Educational intervention based on the extended parallel process model improves adherence to diabetic diet and glycaemic control indices: a randomised, double-blind, controlled, factorial field trial

Nutritional education is pivotal in the medical nutritional therapy of type 2 diabetes mellitus (T2DM). The extended parallel process model (EPPM) is a health education method for inducing desirable health behaviours. The present study aimed to investigate the effect of nutritional education based on the EPPM in T2DM patients on knowledge, attitude, practice, anthropometric indices, glycaemic factors, lipid profile and adherence to the diabetic diet. A randomised, double-blind, controlled, factorial field trial was designed for T2DM patients aged 30-59 years (n 88). Participants were randomly allocated into four groups to receive EPPM-based nutritional education through gain framed message (GFM), loss framed message (LFM), their combination (G\LFM) or usual diabetic education in the control group (CG). Participants were assessed before and after the study duration. After 3 months of intervention, eighty participants finished the study. The EPPM-based intervention increased participants' knowledge, behavioural intention, perceived sensitivity, severity, self-efficacy (P < 0·001 for all) and response efficacy (P = 0·029) in comparison with CG. GFM (P = 0·004) and G\FLM (P = 0·034) reduced carbohydrate intake and LFM (P = 0·034) and G\LFM (P = 0·047) decreased fat intake. Between-group analysis indicated interventions reduced weight (P = 0·046), BMI (P = 0·038), fasting blood sugar (P = 0·030), 2-hour postprandial blood glucose (P = 0·027) and TAG (P = 0·002) in comparison with the CG. Results were NS for protein intake, waist and hip circumference, waist:hip ratio, HbA1c, total cholesterol, LDL and HDL. Nutritional education based on EPPM could increase the knowledge and awareness of T2DM patients. Also, it could be beneficial for blood glucose amendment. Further investigations are recommended.

To assess the contributing factors of nutritional and health status amongst elderlies residing in the nursing homes of fars province, Iran: A cross sectional study

Background and Aims

In line with the global trend, the number of elderly is rising in Iran. It should be noted that the nutritional and health needs of these people, especially those living in nursing houses, are extremely significant. The present study aimed to identify the nutritional and health status and uncover their relationship with received care services by elderlies residing in nursing homes.

Methods

All 373 elderlies living in the nursing homes in Shiraz entered the study, and the requisite data were collected by references to elderlies' files, respective nurses, and elderlies themselves.

Results

The majority of the elderlies were at risk of malnutrition (62.5% of the total population, 55.4% of females, and approximately 44.6% of males). Elderlies with no insurance coverage mainly fell into the at-risk and malnutrition categories. There was a significant relationship between the needs assessment scores, reflecting the need for physical and psychological actions, and elderlies' malnutrition (odds ratio = 1.87, 95% confidence interval: 1.79-1.95). For each unit increase in the Physical and psychological need score, the odds of exposure to malnutrition (vs. nonmalnourished and at risk of malnutrition) was 1.87 times after adjustment for confounders.

Conclusion

The results of our study revealed that most of the elderlies living in the nursing homes of Shiraz had some levels of malnutrition such as at-risk for malnutrition (62.5%) and malnourished (18.9%). Based on these results, it is suggested that health policy-makers take practical steps toward promoting the nutritional care of old people and direct extra supervision to nursing homes and all healthcare provisions.

The effects of powdered drinks enriched with curcumin and probiotics on lipid profile and atherogenic indices in patients with metabolic syndrome: A randomized, double-blinded, placebo-controlled clinical trial

Cardiovascular disease is prevalent globally and is the most common complication of metabolic syndrome (MetS). Previous studies have suggested that curcumin and probiotics may improve the lipid profile, so we aimed to investigate the effects of the edible powder enriched with these substances on lipid profile level and atherogenic indices such as Atherogenic Coefficient (AC), Castelli Risk Index-I (CRI-I), Castelli Risk Index-II (CRI-II), and Atherogenic Index of Plasma (AIP). In the present parallel randomized double-blinded placebo-controlled clinical trial, 124 people with MetS with overweight or obesity were randomly allocated to 4 groups and were followed up for 8 weeks. The participants received a low-calorie diet and a daily sachet of enriched powder drink. The sachets contained either 109 CFU of probiotics or 1 g of curcumin, or probiotic + curcumin (pro + cur), or placebo, respectively. The fasting lipid profile and atherogenic indices were measured at the beginning and end of the study. One hundred and fourteen participants completed the study. At the end of the study, the within- and between-group comparisons showed no significant differences in lipid profile and atherogenic indices (p > .05). Based on the results of the current study, taking an oral powder containing 1 g curcumin and 109 CFU probiotics for 8 weeks had no effect on the lipid profile level and atherogenic indices; however, more studies are recommended.

Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult's Cohort Study (FACS)

BACKGROUND

One of the modifiable risk factors for cardiovascular diseases is the inter-arm blood pressure difference (IAD), which can be easily measured. This study aimed to determine the prevalence and factors related to the Iranian population's inter-arm differences in systolic and diastolic blood pressure.

METHOD

This cross-sectional study was conducted on the baseline data of participants who had Iranian nationality, were at least 1 year of residence in the area, aged within the age range of 35-70 years, and willed to participate from the Fasa Persian Adult Cohort Study (FACS). IAD for systolic and diastolic blood pressure was measured and categorized into two groups of difference < 10 and ≥ 10 mmHg. Logistic regression was used to model the association between independent variables and IAD.

RESULTS

The prevalence of systolic and diastolic IAD ≥ 10 mmHg was 16.34% and 10.2%, respectively, among 10,124 participants. According to the multivariable logistic regression models, age (adjusted odds ratio (aOR): 1.019 [95% CI: 1.013, 1.025]), body mass index (BMI) (aOR: 1.112 [95% CI: 1.016, 1.229]), having type 2 diabetes (aOR Yes/No: 1.172 [95% CI: 1.015, 1.368]), having chronic headaches (aOR Yes/No: 1.182 [95% CI: 1.024, 1.365]), and pulse rate (aOR: 1.019 [95% CI: 1.014, 1.024]) significantly increased the odds of systolic IAD ≥ 10 mmHg. Additionally, high socio-economic status decreased the odds of systolic IAD ≥ 10 mmHg (aOR High/Low: 0.854 [95% CI: 0.744, 0.979]). For diastolic IAD, age (aOR: 1.112 [95% CI: 1.015, 1.210]) and pulse rate (aOR: 1.021 [95% CI: 1.015, 1.027]) significantly increased the odds of diastolic IAD ≥ 10 mmHg. Moreover, high socioeconomic status decreased the odds of diastolic IAD ≥ 10 mmHg (aOR High/Low: 0.820 [95% CI: 0.698, 0.963]).

CONCLUSION

The noticeable prevalence of systolic and diastolic IAD in general population exhibits health implications due to its' association with the risk of cardiovascular events. Sociodemographic and medical history assessments have potentials to be incorporated in IAD risk stratification and preventing programs.

Effects of L-Carnitine and Coenzyme Q10 Supplementation on Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Randomized, Controlled, Clinical Trial

The prevalence of benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS) increases with age. Considering that BPH drug treatment is associated with complications, this study aimed to investigate the effects of L-carnitine (LC) and Coenzyme Q10 (CoQ10) supplementation as an adjunct therapy to finasteride in the management of LUTS in older men affected with BPH. Fifty eligible volunteers (25 per group) were randomly assigned to either intervention (finasteride + LC and CoQ10 supplements) or control (finasteride + placebo) groups. International prostate symptom score (IPSS), international index of erectile function (IIEF), quality of life index (QoL), as well as serum levels of Prostate-specific antigen (PSA), were assessed. Prostate ultrasound evaluation was also performed, before and after 8 wk of intervention. Supplementation with LC and CoQ10 led to a significant decrease in prostate volume (p < 0.001) as well as a significant increase in IIEF (p < 0.001), compared to the control group. However, there were no significant between-group differences in IPSS (p = 0.503), QoL scores (p = 0.339), and PSA levels (p = 0.482). CoQ10 and LC supplements might be beneficial in combination with standard therapies in the management of BPH and its related complications.

The effect of spirulina sauce on glycemic index, lipid profile, and oxidative stress in type 2 diabetic patients: A randomized double-blind clinical trial

We aimed to evaluate the effect of spirulina sauce on glycemic indices, lipid profile, oxidative stress markers, and anthropometric measurement in type 2 diabetic patients. Forty patients were randomly assigned to receive 20 g/day spirulina sauce (containing 2 g of spirulina) or placebo for 2 months. Anthropometric and biochemical indices were measured at the beginning and end of the intervention. Fasting blood glucose (mean difference (MD): -15.3 mg/dL, 95% confidence (CI): -44.2 to 13.60, p = .26), HbA1c (MD: 0.13%, 95% CI: -0.83 to 0.57, p = .75), insulin (MD: -1.46 μIU/mL, 95% CI: -4.0 to 1.09, p = .28), and HOMA-IR (MD: -0.35, 95% CI: -2.0 to 1.32, p = .68) did not change significantly between groups. QUICKI increased significantly (MD: 0.025, 95% CI: 0.006 to 0.045, p = .03). Among the lipid profile, triglyceride (TG) (MD: -68.6 mg/dL, 95% CI: -107.21 to -29.98, p < .001), total cholesterol (MD: -29.55 mg/dL, 95% CI: -55.28 to -3.81, p = .02), and LDL (MD: -17.7 mg/dL, 95% CI: -33.24 to -2.15, p = .01) were significantly decreased in the spirulina group compared to the control; whereas, the change in HDL was non-significant. No significant change was observed in body composition and anthropometric measurements, except waist circumference, which was reduced (MD: -2.65 cm, 95% CI: -3.91 to -1.38, p = .001). Hunger index significantly decreased and fullness increased marginally significantly. Although malondialdehyde was significantly reduced, no change was observed in total antioxidant capacity (TAC). Spirulina sauce was not effective for glycemic control in type 2 diabetes; however, could be useful for controlling appetite and ameliorating lipid profile.

