Adherence to the Mediterranean diet can beneficially affect the gut microbiota composition: a systematic review

AIM

Dietary patterns could have a notable role in shaping gut microbiota composition. Evidence confirms the positive impact of the Mediterranean diet (MD), as one of the most studied healthy dietary patterns, on the gut microbiota profile. We conducted this systematic review to investigate the results of observational studies and clinical trials regarding the possible changes in the gut microbiota composition, metabolites, and clinical outcomes following adherence to MD in healthy cases or patients suffering from metabolic disorders.

METHODS

A systematic literature search was conducted on PubMed, Web of Science, and Scopus databases until October 2023. Two researchers separately screened the titles, abstracts, and then full-text of the articles and selected the relevant studies. Quality assessment of observational and interventional studies was performed by Newcastle-Ottawa and Cochrane checklists, respectively.

RESULTS

A total of 1637 articles were obtained during the initial search. Ultimately, 37 articles, including 17 observational and 20 interventional studies, were included in this systematic review. Ten observational and 14 interventional studies reported a correlation between MD adherence and microbiota diversity. Faecalibacterium and Prevotella were the most frequent bacterial genera with increased abundance in both observational and interventional studies; an Increment of Bacteroides genus was also reported in observational studies. Better glycemic control, lowering fat mass, better bowel movement, decreased bloating, inflammation, and hospitalization risk were the reported clinical outcomes.

CONCLUSION

Adherence to the MD is associated with significant beneficial changes in the gut microbiota diversity, composition, and functions and major clinical improvements in most populations.

The association of infant and mother gut microbiomes with development of allergic diseases in children: a systematic review

OBJECTIVE

It is believed that gut microbiota alteration leads to both intestinal and non-intestinal diseases in children. Since infants inherit maternal microbiota during pregnancy and lactation, recent studies suggest that changes in maternal microbiota can cause immune disorders as well. This systematic review was designed to assess the association between the child and mother's gut microbiome and allergy development in childhood.

DATA SOURCES

In this systematic review, international databases including PubMed, Scopus, and ISI/WOS were searched until January 2023 to identify relevant studies.

STUDY SELECTIONS

Observational studies that analyzed infant or maternal stool microbiome and their association with allergy development in children were included in this study. Data extraction and quality assessment of the included studies were independently conducted by two researchers.

RESULTS

Of the 1694 papers evaluated, 21 studies examined neonate gut microbiome by analyzing stool samples and six studies examined maternal gut microbiota. A total of 5319 participants were included in this study. Asthma followed by eczema and dermatitis were the most common allergy disorders among children. Urbanization caused a lack of diversity in the bacterial microbiota as well as lower levels of Bifidobacterium and Lachnospira associated with a higher risk of allergy. In contrast, higher levels of Roseburia and Flavonifractor were associated with lower allergy risk.

CONCLUSIONS

This systematic review shows that gut microbiota may be associated with allergy development. Further studies are required to provide a definitive answer.

Efficacy of probiotic supplements in improving the symptoms of psychosis, anxiety, insomnia, and anorexia due to amphetamine and methamphetamine use: a randomized clinical trial

RATIONALE

Changes in the density and diversity of gut microbiota in chronic use of methamphetamine have been mentioned as contributors to psychotic and anxiety symptoms, sleep problems, and loss of appetite.

OBJECTIVE

In this placebo-controlled clinical trial, we investigated the effect of the probiotic Lactobacillus Acidophilus in improving psychiatric symptoms among hospitalized patients with chronic methamphetamine use along with psychotic symptoms.

METHODS

60 inpatients with a history of more than 3 years of methamphetamine use, were randomly assigned to one of two groups receiving either a probiotic capsule or placebo along with risperidone for 8 weeks based on a simple randomization method. In weeks 0, 4, and 8, patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Simple Appetite Nutritional Questionnaire (SANQ), and Body Mass Index (BMI).

RESULTS

Compared to the control group, patients receiving probiotics had better sleep quality, greater appetite, and higher body mass index (there were significant interaction effects of group and time at Week 8 in these variables (t = -3.32, B = -1.83, p = .001, d = 0.89), (t = 10.50, B = 2.65, p <.001, d = 1.25) and (t = 3.40, B = 0.76, p <.001, d = 0.30), respectively. In terms of the improvement of psychotic and anxiety symptoms, there was no statistically significant difference between the two groups.

CONCLUSIONS

The use of probiotics was associated with improved sleep quality, increased appetite, and increased body mass index in patients with chronic methamphetamine use. Conducting more definitive clinical trials with larger sample sizes and longer-term follow-up of cases is recommended.

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BACKGROUND

Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

METHODS

We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median).

FINDINGS

From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.

INTERPRETATION

The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.

Efficacy of empagliflozin as adjunctive therapy to citalopram in major depressive disorder: a randomized double-blind, placebo-controlled clinical trial

BACKGROUND

Major depressive disorder is one of the most common psychiatric disorders, which is associated with a high disease burden. Current treatments using antidepressants have limitations, so using medication with neuromodulating and anti-inflammatory properties alongside them could be helpful. In a clinical trial, we studied the effectiveness of empagliflozin, a blood sugar-lowering drug, as an adjunctive therapy to reduce the severity of depression symptoms.

METHODS

A number of outpatients with moderate to severe depression (Hamilton Depression Rating Scale (HDRS) > = 17) who were not under related medication or had not taken medication for at least the last two months, had an age range of 18-60 years and had written informed consent to enter the study (N = 90) were randomly divided into two groups receiving placebo or empagliflozin (10 mg daily) combined with citalopram (40 mg daily) based on permuted block randomization method in an 8-week randomized, double-blind, placebo-controlled clinical trial. They were evaluated using the HDRS in weeks 0, 4, and 8.

RESULTS

HDRS scores were equal to 28.42(± 3.83), 20.20(± 3.82), and 13.42(± 3.42) in the placebo group during weeks 0,4, and 8, respectively. These scores were 27.36(± 3.77), 13.76(± 1.40), and 7.00(± 1.13), respectively, for the group treated with empagliflozin. Compared to the control group, patients treated with empagliflozin using repeated-measures ANOVA showed greater improvement in reducing the severity of depression symptoms over time (p value = 0.0001).

CONCLUSIONS

Considering the promising findings in this clinical trial, further study of empagliflozin as adjunctive therapy in MDD with larger sample sizes and longer follow-ups is recommended.

The impact of vegetarian diet on sperm quality, sex hormone levels and fertility: a systematic review and meta-analysis

BACKGROUND

An increasing number of people have adhered to a vegetarian diet for several years. Nowadays, the favourable effect of this dietary pattern on metabolic diseases is well established, but its impact on fertility and reproductive health as a serious health concern is not clear yet. Therefore, we aim to summarise existing evidence regarding the possible association between a vegetarian diet and fertility as measured by key indicators such as sperm quality and sex hormone levels.

METHODS

We systematically searched online databases, including PubMed, ISI, Scopus and Google Scholar, up to 1 December 2022 using relevant keywords. We included observational studies that compared semen quality, sex hormone levels and infertility in people who adhered to a vegetarian diet versus an omnivore diet. Heterogeneity between studies was assessed using I2 and Q tests. Standardised mean differences (SMD) using a random/fixed model were calculated to assess outcomes between vegetarians and omnivores in included articles.

RESULTS

Finally, out of 972 documents that were retrieved, 20 articles met our inclusion criteria, and 16 were eligible for quantitative synthesis. Results of meta-analyses showed that there were no significant differences between vegetarians and omnivores in terms of semen quality parameters, including total sperm count, total and progressive sperm motility, sperm morphology and sperm concentration. Seven studies on female sex hormone profiles were eligible for meta-analysis. The only significant difference was the lower level of plasma oestrone in vegetarians (pooled SMD: -0.56; 95% confidence interval [CI]: -1.08, -0.05; p-value = 0.03) compared to omnivores. Furthermore, our meta-analysis revealed significantly higher sex-hormone-binding globulin levels in vegetarian men than in omnivores (pooled SMD: 0.52; 95% CI: 0.18, 0.86; p-value = 0.002).

CONCLUSION

Despite the numerous health benefits of a vegetarian diet, our review suggested that there were no conclusive positive or negative associations between vegetarian diet and semen quality, sex hormone levels and infertility. Further studies are recommended to better understand vegetarian dietary pattern effect on infertility and reproductive health.

