Correlates of malnutrition in patients with heart failure: the role of social support

AIMS

Heart failure (HF) is a major public health challenge. Malnutrition has a significant effect on HF prognosis. Understanding the impact of social and clinical factors on the risk of malnutrition is necessary because it may aid in improving the health status of HF patients.

METHODS AND RESULTS

Three hundred twenty patients with HF who were hospitalized in a heart centre in Shiraz, Iran, from March to November 2022 were studied. Two validated questionnaires were used to evaluate malnutrition and social support: (1) Mini-Nutritional Assessment Short Form and (2) Medical Outcomes Study Social Support Survey. The participants were then divided into three groups: those with normal nutritional status (scores 12-14), those at risk of malnutrition (scores 7-11), and those who were malnourished (scores 0-6). The potential correlates of malnutrition (including socio-demographic, clinical, comorbidities, and laboratory factors) were included in the study. Then, ordinal logistic regression was used to investigate the correlates of malnutrition. The mean age of the participants was 64.2 ± 11.2 years, and more than half were male and married. Normal nutritional status was seen in 110 (34.4%) participants, 151 (47.2%) were at risk of malnutrition, and 58 (18.1%) were malnourished. The mean social support score of the participants was 61.65 ± 12.91. According to the adjusted odds ratios (95% confidence intervals) obtained from multivariate analysis, increased risk of malnutrition was associated with having a lower social support score [0.95 (0.93-0.97), P-value ≤ 0.001], lower body mass index [0.91 (0.86-0.97), P-value = 0.004], higher New York Heart Association classification [1.26 (1.02-1.56), P-value = 0.03], longer duration of disease [1.006 (1.001-1.01), P-value = 0.006], and lower serum albumin level [0.25 (0.08-0.75), P-value = 0.01].

CONCLUSIONS

Besides the clinical conditions affecting the risk of malnutrition in patients with HF, social support may play an important role. Including this factor in HF guidelines and developing educational programmes may help improve HF patients' health.

A healthy diet, physical activity, or either in relation to cardiovascular and all-cause mortality: A prospective cohort study

OBJECTIVES

The aim of our study was to compare four lifestyles-healthy diet and low activity, unhealthy diet and high activity, unhealthy diet and low activity, and healthy diet and high activity-in relation to the risk of cardiovascular disease (CVD) and all-cause mortality.

METHODS

A total of 6504 adults ages ≥35 y were recruited to participate in the Isfahan Cohort Study and followed for 13 y. Diet was assessed using a validated 48-item food frequency questionnaire, and the quality of diet was assessed using the Dietary Quality Index. Physical activity (PA) was evaluated using the International Physical Activity Questionnaire. The primary outcomes were CVD and all-cause mortality. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and the 95% CIs.

RESULTS

During 771 440 person-years of follow-up, 390 and 147 deaths occurred due to all causes and CVD, respectively. High PA, either with a healthy or unhealthy diet, was associated with a lower risk of death from CVD (HR = 0.43; 95% CI, 0.26-0.69, and HR = 0.32; 95% CI, 0.18-0.56, respectively) and also all-cause mortality(HR = 0.53, 95% CI, 0.39-0.71, and HR = 0.5, 95% CI, 0.36-0.68). Moreover, type of PA was important, such that when leisure time PA was considered, none of the lifestyles was associated with a lower risk of CVD and all-cause mortality. However, for occupational PA, the result was the same as the total PA.

CONCLUSIONS

Having high PA (total or occupational), with or without adhering to a healthy diet, is associated with a lower risk of death from any cause and CVD; although leisure time PA, irrespective of adhering to a healthy diet, was not associated with a lower risk of all-cause and CVD mortality.

Trend Analysis of Homicide Mortality and Years of Life Lost in the South of Iran, 2004-2019

BACKGROUND

This study was conducted to determine the mortality rate and years of life lost (YLL) due to homicide in Fars province.

STUDY DESIGN

This was a cross-sectional study.

