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Introduction: Apelin could be one of the last protective defenses before developing obesity-related disorders, including insulin resistance, type 2 diabetes, and hypertension, which can be modified by dietary intake. The present study investigated the association of habitual intake of total fatty acids (TFAs), saturated-, monounsaturated-, polyunsaturated FAs, n-3, and n-6 FAs with Apelin expression in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Methods: We obtained VAT and SAT from 168 participants (64 nonobese and 104 obese) who had undergone open abdominal surgery. Dietary intake information was gathered with a valid and reliable food frequency questionnaire. The mRNA expression of the Apelin gene was analyzed by real-time PCR. Results: Apelin serum levels were increased in the obese subjects compared to the nonobese group (p = 0.016). The SAT and VAT Apelin mRNA levels were significantly elevated in the obese participants compared to the nonobese ones (p < 0.05). Based on BMI status, only obese subjects indicated a positive association between SAT and VAT Apelin expression and TFA intake (p < 0.001). However, this association was observed between SAT and VAT Apelin gene expression and polyunsaturated fatty acid (PUFA) and n-3 FA intakes in both obese and nonobese groups (p < 0.05). Conclusion: High Apelin gene expression was associated with TFA intake in obese subjects in both fat tissues. However, habitual intake of PUFA and n-3 FA was associated with Apelin gene expression in obese and nonobese individuals. Our results indicate a determinative role of the quality and quantity of FA intake on adipose tissue.

Abstract: Background: Adequate evidence supports beneficial effects of plant-derived phytochemicals against type 2 diabetes (T2D). Among phytochemicals, dietary flavonoids is one of the superb candidates. The whole studies are carried out in Western populations, so it is needed to investigate the risk of T2D by dietary flavonoid intakes in ethnic origins and other regions to confirm these relations. This study was conducted to investigate whether the daily consumption of total flavonoid and its subclasses can affect the incidence of type 2 diabetes (T2D) in the Iranian population. Methods: Eligible adults ( n=6547) were selected from among participants of the Tehran lipid and glucose study with an average follow-up of 3.0 years. Dietary intakes were assessed using a valid and reliable 168-item semi-quantitative food frequency questionnaire. Multivariate Cox proportional hazard regression models were used to estimate the development of T2D in relation to total intake of flavonoids. Results: This study was conducted on 2882 men and 3665 women, aged 41.3±14.6 and 39.0±13.4 years, respectively. After adjustment for several potential confounders (age, sex, diabetes risk score, physical activity, energy, fiber and total fat intakes), risk of T2D decreased from tertiles 1 to 3 for flavonols (HR (95% CI): 1.00, 0.86 (0.64–1.16), 0.87 (0.63–0.93), Ptrend=0.01) and isoflavonoids (HR (95% CI): 1.00, 0.84 (0.62–1.13), 0.64 (0.46–0.88), Ptrend=0.02), whereas non-significant results were found for total flavonoid and other subclasses of flavonoid. Conclusion: These results emphasize the potential protective role of flavonols and isoflavonoids rich food (e.g. apple, tea, soy, and dark chocolate) in the prevention of T2D.

In the current study, we aimed to assess the effect of dried Ziziphus jujube on blood glucose, lipid profiles, anthropometric indices, and inflammatory factors in type 2 diabetic(T2D) patients.In this randomized controlled clinical trial, 48 patients, aged 30-65 years, were randomly assigned to two intervention(n = 24) and control(n = 24) groups. The subjects in the intervention group received 30 g Ziziphus jujube daily for 12 weeks. At baseline and the end of the 12th week, 10 ml of blood was taken from each patient after a 12- to 14-h overnight fasting. Plasma levels of fasting plasma glucose (FPG), triglycerides(TGs), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), high-sensitivity C-reactive protein(hs-CRP), and interleukin-6(IL-6) were measured. Anthropometric indices were determined.Plasma FPG, TG, TC, and LDL-C decreased significantly up to -11.36%, -13.59%, -7.46%, -7.65% in the Ziziphus jujube group at the end of week 12 compared to baseline, respectively (P 0.05), and this reduction was significant in comparison with the control group (P 0.05). The plasma hs-CRP reduced significantly up to -24.46% in the Ziziphus jujube group at the end of week 12 compared to baseline (P 0.05), however, this reduction was not significant in comparison with the control group (P 0.05). Also, there were no significant differences between the two groups in mean changes of body mass index, plasma HDL-C, and IL-6.The current study showed that daily consumption of Ziziphus jujube may have beneficial effects on the lipid profiles and blood glucose levels in T2D.T his clinical trial was registered at the Iranian registry of clinical trials (IRCT registration number: IRCT20181210041913N1).

Adipocyte expansion through adipogenesis can offset the adverse metabolic effects of obesity.Nigella sativa(NS) (black seed) oil is shown to have therapeutic features in the management of obesity. NS oil might have beneficial changes in obese populations through mediating serum levels of adipogenesis-related parameters and relative transcriptional gene–diet interactions (nutrigenomics), though no previous studies assessed this mechanism in overweight/obese participants. This study assessed the effects of NS oil supplements on blood concentration and mRNA expression levels of TNF-α, PPAR-γand serum adiponectin and expression ofAdipoR1, as major adipogenesis and obesity-related parameters, in overweight/obese women using a cross-over design. Eligible women were randomised to receive either NS oil supplements (2000 mg/d) or placebo. Two periods of interventions (8 weeks in each) were cross-changed by a 4-week washout period. An individualised diet plan without calorie deficits was given to participants to match their energy/macronutrient intakes. The Pkcross procedure and intention-to-treat analysis were performed using Stata.Cohen’s d(d)was estimated to measure the magnitude of the effects. Forty-six participants were included. NS oil capsules reduced transcription levels ((d= –2·31),P< 0·001) and blood concentrations of TNF-α((d= –0·29),P< 0·001). AdipoR1 expression (d= 2·24,P< 0·001) and serum adiponectin (d= 0·88,P< 0·001) showed a significant augmentation with a medium-high effect size, as did gene expression (d= 0·69,P< 0·001) and serum levels of PPAR-γ(d= 0·97,P< 0·001). There was a moderate but significant decrease in body weight (d= 0·6,P< 0·001). The present beneficial findings would provide strong information for future nutrigenomics/clinical trial studies assessing the role of NS in the management of obesity and other comorbidities.

Aim. In the current study, we examined the association of dietary diabetes risk reduction score (DDRRS) with chronic kidney disease (CKD) among an Iranian adult population. Methods. We followed up 2076 ≥20-year-old participants of the Tehran Lipid and Glucose Study (2006–2008), who were initially free of CKD for 5.98 years. The dietary diabetes risk reduction score was calculated based on scoring eight components, including cereal fiber, nuts, coffee, polyunsaturated fatty acids-to-saturated fatty acids ratio, glycemic index, sugar-sweetened beverages, trans fatty acids, and red and processed meat using a valid and reliable 168-item food frequency questionnaire. CKD was defined as estimated glomerular filtration rate (eGFR)

Background There are no data available regarding the association of dietary diabetes risk reduction score (DDRRS) and risk of cardiovascular disease (CVD) worldwide. We aimed to investigate the association of the DDRRS with the risk of CVD outcomes in a prospective population-based study. Method Individuals without CVD (n=2,195) were recruited from participants of the Tehran Lipid and Glucose Study (2006–2008) and followed for a mean of 6.7 years. The DDRRS was determined on the basis of eight components using a validated 168-item food frequency questionnaire. Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the hazard ratios and 95% confidence interval (CI) of CVD across quartiles of DDRRS. Results The mean ± standard deviation age of participants (44.8% male) was 38.8±13.0 years at baseline. Median DDRRS for all patients was 23 (intequartile range 20–26). During follow-up, 77 (3.5%) new cases of CVD were identified. After adjustment for confounding variables, including age, sex, body mass index, physical activity, smoking, energy intake, diabetes, and hypertension, no association was found between DDRRS and risk of CVD (odds ratio, 0.70; 95% CI, 0.36–1.37 [p-value for trend=0.351]). Conclusions The findings of this study showed that higher DDRRS is not associated with risk of CVD events.