The presence of abnormal septal motion on echocardiography is a predictor of abnormal cardiac magnetic resonance in systemic sclerosis

OBJECTIVES

We aimed to perform a comprehensive analysis of the ECG, two-dimensional echocardiography (2DE) and cardiac MRI (CMR) findings in patients with systemic sclerosis (SSc), and also to investigate correlations between CMR findings and some ECG and echocardiography (ECHO) results.

METHODS

We retrospectively analysed data from patients with SSc who were regularly seen at our outpatient referral centre, all assessed with ECG, Doppler ECHO and CMR.

RESULTS

Ninety-three patients were included; mean (s.d.) age of 48.5 (10.3) years, 86% female, 52% diffuse SSc. Eighty-four (90%) of the patients had sinus rhythm. The most common ECG finding was the left anterior fascicular block, recorded in 26 patients (28%). The abnormal septal motion (ASM) was found in 43 (46%) patients on ECHO. Myocardial involvement (inflammation or fibrosis), as assessed by multiparametric CMR, was present in >50% of our patients. The age- and sex-adjusted model showed that ASM on ECHO increased significantly the odds of increased extracellular volume [odds ratio (OR) 4.43, 95% CI 1.73, 11.38], increased T1 Relaxation time (OR 2.67, 95% CI 1.09, 6.54), increased T2 Relaxation time (OR 2.56, 95% CI 1.05, 6.22), increased signal intensity ratio in T2-weighted imaging (OR 2.56, 95% CI 1.05, 6.22), presence of late gadolinium enhancement (OR 3.85, 95% CI 1.52, 9.76) and mid-wall fibrosis (OR 3.64, 95% CI 1.48, 8.96).

CONCLUSION

This study indicates that the presence of ASM on ECHO is a predictor of abnormal CMR in SSc patients, and a precise assessment of ASM may serve as an important point for selecting the patients that should be evaluated by CMR for early detection of myocardial involvement.

Association between Gut Microbiota Compositions with Microvascular Complications in Individuals with Diabetes: A Systematic Review

BACKGROUND

Diabetes is one of the chronic and very complex diseases that can lead to microvascular complications. Recent evidence demonstrates that dysbiosis of the microbiota composition might result in low-grade, local, and systemic inflammation, which contributes directly to the development of diabetes mellitus and its microvascular consequences.

OBJECTIVE

The aim of this systematic review was to investigate the association between diabetes microvascular complications, including retinopathy, neuropathy, nephropathy, and gut microbiota composition.

METHODS

A systematic search was carried out in PubMed, Scopus, and ISI Web of Science from database inception to March 2023. Screening, data extraction, and quality assessment were performed by two independent authors. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment.

RESULTS

About 19 articles were selected from 590 retrieved articles. Among the included studies, nephropathy has been studied more than other complications of diabetes, showing that the composition of the healthy microbiota is changed, and large quantities of uremic solutes that cause kidney injury are produced by gut microbes. Phyla, including Fusobacteria and Proteobacteria, accounted for the majority of the variation in gut microbiota between Type 2 diabetic patients with and without neuropathy. In cases with retinopathy, an increase in pathogenic and proinflammatory bacteria was observed.

CONCLUSION

Our results revealed that increases in Bacteroidetes, proteobacteria and fusobacteria may be associated with the pathogenesis of diabetic nephropathy, neuropathy, and retinopathy. In view of the detrimental role of intestinal dysbiosis in the development of diabetes-related complications, gut microbiota assessment may be used as a biomarker in the future and interventions that modulate the composition of microbiota in individuals with diabetes can be used to prevent and control these complications.

Efficacy of vitamins B1 and B6 as an adjunctive therapy to lithium in bipolar-I disorder: A double-blind, randomized, placebo-controlled, clinical trial

BACKGROUND

The use of adjunctive therapy for bipolar disorder is increasingly considered to increase the efficacy of standard treatments. In this randomized clinical trial, we evaluated the effect of vitamins B1 and B6 in separate treatment arms on mood symptoms, cognitive status, and sleep quality in hospitalized patients with bipolar disorder in manic episodes.

METHOD

In addition to receiving standard lithium treatment, participants (N = 66) were randomized to one of three conditions: 100 mg of vitamin B1, 40 mg of vitamin B6, or placebo. Outcomes were assessed one and 8 weeks of daily treatment, including the Young Mania Rating Scale (YMRS), Pittsburgh Sleep Quality Scale (PSQI), and Mini-Mental State Examination (MMSE). This study was performed between December 2020 and September 2021 based on the registration code number IRCT20200307046712N1.

RESULTS

Vitamin B6 had a significant effect (P value < 0.025 as significant) on mood improvement compared to placebo (F (1, 27.42) = 30.25, P < 0.001, r = 0.72), but vitamin B1 had no significant effect on mood improvement compared to Placebo (F (1/35.68) = 4.76, P = 0.036, r = 0.34). The contrasts between groups on PSQI showed a significant effect (P value < 0.025 as significant) of vitamin B6 over placebo for sleep status improvement (F (1/32.91) = 16.24, P < 0.001, r = 0.57) and also a significant effect of vitamin B1 over placebo (F (1/41.21) = 13.32, P < 0.001, r = 0.49).

CONCLUSIONS

The use of vitamin B6 as an adjunctive therapy to lithium can be associated with the improvement of mood symptoms in patients with bipolar disorder in the midst of a manic episode.

Dietary fiber intake and all-cause and cause-specific mortality: An updated systematic review and meta-analysis of prospective cohort studies

BACKGROUND

Accumulating evidence supports the effects of dietary fiber on the risk of non-communicable diseases (NCDs). However, there is no updated systematic review and meta-analysis that compares and pools the effect of different types of fiber on mortality.

METHODS

In this systematic review and meta-analysis, all prospective cohort studies that evaluated the relationship between dietary fiber intake and all-cause or cause-specific mortality were included. The PubMed, SCOPUS, and Web of Science databases were searched up to October 2022. Data extraction and quality assessment were performed by two researchers independently. Heterogeneity between studies was assessed using Chi-square based test. Random/fixed effect meta-analysis was used to pool the hazard ratios (HR) or relative risks (RR) and 95 % confidence intervals (CI) for the association between different types of fiber and mortality.

RESULTS

This systematic review included 64 eligible studies, with a total sample size of 3512828 subjects, that investigated the association between dietary fiber intake and mortality from all-cause, cardiovascular disease (CVD), and cancer. Random-effect meta-analysis shows that higher consumption of total dietary fiber, significantly decreased the risk of all-cause mortality, CVD-related mortality, and cancer-related mortality by 23, 26 and 22 % (HR:0.77; 95%CI (0.73,0.82), HR:0.74; 95%CI (0.71,0.77) and HR:0.78; 95%CI (0.68,0.87)), respectively. The consumption of insoluble fiber tended to be more effective than soluble fiber intake in reducing the risk of total mortality and mortality due to CVD and cancer. Additionally, dietary fiber from whole grains, cereals, and vegetables was associated with a reduced risk of all-cause mortality, while dietary fiber from nuts and seeds reduced the risk of CVD-related death by 43 % (HR:0.57; 95 % CI (0.38,0.77)).

CONCLUSION

This comprehensive meta-analysis provides additional evidence supporting the protective association between fiber intake and all-cause and cause-specific mortality rates.

The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials

AIMS

Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment.

RESULTS

In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels.

CONCLUSIONS

IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.

Waist to height ratio as a simple tool for predicting mortality: a systematic review and meta-analysis

BACKGROUND

The association of central obesity with higher rates of mortality is not well studied. This study evaluates the association between waist-to-height ratio (WHtR), as a measure of central obesity, with mortality.

METHODS

Documents were retrieved from PubMed, Web of Science, Scopus, and Google Scholar databases until May 2022. Data were extracted from cohort studies reporting effect size (hazard ratio (HR)) regarding the association between WHtR as a continuous (per 1 SD increment) or categorical (highest/lowest) measure and all-cause and cause-specific mortality. Screening of included studies was performed independently by two authors. Moreover, the quality assessment of included studies was performed based on the Newcastle-Ottawa assessment scale. Finally, random effect meta-analysis was performed to pool the data, and the outcomes' certainty level was assess based on the GRADE criteria.