METHODS

All data related to deaths due to homicide in Fars province were obtained from the Populationbased Electronic Death Registration System. Crude and age-standardized mortality rate, YLL, and YLL rate data were calculated and joinpoint regression was used to examine the trend.

RESULTS

During 2004-2019, 2148 deaths due to homicide occurred in Fars province, and (1782 cases (83.0%) were men. The crude mortality rate in men decreased by 44.0% from 2004 to 2019, but a stable trend was observed in women. The total YLL due to homicide during these 16 years was 43230 (1.37 per 1000 people) in men and 8931 (0.29 per 1000 people) in women. According to the joinpoint regression analysis, the 16-year trend of the YLL rate due to premature mortality in men was decreasing, and the annual percent change (APC) was -4.00% (95% confidence interval [CI]: -6.60 to -1.20, P=0.008). However, women demonstrated stable trends in this respect, and APC was -0.50% (95% CI: -3.10 to 2.20, P=0.704).

CONCLUSION

The crude and standardized mortality rates and the number of YLL due to homicide in the study period had a significant decreasing trend in men but a stable trend in women. To control this issue, officials and policymakers should identify the areas of homicide and control its risk factors such as economic and social issues, drug addiction, and the state of violence.

The effect of COVID-19 pandemic on diabetes care indices in Southern Iran: an interrupted time series analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) requires a continues bulk of cares. It is very probable COVID-19 pandemic is affected its healthcare coverage.

METHODS

The interrupted time series analysis is used to model the trend of diabetes healthcare indices, such as the health worker visits, physician visits, body mass index (MBI), fasting blood sugar (FBS), and hemoglobin A1c (HbA1c), before and after the start of COVID-19 pandemic. The reference of data was the totals of all T2DM patients living in Fars Province, Southern Iran, areas covered by Shiraz University of Medical Science (SUMS), from 2019 to 2020.

RESULTS

A significant decrease for visits by the health workers, and physicians was observed by starting COVID-19 pandemic (β₂ = -0.808, P < 0.001, β₂ = -0.560, P < 0.001); Nevertheless, the coverage of these services statistically increased by next months (β₃ = 0.112, P < 0.001, β₃ = 0.053, P < 0.001). A same pattern was observed for the number of BMI, FBS and HbA1c assessments, and number of refer to hospital emergency wards (β₃ = 0.105, P < 0.001; β₃ = 0.076, P < 0.001; β₃ = 0.022, P < 0.001; β₃ = 0.106, P < 0.001). The proportion of T2DM patients with HbA1C < 7%, and controlled hypertension during study period was statistically unchanged.

CONCLUSIONS

When the COVID-19 pandemic was announced, T2DM healthcare coverage drastically decreased, but it quickly began to rebound. The health monitoring system could not have any noticeable effects on diabetes outcomes.

Validity of Body Image Pictogram to Determine Overweight/Obesity in Adults from Less Developed Populations: Results From Pars Cohort Study

BACKGROUND

Despite the evidence for validity of body image pictogram (BIP) to discriminate overweight, obese, and normal individuals, there is little evidence on the probable effect of socio-demographic variables on its validity. To investigate the effects of socioeconomic status (SES), age, ethnicity, and educational level on the validity of BIP to discriminate normal weight, overweight, and obese people.

METHODS

We used the Pars Cohort Study (PCS) data. Stunkard's BIP score was used as test measure. Participants were classified as normal (body mass index [BMI]<25), overweight (BMI=25 to 29.9), and obese (BMI≥29.9) based on their BMI (kg/m2 ). Area under curve (AUC) and its 95% CI were estimated and compared. Optimal cutoff points and their sensitivity, specificity, and likelihood ratio were reported.

RESULTS

A total of 9232 participants with a female/male ratio of 1.03 were included. The prevalence of overweight and obesity was 37.4% and 18.2%, respectively. Regardless of socio-demographic levels, the optimal cut-points to discriminate normal BMI from overweight, and overweight from obese participants were BIP score of four and five, respectively. Estimated AUC correlated with ethnicity (P<0.001) for both genders, and with SES for females (P<0.05).