Inulin is a prebiotic and has beneficial effects on health, such as improving the immune function, lipid profile, and gut microbiota. Some previous studies have assessed the effects of inulin supplementation on cardiometabolic diseases, but the relationship between dietary inulin and these diseases has not been investigated yet. Thus, this survey was designed to assess the potential association between the dietary intake of inulin and the incidence of cardiometabolic diseases, including cardiovascular disease (CVD), hypertension (HTN), chronic kidney disease (CKD), and type 2 diabetes (T2D) among adults. The present prospective cohort study was conducted on participants in the third wave of the Tehran Lipid and Glucose Study (2006-2008) and was followed up until March 2018. The dietary intake of inulin was estimated using a special database that reports values of inulin and oligofructose in grams per 100 g of each food. Cox proportional hazards regression showed that higher consumption of inulin was associated with a lower risk of HTN (HR: 0.79, 95% CI: 0.63 to 0.99) and T2D (HR: 0.94, 95% CI: 0.89 to 1.00). We found no relationship between higher consumption of dietary inulin and the incidence of CKD and CVD in our population. According to our results, it seems inulin from foods had a preventive effect against HTN and T2D, which are major risk factors for cardiovascular and renal events. However, more investigations are warranted.

Aims There is still controversy on optimal percentage of macronutrient intakes especially carbohydrate on prevention of type 2 diabetes (T2D). The aim of the current study was to evaluate the iso-energetic substitution of dietary macronutrients in relation to incidence of T2D. Methods This prospective study was conducted on 6547 subjects who were followed for 3.0 ± 1.6 years. Dietary intakes were evaluated using a valid and reliable semi-quantitative food frequency questionnaire. Biochemical variables and anthropometrics were evaluated at baseline and follow-up examinations. Multivariate Cox proportional hazard regression models were used to estimate the hazards ratio (HR) of T2D. Results A one unit higher proportion of carbohydrate from whole grain at the expense of carbohydrate from non-whole grain (HR = 0.82, 95% CI = 0.71–0.95), protein (HR = 0.75, 95% CI = 0.60–0.94), total fat (HR = 0.79, 95% CI = 0.67–0.93), saturated fatty acid (HR = 0.79, 95% CI = 0.65–0.96), poly-unsaturated fatty acid (HR = 0.81, 95% CI = 0.68–0.96) and mono-unsaturated fatty acid (HR = 0.75, 95% CI = 0.60–0.94) was associated with decreased risk of T2D. The substitution of protein and fats was not associated with diabetes. Risk of T2D increased from quartiles 1–4 for trans-fatty acid (HR: 1.00, 1.27, 0.95, 1.97, Ptrend = 0.01). Conclusions A higher proportion of carbohydrate from whole grain in replacement of refined grain, and other macronutrients was associated with decreased risk of T2D. Also our study suggests a positive association between trans-fatty acid intake and risk of T2D.

BACKGROUND Adipose tissue (AT) is a passive reservoir for energy storage and an active endocrine organ responsible for synthesizing bioactive molecules called adipokines. Omentin is known as an anti-inflammatory adipokine that can modulate insulin sensitivity. The present study aimed to investigate the relationship between omentin mRNA expression and glucose homeostasis of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in non-diabetic adults. METHODS VAT and SAT adipose tissues were collected from 137 adults aged ≥ 18 years hospitalized for abdominal surgery. Before surgery, preoperative blood samples were taken from the participants to measure fasting plasma glucose, insulin, and triglyceride. BMI, HOMA-IR, HOMA-B, and QUICKI were calculated. Insulin levels were measured with Mercodia kits using enzyme-linked immunosorbent assay (ELISA). In order to obtain omentin mRNA expression, real-time PCR was performed. RESULTS Overall, 91 (66.4%) subjects were healthy [without insulin resistance (IR)], and 46 (33.6%) participants were with IR. In healthy and IR subjects, omentin gene expression was 1.04 and 2.32, respectively in VAT, and 3.06 and 1.30, respectively, in SAT (P > 0.05). After controlling for age and BMI, linear regression analysis indicated a significant positive association of SAT omentin expression with insulin concentration (β = 0.048; 95% CI 0.009, 0.088, P = 0.017) and HOMA-IR (β = 0.173; 95% CI 0.023, 0.323, P = 0.014). Moreover, a negative association of SAT omentin expression with HOMA-B (β = - 0.001; 95% CI 0.002, - 0.001, P

BackgroundEvidence of possible beneficial effects of dietary diabetes risk reduction score (DDRRS) on reducing the risk of various chronic diseases such as metabolic syndrome (MetS) are limited. This is a prospective, population-based cohort study, which aimed to investigate the relationship of the DDRRS and its components with MetS incident in Iranian adults.MethodsIndividuals without MetS (n=3561) were recruited from participants of the Tehran Lipid and Glucose Study (2009-2011) and followed for a mean of 6.01 years. A validated food frequency questionnaire was used to determine the DDRRS using based on eight components, including higher intakes of cereal fiber, nuts, coffee, and polyunsaturated: saturated fat ratio and lower intakes of red or processed meats, sugar-sweetened beverages, trans fatty acids, and low glycemic index. We used the multivariable logistic regression analysis to determine the odds ratio (ORs) and 95 % confidence interval (CI) of MetS across the tertiles of DDRRS.ResultsThe mean (SD) age of individuals was 38.1(12.6) years at baseline. Median (25-75 interquartile range) DDRRS for all participants was 20(18-22). During the study follow-up, 682(19.1 %) new cases of MetS were reported. Based on the age and sex-adjusted model, participants in highest tertile of DDRRS had lower risk of MetS in compared with the lowest one (OR=0.64;95 %CI:0.52-0.79, P for trend=0.001). In the multivariable adjusted model, after adjustment for all possible confounding variables, the risk of MetS is decreased across tertiles of DDRRS (OR=0.60;95 %CI:0.48-0.75, P for trend=0.001). Also, higher scores of some DDRRS components including red and processed meat, sugar sweetened beverages, and coffee were related to decreased incidence of MetS.ConclusionsThe results of this study revealed that greater adherence to DDRRS can be associated with decreased risk of MetS in Iranian adult.