RESULTS

Of the 815 initial studies, 20 were included in the meta-analysis. Random effect meta-analysis showed that in the general population, the all-cause mortality HRs for categorical and continuous measurements of WHtR increased significantly by 23% (HR:1.23; 95% CI: 1.04-1.41) and 16% (HR:1.16; 95% CI: 1.07-1.25), respectively. Moreover, the hazard of cardiovascular (CVD) mortality increased significantly for categorical and continuous measurements of WHtR by 39% (HR:1.39; 95% CI: 1.18-1.59) and 19% (HR:1.19; 95% CI: 1.07-1.31). The quality assessment score of all included studies was high.

CONCLUSIONS

Higher levels of WHtR, indicating central obesity, were associated with an increased hazard of CVD and all-cause mortality. This measure can be used in the clinical setting as a simple tool for predicting mortality.

Association of dietary phytochemical index with cardiometabolic risk factors

Objective(s): Cardio-metabolic risk factors are becoming a global health concern. To address this problem, one of the proposed ways is to focus on phytochemical-rich foods consumption. Therefore, we aimed to summarize the results of observational studies (cohorts, case-control, and cross-sectional) that investigated the association between dietary phytochemical index (PI) as a new index for evaluating phytochemical-rich food intake and various risk factors of cardio-metabolic disorders. Methods: We conducted a comprehensive systematic review through PubMed, Scopus, and Web of Science databases. The literature search was performed up to August 2021 with no publication year restriction on observational studies investigating the association between PI and cardiometabolic risk factors on adults and children. A random-effect meta-analysis was used. Results: Overall, 16 articles (cross-sectional, case-control, cohort) were eligible for this systematic review and 8 studies with 99771 participants were included in the meta-analysis. Random effect meta-analysis showed that adherence to higher dietary PI decrease the odds of abdominal obesity (OR: 0.73, 95% CI: 0.58, 0.88, I2: 84.90), generalized obesity (OR: 0.84, 95% CI: 0.69, 0.98, I2: 68.10), hypertriglyceridemia (OR: 0.81, 95% CI: 0.73, 0.89, I2: 0.00), hypertension (OR: 0.86, 95% CI: 0.73, 0.99, I2: 7.02), and MetS (OR: 0.79, 95% CI: 0.69, 0.88, I2: 84.90). However, results considering the associations between dietary PI with glycemic indices, and low high-density lipoprotein cholesterol (HDL-C) were not significant (p<0.05). Conclusion: Evidence showed adverse associations between dietary PI and some cardio-metabolic risk factors such as obesity, hypertriglyceridemia, hypertension and metabolic syndrome.

Dietary carbohydrate quality index and cardio-metabolic risk factors

Introduction: Improving the quality of diet is known as one of the practical ways to reduce cardio-metabolic risk factors (CMRFs). The carbohydrate quality index (CQI) is a relatively new index to evaluate diet quality. It is calculated based on the ratio of solid carbohydrates to total carbohydrates, dietary fibre intake, glycemic index and the ratio of whole grains to total grains. This systematic review and meta-analysis was designed to investigate the association between dietary CQI and CMRFs. Methods: In this systematic review, some international databases, including Scopus, PubMed, EMBASE, Web of Science, and Google Scholar up to July 2022, were searched according to appropriate keywords. All observational studies with an English full text assessing the association between the dietary CQI and CMRFs were included. Two researchers independently extracted the data and assessed the quality of the articles with the Newcastle-Ottawa Scale. Random/fixed-effect meta-analysis was used to pool standardized mean difference (SMD) as an effect size. Results: 11 studies with a total of 63962 subjects were found to be eligible and included in the qualitative synthesis; only BMI, WC and metabolic syndrome reached the threshold of 3 reports with the same effect size and thus only 5 were included in the meta-analysis. The main finding of the included studies was that there were inverse associations between CQI and CMRFs, mainly obesity, glucose metabolism indices, and blood pressure. In the five studies included in the random effect meta-analysis, the association between CQI and body mass index (SMD: 0.45, 95%CI: -0.12, 1.01), waist circumference (SMD: -0.09, 95%CI: -0.34, 0.15) and metabolic syndrome (SMD: 0.63, 95%CI: -0.01, 1.28) was not statistically significant. Conclusion: Although the qualitative findings support the positive association of CQI with CMRFs, the evidence is insufficient to conclude robust findings. Further observational and interventional studies are needed to clearly elucidate this association.

Oxidative balance score and risk of cancer: a systematic review and meta-analysis of observational studies

BACKGROUND

The oxidative balance score (OBS) has been utilized to assess the overall pro- and antioxidant exposure status in various chronic diseases. The current meta-analysis was carried out to pool the association between OBS and the risk of cancer.

METHODS

We systematically searched the Web of Science, PubMed, Scopus, Embase, and Google Scholar up to August 2023. All observational studies which evaluated the association of OBS with the risk of cancers were included. There was no time of publication or language restrictions. Heterogeneity between studies was assessed using the Chi-square-based Q-test and the I2. A random-effects model meta-analysis was conducted to estimate the pooled effect sizes. Possible sources of heterogeneity were explored by subgroup and meta-regression analysis.

RESULTS

Totally, 15 studies (9 case-control and 6 cohorts) were eligible for meta-analysis. Random effect model meta-analysis of case-control studies showed that higher OBS significantly decreases the odds of cancers (pooled OR: 0.64, 95% CI: 0.54, 0.74). In the cohort studies, the association of OBS with the risk of cancers was not significant (pooled HR: 0.97, 95% CI: 0.80,1.18). The subgroup analysis showed that cancer type and gender were the potential sources of heterogeneity.

CONCLUSION

Our results show an inverse and significant association between higher OBS and odds of colorectal cancers in case-control and cohort studies. In the case of prostate cancer in cohort studies, our results did not align with the hypothesis. Considering the importance of diet and antioxidant balance in the conditions of malignancy, it is suggested to conduct more comprehensive studies with standard measurement methods to obtain conclusive results.

Does the ketogenic diet improve neurological disorders by influencing gut microbiota? A systematic review

BACKGROUND

The aim of this systematic review is to evaluate the changes in gut microbiota (GM) induced by the Ketogenic Diets (KD) as a potential underlying mechanism in the improvement of neurological diseases.

METHODS

A comprehensive search was conducted on three electronic databases, including PubMed/Medline, Web of Science, and Scopus until December 2022. The inclusion criteria were studies that described any changes in GM after consuming KD in neurological patients. Full text of studies such as clinical trials and cohorts were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale and for the clinical trials using the Cochrane Collaboration tool. The search, screening, and data extraction were performed by two researchers independently.

RESULTS

Thirteen studies examining the effects of the KD on the GM in neurological patients were included. Studies have shown that KD improves clinical outcomes by reducing disease severity and recurrence rates. An increase in Proteobacteria phylum, Escherichia, Bacteroides, Prevotella, Faecalibacterium, Lachnospira, Agaricus, and Mrakia genera and a reduction in Firmicutes, and Actinobacteria phyla, Eubacterium, Cronobacter, Saccharomyces, Claviceps, Akkermansia and Dialister genera were reported after KD. Studies showed a reduction in concentrations of fecal short-chain fatty acids and branched-chain fatty acids and an increase in beta Hydroxybutyrate, trimethylamine N-oxide, and N-acetylserotonin levels after KD.

CONCLUSION

The KD prescribed in neurological patients has effectively altered the GM composition and GM-derived metabolites.

Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6-18 years

BACKGROUND

Waist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide.

METHODS

We used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors.

RESULTS

Based on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA).

CONCLUSIONS

The proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

The Association Between Antioxidants and COVID-19 Outcomes: a Systematic Review on Observational Studies

It is proven that the blood concentration of antioxidants can impress the severity of viral infections, including COVID-19. However, the lack of a comprehensive study accumulating existing data regarding COVID-19 can be perceived. Therefore, this systematic review is aimed to report the association between the blood concentration of several antioxidants and the overall health condition of COVID-19 patients. We summarized the available data surrounding the serum antioxidant level in COVID-19 patients and COVID-19 outcomes. A systematic search was performed in PubMed, Scopus, Web of Science, and Cochrane, and studies that evaluated the association between antioxidants and COVID-19 outcomes were included. Of 4101 articles that were viewed in the database search, 38 articles were included after the title, abstract, and full-text review. Twenty-nine studies indicated that lower serum antioxidants are associated with worse outcomes, and one study reported no association between serum zinc (Zn) level and COVID-19 outcomes. In most cases, antioxidant deficiency was associated with high inflammatory factors, high mortality, acute kidney injury, thrombosis, intensive care unit (ICU) admission, acute respiratory distress syndrome, cardiac injury, and the need for mechanical ventilation (MV), and there was no significant association between serum antioxidants level and ICU or hospital length of stay (LOS). It seems that higher levels of antioxidants in COVID-19 patients may be beneficial to prevent disease progression. However, clinical trials are needed to confirm this conclusion.

