A multinational study on artificial intelligence adoption: Clinical implementers' perspectives

BACKGROUND

Despite substantial progress in AI research for healthcare, translating research achievements to AI systems in clinical settings is challenging and, in many cases, unsatisfactory. As a result, many AI investments have stalled at the prototype level, never reaching clinical settings.

OBJECTIVE

To improve the chances of future AI implementation projects succeeding, we analyzed the experiences of clinical AI system implementers to better understand the challenges and success factors in their implementations.

METHODS

Thirty-seven implementers of clinical AI from European and North and South American countries were interviewed. Semi-structured interviews were transcribed and analyzed qualitatively with the framework method, identifying the success factors and the reasons for challenges as well as documenting proposals from implementers to improve AI adoption in clinical settings.

RESULTS

We gathered the implementers' requirements for facilitating AI adoption in the clinical setting. The main findings include 1) the lesser importance of AI explainability in favor of proper clinical validation studies, 2) the need to actively involve clinical practitioners, and not only clinical researchers, in the inception of AI research projects, 3) the need for better information structures and processes to manage data access and the ethical approval of AI projects, 4) the need for better support for regulatory compliance and avoidance of duplications in data management approval bodies, 5) the need to increase both clinicians' and citizens' literacy as respects the benefits and limitations of AI, and 6) the need for better funding schemes to support the implementation, embedding, and validation of AI in the clinical workflow, beyond pilots.

CONCLUSION

Participants in the interviews are positive about the future of AI in clinical settings. At the same time, they proposenumerous measures to transfer research advancesinto implementations that will benefit healthcare personnel. Transferring AI research into benefits for healthcare workers and patients requires adjustments in regulations, data access procedures, education, funding schemes, and validation of AI systems.

Early diagnosis of candidemia with explainable machine learning on automatically extracted laboratory and microbiological data: results of the AUTO-CAND project

BACKGROUND

Candidemia is associated with a heavy burden of morbidity and mortality in hospitalized patients. The availability of blood culture results could require up to 48-72 h after blood draw; thus, early treatment decisions are made in the absence of a definite diagnosis.

METHODS

In this retrospective study, we assessed the performance of different supervised machine learning algorithms for the early differential diagnosis of candidemia and bacteremia in adult patients on a large dataset automatically extracted within the AUTO-CAND project.

RESULTS

Overall, 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included in the analysis. A random forest classifier achieved the best diagnostic performance for candidemia, with sensitivity 0.98 and specificity 0.65 on the training set (true skill statistic [TSS] = 0.63) and sensitivity 0.74 and specificity 0.57 on the test set (TSS = 0.31). Then, the random classifier was trained in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values by exploiting the feature ranking learned in the entire dataset. Although no statistically significant differences were observed from the performance measures obtained by employing BDG and PCT alone, the performance measures of the classifier that included the features selected in the entire dataset, plus BDG and PCT, were the highest in most cases.

CONCLUSIONS

Random forest classifiers trained on large datasets of automatically extracted data have the potential to improve current diagnostic algorithms for candidemia. However, further development through implementation of automatically extracted clinical features may be necessary to achieve crucial improvements.

Prevalence and Risk Factors of Anemia in the MASHAD Cohort Study

BACKGROUND

Anemia is a serious public health problem which may be associated with cardiovascular diseases (CVDs) and brain damage. This survey aims to determine the prevalence of anemia and its association with demographic and biochemical factors and metabolic syndrome in a human sample derived from the MASHAD cohort study.

METHODS

This survey was conducted on a sub-sample of 9847 individuals aged 35 to 65 as part of the MASHAD cohort study. Demographic characteristics and biochemical and anthropometrics indices were recorded. Data were analyzed using SPSS version 20.

RESULTS

Anemia was seen in 11.5% of the population. Anemia was significantly more prevalent in younger subject (P<0.001), females (P<0.001) and those with elevated body mass index (BMI) (P<0.001). Mean high-density lipoprotein (HDL) was higher in anemic participant (P=0.032). The incidence of anemia was significantly lower in smokers (P<0.001) and also participant with hypertension (HTN) (P<0.001), diabetes mellitus (DM) (P<0.001) and metabolic syndrome (MetS) (P<0.001). Mean FBG (P<0.001), TG (P<0.001), total cholesterol (P<0.001), LDL (P<0.001) and uric acid (P<0.001) were significantly lower in anemic subjects. Cholesterol, MetS, low-density lipoprotein (LDL), BMI, uric acid, diabetes mellitus and also TG remained significantly different after multivariate analysis between anemic and healthy participants.

CONCLUSION

The studied population had a lower prevalence of anemia compared to the previous WHO report for Iranians. Iron deficiency is recognized as the most important cause of anemia in Iran; however, further investigations will be need to confirm this pattern. We demonstrated that anemia is adversely associated with MetS and DM.

Investigating the inflammatory status in the patients candidate for second angiography after coronary stent implantation

BACKGROUND

Inflammation has been shown to be an important feature of atherosclerosis. We aimed to assess a profile of inflammatory cytokines and growth factors in patients with established coronary artery disease (CAD), 12 months after stent implantation.

METHODS

A total of 193 patients with CAD, who were candidates for angiography, 12 months after stent implantation (cases), were compared with 107 patients with CAD, who were candidates for their first angiography (controls). Fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and high-sensitive C-reactive protein (hs-CRP) were measured using routine methods. The serum concentrations of IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ, MCP-1, EGF and VEGF were determined using competitive chemiluminescence immunoassays.

RESULTS

Serum levels of FBG (p = .002), TG (p = .029) and hs-CRP (p = .005) were significantly lower in cases than controls. The cytokines and growth factor profiles in cases were significantly different from controls. After multivariate analysis, serum levels of IL-2 (p < .001), IL-4 (p = .028) were significantly lower in cases compared with the controls while serum levels of IL-8, TNF-α, MCP-1, EGF and VEGF were significantly higher in the cases (p < .001).

CONCLUSIONS

In patients with CAD and higher consumption of drug used (statins, aspirin and glucose lowering agents) to mitigate the risk of a secondary event, the level of hs-CRP one year after stent implantation decreased despite of significant higher serum levels of pro- and anti-inflammatory cytokines and growth factors.

Artificial Intelligence Implementation in Healthcare: A Theory-Based Scoping Review of Barriers and Facilitators

There is a large proliferation of complex data-driven artificial intelligence (AI) applications in many aspects of our daily lives, but their implementation in healthcare is still limited. This scoping review takes a theoretical approach to examine the barriers and facilitators based on empirical data from existing implementations. We searched the major databases of relevant scientific publications for articles related to AI in clinical settings, published between 2015 and 2021. Based on the theoretical constructs of the Consolidated Framework for Implementation Research (CFIR), we used a deductive, followed by an inductive, approach to extract facilitators and barriers. After screening 2784 studies, 19 studies were included in this review. Most of the cited facilitators were related to engagement with and management of the implementation process, while the most cited barriers dealt with the intervention's generalizability and interoperability with existing systems, as well as the inner settings' data quality and availability. We noted per-study imbalances related to the reporting of the theoretic domains. Our findings suggest a greater need for implementation science expertise in AI implementation projects, to improve both the implementation process and the quality of scientific reporting.

Factors Associated With Trabecular Bone Score and Bone Mineral Density; A Machine Learning Approach

INTRODUCTION

Bone indexes including trabecular bone score (TBS) and bone mineral density (BMD) have been shown to be associated with wide spectrum of variables including physical activity, vitamin D, liver enzymes, biochemical measurements, mental and sleep disorders, and quality of life. Here we aimed to determine the most important factors related to TBS and BMD in SUVINA dataset.

METHODS

Data were extracted from the Survey of Ultraviolet Intake by Nutritional Approach (SUVINA study) including all 306 subjects entered this survey. All the available parameters in the SUVINA database were included the analysis. XGBoost modeler software was used to define the most important features associated with bone indexes including TBS and BMD in various sites.

RESULTS

Applying XGBoost modeling for 4 bone indexes indicated that this algorithm could identify the most important variables in relation to bone indexes with an accuracy of 92%, 93%, 90% and 90% respectively for TBS T-score, lumbar Z-score, neck of femur Z-score and Radius Z-score. Serum vitamin D, pro-oxidant-oxidant balance (PAB) and physical activity level (PAL) were the most important factors related to bone indices in different sites of the body.