The effect of celery (Apium graveolens) powder on cardiometabolic factors in overweight/obese individuals with type 2 diabetes mellitus: A pilot randomized, double-blinded, placebo-controlled clinical trial

Celery (Apium graveolens) was shown to have beneficial effects on cardiometabolic factors in animal models. As the progression of type 2 diabetes mellitus (T2DM) adversely affects cardiometabolic factors, we aimed to assess the effects of celery powder on glycemic and anthropometric indices, lipid profile, liver function, oxidative stress, and blood pressure of individuals with T2DM. In a pilot randomized, double-blinded, placebo-controlled clinical trial, 50 eligible adults with T2DM were randomly divided into two groups of intervention and control to consume either 750 mg of celery powder (obtained from fresh celery) or placebo along with a low-calorie diet for 12 weeks, respectively. Dietary intake, physical activity, and cardiometabolic factors were assessed before and at the end of the study. Thirty-six patients finished the study (18 in each group). Consumption of celery powder significantly reduced body fat percentage (p = .021). Between-group analysis for changes in cardiometabolic factors did not show significant differences. Although malondialdehyde was reduced in the intervention group and increased in the control group, between-group changes were not significant. Although the insulin-level change was statistically insignificant, a clinical improvement was observed in the intervention group. A 750-mg daily supplementation of celery powder for 12 weeks did not improve the cardiometabolic factors of patients with T2DM. Further studies are suggested.

Predictive value of triglycerides to high-density lipoprotein cholesterol and triglyceride glycemic index for diabetes incidence in pre-diabetes patients: a prospective cohort study

BACKGROUND

The triglyceride glucose (TyG) and triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-c) are the indices that can predict the progression of pre-diabetes to type 2 diabetes mellitus (T2DM). This study aimed to examine the relationship between TyG and TG/HDL-c indices with the incidence of T2DM in pre-diabetes patients.

METHODS

A total of 758 pre-diabetic patients aged 35-70 years who were enrolled in a prospective Fasa Persian Adult Cohort were followed up for 60 months. TyG and TG/HDL-C indices were obtained at baseline data and divided into quartiles. The 5-year cumulative incidence of T2DM was analyzed by Cox proportional hazards regression analysis while controlling for baseline covariates.

RESULTS

During 5 years of follow-up, there were 95 incident cases of T2DM, with an overall incidence rate of 12.53%. After adjusting for age, sex, smoking, marital status, socioeconomic status, body mass index, waist circumference, hip circumference, hypertension, total cholesterol, and dyslipidemia, the multivariate-adjusted hazard ratios (HRs) demonstrated that patients with the highest TyG and TG/HDL-C indices quartile were at higher risk of T2DM (HR = 4.42, 95%CI 1.75-11.21) and (HR = 2.15, 95%CI 1.04-4.47), respectively, compared to participants in the lowest quartile. As the quantiles of these indices increase, the HR value shows a significant increment (P < 0.05).

CONCLUSION

The results of our study showed that the TyG and TG/HDL-C indices can be important independent predictors for the progression of pre-diabetes to T2DM. Therefore, controlling the components of these indicators in pre-diabetes patients can prevent developing T2DM or delay its occurrence.

Milk kefir drink may not reduce depression in patients with non-alcoholic fatty liver disease: secondary outcome analysis of a randomized, single-blinded, controlled clinical trial

BACKGROUND

Depression is prevalent among individuals with non-alcoholic fatty liver disease (NAFLD) and can cause poor health outcomes. Moreover, a solid bilateral association between NAFLD and depression has been shown, which may alleviate by kefir consumption. Thus, we aimed to investigate the effect of milk kefir drinks on the depression status of individuals with NAFLD.