CONCLUSION

Although BIP may be a valid measure to categorize the general adult population into normal, overweight and obese, its validity depends on SES and ethnicity. BIP may be available as a proxy measure for BMI categories in socio-demographically homogeneous populations but not in heterogeneous populations.

COVID-19 Vaccine Acceptance and Its Risk Factors in Iranian Health Workers 2021

Background

Ensuring vaccine acceptance in societies is a growing challenge for healthcare systems worldwide. This study aimed to identify factors associated with vaccine acceptance rates.

Methods

This cross-sectional study was conducted as a national web-based survey from February 9^th-13^th, 2021, just before the release of the COVID-19 vaccine in Shiraz, Iran. Independent variables included age, gender, occupation, history of COVID-19 infection, underlying diseases, and source of information. The willingness to be vaccinated was the dependent variable. A logistic regression analysis was performed to determine the relationship between different variables and the willingness to receive the COVID-19 vaccine. The significance level was set at less than 0.05. The data were analyzed using SPSS software version 21.

Results

Of 2,699 healthcare respondents, 70.3% indicated a willingness to receive the COVID-19 vaccine, of whom 49.2% preferred to receive a foreign vaccine and 24.68% desired to receive an Iranian vaccine. The women were more willing to receive the vaccine (67.6%) than the men (78.2%). Based on the results of logistic regression, gender (P<0.001) and job (P=0.005) were the most important associating factors to the willingness to receive the COVID-19 vaccine.

Conclusion

Although the majority of participants were willing to receive the COVID-19 vaccine, 29.6% were not yet ready. Women's healthcare providers were more hesitant to recommend the vaccine. As a result, the findings of this study can help policymakers and decision-makers in the field of health, treatment, and prevention of COVID-19 in raising the level of vaccination awareness among healthcare workers.

The Association of Opium Abuse with Mortality Amongst Hospitalized COVID-19 Patients in Iranian Population

Opioid abuse is a serious problem in the society. Since the first months of COVID-19 pandemic, several myths, rumors and misconceptions have been spread about the benefits of opium consumption for COVID-19 outcome. In addition, data are limited on the relationship between opium abuse and COVID-19 mortality amongst hospitalized COVID-19 patients. In this historical cohort study, we assessed the risks of several variables for mortality amongst all hospitalized COVID-19 patients from the beginning of COVID-19 pandemic in South of Iran from March 15th, 2021 to October 14th, 2021. Data was acquired from the Medical Care Monitoring Center (MCMC), affiliated to Shiraz University of Medical Sciences. A total of 64,427 hospitalized COVID-19 patients were included into the analysis. The mortality rate was 10.59% (n = 6756). Of all, 2030 (3.15%) patients—1702 males and 328 females—reported the positive history of opium abuse with a mean age of 57 ± 17.21 years. The results of multivariable risk showed that the positive history of opium abuse had a significant association with mortality (adjusted RR: 1.173; p = 0.007). Other significant predictive risk factors were male gender, elder ages, and comorbidities such as pulmonary diseases, cardiovascular disease, cancer, nephrological diseases, neurological diseases, and diabetes. However, being a health care worker and having thyroid gland diseases were protective factors amongst hospitalized COVID-19 patients (adjusted RR: 0.650 and 0.642; p = 0.040 and < .0001, respectively). Opium abuse is a risk factor for mortality amongst hospitalized COVID-19 patients. It is vital to educate societies about the consequences of unauthorized opium consumption.

Association of self-reported adherence to the Mediterranean diet with anthropometric indices, comorbidities, and degree of disability in patients with multiple sclerosis

BACKGROUND

One of the important challenges in the treatment of patients with multiple sclerosis (MS) is determining the effective factors in the treatment of MS, including dietary adherence. The aim of this study was to investigate the relationship between adherence to the Mediterranean diet with anthropometric indices and the expanded disability status scale (EDSS) scores in patients with MS.