Summary Background & aims This study aimed to determine the prospective relationship between the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice and metabolic syndrome (MetS) and to investigate whether weight change can modify this association in a representative sample of the population of Tehran, Iran. Methods In this 8.9-year follow-up study, the consumption of SSBs and 100% fruit juice by 1915 individuals, who participated in Tehran Lipid and Glucose Study (TLGS), was examined using a validated food frequency questionnaire. The MetS was defined according to the Joint Interim Statement. Participants were categorized as those who lost weight (≥-2%), those with weight stability (−1.9%–1.9%), and those who gained weight (≥2%). The Cox regression model was used to determine the relationship between the consumption of SSBs and 100% fruit juice and the risk of MetS and weight gain ≥2%. Also, the modifying effect of weight change including weight loss, weight stability and weight gain on the relationship between SSBs and 100% fruit juice consumption and the incidence of MetS was assessed. Results There was no significant association between the consumption of SSBs and the risk of MetS in the crude model; however, after adjustments for confounders, a significant positive association was found between the consumption of SSBs and the risk of MetS (HR: 1.33; 95% CI: 1.07–1.66). Also, no significant association was observed between the consumption of 100% fruit juice and the risk of MetS in the crude model. However, after adjustments for the potential confounders, 100% fruit juice was inversely associated with the MetS risk (HR: 0.78; 95% CI: 0.63–0.95). The consumption of SSBs and 100% fruit juice was positively associated with weight gain (≥2% during the follow-up). Nevertheless, after adjustments for lifestyle and dietary factors, there was no significant association between the consumption of SSBs and weight gain. On the other hand, the consumption of 100% fruit juice was positively associated with the increased risk of weight gain (HR: 1.41; 95% CI: 1.20–1.65). Among participants with weight loss, the first, second and third tertiles of 100% fruit juice reduced the risk of MetS by 29% (HR: 0.71; 95% CI: 0.51–0.99), 47% (HR: 0.53; 95% CI: 0.37–0.75) and 35% (HR: 0.65; 95% CI: 0.46–0.92), respectively. Conclusion Although 100% fruit juice reduced the risk of MetS, its consumption must be limited due to its positive effect on weight gain. On the other hand, the consumption of 100% fruit juice reduced the risk of MetS, depending on the individual's weight change. Also, high consumption of SSBs was associated with the incidence of MetS.

Uric acid (UA) is the end product of purine catabolism in humans. Hyperuricemia, defined as elevated plasma concentrations of UA above 7 mg/dL, is a risk factor for developing hypertension, cardiovascular diseases, chronic kidney disease, and type 2 diabetes. Hyperuricemia can induce pancreatic β-cell death and impaired insulin secretion. It can also disrupt insulin-induced glucose disposal and insulin signaling in different insulin-sensitive tissues, including cardiomyocytes, skeletal muscle cells, adipocytes, hepatocytes, and endothelial cells. These events lead to the development of systemic insulin resistance and impaired glucose metabolism. Induction of inflammation, oxidative stress, and impairment of nitric oxide (NO) metabolism mediate hyperuricemia-induced insulin resistance and dysglycemia. This chapter is focused on the potential mediatory role of NO metabolism on hyperuricemia-induced dysglycemia and insulin resistance.

Nitric oxide (NO) donors are chemical agents that produce NO-related activity in biological systems, mimic endogenous NO-related responses, or compensate for NO deficiency. NO donors have been increasingly studied as promising therapeutic agents for insulin resistance and type 2 diabetes (T2D). Here, we provide evidence, which investigated the effects of the most frequently studied and implemented NOreleasing compounds, including sodium nitroprusside (SNP), S-nitrosothiols [RSNOs, i.e., S-nitrosoglutathione (GSNO), S-nitroso-N-acetyl-penicillamine, (SNAP)], and NDiazeniumdiolates (NONOates, i.e., spermine NONOate, diethylamine NONOate) on glucose and insulin homeostasis. Available evidence could not draw a clear conclusion regarding therapeutic applications of NO donors in T2D due to different methodological approaches (i.e., in vitro vs. in vivo) and different doses and formulations used to assess the potential effects of NO donors on carbohydrate metabolism. Considering key properties and different kinetic behaviors between various classes of NO donors, targeted compound selection, defining optimum doses, and appropriate use of NO-releasing platforms (topical vs. systemic delivery mode) seem to be critical issues that can accelerate the bench-to-beside translation of NO donors in T2D.

L-citrulline (Cit), a neutral, non-essential, and non-protein amino acid, is a precursor of L-arginine (Arg) and is involved in nitric oxide (NO) synthesis. Since oral ingestion of Cit can effectively elevate total Arg flux in the entire body and promote NO production, its supplementation has recently received much attention in the realm of cardio-metabolic diseases where NO metabolism is disrupted. Although preliminary data obtained from in vitro and in vivo animal experiments indicates that Cit improves glucose and insulin homeostasis and can effectively prevent hyperglycemia-induced complications such as inflammation, oxidative stress, renal dysfunction, and endothelial dysfunction, these findings are yet to be realized in well-designed longterm clinical studies in patients with type 2 diabetes (T2D). If Cit is shown to be an effective anti-diabetic agent with a good safety profile, its supplementation will be superior to that of Arg because it effectively increases systemic Arg availability more than Arg itself, and hence NO production.

Abnormal nitric oxide (NO) metabolism has been associated with the development of insulin resistance and type 2 diabetes (T2D). The concept of NO deficiency is supported by human studies on polymorphisms of endothelial NO synthase (eNOS) gene, animal knockout models for NO synthase isoforms (NOSs), and pharmacological evidence, showing detrimental effects of NOS inhibitors and salutary effects of NO donors on carbohydrate metabolism. On the other hand, T2D and insulin resistance may impair NO homeostasis due to hyperglycemia, oxidative stress, and inflammation. Reduced production of NO [i.e., impaired L-arginine-NOS pathway and function of the nitrate (NO3)-nitrite (NO2)-NO pathway], impaired NO transport within the circulation and delivery to target cells, as well as disrupted NO signaling (e.g., via oxidative-induced NO quenching, and impaired NO-cGMP signaling pathway) can all lead to a reduced NO bioactivity in T2D. This chapter focuses on the role of impaired NO metabolism in T2D.

The nitrate (NO3)-nitrite (NO2)-nitric oxide (NO) pathway, as a storage reservoir for endogenous NO production, is dependent on the oral bacteria with NO3- reducing capacity. Undesirable changes of oral microbiota towards a decreased load of health-related NO3-reducing bacteria and an overgrowth of pathogenic species, leading to subsequent decreased NO2 production in the oral cavity and decreased systemic NO availability, are now considered risk factors for the development of insulin resistance and type 2 diabetes (T2D). This chapter discusses available evidence focusing on oral microbiota dysbiosis in T2D, especially NO3-reducing bacteria and their metabolic activity (including NO3-reductase and NO2-reductase activity), affecting net oral NO2 accumulation and the NO3-NO2-NO pathway.

L Arginine (Arg), a semi-essential essential amino acid, has received significant research interest over the last two decades as nitric oxide (NO) precursor. Arg is widely used as a complementary treatment in various NO-disrupted conditions, e.g., hypertension, preeclampsia, and endothelial dysfunction. Here, we provide an overview of the potential efficacy of Arg as a NO precursor and its effects on glucose and insulin homeostasis and diabetes-induced cardiovascular complications.