CONCLUSIONS

Our findings indicated that XGBoost could identify the most important variables with an accuracy of &gt;90% for TBS and BMD. The most important features associated with bone indexes were serum vitamin D, PAB and PAL.

Factors determining the serum 25-hydroxyvitamin D response to vitamin D supplementation: Data mining approach

Vitamin D supplementation has been shown to prevent vitamin D deficiency, but various factors can affect the response to supplementation. Data mining is a statistical method for pulling out information from large databases. We aimed to evaluate the factors influencing serum 25-hydroxyvitamin D levels in response to supplementation of vitamin D using a random forest (RF) model. Data were extracted from the survey of ultraviolet intake by nutritional approach study. Vitamin D levels were measured at baseline and at the end of study to evaluate the responsiveness. We examined the relationship between 76 potential influencing factors on vitamin D response using RF. We found several features that were highly correlated to the serum vitamin D response to supplementation by RF including anthropometric factors (body mass index [BMI], free fat mass [FFM], fat percentage, waist-to-hip ratio [WHR]), liver function tests (serum gamma-glutamyl transferase [GGT], total bilirubin, total protein), hematological parameters (mean corpuscular volume [MCV], mean corpuscular hemoglobin concentration [MCHC], hematocrit), and measurement of insulin sensitivity (homeostatic model assessment of insulin resistance). BMI, total bilirubin, FFM, and GGT were found to have a positive relationship and homeostatic model assessment for insulin resistance, MCV, MCHC, fat percentage, total protein, and WHR were found to have a negative correlation to vitamin D concentration in response to supplementation. The accuracy of RF in predicting the response was 93% compared to logistic regression, for which the accuracy was 40%, in the evaluation of the correlation of the components of the data set to serum vitamin D.

Association between serum Vitamin E concentrations and the presence of Metabolic Syndrome: A population-based cohort study

BACKGROUND

Metabolic syndrome (MetS) is a cluster of clinical and metabolic features that include central obesity, dyslipidemia, hypertension and impaired glucose tolerance. These features are accompanied by increased oxidative stress and impaired antioxidant defenses. Vitamin E is a major factor in the non-enzymatic antioxidant defenses. The aim of present study was to investigate the association between serum levels of vitamin E and the presence of MetS and its components in a sample population of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study.

METHODS

This cross-sectional study was carried out in 128 subjects with MetS and 235 subjects without MetS. MetS was defined according to the International-Diabetes-Federation criteria. Serum levels of vitamin E were measured using the HPLC method. Anthropometric and biochemical parameters were measured using standard protocols.  Results. MetS patients had significantly lower serum levels of vitamin E (Vit E), Vit E/Total cholesterol (TC), and Vit E/ (TC+triglyceride(TG)) compared to the control group (P < 0.05).  Vit E/ (TG+TC) was also significantly lower in diabetics or those with elevated levels of high sensitive C-reactive protein (hs-CRP). Additionally, there was a significant association between Vit E/ (TG + Total Cho) and the number of components of the metabolic syndrome (p= 0.02) Conclusions. There is a significant inverse association between indices of Vit E status and the presence of MetS. Moreover, a significantly lower Vit E/ (TC+TG) was observed along with individuals with increasing numbers of components of the MetS.

Association of Healthy Eating Index and the Alternative Healthy Eating Index with the cell blood count indices

OBJECTIVES

There is an association between diet quality and markers of inflammation. We aimed to investigate the relationship between diet quality with cell blood count (CBC) and inflammatory indices such as red cell distribution width (RDW) and white blood cell count (WBC).

STUDY DESIGN

A total of 367 male subjects aged 20-69 yrs, who were employees of Shahid Hasheminejad Gas Processing Company (SGPC) completed the study.

METHODS

All participants completed a questionnaire that contained questions about demography. Standard protocols were used for measuring anthropometric indices in all subjects. Blood samples were collected after a 12 hrs fast from all participants. Biochemical parameters were determined in all participants using an auto-analyzer (Eppendorf, Germany). Systolic and diastolic blood pressure were measured using a standard mercury sphygmomanometer. CBC was measured using the Sysmex auto analyser system (KX-21 N). The HEI/AHEI scores extracted from a validated food frequency questionnaire (FFQ) to evaluate the diet quality. Data analyses were performed using SPSS 16 (SPSS Inc., IL, and USA).

RESULTS

A total of 674 men (aged 43.68±9.09 yrs) completed the study. The CBC indices were not significantly different between the HEI/AHEI classifications among the Iranian men (p-value >0.05 for all variables). Moreover, there was no association between HEI/ AHEI with the CBC indices in our population (p-value >0.05 for all variables).

CONCLUSIONS

In summary, there was no association between the diet quality with the cell blood count parameters among Iranian men.

Effect of low-fat dairy products fortified with 1500IU nano encapsulated vitamin D3 on cardiometabolic indicators in adults with abdominal obesity: a total blinded randomized controlled trial

BACKGROUND & AIMS

Vitamin D deficiency is widespread worldwide. In this study, we aimed to evaluate the effect of a nano encapsulated form of vitamin D used for fortifying low-fat dairy products (milk and yogurt) on anthropometric indices, glycemic status, and lipid profile in subjects with abdominal obesity.

METHODS

In a totally (quadruple) blinded, randomized, and parallel-controlled trial, 306 individuals with abdominal obesity were randomly allocated to one of four groups: fortified low-fat yogurt (FY, 1500 IU nano encapsulated vitamin D₃ per 150 g/d), non-fortified low-fat yogurt (nFY), fortified low-fat milk (FM, 1500 IU nano encapsulated vitamin D₃ per 200 g/d), non-fortified low-fat milk (nFM), for 10 weeks (nFM and nFY, were considered as the control groups). Anthropometric and biochemical parameters were measured at baseline and after a ten-week trial in Mashhad, Iran.

RESULTS

After the ten-week intervention, we found a significant increase in serum concentration of 25(OH)D in both the FM and FY groups compared to the respective control groups (19.10 ± 5.69 ng/mL and 20.88 ± 5.76 ng/mL respectively, p < .001). We observed a significant reduction in weight to hip ratio (p = .04) and a significant improvement in triglyceride (p < .001) and HDL-C (p = .01) only in FM group compared to nFM group. Also, we found a significant reduction in fasting serum insulin (p < .001), and a significant improvement of HOMA-IR (p < .001) and QUICKI (p < .001) in both intervention groups compared to their placebos.

CONCLUSIONS

An intake of fortified dairy products containing nano-encapsulated vitamin D₃ was associated with an improvement in some measures of anthropometric indices, glucose homeostasis, and lipid profiles, particularly in individuals receiving fortified milk. Hence, along with other benefits, fortification of dairy products with vitamin D may be an effective approach to improve some cardiometabolic indicators, such as insulin resistance.

TRIAL REGISTRATION NUMBER

IRCT20101130005280N27.

Potential value and impact of data mining and machine learning in clinical diagnostics

Data mining involves the use of mathematical sciences, statistics, artificial intelligence, and machine learning to determine the relationships between variables from a large sample of data. It has previously been shown that data mining can improve the prediction and diagnostic precision of type 2 diabetes mellitus. A few studies have applied machine learning to assess hypertension and metabolic syndrome-related biomarkers, as well as refine the assessment of cardiovascular disease risk. Machine learning methods have also been applied to assess new biomarkers and survival outcomes in patients with renal diseases to predict the development of chronic kidney disease, disease progression, and renal graft survival. In the latter, random forest methods were found to be the best for the prediction of chronic kidney disease. Some studies have investigated the prognosis of nonalcoholic fatty liver disease and acute liver failure, as well as therapy response prediction in patients with viral disorders, using decision tree models. Machine learning techniques, such as Sparse High-Order Interaction Model with Rejection Option, have been used for diagnosing Alzheimer's disease. Data mining techniques have also been applied to identify the risk factors for serious mental illness, such as depression and dementia, and help to diagnose and predict the quality of life of such patients. In relation to child health, some studies have determined the best algorithms for predicting obesity and malnutrition. Machine learning has determined the important risk factors for preterm birth and low birth weight. Published studies of patients with cancer and bacterial diseases are limited and should perhaps be addressed more comprehensively in future studies. Herein, we provide an in-depth review of studies in which biochemical biomarker data were analyzed using machine learning methods to assess the risk of several common diseases, in order to summarize the potential applications of data mining methods in clinical diagnosis. Data mining techniques have now been increasingly applied to clinical diagnostics, and they have the potential to support this field.