METHODS

In a secondary outcome analysis of a randomized, single-blinded, controlled clinical trial, 80 adults with grades 1 to 3 of NAFLD were included in an 8-week intervention. Participants were randomly assigned to Diet or Diet + kefir groups to either follow a low-calorie diet or a low-calorie diet along with a 500 cc milk kefir drink daily. The participants' demographic, anthropometric, dietary, and physical data were recorded before and after the study. Depression status was assessed using the Persian format of the second version of the Beck Depression Inventory (BDI-II-Persian) at the baseline and after 8 weeks of intervention.

RESULTS

Overall, 80 participants aged 42.87 ± 10.67 years were included in the analysis. The data on the baseline demographic, dietary, and physical activity of the groups were not significantly different. During the study, participants in Diet + Kefir group had a significantly decreased energy (P = 0.02), carbohydrate (P = 0.4), and fat consumption (P = 0.4). However, during the study, the depression score was not significantly reduced in the Diet group, the Diet + Kefir group showed a significant reduction in depression (P = 0.02). However, between-group analyses for changes in depression were not significant (P = 0.59).

CONCLUSION

Consumption of milk kefir drink for 8 weeks may not reduce depression symptoms in adults with NAFLD.

TRIAL REGISTRATION

The trial was registered at IRCT.ir as IRCT20170916036204N6 (August 2018).

Food insecurity status and its contributing factors in slums' dwellers of southwest Iran, 2021: a cross-sectional study

BACKGROUND

One major factor causing food insecurity is believed to be poverty. Approximately 20 million Iranians live in slums with a vulnerable socioeconomic context. The outbreak of COVID-19, on top of the economic sanctions against Iran, has increased this vulnerability and made its inhabitants prone to food insecurity. The current study investigates food insecurity and its associated socioeconomic factors among slum residents of Shiraz, southwest Iran.

METHODS

Random cluster sampling was used to select the participants in this cross-sectional study. The heads of the households completed the validated Household Food Insecurity Access Scale questionnaire to assess food insecurity. Univariate analysis was utilized to calculate the unadjusted associations between the study variables. Moreover, a multiple logistic regression model was employed to determine the adjusted association of each independent variable with the food insecurity risk.

RESULTS

Among the 1227 households, the prevalence of food insecurity was 87.20%, with 53.87% experiencing moderate and 33.33% experiencing severe food insecurity. A significant relationship was observed between socioeconomic status and food insecurity, indicating that people with low socioeconomic status are more prone to food insecurity (P < 0.001).

CONCLUSIONS

The current study revealed that food insecurity is highly prevalent in slum areas of southwest Iran. The socioeconomic status of households was the most important determinant of food insecurity among them. Noticeably, the coincidence of the COVID-19 pandemic with the economic crisis in Iran has amplified the poverty and food insecurity cycle. Hence, the government should consider equity-based interventions to reduce poverty and its related outcomes on food security. Furthermore, NGOs, charities, and governmental organizations should focus on local community-oriented programs to make basic food baskets available for the most vulnerable households.

Effects of Nutrition Education via a Mobile-Based Game on Nutritional Knowledge, Dietary Habits and Anthropometric Indices in Preschool Children: a study protocol

Preschool age is a great time to learn a healthy lifestyle, for behavior therapy. Mobile health procedures are inexpensive, reliable, and accessible. This project has two phases. The KidFood mobile game and two nutrition knowledge questionnaires were designed during the first phase. In the second phase, a six-month, parallel, blinded, randomized controlled trial will perform on 120 Iranian children aged 5 to 6 years. Before and after nutritional education via KidFood, the dietary habits, the nutritional knowledge of parents and children, and the anthropometric indices of children will be evaluated.

Structural equation modeling of direct and indirect associations of social media addiction with eating behavior in adolescents and young adults

Social media (SM) exerts important effects on health-related behaviors such as eating behaviors (EB). The present study was designed to determine the direct and indirect association of SM addiction with EB in adolescents and young adults through body image (BI). In this cross-sectional study, 12-22 years old adolescents and young adults, with no history of mental disorders or psychiatric medications usage were studied through an online questionnaire shared via SM platforms. Data were gathered about SM addiction, BI, and EB in its sub-scales. A single approach and multi-group path analyses were performed to find possible direct and indirect associations of SM addiction with EB through BI concerns. Overall, 970 subjects, 55.8% boys, were included in the analysis. Both multi-group (β = 0.484, SE = 0.025, P < 0.001) and fully-adjusted (β = 0.460, SE = 0.026, P < 0.001) path analyses showed higher SM addiction is related to disordered BI. Furthermore, the multi-group analysis showed one unit increment in SM addiction score was associated with 0.170 units higher scores for emotional eating (SE = 0.032, P < 0.001), 0.237 for external stimuli (SE = 0.032, P < 0.001), and 0.122 for restrained eating (SE = 0.031, P < 0.001). The present study revealed that SM addiction is associated with EB both directly and also indirectly through deteriorating BI in adolescents and young adults.