Comparison of habitual and meal-specific dietary patterns identified by latent class analysis and confirmatory factor analysis in adults: A cross-sectional study

OBJECTIVE

The aim of this study was to compare characteristics of habitual and meal-specific dietary patterns identified by latent class analysis (LCA) and confirmatory factor analysis (CFA).

METHODS

Participants included 778 adults selected for the present cross-sectional study from local health care centers in Tehran, Iran. Three 24-h dietary recalls evaluated dietary intake. LCA was used to group study participants into exclusive subgroups of individuals with similar patterns of dietary intake. CFA was applied to identify patterns of habitual and meal-specific dietary intake. Analysis of variance was used to compare the average scores of habitual and meal-specific CFA-derived dietary patterns across classes identified by LCA.

RESULTS

Using habitual dietary intake, CFA grouped correlated food items into three major factors: fruits and vegetables, mixed, and Western dietary patterns. LCA grouped study participants with similar patterns of habitual intake into four subgroups of individuals: fruits and vegetables, mixed, Western, and low consumer classes. LCA-fruits and vegetables, LCA-Western, and LCA-mixed classes had, respectively, higher mean scores of CFA-fruits and vegetables, CFA-Western, and CFA-mixed dietary patterns compared with other classes (P < 0.001). Similar findings were observed for meal-specific dietary intake, where classes identified by LCA had the highest mean scores of their corresponding dietary pattern identified by CFA.

CONCLUSION

Habitual and meal-specific classes identified by LCA were well characterized by the dietary patterns derived by CFA, suggesting that LCA may be an appropriate statistical approach to classify study participants with similar patterns of intake into exclusive subgroups of individuals.

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.

Association between childhood obesity and infertility in later life: a systematic review of cohort studies

BACKGROUND

The global prevalence of childhood obesity has exhibited a troubling surge in recent years. Due to the raised questions regarding its potential correlation with infertility in adulthood, this systematic review has been undertaken to explore the relationships between childhood obesity, and infertility later in life.

METHODS

A comprehensive search was performed in three international databases (PubMed, Web of Science, and Scopus). All cohort (retrospective or prospective), case-cohort, and nested case-control studies until April 2022 which assessed the association of obesity in children and adolescents with male and female infertility indicators in later life were included. The quality of the included studies was assessed by Newcastle-Ottawa quality assessment checklists.

RESULT

Out of the initial 32,501 documents, eleven eligible studies with a total sample size of 498,980 participants were included. Five studies focused on the number of offspring and indicated that obesity, especially in adolescence had an association with later life lower number of children, nulliparity, and childlessness in both men and women. Concerning conceiving problems, two studies showed that obesity before age 12 increased the risk of female fertility problems in the future. Two studies reported that obesity in early life raised the risk of impaired female reproductive system such as menstrual or ovulatory problems. As well as females, a study discovered that obesity in men during their 20s was linked to an elevated risk of low sperm motility and poor sperm morphology. Another study has reported men with higher pre-pubertal BMI had lower sex hormone-binding globulin; however, the same association was not seen between childhood BMI and semen quality.

CONCLUSION

The evidence suggests a positive association between childhood obesity with infertility indicators in later life. Childhood weight reduction strategies are suggested to be implemented in societies in order to reduce infertility rates in later life.

Suicidal ideation, burnout, and their correlation among health care workers at the end of the fourth wave of the COVID-19 pandemic in Alborz Province, Iran

Background

During the COVID-19 pandemic, Health Care Workers (HCWs) were more vulnerable than ever to Burnout and Suicidal thoughts due to stressful work conditions. This study, investigated the level of Burnout and Suicidal thoughts among HCWs during the fourth wave of the pandemic in Alborz Province in Iran and compared it with the conditions at the beginning of the pandemic.

Methods

A total of 305 HCWs from 3 referral hospitals for COVID-19, including 155 men and 150 women, participated in the study. A cross-sectional study was carried out with a sample of HCWs dealing with COVID-19 patients using the available sampling method. The results of this online survey, which was conducted from June 7 to July 5, 2021 (at the end of the Fourth Wave of the COVID-19 Pandemic in Iran), have been compared with the conditions of the First Wave of the Pandemic (from February 24 to April 27, 2020). The participants were evaluated by the Beck Scale for Suicidal Ideations (BSSI) and Maslach Burnout Inventory (MBI).

Results

The mean age of the participants was 36.34 ± 7.37. The means of Suicide Index (SI), Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scores were 0.76 ± 1.74, 19.94 ± 4.69, 4.92 ± 1.51, and 31.30 ± 5.88, respectively. SI and PA were significantly higher in workers other than nurses and physicians and EE was higher among workers with night shifts (p value<0.05 in all indices). Age had a significant and negative correlation with EE (p value<0.01) and DP (p value<0.05) and a significant and positive correlation with PA (p value<0.01).

Conclusion

This study showed a high level of SI and Burnout indices among HCWs in the fourth wave of the pandemic in Iran. Paying attention to the factors affecting the development of social capital and creating health policy changes may be effective in reducing Burnout indices and high Suicide index among HCWs.

Meta-analysis of the anti-oxidative and anti-inflammatory effects of hypoglycaemic plant-derived medicines

BACKGROUND

The pivotal role of oxidative stress and inflammation in the pathophysiology of type 2 diabetes mellitus (T2DM) has been firmly established. However, the evidence concerning hypoglycaemic medicinal plants' antioxidant and anti-inflammatory effects remains inconclusive due to inconsistencies in prior studies. To address this gap, our study aims to perform a comprehensive systematic review and meta-analysis of randomized controlled trials (RCTs) to consolidate previous research findings in this field.

METHODS

We conducted a comprehensive search in the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases to identify relevant English randomized controlled trials (RCTs). Our study adhered to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. All eligible studies that evaluated concurrently the antioxidative and anti-inflammatory effects of hypoglycaemic plant-derived supplements on type 2 diabetes mellitus (T2DM) were included in the meta-analysis. The meta-analysis itself was carried out using both fixed and random effects models to synthesize the findings from the selected studies.

RESULTS

Our study included 47 trials with a total of 2636 participants, both male and female, aged between 20 and 79 years, diagnosed with prediabetes, type 2 diabetes mellitus (T2DM), or metabolic syndrome. The meta-analysis revealed that plant-derived treatments, compared to placebos or other medicines, significantly improved oxidative stress (SMD = - 0.36, 95% CI - 0.64 to - 0.09), inflammation (SMD = - 0.47, 95% CI - 0.63 to - 0.31), total antioxidant capacity (SMD = 0.46, 95% CI 0.16-0.75), and antioxidant enzyme activity (SMD = 1.80, 95% CI 1.26-2.33). The meta-regression analysis showed that treatment duration exceeding 8 weeks significantly impacted the heterogeneity of the oxidative stress data.

CONCLUSIONS

Several hypoglycaemic plant-based treatments appear to positively affect T2DM patients by concurrently lowering oxidative stress and inflammatory indicators and boosting antioxidant enzyme activity.

CLINICAL TRAIL REGISTRY

PROSPERO ID: CRD42021226147.

The effects of probiotics on gastrointestinal symptoms and microbiota in patients with celiac disease: a systematic review and meta-analysis on clinical trials

Gluten-free diet (GFD) is the most effective method to manage celiac disease (CD). Many patients do not reach the complete symptom alleviation, even by strict GFD. Recent studies have reported inconsistent results regarding the beneficial benefits of taking probiotics. Therefore, we aimed to evaluate the effects of probiotics on gastrointestinal (GI) symptoms and the possible underlying causes in CD and celiac disease autoimmunity (CDA) patients. Databases, including PubMed, Scopus, Embase, Web of Science and Google Scholar, were searched for clinical trials published until July 2022 about assessing the effects of probiotics or synbiotics on CD or CDA patients. We collected data on GI symptoms, CD markers, inflammatory and immune responses, adverse events, and gut microbiota. A random effect meta-analysis was used to estimate the pooled standardized mean difference (SMD) and confidence interval (CI). We screened 7234 articles, of which 14 were included in the qualitative analysis and 5 in the quantitative analysis. Probiotics might alleviate GI symptoms, especially in the highly symptomatic patients, and improve immune response in CD and CDA patients. Results of the meta-analysis showed that probiotics increased the abundance of Bifidobacterium (SMD: 0.72, 95%CI (0.13, 1.30) and Lactobacillus (SMD: 0.49, 95%CI (0.18, 0.80) as compared with placebo. Probiotics did not increase the adverse events compared to the placebo. Probiotics might alleviate GI symptoms and immune response and improve dysbiosis in CD and CDA patients. However, high-quality clinical trials are needed to increase the level of evidence. Also, the most suitable combination of probiotics is yet to find.