Comprehensive laboratory reference intervals for routine biochemical markers and pro-oxidant-antioxidant balance (PAB) in male adults

Background

Reference values of biochemical markers are influenced by various parameters including age, sex, region, and lifestyle. Hence, we aimed to determine age‐ and BMI‐specific reference intervals (RIs) for important clinical biomarkers in a healthy adult male population from northeastern Iran. This is also the first study to investigate reference values for pro‐oxidant‐antioxidant balance (PAB).

Methods

Seven hundred and twenty (720) healthy men, aged 20‐60 years, were recruited from Sarakhs in the northeast region of Iran. Reference values for lipid profiles (total cholesterol, triglyceride, HDL‐C and LDL‐C), fasting blood glucose, inflammatory factors (hs‐CRP and PAB), minerals (zinc and copper), uric acid, and blood pressure were measured and statistically analyzed to establish accurate age‐ and BMI‐specific RIs in alignment with CLSI Ep28‐A3 guidelines.

Results

RIs for lipid profiles, inflammatory factors, minerals, and uric acid required no age partitioning with the exception of fasting blood glucose and blood pressure, which demonstrated significantly higher values in subjects aged 50 years and older. Among these biomarkers, only uric acid, blood pressure, and triglycerides demonstrated statistically significant increases in reference value concentrations with increasing BMI.

Conclusion

In this study, age‐ and BMI‐specific RIs for several biochemical markers were determined in healthy adult Iranian men. Partitioning by age and BMI was only required for a few analytes with most demonstrating no statistically significant changes with these covariates. These data can be useful to monitor various diseases in male adults with varying BMI in this region and others.

Dietary Inflammatory Index is associated with Healthy Eating Index, Alternative Healthy Eating Index, and dietary patterns among Iranian adults

Background

Recent investigations have evaluated the effect of the inflammatory potential of diet in several populations by calculating the Dietary Inflammatory Index (DII) score. We aimed to evaluate the association of the DII with the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), and dietary pattern (DP) among healthy Iranian adults.

Methods

A cross‐sectional study was conducted among 4365 middle‐aged adults. Major DPs and DII score were identified using a validated semi‐quantitative food frequency questionnaire (FFQ). Poisson regression was used to evaluate the association of DPs, HEI, and AHEI across tertiles of DII.

Results

After adjustment for confounding variables, a low HEI (HEI < 55) and AHEI (AHEI < 56.5) were more prevalent among the participants in the highest tertile of DII compared to the first tertile (PR: 1.13, P‐value <.05; PR: 1.10, P‐value <.05; respectively). Adherence to a balanced healthy dietary pattern was significantly lower in subjects with a diet that was more pro‐inflammatory compared to those with anti‐inflammatory diet (PR: 0.85, P‐value P < .01). No significant association was found between the DII and a western DP. High levels of HDL and hip and waist circumference were observed in the highest tertile of DII, and high levels of dietary intake of protein and fiber, minerals, fasting blood glucose, and monounsaturated fat were reported in the lowest tertile of DII.

Conclusion

The highest tertile of the DII (a pro‐inflammatory diet) was associated with a lower HEI, AHEI, and lower adherence to balanced DP in a representative sample of adults in Iran.

Prevalence of ABO and Rh blood groups and their association with demographic and anthropometric factors in an Iranian population: Mashad study

Background

Blood groups appear to be markers for various human diseases and their distribution among different communities, ethnic groups and geographical boundaries varies over time.

Aims

We aimed to investigate the frequency of ABO and Rh blood groups and their relationship with demographic and anthropometric characteristics among Iranian residents in Mashad.

Methods

ABO and Rh blood groups were determined among 7268 participants from the MASHAD cohort study and their relationships with demographic and anthropometric parameters were evaluated. This part of the study was done in January 2017. Student t-test, ANOVA, Bonferroni' and Chi-squared were used for comparison of quantitative and qualitative variables.

Results

The most common blood group was O (33.8%); AB was the least common (8.3%). The prevalence of Rh-positive and Rh-negative was 88.2% and 11.8% respectively. There were statistically significant associations between ABO blood groups and demi-span (P = 0.03), even after correction for multiple comparisons.

Conclusion

Our findings showed there was no relationship between ABO blood groups and demographic characteristics although there was an association with anthropometric measurements such as demi-span.

A comparison of dietary intake between personnel of a gas processing company and a sample population of public employees from Mashhad

INTRODUCTION

An imbalanced dietary pattern may result in a number of non-communicable disorders that include: obesity, diabetes, metabolic syndrome, cardiovascular diseases, and subsequently impaired quality of life (QOL). Micro- and macro-nutrients play some important roles in maintaining human health. The objective of this study was to compare dietary intake of employees of a gas processing company, who were provided with meals by their employee, with staff from other public employers from Mashhad, in northeastern Iran.

METHODS

Twenty-four-hour food recall and a food frequency questionnaire (FFQ) were used to evaluate dietary intakes of 654 male employees of Shahid Hasheminejad Gas Processing (SHGP) Company (case group), and 681 randomly selected male public employees from Mashhad as control subjects in this observational, analytic, longitudinal, prospective cohort study. The analysis of the dietary intakes was performed using Dietplan6 software.

RESULTS

Dietary macro and micro-nutrients were evaluated: including total energy, fat, MUFA, PUFA, trans fatty acids, cholesterol, starch, fiber, protein, total nitrogen, zinc, phosphor, potassium, calcium, manganese, selenium, iodine, sodium, copper, retinol, carotene, thiamin, riboflavin, niacin, pantothen, vitamin B6, biotin, folate, vitamin B12, vitamin C and vitamin D. The intake of macro-nutrients, including: energy, fat, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, starch, and protein; minerals including zinc, iron, selenium; and vitamins including niacin and vitamin D were higher in the SHGP group, compared to the control group (P < 0.05). The dietary intake of the SHGP group contained lower amounts of several mineral and vitamins, which included: iodine, sodium, carotene, thiamin, pantothenic acid, vitamin B6, biotin, folic acid, and vitamin C, in comparison with the control group (P < 0.05).

CONCLUSION

In conclusion, we suggest it will be important to evaluate the composition of meals provided by companies and organizations, especially those that provide their employees with the majority of their food intake.

Association of a genetic variant in the AKT gene locus and cardiovascular risk factors

Cardiovascular disease (CVDs) is the leading cause of morbidity and death worldwide. Most genetic variants could be identified by several genome-wide-association-studies (GWAS), including within genes encoding proteins involved in the AKT/PI3K pathways that are related with an increased risk of metabolic syndrome and CVDs. Therefore, due to the importance of genetic variants in the prognosis of diseases, we examined the genetic polymorphism of AKT-rs1130233 located on chromosome 14 with cardiovascular risk factors. In this cross-sectional study, 721 subjects recruited from the Mashhad-Stroke and Heart-Atherosclerotic-Disorders (MASHAD) cohort study. The participants including 257 subjects with metabolic syndrome, 144 subjects with cardiovascular disease and 320 subjects as a control group. Anthropometric, biochemical and demographic information measures were prepared. Dietary assessment was managed by 24h dietary recall. DNA extraction and genotyping were carried out by using the TaqMan real-time-PCR based method. The association of AKT rs1130233 locus with dietary intakes, metabolic syndrome and cardiovascular risk factors were assessed. Data were analyzed by using SPSS 21 software. Frequencies of genotypes AA, AG and GG of the AKT rs1130233 polymorphism were 12.6%, 44.5% and 42.9% in subjects with metabolic syndrome and 9.7%, 39.6% and 50.7% in subjects with cardiovascular disease, respectively. The frequency of allele A and G in cardiovascular disease and metabolic syndrome population were 29.5%, 70.5% and 34.8%, 65.2%, respectively. We have found no significant association between the AKT rs1130233 polymorphism with cardiovascular risk factors and metabolic syndrome. The results of dietary intake showed that the levels of phosphorus intake (p=0.008), calcium intake (p=0.007) and iodine intake (p=0.04) were different in subjects with and without metabolic syndrome. And also, energy intake was significantly different in subjects with cardiovascular disease (p=0.01) compared to the control group. Our findings suggest that AKT rs1130233 was not associated with the risk of metabolic syndrome and cardiovascular disease in the Iranian population. More studies are needed to validate our results. We did functional analysis, due to certify our investigation about value of this genetic biomarker for CVD risk.