Nitric oxide (NO), a multifunctional gasotransmitter, is now considered an endocrine hormone that essentially contributes to the regulation of glucose and insulin homeostasis. Here, we discuss current genetic data linking NO metabolism to metabolic disorders, especially insulin resistance and type 2 diabetes (T2D). Although several gene variants of NO synthases [NOSs, i.e., neuronal NOS (nNOS), endothelial NOS (eNOS), and inducible NOS (iNOS)] isoforms have been identified in humans that affect NO bioactivity and metabolism, only the eNOS polymorphisms are reported to be associated with insulin resistance and T2D. Among the functional eNOS gene polymorphisms, the single nucleotide polymorphisms (SNPs) rs2070744 (T786C), rs1799983 (G894T), and rs869109213 (eNOS 4b/4a) are related to the risk of developing insulin resistance and T2D.

Asymmetric dimethylarginine (ADMA), an endogenous competitive inhibitor of nitric oxide (NO) synthase (NOS) isoenzymes, can substantially inhibit vascular NO production at concentrations that are observed in pathophysiological conditions. Over-production of ADMA (via overexpression and/or activity of class 1 of the protein arginine methyltransferases, PRMT-1) alongside decreased catabolism (due to decreased expression and/or activity of dimethylarginine dimethyloaminohydrolase, DDAH) in type 2 diabetes (T2D) and insulin resistance results in increased circulatory and intracellular ADMA levels. Such pathological elevated ADMA levels lead to a decreased NO bioavailability and the development of diabetes complications, including cardiovascular diseases, nephropathy, and retinopathy; elevated ADMA levels also increase the mortality risk in these patients. Here, we discuss current documents indicating how disrupted ADMA metabolism contributes to the development of T2D and its complications. The role of other endogenous methylarginines, i.e., NGmonomethyl- L-arginine (L-NMMA) and NG, NG′-dimethyl-L-arginine (SDMA) on NO production and T2D are also discussed.

Recent research punctuates that the nitrate (NO3)-nitrite (NO2)-nitric oxide (NO) pathway may be a potential therapeutic target in type 2 diabetes (T2D), a NOdisrupted metabolic disorder. Nutritional aspects of the NO3-NO2-NO pathway has been highlighted by focusing on the protective effects of some traditional high-NO3 diet, such as Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets and their NO3-rich components, i.e., fruits, vegetables, legumes, and green leafy vegetables, against the development of T2D. Both acute and long-term administration of inorganic NO3 and NO2 in animal experiments display anti-diabetic properties; inorganic NO3 decreases fasting blood glucose, glycosylated hemoglobin, and proinsulin to insulin ratio and improves glucose tolerance. In contrast to animal experiments, NO3/NO2 therapy has failed to show anti-diabetic properties and beneficial effects on glucose and insulin homeostasis in humans. This lost-i- -translation remains an open question, and long-term clinical trials are needed to confirm the salutary effects of inorganic NO3 and NO2 as the natural NO boosters in patients with T2D.

Background Dietary branched chain amino acids (BCAAs) are proposed as a potential related factor in various diseases, including cancer. We aimed to investigate the relationship between dietary intake of BCAAs and their components with cancer and all-cause mortality in a meta-analysis study of observational studies. Methods To identify relevant studies, a comprehensive search was conducted between electronic databases (PubMed, Scopus, and Web of Science) until September 2022. Odds ratios (OR), hazard ratios (HR), and relative risks (RR) with 95% confidence interval (CI) were extracted from eligible studies, and a meta-analysis was performed to calculate the combined effect size. Results Eight articles (3 case-control and 5 cohorts) were included in this meta-analysis. 6 studies reported effect sizes for cancer risk and 3 for cancer or all-cause mortality. Overall, we did not observe any statistically significant association between dietary intake of BCAAs and their components with cancer (RRBCAA: 0.87, 95%CI: 0.68–1.10, RRLeucine: 0.74, 95%CI: 0.52–1.04, RRIsoleucine: 0.98, 95%CI: 0.93–1.04, RRValine: 0.76, 95%CI: 0.55–1.05). Also, we observed any significant relationship between dietary BCAAs and their components with both cancer mortality (RRBCAA: 0.95, 95%CI: 0.68–1.33, RRLeucine: 0.95, 95%CI: 0.79–1.15, RRIsoleucine: 0.95, 95%CI: 0.79–1.14, RRValine: 1.01, 95%CI: 0.84–1.21) and all-cause mortality (RRBCAA: 0.98, 95%CI: 0.73–1.32, RRLeucine: 1.02, 95%CI: 0.81–1.29, RRIsoleucine: 0.96, 95%CI: 0.73–1.27, RRValine: 1.02, 95% CI: 0.79–1.32). Conclusions The findings of the present study showed no significant association between dietary intake of BCAA and its components with cancer, cancer mortality, and all-cause mortality.

Context: Cruciferous vegetables are among the popular functional foods in disease prevention and health promotion. Emerging literature suggest that Sulforaphane-yielding broccoli sprouts can influence cardiometabolic diseases management. Objectives: Given the increasing prevalence of cardiometabolic diseases worldwide, this systematic review and meta-analysis aimed to study the cardiometabolic implications of broccoli sprout supplementation within the literature. Methods: Eligible literature was retrieved through Pubmed and Scopus up to June 2022. Results: Ten clinical trials investigating broccoli sprout supplementation and cardiometabolic health among human subjects were extracted for meta-analysis. The earliest study was published in 2004, and the most recent was released in 2019. Seven studies included control groups for valid comparison. Overall, the dietary intake of broccoli sprouts significantly reduced systolic (-10.9 mmHg; 95% confidence interval (CI): -17.0, -4.86) and diastolic (-6.95 mmHg; 95% CI: -10.6, -3.28) blood pressures. Marginally significant changes were also detected in blood lipid biomarkers compared to the baseline. Conclusions: Our results confirm the hypotensive properties of broccoli sprout and highlight the potential sulforaphane-dependent effects of this vegetable.

Hyperuricemia, defined as elevated serum concentrations of uric acid (UA) above 416 µmol L−1, is related to the development of cardiometabolic disorders, probably via induction of endothelial dysfunction. Hyperuricemia causes endothelial dysfunction via induction of cell apoptosis, oxidative stress, and inflammation; however, it's interfering with insulin signaling and decreased endothelial nitric oxide (NO) availability, resulting in the development of endothelial insulin resistance, which seems to be a major underlying mechanism for hyperuricemia-induced endothelial dysfunction. Here, we elaborate on how hyperuricemia induces endothelial insulin resistance through the disruption of insulin-stimulated endothelial NO synthesis. High UA concentrations decrease insulin-induced NO synthesis within the endothelial cells by interfering with insulin signaling at either the receptor or post-receptor levels (i.e., proximal and distal steps). At the proximal post-receptor level, UA impairs the function of the insulin receptor substrate (IRS) and phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) in the insulin signaling pathway. At the distal level, high UA concentrations impair endothelial NO synthase (eNOS)-NO system by decreasing eNOS expression and activity as well as by direct inactivation of NO. Clinically, UA-induced endothelial insulin resistance is translated into impaired endothelial function, impaired NO-dependent vasodilation, and the development of systemic insulin resistance. UA-lowering drugs may improve endothelial function in subjects with hyperuricemia.