MATERIAL AND METHODS

The present multicenter and cross-sectional study was conducted on patients with clinically definite MS (according to the 2017 revised McDonald criteria) who were referred to the MS clinics at medical centers affiliated to Shiraz and Tehran Universities of Medical Sciences during 2019. Disease phenotype, EDSS, waist circumference (WC), body mass index (BMI), and comorbidities were assessed. Adherence to the Mediterranean diet was measured with a 14-item modified Mediterranean Diet Adherence Questionnaire. In this questionnaire, a score of 0-5 indicates low adherence, a score of 6-9 shows moderate adherence, and a score of 10 and above demonstrates high adherence (healthy eating pattern).

RESULTS

This study was performed on 478 patients with a mean age of 37.99 ± 9.60 years, out of which 352 patients (73.6%) were female. The percentage of low, medium, and high adherence to the Mediterranean diet in patients with MS was 26.4%, 64%, and 9.6%, respectively. The difference in the level of education between the groups based on adherence to the Mediterranean diet was statistically significant. Low adherence to the Mediterranean diet in underweight, normal, and overweight patients was, respectively, 1.31, 1.32, and 2.29 times higher than in obese patients. This increased risk was only significant in overweight patients (P = 0.019). The results revealed that the score of adherence to the Mediterranean diet had no significant relationship with mild (2.86 ± 2.18), moderate (2.76 ± 2.16), and severe (2.70 ± 2.02) levels of disability.

CONCLUSION

The level of adherence to the Mediterranean diet in Iranian patients with MS was moderate. This level was associated with BMI, such that low adherence to the Mediterranean diet was higher in overweight patients than obese patients.

Relationship between dietary variety, adequacy, moderation, and balanced diet and cardiovascular risk factors

Background

The relationship between dietary variety, adequacy, moderation, and balanced diet as diet quality indices and cardiovascular risk factors has not been yet evaluated amongst patients with Mmyocardial Iinfarction (MI).

Method

This cross-sectional study was conducted on 225 males and 93 females with MI who were admitted in two heart hospitals, Shiraz, Iran from November 2019 to April 2020. Dietary intake was assessed using a validated food frequency questionnaire and the Diet Quality Index-International (DQI-I). DQI-I included four subscales, namely variety (20 scores), adequacy (40 scores), moderation (30 scores), and balanced diet (10 scores).

Results

The mean age of the participants was 54 ± 8 years. The mean scores of total DQI-I and variety, adequacy, moderation, and balanced diet subscales were 58 ± 12.2, 12.7 ± 3.8, 28.5 ± 7.0, 9.88 ± 5.6, and 7.8 ± 1.1, respectively. The results showed that waist circumference (WC) was influenced by adequacy (-0.26 ± 0.04) and moderation (-0.28 ± 0.03) subscales, while body mass index (BMI)was only related to the moderation subscale (0.15 ± 0.07).

Additionally, low density lipoprotein (LDL) cholesterol was influenced by variety (-0.18 ± 0.01), adequacy (-0.14 ± 0.02), moderation (-0.2 ± 0.02), and balanced diet (-0.2 ± 0.003) subscales, while total cholesterol was associated with the adequacy subscale (-0.18 ± 0.01). In addition, high density lipoprotein (HDL) cholesterol was related to variety (0.16 ± 0.03), moderation (0.14 ± 0.04), and balanced diet (0.13 ± 0.01) subscales,while triglyceride was only influenced by the variety subscale (-0.15 ± 0.004).

Conclusion

Dietary advice based on variety, adequacy, moderation, and balanced diet could be useful in practice to provide personalized messages to improve the risk factors amongst patients with MI.

How do overweight people dropout of a weight loss diet? A qualitative study

Background

The growing trend of overweight and obesity in many developed and developing countries in recent years has made obesity one of the most significant health problems in the world. The treatment of overweight and obese people is challenging, as patients have difficulty adhering to a weight-loss diet. Thus, the present study aimed to identify the reasons for the dropout of weight-loss diets.