Association of a genetic variant in the AKT gene locus and cardiovascular risk factors

Cardiovascular disease (CVDs) is the leading cause of morbidity and death worldwide. Most genetic variants could be identified by several genome-wide-association-studies (GWAS), including within genes encoding proteins involved in the AKT/PI3K pathways that are related with an increased risk of metabolic syndrome and CVDs. Therefore, due to the importance of genetic variants in the prognosis of diseases, we examined the genetic polymorphism of AKT-rs1130233 located on chromosome 14 with cardiovascular risk factors. In this cross-sectional study, 721 subjects recruited from the Mashhad-Stroke and Heart-Atherosclerotic-Disorders (MASHAD) cohort study. The participants including 257 subjects with metabolic syndrome, 144 subjects with cardiovascular disease and 320 subjects as a control group. Anthropometric, biochemical and demographic information measures were prepared. Dietary assessment was managed by 24h dietary recall. DNA extraction and genotyping were carried out by using the TaqMan real-time-PCR based method. The association of AKT rs1130233 locus with dietary intakes, metabolic syndrome and cardiovascular risk factors were assessed. Data were analyzed by using SPSS 21 software. Frequencies of genotypes AA, AG and GG of the AKT rs1130233 polymorphism were 12.6%, 44.5% and 42.9% in subjects with metabolic syndrome and 9.7%, 39.6% and 50.7% in subjects with cardiovascular disease, respectively. The frequency of allele A and G in cardiovascular disease and metabolic syndrome population were 29.5%, 70.5% and 34.8%, 65.2%, respectively. We have found no significant association between the AKT rs1130233 polymorphism with cardiovascular risk factors and metabolic syndrome. The results of dietary intake showed that the levels of phosphorus intake (p=0.008), calcium intake (p=0.007) and iodine intake (p=0.04) were different in subjects with and without metabolic syndrome. And also, energy intake was significantly different in subjects with cardiovascular disease (p=0.01) compared to the control group. Our findings suggest that AKT rs1130233 was not associated with the risk of metabolic syndrome and cardiovascular disease in the Iranian population. More studies are needed to validate our results. We did functional analysis, due to certify our investigation about value of this genetic biomarker for CVD risk.

Prevalence and Socio-Demographic Correlates of Mental Health Problems Among Iranian Health Sciences Students

OBJECTIVE

The primary objective of the present study was to compare the mental health status of Iranian medical vs other health sciences students and to examine how demographic factors relate to their mental health problems.

METHODS

A total of 560 medical and other health sciences students (250 (44.6%) males and 310 (55.4%) females) were recruited from Iran University of Medical Sciences. Data were obtained by self-administered questionnaire, including questions on socio-demographic characteristics. The Beck Depression Inventory, Beck Anxiety Inventory, General Health Questionnaire, and WHO well-being index were used to assess mental health status of students.

RESULTS

Ten percent of students had BDI scores consistent with clinically significant depression (6.6% mild, 1.8% moderate, 1.6% severe), and 28.7% had BAI scores consistent with clinically significant anxiety (20.7% mild, 7.1% moderate, 0.9% severe). Kurdish students had an odds ratio (OR) of 2.71 (95% CL, 1.22-6.02) for mild to severe depression symptoms when compared to Persian students. The prevalence of distressed health sciences students and poor psychological well-being was 13.4% and 14.1%, respectively. Maternal education gave an OR of 0.57 (0.35-0.93) for anxiety symptoms, after adjustment for all other factors. The possibility of general psychiatric morbidity was significantly lower in students who studied medicine (OR, 0.40 (0.21-0.71)). Being born in the capital city was associated with better psychological well-being (OR, 0.48 (0.26-0.86)).

CONCLUSIONS

Ethnicity, birthplace, discipline, and maternal educational level were major determinants of mental health status among health sciences students. Further research should be undertaken to determine the prevalence of psychological disorders using more reliable diagnostic interview.

Adherence to a Dietary Approach to Stop Hypertension (DASH)-Style in Relation to Daytime Sleepiness

BACKGROUND

The beneficial impact of adherence to a DASH diet on several metabolic conditions and psychological well-being has been shown previously. Dietary modification can affect sleep quality. Thus, the aim of this present study was to investigate the correlation between adherence to the DASH diet and daytime sleepiness score in adolescent girls.

METHODS

A total of 535 adolescent girls aged between 12 and 18 years old were recruited from different regions of Khorasan Razavi in northeastern of Iran, using a random cluster sampling method. DASH scores were determined according to the method of Fung et al. A Persian translation of the Epworth Sleepiness Scale (ESS-IR) was used to assess of daytime sleepiness. To investigate the correlation between DASH-style diet and daytime sleepiness score, we applied logistic regression analysis in crude and adjusted models.

RESULTS

As may be expected, participants with the greatest adherence to the DASH diet had significantly higher intakes of fruits, vegetables, low-fat dairy products, fish and nuts, and lower consumption of refined grains, red and processed meat, sugar-sweetened beverages and sweets. There was an inverse correlation between adherence to the DASH-style diet and scores for daytime sleepiness in crude model (β= -0.12; P=0.005). These findings were remained significant after adjustment for confounding variables (β= -0.08 P=0.04).

CONCLUSION

There is an inverse correlation between adherence to DASH diet and daytime sleepiness score. Further studies, particularly longitudinal studies, are required to determine whether dietary intervention may improve daytime sleepiness.

50 bp deletion in promoter superoxide dismutase 1 gene and increasing risk of cardiovascular disease in Mashhad stroke and heart atherosclerotic disorder cohort study

Cardiovascular disease (CVD), one of the main mortality causes worldwide is considered to be affected by general oxidative stress and inadequacy antioxidant system. Superoxide dismutase 1 (SOD1), a cytosolic antioxidant enzyme has a key role in neutralizing the excessive prooxidant by scavenging the super oxide anions. SOD1 polymorphic variants exhibit the altered activity properties. In the current study, we are aimed to investigate the association between the SOD1 polymorphism and CVD prevalence. A 6-years case control follow up study was designed to genotype the 526 participants (311 controls and 215 cases) for studying the 50 bp INS/DEL polymorphism at SOD1 promoter gene and analyze their blood lipid profile and anthropometric characteristics. Among the two possible alleles of the SOD1 gene (Wild [W] and Mutant [M]) the meaningful association was detected between the Mutants' frequency and the prevalence of CVD patients (p-value <.001). The W and M allele refer to inserted and deleted 50 bp in the polymorphic site of the SOD1 promoter, respectively. The WM and MM genotypes' frequency which indicate the wild heterozygotes and Mutant homozygotes, respectively, were significantly correlated with the prevalence of cardiovascular disease (p-value <.001). The present study has the potential to introduce the 50 bp INS/DEL polymorphism of SOD1 genotyping as a novel unique diagnostic approach for screening the high risk CVD.

Altered serum Zinc and Copper in Iranian Adults who were of normal weight but metabolically obese

Metabolically obese normal weight (MONW) individuals are potentially at increased risk of developing metabolic syndrome. Serum zinc and copper concentrations were assessed in individuals with MONW to determine whether MONW is associated with altered serum zinc and/or copper status. Normal weight subjects (total n = 2419; 1298 men and 1121 women), were recruited as part of Mashhad Stroke and Heart Association Disorder (MASHAD) Study cohort. They were divided into two groups according to the presence or absence of MetS, defined using IDF criteria. Serum zinc and copper concentrations were determined by atomic absorption. Of the 2419 normal weight adults, 377 had MetS. Of this group, 53.7% and 49.7% had a serum zinc <70 µg/dl (Q1) (p = 0.001) or a serum copper <79 µg/dl (Q1) respectively. Furthermore, 27.3% had a serum copper >131 µg/dl (Q4) (p = 0.034), and 18.8% had a serum zinc >95 µg/dl (Q4). Logistic regression analysis was performed to determine the odds ratio (OR) for an association of serum zinc, copper and zinc to copper ratio with MetS in normal weight subjects. The subjects with a serum zinc >95 µg/dl (Q4) had 0.386 [OR: 0.614(95%CI 0.457–0.823)] lower chance of MetS (p = 0.001) and the subjects with a serum copper >131 (Q4) had OR 1.423 (95% CI: 1.09–1.857) higher chance of MetS (p = 0.009). These data remained significant after adjustment for age and sex, for serum zinc and copper, respectively. Furthermore, our results strongly suggested that zinc and copper were the independent risk factor for metabolic syndrome in normal weight subjects. There is an imbalance between serum copper and zinc concentrations among individuals with MONW when compared with normal BMI individuals without MetS. This may increase the risk of individuals with MONW developing conditions associated with this imbalance, such as diabetes and cardiovascular disease.

