis was carried out. The Cochrane Collaboration tool was used for checking the quality assessment. We hypothesized that probiotics would improve inflammatory markers (CRP and IL-6) and the length of ICU stay in traumatic brain injury and multiple trauma patients., Results: The present meta-analysis, which includes a total of seven studies, showed that there were no significant effects of probiotics supplementation on interleukin (IL)-6 (Hedges's g  = -2.46 pg/ml; 95% CI: -12.16, 7.25; P =0.39), C-reactive protein (CRP) (Hedges's g  = -1.10 mg/L; 95% CI: -2.27, 0.06; P =0.06), and the length of staying in ICU. The overall number of RCTs included in the analysis and the total sample size were insufficient to make firm conclusions., Conclusion: As a result, more carefully designed RCTs are needed to investigate the effect of probiotics on inflammatory biomarkers and the length of ICU stay in traumatic brain injuries and multiple trauma patients in greater detail., Competing Interests: All authors declare that there are no conflicts of interest., (Copyright © 2022 Nooshin Noshadi et al.)

Objective: Smoking is a common public problem leading to increases in oxidative stress and decreases in the levels of some micronutrients, finally affecting adipokine levels. The aim of this study was to compare the serum levels of omentin (intelectin-1), chemerin, TNF-α, and some micronutrient intakes in male smokers and non-smokers., Methods: 40 male smokers and 40 male non-smokers with a mean age of 38.6±14.1 years were included in this study. Serum levels of omentin, chemerin, and TNF-α were measured. To calculate the daily intake of energy, carbohydrate, protein, fat, and some of the micronutrients, the 24-h recall and semi-quantitative food frequency questionnaire (FFQ) was used., Results: Omentin, chemerin, and TNF-α levels in male smokers were lower than non-smokers, but these differences were not statistically significant. However, after adjustment for total and saturated fat intakes and age, omentin (β=138.4, p=0.027) and TNF-α (β=144.5, p=0.015) revealed significant differences., Conclusion: The serum levels of omentin, chemerin, TNF-α, and some micronutrient intakes were not significantly different between smokers and non-smokers. Further population studies are needed to clarify this subject., (Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Probiotics exert several promoting effects on the glycemic status, however, the results of meta-analyses are inconsistent. we conducted an umbrella meta-analysis, across existing systematic reviews and meta-analyses of clinical trials to determine the definite effects of supplementation with probiotics on glycemic indices., Methods: A comprehensive systematic search of PubMed/Medline, Scopus, EMBASE, and Web of Science was carried out till August 2021. The random-effects model was employed to conduct meta-analysis. Meta-analysis studies of randomized clinical trials examining the impacts of probiotics supplementation on glycemic indices were qualified in the current umbrella meta-analysis., Results: 48 articles out of 693 in the literature search qualified for inclusion in the umbrella meta-analysis. Pooled effects of probiotics on fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), and insulin levels were reported in articles 45, 21, 35, and 33, respectively. The analysis indicated a significant decrease of FPG (ES= -0.51 mg/dL; 95% CI: -0.63, -0.38, p < 0.001), HbA1c (ES = -0.32 mg/dL; 95% CI: -0.44, -0.20, p < 0.001), HOMA-IR (ES= -0.56; 95% CI: -0.66, -0.47, p < 0.001), and insulin levels (ES= -1.09 IU/mL; 95% CI: -1.37, -0.81, p = 0.006) by probiotics supplementation., Conclusion: Probiotics have amending effects on FPG, HbA1c, HOMA-IR, and insulin levels. A < 8-week period of probiotic supplementation in the moderate dosages (10 8 or 10 9 CFU) is an efficacious approach in improving glycemic parameters. Overall, probiotics could be recommended as an adjuvant anti-hyperglycemic agent., Competing Interests: Conflict of interest No conflict of interest to declare., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Although several studies have indicated that consumption of probiotics is effective in the treatment of obesity, the results in this regard have yielded controversial findings. The current umbrella meta-analysis was performed to evaluate the effects of probiotics supplementation on obesity indices in adults. Scopus, PubMed, Web of Science, Embase and Google Scholar were searched for relevant studies published till November 2021. Meta-analysis was conducted using the random-effects model. Sensitivity and subgroup analyses were performed. In total, 29 meta-analyses with 14,366 participants, including 112, 78, and 38 unique trials for body mass index (BMI), body weight (BW), and waist circumference (WC), were included in the study, respectively. The findings demonstrated that the probiotics supplementation was significantly effective on decreasing of BMI (ES = -0.21; 95% CI: -0.30, -0.13, p < 0.001; I 2  = 83.0%, p < 0.001), BW (ES = -0.38, 95% CI: -0.60, -0.16; p < 0.001; I 2  = 81.8%, p < 0.001), and WC (ES = -0.60; 95% CI: -0.89, -0.31; p < 0.001; I 2  = 89.1%, p < 0.001). Greater effects on BW were observed when intervention duration was >8 weeks and on obese individuals. BMI was also greatly modified in participants with metabolic syndrome and when intervention duration lasted for ≥12 weeks. The methodological quality (AMSTAR2) was moderate in 83%, low in 10%, and critically low in 7% of included studies. The current umbrella meta-analysis indicated that supplementation of probiotics in adults led to a meaningful reduction in BW, BMI, and WC. Therefore, our findings strongly recommend supplementation with probiotics as a potent intervention in the management of obesity., (Copyright © 2022. Published by Elsevier B.V.)