Methods

This qualitative study using content analysis was conducted in a comprehensive health center in Shiraz, southern Iran, between April and October 2020. The study was performed on 27 participants with a history of obesity and diet dropout selected via purposive and theoretical sampling. The data were gathered through semi-structured interviews and were thematically analyzed.

Results

The participants included 25 females (92.6%) and two males (7.4%) with a mean age of 33.4 ± 8.4 years. Data analysis resulted in the emergence of three themes and 14 sub-themes. The first theme was personal reasons for diet dropout, which included six sub-themes; i.e., misunderstanding of diet, not having enough motivation, stress and hormonal disorder, having the feel of “being harmful to health”, lack of mental and psychological preparation, and personal taste. The second theme was familial and social reasons for diet dropout, including two sub-themes, i.e., social and familial problems. Finally, the third theme was the reasons related to diet characteristics, including six sub-themes: ineffectiveness of diet, expensiveness of diet food and dietary supplements, family problems, unavailability of food, unscientific and unconventional diets feeling bad about the diet, and unpalatable diet food. All the concepts were related to each other and resulted in a pattern revealing the experiences of overweight people and who had dropped out of weight-loss diets.

Conclusion

The reasons for diet dropout were divided into three levels: personal reasons, familial and social reasons, and diet characteristics. Overall, clinicians should pay attention to the complexity of diets to increase the success rate of weight management. Based on the current study findings, a guideline is recommended to guide patients who dropout of weight-loss diets.

Association between multiple sclerosis and dietary patterns based on the traditional concept of food nature: a case-control study in Iran

INTRODUCTION

It remains a matter of debate whether traditional concepts regarding the nature of food affect the development and progression of multiple sclerosis (MS).To date, there are limited studies that have investigated the association between MS and dietary patterns based on the categories of food nature (hot, cold, or balanced) defined in traditional medicine.

METHOD

This case-control study was conducted from October 2019 to February 2020. In total, 60 patients diagnosed with MS within the preceding 6 months and referred to our neurology outpatient clinic were included in our case group. The control group included 180 patients who were referred to the same center for general or orthopedic surgery. Dietary intake was assessed in both groups through a reliable and valid semi-quantitative food frequency questionnaire. Data were assessed using principal component analysis.

RESULTS

The mean age of the participants was 44.9 ± 17.33 years. The analysis showed that four food patterns were distinguished (eigenvalue > 1), namely "additives and cold-natured foods", "hot and balanced foods and nuts", "dairy and legumes", and "hot and balanced starches". These food patterns explained 57.8% of the total variance. After adjusting all confounding factors, individuals in the highest quartile and medium quartile of "additives and cold-natured foods" had an elevated MS risk compared with the lowest quartile (OR = 7.21, 95%CI = 2.01-12.38 and OR = 3.37, 95%CI = 1.02-11.35, respectively). Furthermore, individuals in the highest quartile of the "hot and balanced foods and nuts" group were protected against MS compared with its lowest quartile (OR = 0.28, 95%CI = 0.08-0.90). Moreover, a protective effect against MS was seen in the highest quartile of the "hot and balanced starches" group relative to its lowest quartile (OR = 0.34, 95%CI = 0.12-0.98). No significant association was found between "dairy and legumes" and the risk of MS.

CONCLUSION

This study revealed that dietary patterns based on the traditional concept of food nature might be associated with the risk of developing MS. This represents the first work in this area, so further research is recommended.

Prevalence, Pattern, and Correlates of Polypharmacy among Iranian Type II Diabetic Patients: Results from Pars Cohort Study

BACKGROUND

Polypharmacy can negatively affect the life of type 2 diabetes (T2DM) patients. There is little evidence on the associated factors of, and patterns of polypharmacy among T2DM patients in developing regions. The aim of this study is to determine the population-based prevalence of polypharmacy, its associated factors, and pattern in southern Iran.