Determinants of the magnitude of response to vitamin D supplementation in adolescent girls identified using a decision tree algorithm

Vitamin D (VitD) supplementation is an inexpensive and effective approach for improving VitD insufficiency/deficiency. However, the response to supplementation, with respect to the increase in serum 25(OH)D level varies between individuals. In this study, we have assessed the factors associated with the response to VitD supplementation using a decision-tree algorithm. Serum VitD levels, pre- and post-VitD supplementation was used as the determinant of responsiveness. The model was validated by constructing a receiver operating characteristic curve. Serum VitD at baseline levels was at the apex of the tree in our model, followed by serum low-density lipoprotein cholesterol and triglyceride, age, waist-hip ratio, and high-density lipoprotein cholesterol. Our model suggests that these determinants of responsiveness to VitD supplementation had sensitivity, specificity, and accuracy, 59.4, 75.8 and 69.3%, respectively. The decision tree model appears to be a relatively accurate, specific, and sensitive approach for identifying the factors associated with response to VitD supplementation.

Association Between Trace Element Status and Depression in HTLV-1-Infected Patients: a Retrospective Cohort Study

Depression and Anxiety are two important public health problems that are known to be associated with viral infections. The association between the intake of nutrients such as zinc and copper with symptoms of depression has been studied previously. The aim of the current study was to investigate the association between depression with human T cell lymphotropic virus type 1 (HTLV-1) infection and serum content of zinc and copper in a large Iranian population cohort. The study population consisted of 279 HTLV-1-positive patients who were identified after recruitment as part of a large cohort study: the Mashhad Stroke and Heart Association Disorder (MASHAD) study. They were divided into two groups of diagnosed with or without depression based on their symptoms. Serum zinc and copper levels of all subjects were measured using the flame atomic absorption spectrometry. The population sample comprised of 279 individuals infected with HTLV-1 of whom 192 (68.8%) were women. The mean serum zinc in the group with and without depression was 78.69 ± 13.79 μg/dl and 86.87 ± 19.44 μg/dl, respectively (p < 0.001). Also, the serum copper level was higher in the depressive group (116.75 ± 39.56) than in the non-depressive group (104.76 ± 30.77) (p 0.004). The association between serum zinc and copper with depression in HTLV-1-infected patients which was shown in this study could be considered in the treatment strategies in these patients.

The relationship between adherence to a Dietary Approach to Stop Hypertension (DASH) dietary pattern and insomnia

BACKGROUND

Adherence to a DASH- style diet has been reported to be associated with several health-related outcomes. A limited number of reports suggest that diet is an important behavioral determinant of insomnia. The current study aimed to explore the relationship between adherence to a DASH diet and the prevalence of insomnia in adolescent girls.

METHODS

A total of 488 adolescent girls aged 12-18 years old were recruited from different regions of Khorasan Razavi in northeastern of Iran, using a random cluster sampling method. DASH scores were determined according to the method of Fung et al. A validated Iranian version of the Insomnia Severity Index questionnaire was used to assess sleep insomnia. To assess the association between the DASH dietary pattern and insomnia, we applied logistic regression analysis in crude and adjusted models.

RESULTS

As may be expected, participants in the upper quintile of the DASH diet had significantly higher intakes of fruits, vegetables, low fat dairy products, fish and nuts and lower consumption of refined grains, red and processed meat, sugar-sweetened beverages and sweets. We found that a high adherence to a DASH-style diet was associated with a lower odds of insomnia (OR: 0.51; 95% CI 0.26-1.00) compared with those with lowest adherence. Similar results were found after adjustment for potential confounders.

CONCLUSIONS

There is an inverse association between adherence to DASH dietary patterns and insomnia. Further prospective studies are required to demonstrate these findings.

The relationship between short stature and menstrual pattern in a large cohort of Iranian girls

The aim of this study was to investigate the relationship between stature and menstrual pattern. Nine hundred and seventy six girls were selected from regions within two cities in north-eastern Iran in 2015. They were assessed with respect to: their stature and menstrual pattern, age of menstruation, severity of dysmenorrhoea, duration of their menstrual cycle and flow. 841 girls had experienced menarche. 10.5% had a short stature. There were significant differences in age, height, weight and body mass index between those who had experienced their first menstrual cycle and others (p < .001). There were weak and negative correlation between age of menarche and height percentiles (r  =  -0.12, p < .001). Premenstrual syndrome, duration of menstruation cycle and bleeding period did not differ between these two groups (p > .05). We found that dysmenorrhoea was significantly influenced by height. Although the mean age at menarche was statistically significant among different statures, the range was narrow (12.2-12.7). Further studies considering environmental factors, including socioeconomic status and nutrition concurrently, are also required.Impact statementWhat is already known on this subject? Various menstrual characteristics, including age of menarche, severity of dysmenorrhoea and duration of menstrual period may be associated with height. But, there have been few studies on the relationship between short stature and its impact on health status and menstrual patterns in adolescents.What do the results of this study add? There were significant differences in age, height, weight and body mass index between adolescent girls who had experienced their first menstrual cycle, and others. There were weak, negative, significant correlations between age of menarche and height percentiles. Dysmenorrhoea was significantly influenced by height.What are the implications of these findings for clinical practice and/or further research? Life style modification and nutritional interventions that optimise the height of girls may resolve their menstrual problems and dysmenorrhoea.

Association of dietary patterns and risk of cardiovascular disease events in the MASHAD cohort study

BACKGROUND

Cardiovascular disease (CVD) is the principal cause of mortality and disability in Iranian adults. We aimed to evaluate the relationship between dietary patterns and CVD incidence in a large sample of adults in northeastern Iran.

METHODS

The present study comprised a prospective study of 5706 CVD-free men and women aged 35-65 years who participated in a cohort study. All of the participants were followed up for a 6-year period. Dietary patterns were derived from a 65-item validated food frequency questionnaire and the factor analysis method was used to determine dietary patterns.

RESULTS

We identified two major dietary patterns: (i) a Balanced dietary pattern (a high intake of green leafy vegetables, other vegetables, fruits, dairy products, red meats, poultry, seafoods, legumes and nuts, as well as a low intake of sugar) and (ii) a Western dietary pattern (a high intake of sugar, tea, egg, snacks, fast foods, potato, carbonated beverages, pickled foods, organs meat and butter) by factor analysis. The hazard ratio (HR) and 95% confidence intervals (CIs) of total CVD in the highest versus lowest tertiles of the Balanced pattern were 1.29 (95% CI = 0.67-2.47; P = 0.44). The HR and 95% CIs of CVD in the highest versus lowest tertiles of Western pattern were 2.21 (95% CI = 1.08-4.45; P = 0.03).

CONCLUSIONS

During the 6-year follow-up, we found that adherence to a Balanced dietary pattern was not significantly associated with CVD events. However, adherence to a Western dietary pattern was associated with a significantly increased risk of CVD events and its associated risk.

Common Polymorphisms in Genes Related to Vitamin D Metabolism Affect the Response of Cognitive Abilities to Vitamin D Supplementation

It is possible that vitamin D acts as a neurosteroid and that vitamin D deficiency may have an adverse impact on brain function and cognitive function. There are a few reports that have demonstrated an association between polymorphisms of genes involved in vitamin D metabolism and neurodegenerative disease. We aimed to evaluate the relationship between common, functional vitamin D-associated gene variants and cognitive abilities and to investigate the effect size of this polymorphism on cognitive capabilities associated with high-dose vitamin D supplementation. A total of 319 healthy adolescents received a high dose of vitamin D (50,000 IU)/week for 9 weeks. A questionnaire was used to assess cognitive abilities at baseline and after treatment. The genotypes of the CYP2R1-rs10766197 and GC-rs4588 variants were determined using TaqMan genotyping techniques. At baseline, total cognitive ability scores were higher in the AA group who were homozygous for the uncommon allele, compared with the other (AG and GG) genotypes of the CYP2R1-rs10766197 polymorphism (104.9 ± 27.8 vs. 79.1 ± 38.8 vs. 73.1 ± 25.6; p < 0.001, respectively). During the supplementation period, cognitive ability scores increased in individuals with the AG and GG genotypes, while individuals with a AA genotype did not show significant change in total score after intervention (p = 0.17). For GC SNP (rs4588), no major differences at baseline and trial-net change of cognitive tasks score were observed between the genotypes under three genetic models (p_SNP = 0.67). Vitamin D supplements have trait-dependent effects on cognitive performance that suggests a causal role for vitamin D in cognitive performance. The rs10766197 variant, near the CYP2R1 gene locus, significantly modified the efficacy of high-dose vitamin D3 supplementation for its effects on improving cognitive abilities indicate that some subjects might require a higher dose to benefit from in terms of cognitive performance.