Junk food consumption and psychological distress in children and adolescents: a systematic review and meta-analysis

Background: Available evidence indicates that junk foods, defined as unhealthy foods with high-calorie and low-nutrient value, negatively affect mental and metabolic health of children. This study aimed to conduct a meta-analysis to clarify the association between junk food consumption and psychological distress in children and adolescents.Methods: A systematic literature search of relevant documents published in PubMed, Web of Science, and SCOPUS was conducted up to 2022. All observation studies which assessed association of junk foods and psychological distress in children and adolescents were included. Random-effect model was used to pool odds ratio (OR) and 95% confidence interval (CI) from individual studies. Subgroup meta-analysis was performed based on junk foods categories (sweet drinks, sweet snacks and snacks).Results: Data of 17 included articles on junk foods consumption in relation to depression, stress, anxiety, sleep dissatisfaction and happiness in children and adolescents were included in this systematic review. According to random effect model, the pooled OR in the highest vs. the lowest category of junk foods was 1.62 (95% CI: 1.35-1.95) for depression, 1.34 (95% CI: 1.16-1.54) for stress, 1.24 (95% CI: 1.03-1.50) for anxiety, 1.17 (95% CI: 1.05-1.30) for sleep dissatisfaction and 0.83 (95% CI: 0.75-0.92) for happiness. In subgroup meta-analysis, there were significant associations between different types of junk foods and psychological distress (P < 0.05).Conclusion: This meta-analysis showed that junk foods consumption was associated with increased odds of psychological distress in children and adolescents. These findings support the current recommendation of decreasing junk foods intake.

The effect of psychological interventions targeting overweight and obesity in school-aged children: a systematic review and meta-analysis

BACKGROUND

Multi-component psychological interventions may mitigate overweight and obesity in children and adolescents. Evidence is, however, scattered on the effectiveness of such interventions. This study aims to review the available evidence on the effectiveness of multi-component psychological interventions on anthropometric measures of school-aged children with overweight or obesity.

METHODS

We systematically searched international databases/search engines including PubMed and NLM Gateway (for MEDLINE), Web of Science, SCOPUS, and Google Scholar up to November 2022 for relevant articles pertaining to psychological weight-loss interventions targeting school-aged children. Two reviewers screened and extracted pertinent data. The quality of included studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. Random effect meta-analysis was used to calculate, and pool standardized mean differences (SMD). We distinguished between intervention and maintenance effects. Intervention effects were defined as the mean change in outcome measurement detected between baseline and post-treatment. Maintenance effects were defined as the mean change in outcome measurement between post-treatment and last follow-up.

RESULTS

Of 3,196 studies initially identified, 54 and 30 studies were included in the qualitative and quantitative syntheses, respectively. Most studies reported on group-based interventions. The significant effects of intervention on BMI z-score (SMD -0.66, 95% CI: -1.15, -0.17) and WC (SMD -0.53, 95% CI: -1.03, -0.04) were observed for interventions that centered on motivational interviewing and cognitive behavioral therapy, respectively. Mean BMI and WC did not differ significantly between post-treatment and last follow-up measurement (maintenance effect), indicating that an initial weight loss obtained through the intervention period could be maintained over time.

CONCLUSIONS

Findings indicate that motivational interviewing and cognitive behavioral therapy as interventions to reduce BMI z-score (generalized obesity) and waist circumference (abdominal obesity) are effective and durable. However, detailed analyses on individual components of the interventions are recommended in future effectiveness studies.

Neurological Involvements in COVID-19: A hospital-based study

Objectives

The SARS-CoV-2 pandemic is the most challenging crisis in the contemporary world. Besides severe pulmonary involvement, the disease also has several extrapulmonary manifestations, and new signs and symptoms are associated with it every dayThe present study aimed to inquire about the frequency of neurological manifestations and risk factors of COVID-19.

Materials & Methods

This retrospective, descriptive study included patients with neurological involvement admitted to the Alborz University of Medical Sciences academic hospitals from March 2020 to July 2020 with confirmed COVID-19 infection. The data included in the analysis were the patient's demographic information, underlying diseases, neurological manifestations, and laboratory findings.

Results

The study included ninety-five patients with a mean age of fifty-nine. Neurological symptoms and signs were observed in 91.6% and 10.5% of the patients, respectively. The most frequently associated neurological symptoms of COVID-19 were fatigue (49.5%), headache (47.4%), and dizziness (45.3%). Furthermore, the most common neurological involvements included gait disorders (6.3%), cerebellar dysfunction (4.2%), and cerebrovascular accidents (3.15%). Positive troponin was shown to be the strongest predictor of neurological signs (OR=21, P=0.017), followed by WBC≥15,000 (OR = 20.75, P=0.018) and a history of respiratory disease (OR=7.42, P=0.007).

Conclusion

Neurological symptoms were observed in more than 91% of the patients, while neurological signs were present in 10.5% of the COVID-19 patients. Additionally, positive troponin, WBC≥15,000, and a history of respiratory disease were the strongest predictors of neurological signs.

Herbal medicines in the treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD): An updated systematic review of clinical trials

Objective

This study was performed to provide an updated systematic review of herbal medicines and phytochemicals used for treatment of the pediatric patients with attention- deficit/hyperactivity disorder (ADHD).

Materials and Methods

International electronic databases, including Scopus, PubMed, ScienceDirect, and Google Scholar were investigated from 1st January 2000 to late October 2021. Interventional studies published in English language, including randomized controlled trials (RCTs) or open-label clinical studies, which evaluated the effect of herbal medicines and phytochemicals on pediatric ADHD were included in this review.

Results

Fifteen studies met the inclusion criteria. Several pieces of evidence support the efficacy of Ginkgo biloba L. and Pycnogenol; mainly inconclusive evidence could be found for Valeriana officinalis L., Melissa officinalis L., and ginseng. The results showed that while Hypericum perforatum L. was ineffective for ADHD, Passiflora incarnata L., Crocus sativus L, and Prunus dulcis (Mill.) D.A.Webb had similar efficacy compared to methylphenidate (MPH).

Conclusion

A number of herbal medicines appear to be relatively safe and provide potential efficacy in amelioration of ADHD. However, due to lack of adequate reports of RCTs, no definitely specific recommendations could been made so far.

Evaluation of the frequency of attention deficit hyperactivity disorder in patients with asthma

BACKGROUND

Asthma is the most prevalent respiratory disease caused by chronic airway inflammation. Attention Deficit Hyperactivity Disorder (ADHD) is children's most common psychological and neurodevelopmental disorder. Increased risk for ADHD in patients with inflammatory and autoimmune diseases supports the role of inflammatory mechanisms in the occurrence of ADHD. However, the association between asthma and ADHD remains unclear.

OBJECTIVE

This study was designed to evaluate the prevalence of ADHD in patients with asthma who were referred to the clinic of allergy and clinical immunology.

METHODS

This cross-sectional study was conducted on children aged 6 to 18 with asthma at Imam Ali hospital, Karaj, Iran. The patient's demographic data, history of childbirth delivery type, premature birth, hospital admission, family income, birth rate, and family history information related to the patient's asthma and medicines were recorded. ADHD diagnosis was made using the Persian version of Conners Parent Behavioral Problems Rating Scale (CPRS-26).

RESULTS

In this study, 677 asthmatic patients were enrolled; 46 patients (6.8%) had ADHD. The probability of ADHD in asthmatic patients inhabited in a rural area, males, and patients with a history of food allergy, allergic rhinitis, urticaria, and eczema was significantly higher (p < 0.05). In addition, our result demonstrated that the likelihood of ADHD in patients with asthma and a history of PICU admission was significantly higher (p < 0.05).

CONCLUSIONS

The present study showed that severe asthma, was the risk factor for ADHD in patients with asthma. Physicians should be aware of this co-morbidity to refer asthmatic patients who have the symptoms of ADHD to a psychologist.