Milk-protein-derived bioactive peptides (BPs) have been proposed as modulators of different regulatory processes involved in blood pressure regulation. Studies on the long-term effects of BPs on blood pressure have not yet been conducted. We aimed to investigate the association of dairy-originated BPs with the risk of hypertension (HTN) in the Tehran Lipid and Glucose Cohort Study (TLGS). In this cohort study, 4378 subjects with a mean follow-up period of 3.1 years were included in the final analysis. Dietary intake, physical activity, demographic, and anthropometric data and blood pressure measurements were obtained for all participants. Various types of dairy-originated BPs were determined by an in silico method. High intake of total digestion-resistant and bioactive peptides (OR: 1.31, CI 95%: 1.01-1.70), dipeptides (OR: 1.33, CI 95%: 1.03-1.73), peptides with more than seven residues (OR: 1.32, CI 95%: 1.01-1.71), glycosylated residues (OR: 1.39, CI 95%: 1.07-1.80), highly hydrophilic peptides (OR: 1.32, CI 95%: 1.01-1.71), and low hydrophobic peptides (OR: 1.32, CI 95%: 1.01-1.71) was associated with an increased risk of HTN in the adjusted model. In addition, subjects in the higher tertile of anti-HTN peptide (OR: 1.33, CI 95%: 1.02-1.72) and antidiabetic peptide (OR: 1.35, CI 95%: 1.04-1.76) intake had a higher risk of HTN than those in the lower tertile. No significant association emerged between calcium intake from dairy and incident risk of HTN. Our results showed that the intake of some forms of digestion-resistant and BPs, such as anti-HTN peptides, dipeptides, and peptides with more than seven residues, can increase the risk of HTN in the TLGS population.

Background Inflammation is a precursor of chronic disease, which is affected by lifestyle and dietary habits. Recently empirical dietary inflammatory patterns (EDIP), dietary inflammation scores (DIS), and lifestyle inflammation scores (LIS) were developed to indicate lifestyle and dietary contributions in systemic inflammation. The current study aimed to investigate the associations between these indices and the incidence of diabetes among Tehranian adults. Methods A total of 4624 individuals, aged 20–75 years, who were free of diabetes at baseline (2008–2011), were followed for 5.71 years (2014–2017) to ascertain incident diabetes. Dietary intakes were collected at baseline using the food frequency questionnaire. The hazard ratio (HR) of diabetes was calculated by Cox proportional hazards regression across quartiles of EDIP, DIS, and LIS, adjusted for potential confounders. Results The mean ± SD for the age and BMI of the study population (45.1% male) were 40.8 ± 12.7 years and 27.1 ± 4.1 Kg.m2, respectively. At the end of the follow-up, 329 (7.1%) diabetes cases were identified. In the multivariable-adjusted model, individuals in the highest compared to the lowest quartile of EDIP (HR = 0.83; 95%CI:0.59–1.15, p for trend = 0.286), and LIS (HR = 2.41; 95%CI:1.61–3.60, P for trend Conclusion Greater adherence to EDIP and LIS scores was associated with a higher risk of diabetes, while no significant association was found between the DIS score and diabetes incident.

Context Numerous meta-analyses have been conducted on the effects of nutritional interventions on various health outcomes in women with polycystic ovary syndrome (PCOS). However, the strength of the evidence and its clinical significance are unclear. Objective This umbrella review aimed to summarize the effects of nutritional interventions on women with PCOS and assess the strength of the evidence. Data Sources PubMed, Scopus, and Web of Science were searched from inception until March 17, 2021. Data Extraction Meta-analyses of randomized clinical trials (RCTs) that examined the impact of dietary modifications or supplementations on women with PCOS were selected. Data extraction, quality assessments of the meta-analyses, and evaluation of the strength of the evidence were conducted independently by 2 investigators and confirmed by a third. Data Analysis Twenty-eight RCT meta-analyses were included, reporting 40 different outcomes. Lower carbohydrate, Dietary Approaches to Stop Hypertension, or lower glycemic index/load diets in women with PCOS significantly improved some anthropometric and metabolic characteristics (with very low to low certainty). Probiotics/synbiotics reduced fasting plasma glucose, fasting insulin (FI), and homeostasis model assessment–estimated insulin resistance (HOMA-IR) (with moderate to high certainty). Curcumin supplementation decreased fasting plasma glucose, FI, and HOMA-IR (with moderate certainty). Fish oil supplementation decreased FI and HOMA-IR, and omega-3 reduced triglycerides (with moderate certainty). There were also improvements in FI after taking vitamin D or inositol supplements (with moderate certainty). Supplementation with fish oil increased adiponectin (with high certainty), and probiotics/synbiotics reduced total testosterone (with moderate certainty). In subfertile women with PCOS, inositol increased the ovulation rates (with moderate certainty). Conclusion There was no high-certainty evidence that diets alone in women with PCOS improved health or reproductive outcomes. Supplementation with vitamin D, probiotics/synbiotics, omega-3, inositol, and curcumin showed favorable effects on some metabolic outcomes. Probiotics/synbiotics possibly reduces total testosterone, and inositol stimulates ovulation in women with PCOS. Registration PROSPERO registration no. CRD42021251496.

Background Although both observational and interventional studies have demonstrated the beneficial effects of the Nordic diet on cardiovascular disease (CVD) risk factors, the association between adherence to this diet and CVD incidents is unknown. Therefore, in the present study, we aimed to investigate the association between adherence to the Nordic diet and the risk of CVD events in non-Nordic adults. Methods In the present cohort study, 2918 participants from the third wave of the Tehran Lipid and Glucose Study (TLGS) were included. All the participants who were free of CVD at baseline were followed up for 10.6 years. The Nordic diet score was assessed by applying a validated food frequency questionnaire (FFQ). Patients’ medical records were used to evaluate cardiovascular events, including coronary heart disease (CHD), stroke, and CVD-related mortality. Results During a median follow-up of 10.6 years, 203 subjects experienced cardiovascular events. Participants in the third and fourth quartiles of the Nordic diet had a 46% (HR: 0.64; 95% CI: 0.44, 0.93) and 58% (HR: 0.48; 95% CI: 0.28 to 0.62) lower risk of CVD than those in the lowest quartile. Among components of the Nordic diet, each score increase in cereals was associated with a 24% (HR: 0.76; 95% CI: 0.67 to 0.87), low-fat milk with a 23% (HR: 0.77; 95% CI: 0.68 to 0.87), and fish with a 22% (HR: 0.78; 95% CI: 0.69 to 0.89) lower risk of CVD. Conclusion We found high adherence to the Nordic diet might be beneficial in the prevention of cardiovascular events in the non-Nordic community. The main components of the Nordic diet that indicated an inverse relationship with CVD were cereals, fish, and low-fat milk.

This study aimed to investigate the interaction of the Healthy eating index (HEI) and the dietary approach to stop hypertension (DASH) diets with FTO polymorphisms in relation to obesity traits. A total of 4480 subjects aged ≥18 years were selected from participants of the Tehran Lipid and Glucose Study and followed-up 3 years. Selected polymorphisms (rs1421085, rs1121980, rs8050136) were genotyped. HEI and DASH scores were computed. The interaction of diet quality scores with FTO gene variants concerning changes in body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and visceral adiposity index (VAI) was assessed. Higher adherence to both DASH and HEI diets were seen in older adults. Individuals with minor allele carriers of rs1121980 had a lower change in BMI when they had higher adherence to HEI, compared to subjects with lower HEI score (P trend=0.01). Change in WC in participants in the fourth quartile of HEI score in minor allele carriers of FTO variants was lower compared to the first quartile. No significant interaction was seen between FTO genetic variations and DASH and HEI diets regarding changes in any of obesity indices. Adherence to HEI and DASH diets modified the association between FTO genetic variations and obesity phenotypes. In minor allele (risk allele) carriers of FTO polymorphisms, low change in BMI and WC were seen with high adherence to the HEI. Conversely, high adherence to the DASH diet by this genotypic group was related to increase WC.