Association Between Hypertension in Healthy Participants and Zinc and Copper Status: a Population-Based Study

The prevalence of hypertension (HTN) is increasing globally. It has been shown that there is an association between micronutrient deficiency and HTN. In the current study, we aimed to assess the association between HTN with serum copper and zinc concentrations in a large representative Iranian population. The participants were enrolled into the Mashhad stroke and heart atherosclerotic disorders study (MASHAD study), a cohort study that was initiated in 2010. Anthropometric indices were assessed using standard procedures. Systolic (SBP) and diastolic (DBP) blood pressures were measured using a standard mercury sphygmomanometer. Fasting blood glucose (FBG), lipid profile, uric acid and blood urea nitrogen (BUN), and hs-CRP were measured using routine methods. HTN defined as persons who had SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg and/or medication use. Flame atomic absorption (Varian AA240FS) was used to measure serum Zn and Cu concentrations. SPSS software was used for all statistical analyses. A total of 9588 participants were recruited into the MASHAD study project. Participants were divided into two groups; 5695 healthy (non-hypertensive) (mean age 45.85 ± 7.5 years) and 3893 hypertensive participants (mean age 51.18 ± 7.67 years). Systolic (p < 0.001) and diastolic blood pressure (p < 0.001) were significantly different for different serum copper quartiles. The participants with serum copper levels < 80 μg/dl had 1.33 times greater risk of an increased blood pressure than other participants. Participants with serum copper levels > 130 μg/dl had a 1.94-fold higher risk of raised blood pressure. Serum zinc was not associated with systolic blood pressure, but individuals in the first quartile level of serum zinc had a diastolic blood pressure that was significantly higher than other quartiles (p = 0.035). Serum copper is associated with blood pressure status in adults in a U-shaped relationship, with a range of serum copper between 80 and 130 μg/dl being associated with normal blood pressure.

Association of a genetic variant in the angiopoietin-like protein 4 gene with metabolic syndrome

Background

Metabolic syndrome (MetS) is characterized by a clustering of cardiovascular risk factors that include: abdominal obesity, dyslipidemia, hypertension and glucose intolerance. Angiopoietin-like protein 4 (ANGPTL4) is a circulating peptide that is an inhibitor of lipoprotein lipase, a key enzyme in lipid metabolism. The objective of this study was to investigate the association of ANGPTL4 gene variants (E40K) with fasting serum triglyceride levels and with cardiovascular risk factors, that included the presence of MetS in 817 subjects recruited from the Mashhad stroke and heart Atherosclerosis Disorders (MASHAD) cohort Study.

Method

ANGPTL4 genotypes were determined using a TaqMan genotyping based real time PCR method. The association of the genetic variant with the risk of metabolic syndrome and its relationship with lipid profile were determined.

Result

The frequency of GG, GA and AA genotypes were 96.9, 2.7 and 0.4% in individuals with MetS, and 78.8, 20.8, 0.4%, in those without MetS. The GA genotype of the rs116843064 polymorphism was associated with a lower risk for MetS (e.g., OR in Codominant genetic model: 0.14, 95% CI: (0.06–0.33), p < 0.0001). Subject with an A allele had a higher risk for MetS (OR: 6.72, 95% CI: (3.05–14.82), p < 0.0001). There was a significant difference in fasted lipid profiles across the genotypes for ANGPTL4. Carriers of the AG genotype had higher levels of serum HDL-cholesterol (HDL-C) and lower TG, compared to the GG homozygotes genotype.

Conclusion

The G allele at the rs116843064 polymorphic locus of the ANGPTL4 gene was associated with a lower prevalence of MetS.

Depression in adolescent girls: Relationship to serum vitamins a and E, immune response to heat shock protein 27 and systemic inflammation

BACKGROUND

The inflammation and oxidative stress are thought to play an important role in the etiopathogenesis of some psychological disorders. We aimed to assess the potential relationships between serum fat soluble vitamins (Vitamins A and E), antibody titers to Hsp27 (anti-Hsp27) and hematological markers of inflammation, with mood disorders in a population of adolescent girls.

METHODS

A total of 563 adolescent girls (Age 12-18 years) were included in the study. The presence and severity of depression, insomnia and sleepiness were assessed using validated questionnaires. Serum vitamins A and E, anti-Hsp27 antibody titers, white blood cell, lymphocyte, neutrophil, platelet counts, and red blood cell distribution width (RDW), were also measured. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and RDW to platelet ratio (RPR) were calculated.

RESULTS

Serum anti-HSP27 antibody titers, PLR, and RPR values was significantly higher in subjects with a high depression score compared to normal individuals (p < 0.05). However, there was no association between serum inflammatory markers concentrations and sleep disorders; although individuals with insomnia had a lower vitamin E/HDL ratio compared to healthy adolescents. In multivariate logistic regression analyses adjusted for potential confounders, anti-HSP was an independent predictor of severe depression (OR = 5.0, 95% CI: 1.6-15.7, p < 0.05).

LIMITATION

The cross-sectional design of study and the inclusion of only female adolescents participants are limitations.

CONCLUSION

Our findings suggest that serum anti-HSP27 antibody titers may be useful biological marker in depressive patients. This finding may support a role of oxidative stress in the etiology of depression, and targeting this pathway may be of value in the treatment of depression.

An assessment of the risk factors for vitamin D deficiency using a decision tree model

BACKGROUND AND OBJECTIVES

Vitamin D (25-hydroxyvitamin D or 25OHD) has a key role in the pathogenesis of several chronic disorders. Vitamin D deficiency is a common global public health problem. We aimed to evaluate the risk factors associated with vitamin D deficiency using a decision tree algorithm.

METHODS

A total of 988 adolescent girls, aged 12-18 years old, were recruited to the study. Demographic characteristics, serum biochemical factors, all blood count parameters and trace elements such as Zinc, Copper, Calcium and SOD were measured. Serum levels of vitamin D below 20 ng/ml were considered to be deficiency. 70% of these girls (618 cases) were randomly allocated to a training dataset for the constructing of the decision-tree. The remaining 30% (285 cases) were used as the testing dataset to evaluate the performance of decision-tree. In this model, 14 input variables were included: age, academic attainment of their father, waist circumference, waist to hip ratio, zinc, copper, calcium, SOD, FBG, HDL-C, RBC, MCV, MCHC, HCT. The validation of the model was assessed by constructing a receiver operating characteristic (ROC) curve.

RESULTS

The results showed that serum Zn concentration was the most important associated risk factor for vitamin D deficiency. The sensitivity, specificity, accuracy and the area under the ROC curve (AUC) values were 79.3%, 64%, 77.8% and 0.72 respectively using the testing dataset.

CONCLUSIONS

The results suggest that the serum levels of Zn is an important associated risk factor for identifying subjects with vitamin D deficiency among Iranian adolescent girls.

Association of body mass index with serum calcium and phosphate levels

OBJECTIVE

It has been shown that several environmental and physiological factors can affect on the serum levels of calcium and phosphate. The objective of the present study was explored the relationship between serum calcium and phosphate levels with anthropometric and hematological markers.

METHODS

908 subjects were recruited from the Mashhad stroke and heart atherosclerosis disorder (MASHHAD) program. Anthropometric parameters, liver/kidney function tests (e.g., Urea nitrogen, creatinine, urea and uric acid, creatinine, AST, ALT) were determined in all participants. Serum concentrations of calcium and phosphate were measured using Autoanalyzer BT3000P (Pars Azmoon kit, Tehran, Iran). SPSS software was used for statistical analyses.