Changes in clinic visits and diabetes and metabolic control in patients with type 2 diabetes during COVID-19 pandemic: A real world evidence

PURPOSE

The study aim was to evaluate the effects of public lockdown during the covid-19 pandemic on glucose and metabolic parameters as well as body weight control in type 2 diabetic patients.

METHODS

This study was conducted in two outpatient Diabetes Clinics and analyzed data available in database of Diabetes Clinic. Data related to a year before covid-19 pandemic and a year during covid-19 pandemic was collected from the database and analyzed. Patients with type 2 diabetes included in the analysis if they had referred to Diabetes Clinics both before and during covid-19 pandemic. Demographic information and data about metabolic status were collected from the records of previous outpatient Clinic visits and compared RESULTS: Finally 9440 patients with mean age of 61.08 ± 11.62 referred to Diabetes Clinics in both the year before and the year of the corona pandemic. Mean FBS and HbA1c in diabetes patients reduced significantly from 155.37 ± 62.93 and 7.97 ± 1.74 before pandemic, respectively to 138.77 ± 45.39 and 7.54 ± 1.34, respectively during covid-19 outbreak. During covid-19 pandemic, all metabolic parameters including glycemic and lipid profile (except for triglyceride) and BMI (body mass index) reduced significantly statistically, but, these changes were not clinically significant. However, triglyceride level increased statistically significantly but again it was not significant clinically.

CONCLUSION

During COVID-19 lockdown, glycemic and metabolic control of diabetes patients have improved significantly except for triglycerides.

The association between vitamin D status and sleep duration in school-aged children; the CASPIAN-V study

Background

Considering the high prevalence of both vitamin D deficiency (VDD) and sleep impairment in children and adolescents, this study was conducted to determine the association between VDD and sleep duration in the Iranian pediatric population.

Methods

This multicentric national study was conducted in 2019 on 2564 frozen sera obtained from 7 to 18- year students who were studied in the fifth survey of a national school-based surveillance program conducted in 30 provinces of Iran. Sleep duration was assessed using a questionnaire based on the World Health Organization-Global School-based Student Health Survey protocol. Short sleep duration was defined as sleep duration less than 8 h/day VDD Vitamin D < 20 ng/dL, and vitamin D insufficiency as 20-30 ng/dL.An adjusted logistic regression model was applied to evaluate the associations of vitamin D status with sleep duration.

Results

The Mean (SD) of students' age was 12.1(3.0) years; overall 10.6%of participants had VDD and 23% of participants had short sleep duration. in the adjusted logistic model, students with a low level of vitamin D (insufficient and deficient) had a higher odds of short sleep duration in comparison to those with normal vitamin D level (OR: 1.29, 95%CI: 1.02-1.62).

Conclusion

The current study showed that low Vitamin D levels (insufficient and deficient)were significantly associated with short sleep duration in school-aged children. Further studies are recommended to determine the efficacy of vitamin D replacement in improving sleep duration and quality.

Population attributable risk fraction of modifiable risk factors associated with poor self-rated health among children and adolescent; the CASPIAN-V study

BACKGROUND

We aimed to determine the population attributable risk fraction (PARF) of the risk factors for poor SRH in Iranian children and adolescents.

METHOD

This was a nationwide cross-sectional study conducted in 2015 among 14,400 students aged 6-18 years, living in 30 provinces of Iran. Data were collected using global school health survey questionnaire. Logistic regression was employed to determine the adjusted association of modifiable risk factors with SRH. We used average PARF to determine the preventable proportion of poor reported SRH.

RESULTS

Of 14,400 recruited students, data on 13,983 subjects were analyzed in current study. The mean (SD) age of participants (n = 13,983) was 12.3 (3.16) years, and 49.3% were female. Poor SRH was reported in 19% of subjects. In total, 77% of poor reported SRH in Iranian children and adolescents could be attributed to insufficient daily sleep duration, physical injury, lack of close friend, dissatisfaction with family relationship, and the lack of a companion to share personal problems. We also found that physical pain had the largest PARF (32.4%) followed by anxiety (26.1%) and un-satisfaction with family relationship (5.2%).

CONCLUSION

The established physical and social support factors of poor SRH were associated with a remarkable proportion of poor SRH in the Iranian pediatric population. Changing the children's risk factor profile to the lowest physical risk factor as well as reducing the anxiety level and preventing from physical painsmay significantly improve the SRH of children and adolescents.

Association of dietary patterns with migraine: A matched case-control study

Background: Little is known about the association between dietary patterns and odds of migraine. We aimed to investigate the association between posteriori dietary patterns and migraine odds and migraine-related outcomes using principal component analysis (PCA). Methods: A total of 500 participants enrolled in this age- and sex-matched case-control study. Subjects in the case group were migraine patients who were diagnosed by a neurologist (n = 250) and subjects in the control group were healthy individuals (n = 250). Dietary intake was assessed using a 168-item semi-quantitative Food Frequency Questionnaire (FFQ). Extraction of dietary patterns was performed via PCA. Information on the wide range of covariates and migraine-related outcomes were collected. Results: The 2 major dietary patterns of the "Western diet" and "prudent diet" were extracted using PCA. Those who were in the highest quartile of the prudent diet had the lowest odds of migraine in the fully adjusted model [odds ratio (OR) = 0.10; 95% confidence interval (CI): 0.04-0.21]. Additionally, higher adherence to the Western diet was positively associated with migraine odds (P ˂ 0.001) and this association remained significant and even increased after adjusting a wide range of confounders. Among migraine sufferers, those who had the highest score on the Western diet, had significantly higher attack frequency compared to the patients in the first quartile (15.4 ± 8.9 vs. 12.3 ± 8.6; P = 0.004). Conclusion: The finding of a significant association between the 2 extracted dietary patterns and migraine odds highlights the possible role of diet in both the prevention and stimulation of migraine.

Immunologic Profile of Severe COVID-19 Patients in Alborz Province, Iran

Background: The coronavirus disease 2019 (COVID-19) pandemic has prompted researchers to look for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenicity in depth. Immune system dysregulation was one of the major mechanisms in its pathogenesis. The evidence regarding the levels of interferons (IFNs) and pro- and anti-inflammatory cytokines in COVID-19 patients is not well-established. Objectives: Therefore, this study evaluated the expression level of type-I, II, III IFNs, along with interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), and FOXP3 genes in patients with severe COVID-19 to provide additional insights regarding the regulation of these cytokines during COVID-19 infection. Methods: Peripheral blood mononuclear cells were isolated from two groups, including severe COVID-19 patients and healthy controls. Ribonucleic acid was extracted to evaluate the expression level of IFN-a, IFN-b, IFN-g, IFN-la, IL-1, IL-6, IL-10, and FOXP3 genes using real-time polymerase chain reaction. The correlations between the expression levels of these genes were also assessed. Results: A total of 40 samples were divided into two groups, with each group consisting of 20 samples. When comparing the severe COVID-19 group to the controls, the expression levels of IFN-g, tumor necrosis factor-alpha (TNF-α), IL-6, and IL-10 genes were significantly higher in the severe COVID-19 group. The two groups had no significant differences in IFN-a, IFN-b, IFN-la, IL-1, and FOXP3 expression. The correlation analysis revealed a negative correlation between type I and type III IFNs (i.e., IFN-a and IFN-la) and pro-inflammatory cytokines (i.e., IL-1 and IL-10). Conclusions: This study suggests the possible upregulation of IFN-g, IL-6, IL-10, and TNF-α during SARS-CoV-2 pathogenicity. The preliminary findings of this study and those reported previously show that the levels of IFNs and pro- and anti-inflammatory cytokines are not uniformly expressed among all COVID-19 patients and might differ as the disease progresses to the severe stage.

Association between Childhood Obesity and Later Life Kidney Disorders: A Systematic Review

BACKGROUND

Childhood obesity is considered one of the important risk factors for many long-term morbidities. However, the long-term consequences of childhood obesity on kidney function are largely unknown. This systematic review was designed to sum up evidences for the long-term consequences of childhood obesity on kidney function in midlife.

METHODS

In this systematic review, all prospective or retrospective cohort studies and nested case-control articles were searched via some international databases including PubMed, Scopus, Web of Science and Google Scholar using appropriate keywords until July 2022. All studies that were available in English which assessed the association of childhood and adolescence obesity with the occurrence of kidney diseases in later life were included. Studies which assessed the childhood obesity based on self-report weight status were excluded. Data extraction and quality assessment of the included studies was performed by two independent researchers.