Effects of Selenium Supplementation on Incidence and Severity of Preeclampsia: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial

Background: Preeclampsia is a serious hypertensive condition of pregnancy associated with high maternal and fetal morbidity and mortality. In this study, the effect of selenium supplementation on the incidence and severity of preeclampsia in pregnant women was evaluated. Methods: The present double-blind, placebo-controlled, parallel study was registered at Fatemieh Hospital of Hamadan, Iran. One hundred eighty women in the first trimesters of pregnancy were assigned to either selenium (SG, n = 90) or placebo (PG, n = 90) groups. SG and PG received 100 μg of selenium supplement or placebo per day, respectively. Results: In this study, no significant difference was observed between two groups in terms of age, body mass index, and serum selenium before the intervention (P > 0.05). The incidence of preeclampsia in the SG and PG was 9 and 5, respectively (P = 0.28). There was no statistically significant difference between sex and Apgar score of neonates in the two groups (P = 0.73). The mean birth weight, systolic and diastolic blood pressure in the SG was significantly higher than PG (P = 0.003, 0.01, and 0.007, respectively). The mean gestational age in the SG was insignificantly lower than the PG (P = 0.41). After the study, preeclampsia incidence was not significant between the groups (P = 0.28). Conclusion: The administration of 100 μg of selenium supplementation in pregnant women, had no effect on decreasing preeclampsia, but it may reduce the severity of preeclampsia.

Effect of serum lipid profile on the risk of breast cancer: systematic review and meta-analysis of 1,717,054 women

Background

Dyslipidemia has been linked to breast cancer incidence. However, conflicting results exist regarding the associations between lipid components and breast cancer development.

Purpose

The aim of the present meta-analysis was to further investigate the relationships between serum lipid profile and the risk of breast cancer.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to conduct the present systematic review and meta-analysis. Databases such as the PubMed, EMBASE, and Web of Sciences, were searched up to the end of January 2021, using certain MeSH and non-MeSH keywords and their combination to extract related published articles.

Results

Twenty-six prospective studies met the inclusion criteria involving 1,717,054 women, of whom 36,590 were diagnosed with breast cancer during the follow-up. A negative and significant association was found between HDL-C levels and the risk of breast cancer [relative risk (RR): 0.85, 95% CI: 0.72–0.99, I2: 67.6%, p=0.04) (Figure). In contrast, TG (RR: 1.02, 95% CI: 0.91–1.13, I2: 54.2%, p=0.79), total cholesterol (TC) (RR: 0.98, 95% CI: 0.90–1.06, I2: 67.2%, p=0.57), apolipoprotein A (ApoA) (RR: 0.96, 95% CI: 0.70–1.30, I2: 83.5%, p=0.78) and LDL-C (RR: 0.93, 95% CI: 0.79–1.09, I2: 0%, p=0.386) were not associated with breast cancer development. In studies adjusting for hormone use and physical activity, TC was positively correlated to breast cancer risk (RR: 1.05, 95% CI: 1.01–1.10 and 1.05, 95% CI: 1.01–1.10, respectively), as was TG in studies adjusting for baseline lipids (RR: 0.92, 95% CI: 0.85–0.99) and race (RR: 1.80, 95% CI: 1.22–2.65).

Conclusions

In the present meta-analysis, HDL-C was inversely related to breast cancer risk. In contrast, no significant associations were found for TC (except after adjusting for hormone use and physical activity), TG (except after adjusting for baseline lipids and race), LDL-C and ApoA. Overall, data on the links between lipids and breast cancer are conflicting. However, there is increasing evidence supporting that low HDL-C is related to an increased risk for this malignancy. Further research is needed to establish the associations between different lipid components and breast cancer risk in certain populations.

Funding Acknowledgement

Type of funding sources: None.

Socioeconomic determinants of nutritional behaviors of households in Fars Province, Iran, 2018

Introduction

Households' dietary habits are affected by their environment and socioeconomic status (SES). This study aims to investigate eating behaviors and determine the factors affecting nutritional status in households in Fars Province in 2018.

Method

In this cross-sectional study, urban and rural households were selected using the multistage sampling method. A questionnaire was employed to interview the mother or householder to record the demographic, SES, and dietary habits of the family for major food items commonly used. A logistic regression model was used to analyze the data. The p-value less than 0.05 was considered significant.