RESULTS

We observed that obese subjects had a lower level of serum calcium (p˂0.05). Moreover, a relationship was detected between serum phosphate level and different menopausal status (p˂0.05). Serum calcium and phosphate did not change by increasing age in the population. Additionally, there was a correlation between lymphocyte count with serum phosphate level (p˂0.05). No statistically different were detected for the levels of calcium/phosphate with respect to smoking status, physical activity, lipid profile, liver and renal function markers.

CONCLUSION

We found an association between serum calcium and BMI as well as with serum phosphate and menopausal status.

Association Between dietary patterns and the risk of metabolic syndrome among Iranian population: A cross-sectional study

BACKGROUND

The role of dietary patterns in metabolic syndrome has not been investigated sufficiently among Iranian population. The aim of this study is to investigate the association of major dietary patterns with the risk of metabolic syndrome and its components among healthy individuals of Iran.

METHODS

This is a cross-sectional study that was performed on 5895 men and women who participated in MASHAD study project. Factor analysis was employed to determine major dietary patterns with regard to a validated 65-item food frequency questionnaire. Metabolic syndrome was diagnosed using international diabetes federation (IDF). Logistic regression analysis was used to evaluate the association between dietary patterns and metabolic syndrome risk to generate odds ratios (ORs) and 95% confidence intervals (CI).

RESULTS

Three major dietary patterns (Balanced, Western and high carbohydrate) were identified. The Western pattern showed a positive association with metabolic syndrome (OR [95%CI] for highest vs. lowest tertile: 1.58 [1.21-2.06]; p value = 0.001). The high carbohydrate dietary pattern was associated with higher metabolic syndrome risk (OR [95%CI] for highest vs. lowest tertile: 1.17 [1.02-1.33]; P value = 0.022). The Balanced dietary pattern was unrelated to metabolic syndrome, but was related to some individual risk factors for metabolic syndrome.

CONCLUSIONS

These results suggest that the Western and high carbohydrate patterns are associated with an increased risk for metabolic syndrome among Iranian adults. The causality of these associations needs to be confirmed.

Oxidative stress and inflammation, two features associated with a high percentage body fat, and that may lead to diabetes mellitus and metabolic syndrome

Obesity is an important feature of the metabolic syndrome and is associated with an increased risk of type 2 diabetes mellitus, cardiovascular disease, and some cancers. The aim of this study was to determine the relationship between body fat percentage and an imbalance of the prooxidant/antioxidant balance (PAB), serum superoxide dismutase (SOD1) and inflammation (serum hs-CRP) and increase risk of metabolic syndrome and diabetes mellitus. In this study, 9154 individuals were recruited as part of the Mashhad Stroke and Heart Association Disorder (MASHAD) study. Subjects were categorized into two groups according to body fat percentage as defined >25% in male and > 30% in female, according to gender. Biochemical factors, including serum PAB, SOD1, and hs-CRP were measured in all subjects. SPSS version 18 was used for statistical analyses for all. GraphPad Prism 6 for figures was used. Of total number of subjects (9154), 6748 (73.7%) were found to have a high body fat (BF) percentage. Serum hs-CRP and PAB were significantly higher in individuals with a high BF percentage (P < 0.05) but SOD1 was not significantly different between the two groups (P > 0.05). BF percentage, serum PAB and serum hs-CRP were significantly higher in individuals with metabolic syndrome and diabetes versus those without metabolic syndrome and diabetes mellitus (P < 0.05), however serum SOD1 was significantly lower in individuals with metabolic syndrome (P < 0.005). Oxidative stress and inflammation are two factors that may link the presence of high BF percentage with the development of metabolic syndrome, diabetes, and cardiovascular disease. © 2018 BioFactors, 45(1):35-42, 2019.

Serum vitamin E as a significant prognostic factor in patients with dyslipidemia disorders

OBJECTIVES

Obesity and overweight are among the main causes of cardiovascular disease (CVD) mortality. Dyslipidemia, fatty liver index, is strongly related to CVD. Vitamin E as an antioxidant protects the hepatic cells against oxidative stress and prevents fatty liver disease. The aim of the current study is to evaluate the relationship between anthropometric parameters and fasted lipid profile with serum vitamin E levels.

STUDY DESIGN

A randomized trial was designed based on data from the Mashhad stroke and heart atherosclerotic disorders (MASHAD: 2010-2020).

METHODS

363 CVD subjects (173 males and 190 females) was selected at random, among 9704 subjects in three regions of Mashhad, northeast of Iran to investigate the specific correlations among their serum vitamin E, lipid profile (TG, HDL-C, LDL-C and TC), and anthropometric features (height, weight, BMI, hip and waist circumferences.

RESULT

The results indicated the significant relationships between vitamin E, and fasting serum lipid profile in subjects. Serum vitamin E was negatively correlated to TC, TG, and LDL-C and positively related to HDL-C. Also, statistically negative correlations were found between vitamin E and anthropometric parameters (weight, waist and hip circumference, middle Arm, and Systolic Blood Pressure). Moreover, vitamin E ratios such as vitamin E/(TC + TG) and vitamin E/TC values as standardized vitamin E, had significant negative correlation with BMI, the whole of anthropometric parameters, and dyslipidemia risk factors including TC, TG and LDL-C.

CONCLUSION

We found that vitamin E profile was significantly lower in the dyslipidemia subjects. It is generally suggested that vitamin E monitoring might be used as a useful prognostic and therapeutic agent in dyslipidemia disorder.

A comparison of body mass index and percent body fat as predictors of cardiovascular risk factors

BACKGROUND

Cardiovascular disease (CVD) is an important cause of global mortality and morbidity. Body mass index (BMI) is the measure of adiposity that is used most frequently in CVD risk algorithms.

AIMS

We aimed to assess the relationship between several CVD risk factors (RFs) and percent body fat (PBF), and to compare the predictive values obtained using PBF for these cardiovascular RFs with the values obtained using BMI. The CVD RFs included, hypertension (HTN), diabetes mellitus (DM) and the presence of dyslipidemia (DLP).

METHODS AND MATERIALS

The data were derived from the MASHAD study, a cohort study of 9704 volunteers, aged 35-65 years and living in the city of Mashhad. Based on BMI and PBF values, subjects were classified into 4 groups; group 1 (low or normal BMI and PBF, N = 1670), group 2 (low or normal BMI but high PBF, N = 992), group 3 (high BMI and low or normal PBF, N = 837), and group 4 (high BMI and PBF, N = 6245). Chi-square, covariance and logistic regression were used to analyze the data at a significance level of 0.05.

RESULTS

There was an increasing trend from group 1 to group 4 for the mean values of all CVD RFs and their prevalence. There were significant differences in the frequency of a low HDL-C, this was substantially higher in Group 3 (38.6% in Group 3 versus 12.2% in Group 2); the frequency of a high serum TG (24% in Group 3 versus 9.9% in Group 2) and the frequency of dyslipidemia overall (56.2% in Group 3 and 28.8% in Group 2) (P-value<0.001 for all comparisons). The frequency of hypertension (22.9% in Group 3 versus 16.2% in Group 2) and IFG (8.5% in Group 3 versus 5.0% in Group 2) were also substantially higher in Group 3 compared to Group 2 (P-value<0.001 for both comparisons). All the mean values for the RFs were higher in group 3 from group 2 except HDL-C. When Group 1 was used as a reference and calculated OR of any RF for any group 2-4 rather than group 1, OR for all RF in group 3 was higher from group 2.

CONCLUSION

The differences in frequency, means and OR of RFs between Groups 2 and 3 showed a differential impact of a high BMI or high PBF. Compared to PBF, BMI may be a better predictor for several RFs for CVD.

Association between serum zinc and copper levels and antioxidant defense in subjects infected with human T-lymphotropic virus type 1

Introduction

Copper (Cu) and zinc (Zn) are important trace elements that are also structural ions of superoxide dismutase (SOD), which reduce oxidative stress. Zinc deficiency and excess copper have been reported to be associated with inflammation. The human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus, which is believed to cause systemic inflammation. The aim of this study is to measure levels of Zn, Cu, SOD, and prooxidant–antioxidant balance (PAB) in HTLV-1-positive patients and investigate the association between serum Zn and Cu concentrations and levels of oxidative stress in them.

Methods

The serum samples of 1,116 subjects who had participated in the “Mashhad Stroke and Heart Atherosclerotic Disorder” study, including 279 HTLV-1-positive and 837 HTLV-1-negative patients, were used. Levels of Zn, Cu, SOD, and PAB were measured.