RESULTS

Finally after screening 6843 published articles, 8 prospective cohorts studies were included in the qualitative synthesis. All the included studies were published in the last ten years. The overall follow-up duration of studies ranged from 8 to 64 years. Out of eight included studies, six reported a statistically significant positive association between higher BMI levels in early life and greater renal disease risk in later lifkidney diseases and kidney damage related morbidity were appraised as the outcome in six of the included observational studies (highest HR:6.89), and kidney related mortality was reported in one study (HR: 8.4) among cases that were obese in adolescence.

CONCLUSION

Evidence from various populations implicate s a positive link between obesity in early life and kidney disease in later life. This fact may cause motivation among public health executives to establish policies for more serious population-based obesity prevention.

Diminishing benefits of urban living for children and adolescents' growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

The efficacy of topical aminophylline in local fat reduction: A systematic review

Background and aims

Some studies have reported that the topical forms with aminophylline as the active ingredient appear to be relatively effective on local fat burning while having no/minimal side effects. This systematic review accumulates all of the data on the local fat-burning potency of aminophylline topical formulation.

Methods

Documents were retrieved from PubMed, Web of Science, and Scopus databases until Aug 2022. Data were extracted from clinical trials reporting the reduction in thigh or waist circumference as a result of using topical forms containing aminophylline. Screening of included studies was performed independently by two authors and the quality assessment of included studies was performed based on the Cochrane Collaboration's approach.

Results

Of the 802 initial studies, 5 studies were included in the systematic review. Several concentrations of aminophylline were used in different studies. Most studies administred the topical formulation on participants' one thigh, and the other thigh was considered to be the control for comparing the fat reduction amount. Except for one study, all other studies reported that all participants lost more fat on the treated area than the control groups. The amount of fat reduction differed in studies regarding their different aminophylline concentrations and administration routines. In the case of side effects, except for some studies reporting skin rashes, other studies reported no significant side effects at all.

Conclusions

Aminophylline topical formulation offers a safe, effective, and much less invasive alternative to cosmetic surgery for localized fat reduction. It seems that the 0.5% concentration, administered five times a week for five weeks is the most potent concentration. However, more high-quality clinical trials are needed to verify this conclusion.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022353578.

Allium sativum: A potential natural compound for NAFLD prevention and treatment

Introduction

Non-alcoholic fatty liver disease (NAFLD) results from an excessive accumulation of fat particles that causes liver inflammation, which ultimately causes liver damage. There is still considerable uncertainty about the effects of any nutritional supplements compared to no additional intervention. This review aimed to evaluate the efficacy of Allium sativum (A. sativum), known as garlic, in preventing and treating NAFLD.

Methods

A systematic search based on a search strategy consisting of two components of "NAFLD" and "Allium sativum" in databases including PubMed, Web of Science (WoS), and SCOPUS was conducted on papers evaluating the effects of A. sativum on NAFLD treatment and prevention. We obtained studies from inception until 20 September 2022, followed by study selection and data extraction based on our eligibility criteria. Consequently, qualitative and quantitative synthesis was conducted.

Results

Our qualitative analysis reveals that A. sativum consumption is linked to the prevention of NAFLD, especially in males, although qualitative data in this study regarding the therapeutic properties of NAFLD was controversial. Our meta-analysis showed that NAFLD patients treated with A. sativum have significantly declined aminotransferase levels. That is to say, our meta-analysis revealed a lower alanine transaminase (ALT) (SMD = -0.580, 95%CI = -0.822 to -0.338), and aspartate transaminase (AST(SMD = -0.526, 95%CI = -0.767 to -0.284) in NAFLD patients treated with A. sativum compared to the placebo group. Also, pooling data from case-control studies showed that A. sativum consumption decreases the odds of being diagnosed with NAFLD by 46% (OR = 0.538, 95%CI = 0.451-0.625).

Conclusion

A. sativum consumption is not merely associated with NAFLD prevention but also results in a considerable decline in blood aminotransferase levels in patients diagnosed with NAFLD. To put it simply, A. sativum is linked to a decline in AST and ALT, which are considered reliable biomarkers of NAFLD response to treatment. Nevertheless, A. sativum is insufficient to improve NAFLD independent of other dietary amendments and lifestyle modifications.

Association between meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents

BACKGROUND

This study aimed to assess the association of meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents.

METHODS

In this national survey, 14,880 students with 6-18 years of age were selected by stratified multistage sampling method from urban and rural regions of 30 provinces of Iran. Meal frequency was assessed by a questionnaire prepared based on global school-based student health survey. Physical measurements included height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP).

RESULTS

The participation rate was 90.6% including 49.24% girls and 75.5% urban residents. Skipping breakfast and dinner were more frequent in girls than in boys (71.6% vs. 64.1%, 91.2% vs. 86.9%, respectively, P<0.05). Overweight, obesity, and abdominal obesity were more prevalent in those who had two meals, one meal, or very low intake (P<0.001) than those had three meals. There were no significant differences in SBP, DBP, and blood pressure across to different meal frequency groups (P>0.05). Students who had very low intake and one meal per week had a higher risk of abdominal obesity compared with those who had three meals (OR 1.7, 95% CI: 1.3-2.3, and OR 1.6, 95% CI: 1.4-2.0, respectively).

CONCLUSIONS

An inverse significant association between higher meal frequency and anthropometric indices was observed. Therefore, encouraging children and adolescents for regular meal intake should be considered as a health priority in the pediatric population.

Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

Introduction

Waist circumference-to-height ratio (WHtR) is a simple anthropometric index with good screening power and fast interpretation for early detection of childhood abdominal obesity. This systematic review and meta-analysis aims to determine the best cut-off value of WHtR to use in clinical setting.

Methods

Comprehensive searches were conducted in PubMed, Scopus, and Web of Science by the end of March 2021. Observational studies investigated the best WHtR cut-off to detect abdominal obesity in children and adolescents were included. Thirteen articles (n = 180,119) were included in this systematic review and eight documents were included in the meta-analysis.

Results

The overall optimal cut-off was 0.49 with pooled sensitivity, specificity and diagnostic odds ratio (DOR) of 0.93 (95% confidence interval (CI): 0.93-0.96), 0.88 (95% CI: 0.85-0.91) and 102.6 (95% CI: 50.7-207.5), respectively. The optimal WHtR cut-off to predict abdominal obesity in girls and boys were both 0.49.

Discussion

The current study shows that we could use this cut-off as a simple index for predicting abdominal obesity in children and adolescents without the need for any charts in practice.

The effect of vitamin D supplementation on body composition in nursing mothers with overweight or obesity: a randomized double-blind placebo-controlled clinical trial

BACKGROUND

This study aimed to evaluate the effect of vitamin D3 supplementation on body composition and anthropometric measures of nursing mothers.

METHODS

In a double-blind, randomized clinical trial, 90 nursing mothers with overweight or obesity were randomized into three groups for 12 weeks: two groups of vitamin D3 supplementation (2000 IU/d (VD1), n = 32 and 4000 IU/d (VD2), n = 29) and placebo (PL) group (n = 29). The information on body composition was obtained using the body impedance analysis (BIA) method. Serum 25-Hydroxy vitamin D (25(OH) D), Intact Parathyroid Hormone (iPTH), calcium, and phosphorus were measured before and after the intervention. Data were analyzed based on the intention-to-treat (ITT) method. Two-way repeated measure ANOVA (mixed ANOVA) was applied to assess whether the mean changes in the results from baseline to 12 weeks differ in the three groups.

RESULTS

There was a significant increase in the serum 25(OH) D concentration in the VD2 group compared to VD1 and PL groups (mean change (MC), 12.3 ng/ml; 95% CI, 9.4/15.0, p-value < 0.001). In addition, fat mass (MC, - 4.3 kg; 95% CI, - 7.0/- 1.1, p-value < 0.007), fat mass index (MC, - 1.6; 95% CI, - 2.6/- 0.5, p-value < 0.006) and body fat percentage (MC, - 8.1; 95% CI, - 12.0/- 4.2, p-value < 0.007) reduced in VD2 group as compared with VD1 and PL groups.

CONCLUSION

The intake of 4000 IU/d vitamins D3 supplementation would elevate circulating 25(OH) D concentrations in nursing mothers with overweight or obesity and improve some indices of body composition.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials ( http://www.irct.ir : IRCT20140413017254N6) registered on 11-04-2018. The graphical abstract of this clinical trial, is a figure that explains the final results of the manuscript in a clear and attractive way.