Results

In total, 6,429 households participated in the study. The majority of households use traditional flatbread, low-fat milk, and liquid/cooking oil. Frying was the most prevalent method of cooking. Parents' level of education and SES were associated with type of consumed bread, milk and dairy, methods of food preparation, adding salt at the table, eating out, and fast-food usage. Parents' higher level of education was significantly associated with salt storage in optimal conditions and not using salt before tasting the meal.

Conclusion

Most of the households had healthy practices, especially in consumption of certain oils and methods of preparing their food as well as keeping salt in an optimal condition and using iodized salt. The most important unhealthy nutritional behavior was high consumption of fast food and outdoor food, especially in urban regions. Unhealthy dietary habits were more prevalent in households with low household and regional SES. Both households and regions with higher SES had better dietary habits.

Comparison of nutritional supplements for glycemic control in type 2 diabetes: A systematic review and network meta-analysis of randomized trials

AIMS

Direct and indirect evidence were combined in this systematic-review and network meta-analysis (NMA) to assess and compare the effect of nutritional supplements on glycemic control, and rank the supplements accordingly.

METHODS

PubMed, Scopus, and Web of Science were searched up to April 2021. We included randomized controlled trials that investigated the effect of vitamins D, C, and E, magnesium, zinc, calcium, selenium, and omega-3 on at least one glycemic marker, including glycated hemoglobin (HbA1c), fasting blood sugar (FBS), homeostasis model assessment-estimated insulin resistance (HOMA-IR), HOMA-B, and insulin, in adults with type 2 diabetes. To estimate effectiveness of supplements, a random-effects NMA in the Bayesian framework was applied. To assess risk of bias, Cochrane Collaboration Tool was used.

RESULTS

Analysis of 178 studies indicated that zinc, vitamin D, omega-3, vitamin C, and vitamin E were effective in reducing HbA1c with low certainty. For reduction of FBS, zinc, vitamin D, and vitamin C, and for HOMA-IR, vitamin D were effective with low certainty. None of the supplements were effective in the reduction of insulin and HOMA-B with low certainty. After excluding poor-quality studies, only vitamin D was significantly effective in reducing all of the markers. Consistently, when the analysis was restricted to studies with a duration of ≥12-weeks, vitamin D reduced HbA1c, FBS, and HOMA-IR.

CONCLUSIONS

Vitamin D supplementation was more effective compared to other supplements in improving HbA1c, FBS, and HOMA-IR, albeit with low certainty of evidence. This result was confirmed by low-risk of bias studies.

REGISTRATION

CRD42021240691.

Does lower quality of life and daily living activity increase nutritional risk of elderly residing in care home facilities?

INTRODUCTION

Aging is a predictable phenomenon that its prevalence is increasing dramatically in the world. There is an association between quality of life, functional independence, and nutritional risk in elderlies, so the aim of the current study is the evaluation of the quality of life and functional independence's effects on nutritional status.

METHODS

A total of 160 elderly people that had a hospitalization for at least 6 months in the care home facilities were selected from 2 care home facility centers to participate in the study. Quantitative and qualitative data were gathered using questionnaires for demographic characteristics, health data, eating habits, quality of life (WHOQOL-BREF), functional assessment (Barthel Index), and mini-nutrition assessment (MNA) throughout the face-to-face interview.

RESULTS

The overall quality of life score, age, weight, and BMI differed significantly between malnourished and well-nourished subjects. Also, the daily living activity score of subjects who were well-nourished was higher than malnourished participants. Higher daily living activity decreased the risk of being malnourished (OR _{malnutrition/well-nourished} = 0.306, P < 0.001). There was also a significant relationship between BMI (OR _{malnutrition/well-nourished} = 0.731, P = 0.001; OR _{at-risk/well-nourished} = 0.786, P = 0.003) and marital status with MNA score (OR _{single/married} = 1.460, P = 0.001 for malnutrition; OR _{single/married} = 1.183, P = 0.004 for being at risk of malnutrition).

CONCLUSIONS

The elderly living in nursing homes are exposed to nutritional risks and mental disorders. So with timely assessment and interventions to improve the quality of life and physical and mental health of elder dwellers, their malnutrition can be prevented.

Effect of whey protein consumption on IL-6 and TNF-α: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Due to inconsistent data about WP supplementation on inflammatory markers, present systematic review and meta-analysis was done to summarize its effect on TNF-α and IL-6.

METHODS

Our search was done in Pubmed, Scopus, Embase, and Cochrane up to June 2021. Weighted mean difference (WMD) and 95% confidence intervals (CI) was used to indicate the effect sizes. Conceivable sources of heterogeneity were detected by subgroup analysis.