Results

Zinc and SOD levels were lower in the HTLV-1-positive group; however, the difference was statistically significant only for the level of SOD (P=0.003). On the other hand, levels of copper and PAB were significantly higher in HTLV-1 positive subjects; P=0.004 and P=0.002, respectively.

Conclusion

In HTLV-infected patients, serum Zn concentration is lower and Cu concentration is higher than healthy controls. This altered situation might be either primary or secondary to HTLV-1 infection, which should be investigated in larger studies. We showed that SOD is significantly lower in HTLV-1-infected subjects. As in some other viruses that evolve different mechanisms to potentiate virus replication by changing the physiologic condition of host cells, HTLV-1 too probably decreases the activity of copper–zinc SOD1 by suppressing its gene.

Relationship of Dietary and Serum Zinc with Depression Score in Iranian Adolescent Girls

Zinc deficiency, which is common among Iranian populations, is believed to play a crucial role in the onset and progression of mood disorders such as depression in different stages of life. We have therefore investigated the relationship between serum/dietary zinc status and depression scores among adolescent girls living in northeastern Iran. Serum zinc was measured by flame atomic absorption (Varian AA240FS) and the mean zinc intake was assessed using 3-day food record. A validated Persian version of the Beck Depression Inventory (BDI) was used to determine the severity of depressive symptoms for all subjects. Data were analyzed using SPSS 18 software. There was a statistically significant correlation between dietary zinc intake and serum zinc concentration (r = 0.117, p = 0.018). Dietary intake of zinc (7.04 ± 4.28 mg/day) was significantly lower among subjects with mild to severe depression symptoms than those with no or minimal depression symptoms (8.06 ± 3.03 mg/day). Dietary zinc intake was inversely correlated with depression score (r = 0.133, p = 0.008). However, there was no significant difference in serum zinc concentrations among individuals with no or minimal and mild to severe depression symptoms (p = 0.5). Dietary zinc intake, but not serum zinc concentration, was inversely associated with depression symptoms. Therefore, controlled clinical trials are needed to determine the efficacy of zinc supplementation in the treatment of depression disorders.

Relationship between platelet count and platelet width distribution and serum uric acid concentrations in patients with untreated essential hypertension

Hematological parameters have emerged as independent determinants of high serum concentrations of uric acid (UA) and predictive factors in the evaluation of the total cardiovascular risk in patients with essential hypertensive. Here, we have investigated the possible relationships between hematological factors and serum uric acid levels in hypertensive patients recruited as part of Mashhad Stroke and Heart Atherosclerotic Disorders cohort study. Two-thousand three-hundred and thirty-four hypertensive individuals were recruited from this cohort and these were divided into two groups; those with either high or low serum UA concentrations. Demographic, biochemical, and hematological characteristics of population were evaluated in all the subjects. Logistic-regression analysis was performed to determine the association of hematological parameters with hypertension (HTN). Of the 2334 hypertensive subjects, 290 cases had low UA, and 2044 had high serum UA concentrations. Compared with the low UA group, the patients with high serum UA, had higher values for several hematological parameters, whilst platelet counts (PLT) were lower. Multiple linear regression analysis showed that PLT and serum high sensitivity-c reactive protein (hs-CRP) were correlated with serum UA level. Stepwise multiple logistic regression model confirmed that platelet distribution width (PDW) and gender were independent determinant of a high serum UA. PDW and PLT appear to be independently associated with serum UA level in patients with HTN. © 2018 BioFactors, 44(6):532-538, 2018.

Prevalence of combined and noncombined dyslipidemia in an Iranian population

BACKGROUND

Combination of dyslipidemic phenotypes, including elevated plasma levels of low-density lipoprotein cholesterol (LDL-C), elevated plasma triglycerides (TG), and decreased low-density lipoprotein cholesterol (HDL-C) concentrations, is important because of the association of individual phenotypes with increased risk of cardiovascular disease (CVD). We investigated the prevalence of combined dyslipidemias and their effects on CVD risk in an Iranian large population.

METHOD

A total of 9847 individuals were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Anthropometric parameters and biochemical indices were measured in all of the subjects. Different types of combined dyslipidemias including high TG + low HDL-C, high TG + low HDL-C + high LDL-C, low HDL-C + high LDL-C, high TG + high LDL-C, and finally high TG + high LDL-C + low HDL-C were considered. Ten-year CVD risk was calculated using the QRISK2 risk algorithm and adjustments were made as suggested by the Joint British Societies' (JBS2). Logistic regression analyses were performed to determine the association between different combined dyslipidemias and categorical QRISK.

RESULTS

A total of 3952 males and 5895 females were included in this current study. Among the included subjects, 83.4% had one form of dyslipidemia, and 16.6% subjects were not dyslipidemic. The mean age was 48.88 ± 7.9 and 47.02 ± 8.54 years for dyslipidemic and nondyslipidemic groups, respectively. The results showed that the frequency of dyslipidemia was 98%, 87.1%, and 90% in subjects with metabolic syndrome, CVD, and diabetes, respectively. Our results suggested that around 15.7% of study population were at 10 years CVD risk (high ≥20) and it was higher in men than women (P < .001). Moreover, risk of CVD was higher in TG↑ & HDL↓ & LDL↑ group than other groups.

CONCLUSION

Prevalence of dyslipidemia was 83.4% among Iranian adults. The results showed that individuals with increased plasma TG and LDL-C, and low HDL-C levels had the highest 10 years CVD risk compared to other combined dyslipidemic phenotypes.

Association of high level of hs-CRP with in-stent restenosis: A case-control study

BACKGROUND

In-stent restenosis (ISR) is one adverse outcome of coronary stent implantation. Although using drug-eluting stents has reduced the rate of ISR, it remains a major problem. Here, we have investigated the relationship between several patient characteristics including serum high sensitive C-reactive protein (hs-CRP) and ISR.

METHODS

This was a case-control study comprising 104 individuals with ISR and 202 patients without. Baseline characteristics were collected using a questionnaire. Fasting blood glucose (FBG), serum triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and serum high sensitivity C-reactive protein (hs-CRP) were measured using commercial kits on an auto-analyzer. Data were analyzed using SPSS software and a p value ≤ 0.05 was considered significant.

RESULTS

Diabetes mellitus (p < 0.001), stent type (p = 0.005), serum hs-CRP (p = 0.006), FBG (p = 0.038) and serum TG (p = 0.039) were significantly associated with ISR. The association between hs-CRP and ISR remained significant after adjustment for stent type and DM. For patients with a serum hs-CRP <2.64 mg/dL, ISR was only associated with diabetes mellitus (p = 0.016); while for individuals with a serum hs-CRP ≥2.64 mg/dL, ISR was also associated with the presence of diabetes mellitus, serum triglycerides and stent type.

CONCLUSION

Higher levels of serum hs-CRP were significantly associated with the occurrence of ISR.

Dietary Intake and Its Relationship to Different Body Mass Index Categories: A Population-Based Study

BACKGROUND

Obesity is a major public health problem because of its associated diabetes mellitus and cardiovascular disease. We aimed to explore the relationship between dietary macronutrients and adiposity in a cohort study, representative of the city of Mashhad in northeastern Iran.

STUDY DESIGN

A cross-sectional study.

METHODS

The population sample (9847) derived from Mashhad stroke and heart atherosclerotic disorders (MASHAD: 2010-2020) and was obtained using a stratified-cluster method. The subjects were separated into 4 groups by body mass index status: normal weight, underweight, overweight and obese individuals. Individuals with mean age of 48.33 ±8.26 yr were recruited and anthropometric and biochemical factors were measured in all the subjects. Individual dietary intakes were assessed using 24-h dietary recall Dietplan6. Univariate and multivariate analyses were conducted before and after adjustment for age, gender and energy intake.

RESULTS

Obese individuals were significantly less physically active. They had higher levels of serum fasted lipid profile, hs-CRP, uric acid, and glucose, and blood pressures compared to normal weight individuals (P=0.001). There was a significant difference in the dietary intakes of the groups categorized by obese before adjustment for energy intake in the obese compared to the normal weight group. These differences remained statistically significant for Trans fatty acid (P=0.033), lactose (P=0.009), fructose (P=0.025), glucose (P=0.017), sucrose (P=0.021) and maltose (P=0.015) after adjustment for energy intake.

CONCLUSION

Our findings demonstrate a significant association between dietary Trans fatty acid and total sugar intake with adiposity in a representative population sample from northeastern Iran.