The objective of this study was to determine the effects of Nigella sativa oil extract on cardiometabolic risk factors in people with type 2 diabetes (T2D). A randomized, controlled, clinical trial was conducted on 43 patients with T2D (23 women and 20 men; aged 53.5�±�7.4�years). The intervention group (N =�23) received two 500-mg per day soft gel capsules containing Nigella sativa oil extract and the control group (N =�20) received two identical placebo soft gel capsules containing sunflower oil per day for the same period, 8�weeks. Pre- and post-intervention cardiometabolic risk factors were measured. Compared with the placebo, the N. sativa oil significantly decreased FBS (p =�.03(, HbA1c (p =�.001), total cholesterol (p =�.04), TG (p =�.003), LDL-c (p =�.001), BMI (p \textless�.001), waist circumference (p \textless�.001), SBP (p =�.001), and DBP (p =�.002). HOMA-IR (p =�.51) and HDL-c (p =�.91) did not change significantly following Nigella sativa supplementation. Nigella sativa oil exerted beneficial effects on glycemic control, serum lipid profile, blood pressure, and body weight among people with T2D. Further long-term trials in the future may help confirm the current therapeutic benefits of Nigella sativa in T2D.

This study aimed to evaluate the association between the intake of total flavonoids and flavonoid subclasses and metabolic syndrome (MetS) risk and to assess the modulating effects of lifestyle factors on these associations. A total of 1915 participants from the Tehran Lipid and Glucose Study were followed-up during 2006-2008 and 2016-2018. Their dietary intake was assessed by a food frequency questionnaire at baseline and within three-year intervals afterward. Moreover, the modifying effect of weight gain on the association between total flavonoids and MetS was assessed by Cox regression analysis. Participants in the highest tertile of flavonoid, flavonol, and flavone had a significantly lower MetS risk as compared to those in the lowest tertile. Also, in participants with weight gain

Background We aim to assess the association of empirical dietary (EDIH) and lifestyle (ELIH) index for hyperinsulinemia with the risk of insulin resistance, hyperinsulinemia, insulin sensitivity, and β-cell dysfunction in Iranian adults. Methods In this prospective study, a total of 1244 men and women aged ≥ 20 years were selected among participants of the Tehran lipid and glucose study and followed for 3.2 years. Dietary intakes were assessed using a valid semi-quantitative food frequency questionnaire. Dietary and lifestyle insulinemic potential indices were calculated using dietary intake, body mass index, and physical activity information. Multivariable logistic regression was used to estimate the associated risk of a 3-year incidence of insulin-related disorders. Results The mean ± SD age and BMI of all eligible participants (42.7% males) were 43.0 ± 13.0 and 27.4 ± 4.9 in the study's baseline. After adjusting for all potential confounders, participants in the highest tertile of ELIH score had a greater risk of developing hyperinsulinemia (OR:2.42, 95%CI:1.52–3.86, P for trend = Conclusions Empirical lifestyle index for hyperinsulinemia was directly associated with insulin resistance, insulin insensitivity, and hyperinsulinemia and was inversely associated with β-cells dysfunction.

Background Spinach has high antioxidants and polyphenols and showed protective effects against liver diseases in experimental studies. We aimed to assess the association between dietary intake of spinach and odds of nonalcoholic fatty liver disease (NAFLD) in a case–control study among Iranian adults. Methods Totally 225 newly diagnosed NAFLD patients and 450 controls, aged 20–60 years, were recruited in this study. Participants’ dietary intakes were collected using a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ). The logistic regression test was used for assessing the association between total, raw, and boiled dietary spinach with the odds of NAFLD. Results The mean (SD) age and BMI of participants (53% male) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. In the final adjusted model for potential confounders, the odds (95% CI) of NAFLD in individuals in the highest tertile of daily total and raw spinach intake was [0.36 (0.19–0.71), P_trend = 0.001] and [0.47 (0.24–0.89), P_trend = 0.008], respectively compared with those in the lowest tertile. Furthermore, in the adjusted analyses, an inverse association was observed between the highest yearly intake versus no raw spinach consumption and odds of NAFLD [(OR 0.41; 95% CI 0.18–0.96), P for trend = 0.013]. However, there was no significant association between higher boiled spinach intake and odds of NAFLD. Conclusions The present study found an inverse association between total and raw spinach intake with the odds of NAFLD.

Background There are insufficient data in case of the potential association of habitual dietary L-arginine and the risk of type 2 diabetes mellitus (T2DM) incidence. Here we aimed to examine the potential effect of dietary L-arginine on the T2DM incidence. Methods For this cohort study, 2139 T2DM-free adults from the participations of Tehran Lipid and Glucose Study (TLGS) were recruited. Follow up period was approximately 5.8 years. Daily intakes of protein and L-arginine were estimated using a validated food frequency questionnaire with 168 food item. Hazard Ratios (HRs) and 95% confidence intervals (CIs), adjusted for sex, age, smoking, diabetes risk score, physical activity levels, and total energy intakes as well as carbohydrate, fiber, fats and lysine, were calculated for L-arginine as both absolute intake and its ratio from total protein. Results Mean (±SD) age of the participants was 38.9 (±12.6) years and 54.6% were women. Mean (±SD) intake of dietary protein and L-arginine was 77.2 (±22.4) and 4.05 (±1.50) g/d, respectively. An increased risk of T2DM (HR = 2.71, 95% CI = 1.20–6.09) was observed among participants with higher intakes of L-arginine (median intake of > 5.4 vs. 2.69 g/d). Total protein intake and the ratio of L-arginine to total protein intakes were not related to incidence of T2DM in both crude and adjusted models. Conclusion We found that higher dietary L-arginine levels may increase risk of T2DM and it may have an independent role in T2DM development.

A few randomized controlled trials (RCTs) have assessed the effect of brown rice consumption on metabolic parameters compared to white rice, with inconsistent findings. Therefore, the present systematic review and meta-analysis was designed to evaluate the effect of brown rice on adiposity indices, lipid profile, and glycemic markers in adult subjects compared to white rice. In this study, PubMed/Medline, Scopus, Web of Sciences, and Embase databases were comprehensively searched until March 2021. Thirteen RCTs were selected and then included in the meta-analysis. As reported, brown rice significantly reduced weight by -1.63 kg (95% CI: -2.15 to -1.11

The present study aimed to evaluate the efficacy of flaxseed supplementation in the management of metabolic syndrome (MetS)-related parameters among the patients with mild-to-moderate ulcerative colitis (UC). A randomized controlled clinical trial was conducted on 70 patients with UC. Participants were randomized in the intervention group, which received 30 g/day ground flaxseed powder or control group. Anthropometric and biochemical variables were assessed at the beginning and end of 12 weeks of intervention. Of the 70 patients enrolled in this study, 64 subjects were included in the final analysis. From baseline to 12 weeks' intervention, flaxseed supplementation resulted in a significant reduction in the serum concentration of insulin (p .001), HOMA-IR (p .001), triglyceride (p = .001), total cholesterol (p .001), and significant increase in the serum levels of HDL (p = .008). Also, we found a significant improvement in the SCCAI score (p .001), TNF-α (p = .03), and CRP (p .001) following the flaxseed supplementation. However, we not observed any significant differences between two groups regarding the body weight, BMI, waist circumferences, systolic, and diastolic blood pressure (p .05). Overall, 12 weeks of flaxseed supplementation resulted in greater improvement in the some MetS-related parameters.