Association of childhood and adolescence obesity with incidence and mortality of adulthood cancers. A systematic review and meta-analysis

BACKGROUND

Prevalence and subsequent conditions of childhood and adolescent obesity are increasing. It has been seen that obesity in youth is associated with adulthood cancer. This systematic review and meta-analysis aimed to determine the pooled association of childhood obesity with cancers in adulthood.

METHODS

In this systematic review, international electronic databases such as Scopus, PubMed, Web of Science, and EMBASE were searched using relevant keywords until February 2022. All Cohort studies assessing the association of childhood and adolescent obesity (under 18 years old) with the incidence and mortality of all types of cancers were included. Two independent reviewers screened and carried out the quality assessment of included studies. Between-studies heterogeneity was assessed using the I squared and Cochran's Q tests. Random/fixed-effect meta-analyses were used to pool the appropriate effect sizes (Hazard ratios (HR)).

RESULTS

Overall, 46 studies were found to be relevant and were included in this study. Based on the random-effects model meta-analysis, childhood obesity increased the hazard of cancer incidence and mortality in adulthood by 33% (HR: 1.33, 95%CI (1.25, 1.41)) and by 28% (HR: 1.28, 95%CI (1.13, 1.42)), respectively. In the subgroups meta-analysis, the HR of childhood obesity and adulthood cancer incidence mortality in women was higher than in men (HR=1.39, 95%CI (1.25, 1.53) vs HR= 1.20, 95%CI (1.07, 1.32)) and (HR= 1.40, 95%CI (1.10, 1.69) vs HR=1.20, 95%CI (1.04, 1.36)) respectively.

CONCLUSION

This study found that obesity in childhood and adolescence is associated with a significant increase in the incidence and mortality of cancers in adulthood. Prevention of childhood obesity, in addition to its short-term beneficial effects, can reduce the burden of cancer in adulthood. The data sets of this study are present in the Tables of the current manuscript. Moreover this study was registered online in PROSPERO (registration code: CRD42022331958).

SYSTEMIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/Prospero/, identifier CRD42022331958.

Association of normal weight obesity phenotype with inflammatory markers: A systematic review and meta-analysis

Background

Individuals with normal weight could suffer from obesity based on their body fat percentage (also known as normal weight obesity (NWO)), thus being at risk of significant morbidity and mortality compared to the general population. It seems that inflammatory pathways and chronic inflammation are significant contributors to the pathogenicity of NWO. This study aimed to assess and pool the association of proinflammatory and anti-inflammatory cytokines with NWO.

Methods

In this systematic review and meta-analysis, online international databases (PubMed, Scopus, EMBASE, Web of Science, and Google Scholar) were searched until August 2022. All observational studies with an English full text comparing the mean levels of proinflammatory and anti-inflammatory cytokines (e.g., C-reactive protein (CRP), various types of interleukins (IL) s, tumor necrosis factor-alpha (TNF)) and white blood cell (WBC) count, in subjects with NWO and "normal weight non-obese (NWNO)" were included. Two researchers independently screened, reviewed and assessed the quality of included studies. The remaining articles' data were extracted post-screening. The heterogeneity between studies was assessed using the I² and Cochran's Q tests. A random effect model meta-analysis was used to pool the standardized mean difference (SMD) as an effect size.

Results

From the initial 559 studies, 21 and 19 were included in the qualitative and quantitative synthesis, respectively. In the systematic review, 8 studies reported a significant association between various proinflammatory cytokines (CRP, IL₆, IL_1β, and TNFα) and NWO. According to random-effect meta-analysis, the association between NWO with CRP (SMD: 0.60, 95% CI: 0.30, 0.91) and IL6 (SMD: 0.90, 95%CI: 0.14, 1.66) was statistically significant. Moreover, the mean level of TNF_α in subjects with NWO and NWNO did not differ significantly (SMD: 0.67, 95% CI: -0.36, 1.70).

Conclusion

The findings of this study show that NWO was associated with high levels of CRP and IL6. Therefore, inflammatory pathways may play a role in the pathogenicity of NWO.

Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines

Background

In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines.

Methods

Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence.

Results

The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls.

Conclusion

Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.

Changes in Lifestyle Behaviors of Children and Adolescents during the COVID-19 Pandemic and the Impact on the Development of Non-Communicable Diseases: A Narrative Review

Background: Quarantine restrictions have changed the usual lifestyle habits of children and adolescents. In this review, we summarize how the COVID-19 outbreak changed lifestyle during childhood and discuss potential short- and long-term effects of NCD high-risk behaviors on health outcomes. Methods: literature search was conducted in Medline database (PubMed), Scopus, Embase, Web of Science, and Google Scholar. All studies that assessed the relationship between COVID-19 outbreak and lifestyle changes were included. Results: NCD risk factors such as unhealthy diet, physical inactivity, prolonged screen time and sedentary behavior, disrupted sleep schedules and sleep quality, as well as mental disorders during COVID19 in childhood, may increase the susceptibility to NCDs in adulthood. These changes in lifestyle behaviors have short and long-term cardio-metabolic and psychological health outcomes. Since it is not clear when COVID-19 is completely controlled, assessment of the interactions between COVID-19 and lifestyle activities in the pediatric age group is critical. Conclusion: The pandemic of coronavirus disease 2019 (COVID-19) has greatly influenced all levels of health systems. During the COVID-19 pandemic, prevention and management of non-communicable diseases (NCDs) will need to be prioritized even further.

Association of cardiometabolic risk factors with insulin resistance in overweight and obese children

INTRODUCTION

Regarding the increased prevalence of obesity among children and adolescents, and the impact of obesity on insulin resistance (IR) and other metabolic disorders, this study was performed to determine the association of cardiometabolic risk factors (CMRFs) with IR in overweight and obese children.

METHOD

In this cross-sectional study 150 overweight and obese children (BMI ≥ 85^th and BMI ≥ 95^th age-sex specific percentile) and adolescents were selected via convenient sampling method from Endocrinology clinic in Karaj; Iran in 2020. Anthropometric indices, lipid profile, fasting blood glucose (FBG), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were evaluated. IR was defined as HOMA-IR ≥ 2.6. Multivariable linear and logistic regression model was used to assess the association of CMRFs with insulin level and IR respectively.

RESULTS

The mean age of children was 10.37 (± 2.6) years. Fifty-four percent of the participants were girls. IR was increased through increasing age (P < 0.001). In the multivariate logistic regression model, by increasing each unit increment in waist circumference (OR: 1.03, 95% CI: 1.01-1.06), wrist circumference (OR: 1.47, 95% CI: 1.06-2.02) total cholesterol (OR: 1.01, 95% CI: 1.003-1.03) and FBG (OR: 1.11, 95% CI: 1.05-1.18) the odds of IR increased significantly. Moreover, in the adjusted linear regression model, HOMA-IR was associated significantly with waist to height ratio (β: 2.45), and FBG (β: 0.02).

CONCLUSION

There was a significant association between some CMRFS with IR in overweight and obese children.

The effect of almond intake on cardiometabolic risk factors, inflammatory markers, and liver enzymes: A systematic review and meta-analysis

Almond intake may be correlated with improvements in several cardiometabolic parameters, but its effects are controversial in the published literature, and it needs to be comprehensively summarized. We conducted a systematic search in several international electronic databases, including MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until April 2021 to identify randomized controlled trials that examined the effects of almond consumption on cardiometabolic risk factors, inflammatory markers, and liver enzymes. Data were pooled using the random-effects model method and presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twenty-six eligible trials were analyzed (n = 1750 participants). Almond intake significantly decreased diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein (LDL), non-high-density lipoprotein (HDL), and very LDL (p < 0.05). The effects of almond intake on systolic blood pressure, fasting blood glucose, insulin, hemoglobin A1c, homeostatic model assessment of insulin resistance, C-peptide, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, C-reactive protein (CRP), hs-CRP (high sensitivity C-reactive protein), interleukin 6, tumor necrosis factor-α, ICAM (Intercellular Adhesion Molecule), VCAM (Vascular Cell Adhesion Molecule), homocysteine, HDL, ox-LDL, ApoA1, ApoB, and lipoprotien-a were not statistically significant (p > .05). The current body of evidence supports the ingestion of almonds for their beneficial lipid-lowering and antihypertensive effects. However, the effects of almonds on antiinflammatory markers, glycemic control, and hepatic enzymes should be further evaluated via performing more extensive randomized trials.