METHODS

We used baseline data from the Pars Cohort Study (PCS). Age-standardized prevalence of polypharmacy and its 95% confidence interval (CI) were estimated. Association of polypharmacy with demographic and socio-economic factors, anthropometric measures, serum biomarkers, physical activity, cigarette and tobacco smoking, and multimorbidity was assessed by applying multivariable Poisson modeling. Prevalence ratio (PR) and its CI were estimated. The Anatomical Therapeutic Chemical (ATC) classification system was used for drug classification.

RESULTS

Totally, 874 previously diagnosed T2DM patients with a mean age of 56.3±9.2 participated in the study. The estimated age-standardized prevalence for men and women was 17.2% (CI: 12.0-22.0) and 34.1% (CI: 33.2-39.4), respectively. The prevalence of hypertension, hyperlipidemia and cardiovascular disorders among the study population was 39%, 58% and 20%, respectively. Having more than four comorbidities (PR, 3.90; CI, 2.39-6.34), central obesity (PR, 2.66; CI, 1.03-6.84), and female gender (PR, 1.49; CI, 1.14-1.97) were associated with polypharmacy. Also, 56.0% of patients and 23.0% of elder patients (>59 years old) reported using anti-diabetic agents.

CONCLUSION

Polypharmacy was low among T2DM patients. More than 75% of the elder population were not on anti-diabetic medications. Polypharmacy was higher among patients with multiple comorbidities, central obesity, lower physical activity, lower socio-economic status, younger age at diagnosis, and longer duration of T2DM.

Factors related to psychological well-being amongst patients with type 2 diabetes

INTRODUCTION

The effect of diabetes on psychological well-being (PWB) is a concern for the development of medical care in diabetes management. There are few studies have simultaneously evaluated the impacts of related factors in PWB among patients with type 2 diabetes.

METHOD

This cross-sectional study was conducted on 183 male and 317 female patients with diabetes who had been registered in healthcare centers in Behbahan from November 2018 until April 2019. The patients' well-being status, medications, diet, and physical activity (PA) adherances were measured using validated questionnaires.

RESULT

The mean age of the participants was 52.18 ± 10.29 years. The total mean (SD) score of PWB was 87.40 ± 9.945. In addition, the results of univariate and multivariate analyses showed that the level of adherence to medication had a significant or close-to-significant relationship with PWB score (p < 0.001 and p = 0.082, respectively). The results of univariate and multivariate analyses  also indicated that adherence to diet was significantly associated with PWB score (p < 0.001 and p < 0.001, respectively). However, there were no significant differences among PA levels regarding the PWB score (p = 0.087). The results showed that glycemic control was significantly correlated to PWB score (p < 0.001).

CONCLUSION

Despite the wide variety of relating factors to PWB, adherence to the diet and medication could be added to diabetic guidelines to improve glycemic management and well-being.

Medical students' knowledge and attitudes toward history of medicine

Attention to the history of medicine (HM) has been increasing enormously among the scientific community. History of Culture and Civilization of Iran and Islam (HCCII) is taught in medical schools as a required course. However, data on medical students' level of knowledge and attitude about HM is limited.

This is a cross-sectional survey conducted between 2016 and 2017. A multi-stage random cluster sampling was done in which 230 medical students were asked to fill a standardized self-administered questionnaire. Univariate statistical tests and ordinary multivariable linear regression were applied.

Medical students' knowledge level was 50.8%, which is considered fair and weak. Interestingly, the knowledge score of those who attended only in HCCII course did not differ significantly from those who did not attend this course (P = 0.163). The results showed that knowledge scores were considerably greater in those who participated in related volunteer workshops than those who did not (P = 0.0001). The mean score of attitude toward HM was significantly higher in female subjects than male subjects (P = 0.028). Moreover, data indicated that attendance at the HCCII course and workshops was not associated with improvement in attitude.

According to the outcomes, the authors recommend revising the content, teaching method and structure of the HCCII course curriculum.

Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes

INTRODUCTION

The prevalence of type 2 diabetes mellitus (T2D) has increased considerably while the outcome of diabetic management is suboptimal. In order to promote diabetic management, associated factors for adherence to medications, diet, and physical activity (PA) need to be more clearly identified amongst patients with T2D.

METHODS

This cross-sectional study was conducted on 206 men and 294 women amongst patients with diabetes who were registered in ten special diabetic clinics in Shiraz, Iran from November 2018 to April 2019. Levels of adherence to medication, Mediterranean diet (MD), and physical activity were measured with validated and appropriate questionnaires.

RESULTS

Mean age (± SD) was 56.92 ± 0.52 years and 294 (58.8%) were female. Data showed that reduced adherence to medication, MD, and PA increased glycated hemoblobin (HbA1c). Adherence to medication among low, moderate, and high levels was 27.2%, 59.2%, and 13.6%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, divorced widow, smoker, and ex-smoker had a significant influence on adherence to medication, P = 0.017, P = 0.018, P = 0.008. P = 0.045, P = 0.026, P < 0.004, and P = 0.001, respectively. In addition, adherence to MD among low, moderate, and high levels was 5.4%, 77.2%, and 17.4%, respectively. Associated factors such as 50-64 years of age, at least 65 years of age, overweight, obese, and smoker had a significant influence on adherence to MD, P = 0.011, P = 0.046, P = 0.002, P < 0.001, and P = 0.032, respectively. Furthermore, adherence to PA among low, moderate, and high levels was 21%, 68.6%, and 10.4%, respectively. Only the non-smoker factor played a significant role in PA adherence, P = 0.010.

CONCLUSION

Levels of adherence to medications, diet, and PA amongst patients with T2D are not within the acceptable range. Recognized associated factors that contribute to adherence might improve diabetes management and allow one to tailor the appropriate message to improve glycemic indices.

Effects of a therapeutic lifestyle change diet and supplementation with Q10 plus L-carnitine on quality of life in patients with myocardial infarction: A randomized clinical trial

Introduction: Myocardial infarction (MI) has a deleterious effect on quality of life (QoL), which can affect cardiac prognosis after MI. Thus, new strategies have to be identified for improving the QoL. To our knowledge, no studies have been conducted on the impact of therapeutic lifestyle change (TLC) diet and L-carnitine plus Q10 supplementation on QoL after MI. Methods: The study aimed to measure 128 MI patients' QoL using MacNew QoL questionnaire (global scales and physical, emotional, and social subscales) before and 3 months after the intervention. The patients were divided into 4 groups. Group A received TLC diet, group B orally received Q10 150 mg/d and L-carnitine 1200 mg/d, and group C received a combination of carnitine plus Q10 and TLC diet. Finally, group D, as the control group, only underwent the routine care. Results: The results showed a significant increase in MacNew questionnaire's physical, emotional, and social subscales in the four groups after the intervention. The results of within-group analysis showed that the physical and emotional subscales changed significantly (P < 0.001 and P < 0.022, respectively). In the emotional subscale, TLC group showed a significant improvement compared to groups B and D (P < 0.019 and P < 0.001, respectively), but not group C (P < 0.681). In the physical subscale, Q10 plus L-carnitine group showed a significant improvement compared to groups A and D (P < 0.001 and P < 0.0001, respectively), but not group C (P < 0.860). In the global scale, combination of carnitine plus Q10 and TLC diet group demonstrated a considerable improvement compared to groups A, B, and D (P < 0.001, P < 0.001, and P < 0.001, respectively). Nevertheless, the results of within-group analysis revealed no significant differences among the four groups regarding the social subscale (P < 0.229). Conclusion: Both TLC diet and supplementation with Q10 and L- carnitine had a positive effect on the physical and emotional subscales of MacNew questionnaire and may improve post-MI prognosis. Based on the results, combination of Q10 plus L-carnitine and TLC die can be a potential intervention for improving QoL and secondary prevention.