Background Inconsistent findings have been reported for associations between protein intake and age at menarche. We aimed to investigate the association between intake of protein and protein-containing food groups during childhood with menarche among Iranian girls. Methods Girls aged 6–18 years who did not experience menarche in the third or fourth examination cycles of the Tehran Lipid and Glucose Study were selected and were followed to the fifth examination cycle. Daily intakes of protein from different animal/plant sources and ten protein-containing food groups were assessed using a food frequency questionnaire at baseline (the third or fourth examination cycles). Occurrence of menarche and its onset age were asked during each examination cycle. Cox proportional hazards regression was used to estimating hazard ratios (HRs) and 95% confidence interval (95%CI) for the occurrence of menarche per one standard deviation (SD) of dietary intakes. Logistic regression was also used to estimate the odds of reaching menarche ≤12 years. Results During the study, 147(61%) of girls reached menarche, the median age at menarche was 12 years. The adjusted HRs (95% CI) for the occurrence of menarche per one-SD of dietary intakes were 0.68 (0.48, 0.98; p = 0.040) for plant protein and 1.36 (1.01, 1.84; p = 0.042) for animal protein after adjusting for baseline age, BMI Z-score, energy intake, and mother’s early menarche and education. Substituting 10-g animal protein with plant protein was associated with a 16% (95%CI: 5–25%; p = 0.006) lower risk of menarche. Dietary intakes of poultry (adjusted HR: 1.35; 95% CIs: 1.00–1.82; p = 0.049) and low-fat dairy (adjusted HR: 1.20; 95%CIs: 0.99–1.46; p = 0.064) were marginally associated with the increased risk of menarche. However, the odds of early menarche was significant only for plant protein (adjusted odds ratio = 0.39; 95% CI: 0.16–0.96; p = 0.040). Conclusions Our findings indicate that the risk of menarche increases by higher intakes of animal protein and decreases by plant protein. Intakes of poultry and low-fat dairy associate with a higher risk of menarche. The odds of menarche occurrence ≤12 years reduces by higher intakes of plant protein.

Ramadan intermittent fasting may affect whole-body metabolism by affecting appetite-related hormones. This systematic review and meta-analysis aimed to clarify the possible effects of Ramadan intermittent fasting on the main hormones regulating appetite and satiety, including leptin and adiponectin. All English language papers in the PubMed, Scopus, and Embase databases were searched using the keywords “Ramadan fasting”, “adiponectin”, and “leptin”, up to 2020. Data extraction was conducted based on the main data of the studies; the primary outcomes of the analysis were mean changes of adiponectin and leptin levels during the holy month of Ramadan in fasted subjects. Data of 16 eligible studies, conducted between 2003 and 2020, were included in the systematic review. Of these, 10 studies with complete data on leptin and adiponectin were included in the meta-analysis. A significant decrease in leptin levels was observed after Ramadan fasting (WMD = −2.28 ng/ml, 95% CI = −3.72, −0.84). Ramadan fasting had no significant effect on adiponectin levels (WMD = 2.19 ng/ml, 95% CI = −0.29, 4.67). Sub-group analysis demonstrated a greater decrease in leptin levels among normal-weight subjects compared to those of overweight/obese subjects (WMD = −4.67 ng/ml, 95% CI = −6.03, −3.31 vs. WMD = −3.43 ng/ml, 95% CI = −5.69, −1.17). Ramadan fasting may decrease leptin levels, especially in normal-weight subjects. There was high heterogeneity, which may be explained by the differences between the wide ranges of study conditions.

During the last few decades painstaking efforts have been made to eliminate iodine deficiency throughout the world. Todays in regions where dietary iodine intake is adequate or borderline, the main focus is increasing dietary iodine supply in the target population during pregnancy and the first years of life. Objective: The aim of this study was to obtain longitudinal data on urinary iodine excretion and the changes of maternal thyroid parameters in two groups of healthy women with mild-to-moderate iodine deficiency and iodine sufficiency residing in an iodine replete area of Tehran capital city of IR Iran, for more than one decade. Research designs and methods: The present study is part of a cohort study, investigating the relative influences of iodine intake on thyroid size and function of mothers and their infants during and after pregnancy. A total of 500 pregnant women enrolled from two mother-child health care centers and was divided into group I, with median urinary iodine excretion (MUIE) < 150 µg/L, and group II with MUIE ≥ 150 µg/L. Sonographic thyroid volume measurement, urinary iodine excretion and thyroid function tests were measured sequentially in all pregnant women during the three trimesters (T) of pregnancy. Results: The mean ± SD age of the participants was 25.1 ± 5.1 years. The MUIE in group I and II in the first, second and third trimester were 123 and 250 µg/L, 127 and 166 µg/L, 120 and 150 µg/L, respectively. The MUIE in the third trimester of pregnancy in group I did not differ significantly from the values in the first and second trimesters (p = 0.67), but it did decline significantly in group II (p < 0.001). The median thyroid volume of subjects, in the first, second and third trimesters were 7.8, 8.2 and 8.1 ml in group I and 7.5, 8.0 and 8.4 ml in group II, respectively. No difference in thyroid volume was found between two groups in each of the three trimesters of pregnancy (p > 0.05). The mean (± SD) TSH concentration of subjects in first, second and third trimester was 2.3(± 2.6), 2.1(± 1.8), 2.3(± 1.7) mIU/L in group I and 2.1(± 3.1), 2.1(± 1.8) and 2.0(± 1.3) mIU/L in group II, respectively. The trend of TSH rising in group I was 26.7% and in group II it was 13.3%. The mean TSH value in three trimesters did not differ significantly in either groups (p > 0.05). The mean (± SD) total T4 concentrations of subjects in first, second and third trimesters were 13.2(± 3.4), 13.8(± 3.3), 13.0(± 2.9) µg/dl in group I and 13.1(± 3.2), 13.7(± 2.9), 13.4(± 3.2) µg/dl in group II, respectively. The mean total T4 value in three trimesters did not differ significantly in either groups (p > 0.05). There was no correlation between the thyroid volume and three observed parameters (UIE, total T4 and TSH) during the pregnancy in either groups. Conclusion: Even in areas with well-established universal salt iodization program, pregnancy could be a risk of having iodine deficiency and systematic dietary fortification needs to be implemented in this vulnerable group.