The evidence provided by meta-analyses on the beneficial impacts of cinnamon supplementation on anthropometric indices are still conflicting. Present study's aim was to evaluate the effects of cinnamon on obesity indices by an umbrella meta-analysis. The electronic databases including Web of Science, PubMed, EMBASE, Scopus were systematically searched up to March 2021. Data for the effects of cinnamon on anthropometric indices were collected from the meta-analyses. An umbrella meta-analysis was carried out using a random-effects model. The pooled effects of 7 meta-analyses showed that cinnamon supplementation significantly reduced body weight (ES: -0.67 kg; 95% CI: -0.99, -0.35, p ˂ .001), body mass index (ES: -0.45 kg/m 2 ; 95% CI: -0.57, -0.33, p ˂ .001) in comparison to control group. However, the effects of cinnamon on waist circumference (ES: -1.05 cm; 95% CI: -2.26, 0.15, p = .087) were not considerable. According to results, cinnamon could be suggested as a complementary weight loss agent. Favorable results were obtained at a dose of ≥3 g/day. In this study, a comprehensive study was performed on meta-analyses performed on the effect of cinnamon on anthropometric indices. This study could be considered as a final conclusion about the effect of cinnamon on anthropometric indices. The results of this study showed that supplementation with cinnamon significantly reduces BMI and body weight. The impacts were greater in doses of ≥3 g/day and in PCOS patients. PRACTICAL APPLICATIONS: In this study, a comprehensive study was performed on meta-analyses performed on the effect of cinnamon on anthropometric indices. This study could be considered as a final conclusion about the effect of cinnamon on anthropometric indices. The results of this study showed that supplementation with cinnamon significantly reduces BMI and body weight. The impacts were greater in doses of ≥3 g/day and in PCOS patients., (© 2022 Wiley Periodicals LLC.)

Anti-cancer properties of vitamin D have been reported in studies. The aim of this study was to evaluate the expression of some key enzymes involved in vitamin D metabolism and the serum levels of related proteins. Fifty-four patients with acute myeloid leukemia (AML) and 55 eligible individuals were studied as the control group. The expression of VDR, CYP27B1, and CYP24A1 genes was measured. Serum levels of related proteins were quantified. The association between the studied variables and treatment outcomes: duration of fever and neutropenia, length of hospital stay, achievement of complete remission and overall survival has been investigated. Expression of CYP24A1 gene and serum levels of CYP27B1 and CYP24A1 proteins were significantly higher in the patient group. CYP24A1 gene expression, its blood concentrations and serum levels of CYP27B1 were significantly higher in the AML group. Vitamin D status and key enzymes did not show a strong change in AML patients neither did associate with treatment outcomes except CYP24A1.