RESULTS

Overall, 11 eligible RCTs were included. The pooled results showed that WP supplementation had no significant effect on TNF-α and IL-6 status compare to those receiving carbohydrate and other types of proteins as placebo. Results from subgroup analysis based on health status, study duration, WP dosage and sex, expressed no favorable effect of WP on TNF-α and IL-6 levels.

CONCLUSION

It can be concluded that whey supplementation had no favorable effects on inflammatory biomarkers including TNF- α and IL-6.

Did Iranians change their eating behavior following COVID-19 outbreak?

BACKGROUND

Significant lifestyle changes have been reported after COVID-19 outbreak. The present study aimed at investigating changes in dietary habits in response to the COVID-19 outbreak in an Iranian population sample.

MATERIALS AND METHODS

In this cross-sectional study, the dietary habits of Iranian adults were assessed before and during the COVID-19 outbreak. Consumption of different food groups such as meats, dairy, fruits, vegetables, seeds, and nuts was assessed using a digital questionnaire which was shared on social media platforms. For the statistical analysis, the Wilcoxon signed-rank test was used.

RESULTS

In this online survey, 1553 questionnaires were completed. The results showed that the reported consumption of protein-rich foods increased (P < 0.05), but fish and dairy consumption showed a significant reduction (P = 0.006 and <0.001, respectively). There was a significant reduction in reported fast-food consumption (P < 0.001). Fruits and vegetables (P < 0.001), natural fruit juices (P < 0.001), and water (P < 0.001) were consumed more frequently. Individuals also consumed more vitamin and mineral supplements (P < 0.001) including those containing Vitamin D.

CONCLUSION

During the COVID-19 pandemic, participants reported a significant change in their dietary habits and intake of supplements. Higher intakes of meats, protein-rich foods, fruits, vegetables, and nutritional supplements and lower intakes of fish, dairy, and fast foods were reported.

The Prevalence of Overweight and Obesity in Under One–Year-Old Infants in Yazd, Iran

Background: Exceeded weight during the first 1000 days of life can lead to adulthood obesity and health-related problems. In the present study, we aimed to find the prevalence of overweight and obesity and their related demographic factors in the first year of life in Yazd. Methods: In a cross-sectional study, recorded data of 600 infants were collected from health records of eight health centers of Yazd city using the cluster sampling method. Demographic data and socioeconomic status of the family, breastfeeding duration, and birth order were used. Anthropometrics, including height and weight were interpreted by the categorization developed by WHO as length for age and weight for age. P-value < 0.05 was considered significant. Results: The prevalence of overweight and obesity was estimated at 7.3% and 3.5%, respectively. No significant differences were observed between boys (n = 307) and girls (n = 300) (P = 0.15) for weight, while girls had insignificant lower weight (g) (3028.87 ± 496.30 for girls and 3173.72 ± 456.61 for boys). Among different possible determinants, birth order was associated with body mass index status(P = 0.04). Conclusions: A relatively high prevalence of overweight and obesity was observed among infants under one year of age. Although only the order of birth was observed as a related factor, other controllable factors should be considered and monitored by parents and the healthcare system. Further studies are suggested to investigate the related controllable factors.

Association of Spicy Chilli Food Consumption With Cardiovascular and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies

This systematic review and meta-analysis examined the association between spicy food (chilli pepper, chilli sauce, or chilli oil) consumption with cardiovascular and all-cause mortality. Medline and EMBASE were searched from their inception until February 2020 to identify relevant prospective cohort studies. Hazard ratios (HRs)/relative risk (RRs) were pooled via random-effect meta-analysis. Of the 4387 citations identified, 4 studies (from the United States, China, Italy, and Iran) were included in the meta-analysis. The included studies involved a total of 564 748 adults (aged ≥18 years; 51.2% female) followed over a median duration of 9.7 years. The pooled data suggested that compared with people who did not regularly consume spicy food (none/<1 d/wk), regular consumers of spicy food experienced a 12% (HR/RR_pooled 0.88, 95% CI, 0.86-0.90; I ² = 0%) lower risk of all-cause mortality. Moreover, spicy food consumption was associated with significant reduction in the risk of death from cardiac diseases (HR/RR_pooled 0.82, 0.73-0.91; I ² = 0%), but not from cerebrovascular disorders (HR/RR_pooled 0.79, 0.53-1.17; I ² = 72.2%). In conclusion, available epidemiological studies suggest that the consumption of spicy chilli food is associated with reduced risk of all-cause as well as heart disease-related mortality. Further studies in different populations are needed to confirm this association.

Effects of cashew nut consumption on body composition and glycemic indices: A meta-analysis and systematic review of randomized controlled trials

BACKGROUND AND AIMS

Present meta-analysis and systematic review was conducted to synthesis a definitive conclusion from previous randomized controlled clinical trials (RCTs).