To assess the efficacy of different doses of vitamin D3 on serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone(iPTH), calcium, phosphorus, and alkaline phosphatase concentrations in overweight and obese school-children. A total of 378 children and adolescents, 6–13 years of age, with age- and sex-specific body mass index(BMI) Z-score ≥ 1(according to the World Health Organization criteria) were allocated to receive 600, 1000, and 2000 IU vitamin D3/days. 25(OH)D, iPTH, calcium, phosphorus, and alkaline phosphatase concentrations were measured at baseline, 6, and 12 months. In this intention-to-treat analysis, we fitted a linear mixed effect model involving a random effect of participants within treatment groups and fixed effects of dose, time, and their interactions. Mean(SD) of age and BMI Z-score were 9.3 (1.7) years and 2.55 (0.73), respectively. The median (IQR) for 25(OH)D was 11.5 (8.9), 11.7 (10.5), 12.2 (10.2) ng/mL (28.75, 29.25, and 30.50 nmol/L) at baseline and 23.1 (8.0), 25.6 (8.3), 28.6 (10.4) ng/mL (57.75, 64.00, and 71.50 nmol/L) at the end of 12 months in 600, 1000, and 2000 IU, respectively (p values for dose, time, and the interaction being

The evidence for a linkage between dietary intake of choline and betaine, a choline metabolism product, and the risk of hypertension (HTN) is limited. The current population-based cohort study was designed to investigate the possible association between dietary intake of choline and betaine with the risk of HTN in adults. This cohort study was conducted on the participants of the Tehran Lipid and Glucose Study (TLGS). Dietary intake of choline and betaine was calculated using the United States Department of Agriculture (USDA) database. Hypertension was diagnosed as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or used drugs to treat hypotension. In this study, 2865 subjects participated and followed-up for a median of 7.4 years. During the follow-up period, 623 patients with hypertension (22.1%) were detected. Our results revealed per every 100 mg increased dietary intake of choline, the risk of developing HTN decreased by 16% (0.84; 95% CI: 0.74 to 0.96, P for trend = 0.009). No significant association was observed between habitual dietary intake of betaine and the risk of HTN (1.10; 95% CI: 0.88 to 1.38, P for trend = 0.21). After stratification based on age, sex, and BMI, each 100 mg per d increase in dietary choline decreased the risk of HTN occurrence in subjects younger than 55 years old by 17% (0.83; 95% CI: 0.71 to 0.96) and men by 21% (0.79; 95% CI: 0.66 to 0.95). The current study's findings provide further support to confirm the protective properties of choline and choline-rich foods against HTN.

Aim Few studies considered the association between snack patterns and metabolic abnormalities. Here we aimed to characterize the major snack patterns among Iranian adults and determine their association with the risk of metabolic syndrome (MetS). Methods This study was conducted on 1713 MetS-free adults who participated in the third phase of the Tehran Lipid and Glucose Study (TLGS). At baseline, dietary intake of snack was assessed using a validated 168-items food frequency questionnaire, and snack patterns were obtained by principal component analysis (PCA). Adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs) were calculated for the association of incident MetS with the extracted snack patterns. Results PCA identified five major snack patterns, defined as “healthy pattern”, “low-fructose pattern”, “high-trans pattern”, “high-caffeine pattern” and “high-fructose pattern”. Participants in the highest tertile of the “high-caffeine pattern” had lower risk of MetS (HR = 0.80, 95% CI = 0.65–0.99, P for trend = 0.032). Other snack patterns have not shown any significant association with MetS incidence. Conclusions Our findings suggest that consuming a snack pattern with high loads of caffeine, defined as “High-caffeine pattern” in the present study, could reduce the risk of MetS in healthy adults. Further prospective studies are needed to more fully determine the association between snack patterns and MetS incidence.

Introduction: Inflammatory bowel disease (IBD) is one of the most common gastrointestinal diseases affecting people of all ages. Adipokines secreted from adipose tissue have been shown to play an essential role in the pathogenesis of ulcerative colitis (UC). This study aimed to evaluate the effect of supplementation with ground flaxseed (GF) on the concentrations of adiponectin, resistin, and visfatin in patients with UC.Methods: This trial is an open-labeled randomized controlled trial conducted among 70 patients with UC. Patients were randomly divided into two groups: flaxseed and control. Patients in the intervention were received 30 g/day flaxseed powder for 12 weeks. Patients' anthropometric, nutritional, and biochemical factors were evaluated at the beginning and end of the intervention period.Finding: Totally, 64 patients (36 men and 28 women) with a mean age of 31.12 ± 9.67 were included in the final analysis. There wasn’t any significant difference between the two groups regarding baseline weight and height (p>0.05). After the 12 weeks' intervention, flaxseed supplementation led to a significant reduction in the resistin (-4.85 ± 1.89 vs. -1.10 ± 2.25, pConclusion: It has been reported in this study that flaxseed supplementation could exert beneficial effects on adipokine levels in patients with UC. Trial registration: IRCT registration no. IRCT20180311039043N1

Adipocyte expansion through adipogenesis can offset the adverse metabolic effects of obesity.

This study aimed to investigate the effects of vitamin K2 supplementation in the form of menaquinone-7 (MK-7) on glucose, insulin, and lipid metabolism in patients with type 2 diabetes mellitus (T2DM). In this double-blinded, placebo-controlled, randomized trial, 68 insulin-independent people with diabetes received either 180 µg MK-7 twice a day or placebo for 12 weeks. We assessed fasting plasma glucose (FPG) and insulin concentrations (primary outcomes), glycated hemoglobin (HbA1c), insulin sensitivity indices, and lipid profiles (secondary outcomes) at baseline and end of the trial. At the end of the trial, FPG (effect size (ES) = − 0.68; p-adjusted = 0.031) and HbA1c (ES = − 0.36; p-adjusted = 0.004) were significantly lower in the vitamin K2 group compared with the placebo at the end of the trial. The number of participants achieved the target levels of glycemic control based on FPG, and HbA1c concentrations were significantly higher in the vitamin K2 group compared to the placebo group. Insulin concentrations (ES = − 0.29; p = 0.019) and homeostatic model assessment for insulin resistance (HOMA-IR) significantly decreased in the vitamin K2 group (ES = − 0.29; p = 0.019) compared to baseline, but their values were not significantly different compared to the placebo group at the end of the trial. No significant variation was observed in lipid profiles. Daily intake of 360 µg Vitamin K2 in the form of MK-7 for 12-weeks reduces FPG and HbA1c in patients with T2DM but does not have a lipid-lowering effect.

Background and aims Dietary macronutrient composition plays an important role in the prevention of cardiovascular disease (CVD). This study aimed at assessing the iso-energetic substitution of dietary macronutrients in relation to the incidence of CVD. Materials and results This prospective study was conducted on 5102 individuals of Tehran lipid and glucose study participants, aged 20–70 years who were followed for 5.3 years. A valid and reliable semi-quantitative food frequency questionnaire was used to assess dietary intakes. The hazard ratio of CVD for each 5% of energy from macronutrients at the expense of another macronutrient was calculated using the substitution model. During follow-up, a total of 206 CVD outcomes were identified. Mean age of participants (44.2% men) was 47.0 ± 12 and 45.6 ± 11 for men and women, respectively. Substituting 5% of energy from all types of macronutrients by 5% percentage of energy from combined saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) was associated with a decrease in the risk of CVD by almost 20%. Higher energy intake from total-, starchy-, and nonstarchy carbohydrates replaced by other macronutrients was not significantly associated with the risk of CVD. Each 5% of energy from animal protein (HR: 1.09 and CI: 1.02–1.16) independently increased the risk of CVD in the adjusted Cox proportional hazard regression analyses. Conclusion Higher percentage of energy from animal protein independently increased the risk of CVD, replacement of SFA and MUFA together with other macronutrients was inversely associated with CVD risk.