METHODS

A comprehensive search was done up to July 2020, in order to extract RCTs which investigated the effect of cashew nut on weight, body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), insulin, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Weighted mean difference (WMD) and 95% confidence interval (CI) were used to estimate effect size. Meta regression analysis was done to identify probable sources of heterogeneity.

RESULTS

Six clinical trials with 521 participants were included. Combined effect sizes demonstrated no effect of cashew consumption on weight (WMD): 0.02, 95% CI: -1.04, 1.09, P > 0.05), BMI (WMD: 0.1, 95% CI: -0.72, 0.74, P > 0.05), and WC (WMD: -0.13, 95% CI: -1.97, 1.70, P > 0.05). Results were also not significant for FBS (WMD: 3.58, 95% CI: -3.92, 11.08, P > 0.05), insulin (WMD: -0.19, 95% CI: -1.63, 1.25, P > 0.05), and HOMA-IR (WMD: 0.25, 95% CI: -0.55, 1.06, P > 0.05).

CONCLUSION

The sum up, incorporating cashew into the diet has no significant effect on body composition or modifying glycemic indices.

Adherence to Dietary Approaches to Stop Hypertension (DASH)-Style Diet and the Risk of Cancer: A Systematic Review and Meta-Analysis of Cohort Studies

Objective: Several investigators have proposed a protective association between dietary approaches to stop hypertension (DASH) style diet and risk of cancers; however, they have had inconsistent results. The present study aimed to systematically review the prospective cohort studies and if possible quantify the overall effect using meta-analysis. Methods: PubMed, Scopus, and Google Scholar were searched for cohort studies published up to July 2018. Relative risks (RRs) that were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis. The random effects model was used to combine the RRs. Results: Seventeen studies were eligible to be included in the systematic review, from which nine reports assessed the association between the DASH diet and risk of mortality from all cancer types, four assessed incidence of colorectal cancer, and two studies assessed the risk of colon and rectal cancer separately. Four studies examined the association with the incidence of other cancers (breast, hepatic, endometrial, and lung cancer). Meta-analysis showed that high adherence to DASH is associated with a decreased mortality from all cancer types (RR = 0.84, 95% confidence interval [95%CI]: 0.81-0.86). Participants with the highest adherence to the DASH diet had a lower risk of developing colorectal (RR = 0.79, 95%CI: 0.75-0.83), colon (RR = 0.80, 95%CI: 0.74-0.87), and rectal (RR = 0.84, 95%CI: 0.74-0.96) cancers compared to those with the lowest adherence. Conclusion: DASH-style diet should be suggested as a healthy approach associated with decreased risk of cancer in the community. Prospective studies exploring the association for other cancer types and from regions other than the United States are highly recommended.

The relationship between food insecurity with cardiovascular risk markers and metabolic syndrome components in patients with diabetes: A population-based study from Kerman coronary artery disease risk study

Background:

We sought the prevalence of food insecurity and whether cardiovascular risk markers and metabolic syndrome components are significantly different in categories of food insecurity in patients with type 2 diabetes.

Materials and Methods:

In this cross-sectional study, 520 patients with type 2 diabetes from the Kerman coronary artery disease risk study aged between 23 and 87 years (60.8 ± 11.4) who selected by one-stage cluster sampling were assigned into four groups of “food secure” and “mild,” “moderate,” and “severe” food insecure. Household food insecurity was assessed by a 9-item household food insecurity access scale questionnaire.

Results:

The prevalence of food security and mild, moderate, and severe food insecurity in patients with diabetes was 24.4%, 33.1%, 28.9%, and 13.6%, respectively. There was a significant difference among the food-secure/insecure sex groups (P = 0.001). The prevalence of food insecurity and risk factors such as total cholesterol, high low-density lipoprotein cholesterol, and visceral obesity in mild food-insecure females was significantly higher than males (P < 0.001, 0.001, and 0.001, respectively). The fasting blood sugar significantly increased (P = 0.020) in diabetic females with food security than the other female groups. Diastolic blood pressure significantly increased (P = 0.028) in diabetic females with severe food insecurity than the other female groups. The glycosylated hemoglobin significantly increased (P = 0.013) in diabetic males with severe food insecurity than the other male groups. Food insecurity odds ratio in females was 1.74 (95% confidence interval [CI]: 1.10–2.70), 2.39 (95% CI: 1.48–3.88), and 2.73 (95% CI: 1.49–5.01) times higher than in males for mild, moderate, and severe food insecurity, respectively.

Conclusion:

Food insecurity may deteriorate some cardiometabolic biomarkers in type 2 diabetes. Improving food security in patients with diabetes may help reduce cardiovascular disease.