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Background: COVID-19 is a newly emerging disease that causes a pandemic situation in the world. Coronavirus can enter into the body in several ways and it damages other organs of the body in addition to the respiratory system. This study aimed at verifying extra-pulmonary manifestation of COVID-19. Methods: The present study was conducted as cross-sectional in a single center from March 1 to May 1 2020 at Firoozgar educational Hospital in Tehran, Iran. 107 patients with confirmed COVID-19 pneumonia according to WHO interim guidance were recruited in this study. Extra-pulmonary manifestations of COVID-19 were recorded. SPSS version 26 was used for all the analyses. Results: The mean (SD) and the median age were 59.3 (17.4) and 62.0 years, respectively and 58 (54.2%) were men. Body temperature of the patients who were equal or less than 60 years was significantly higher than other patients (39.02 vs. 38.08°C, p=0001). The most common extra-pulmonary manifestation was GI symptoms including nausea, vomiting, abdominal pain, diarrhea, hepatocellular Liver Function Test (LFT) abnormality, cholestatic LFT abnormality, and amylase lipase incensement [37 patients (34.6%]. Ophthalmological, cardiac, neurological and dermatological manifestations were shown in 6.5, 6.5, 14.9 and 14.0% of the patients, respectively. Conclusion: Investigating the clinical and radiological symptoms of COVID-19 showed that SARS-CoV-2 infection may also be associated with extrapulmonary symptoms. Therefore, clinicians and radiologists should be familiar with such symptoms of the disease.

The present study aimed to assess dietary total antioxidant capacity (TAC), dietary phytochemical intake (PI), and dietary inflammatory index (DII) in patients with morbid obesity who are candidates of bariatric surgery and their association with anthropometric and biochemical parameters.One hundred seventy patients with morbid obesity who were referred to surgery clinic of Firoozgar Hospital were enrolled in the study. Ideal body weight and adjusted ideal body weight were calculated. The dietary data were collected using a food frequency questionnaire. Anthropometrics and biochemical parameters were assessed. A p-value of0.05 was considered significant.The strongest correlations of DII with dietary intakes and anthropometric and biochemical biomarkers were found for iron (p0.0001). Significant association was also observed for ferritin (p=0.02) and transferrin (p=0.02). In terms of PI, The strongest associations were also found for iron (p0.0001). Additionally, the value of body mass index (BMI) showed significant correlation with PI (p=0.04). The correlations of dietary total antioxidant indices with dietary intakes and anthropometric and biochemical biomarkers were assessed. Non-significant correlation was found between fasting blood sugar (FBS), hemoglobin A1C (HbA1C), vitamin B12, and vitamin D3 with ORAC index. Significant strong correlation showed for the value of iron in both ferric reducing ability of plasma (FRAP) and Oxygen Radical Absorbance Capacity (ORAC) indices (p0.0001).We find statistical significance correlation for dietary PI and BMI. The inflammatory and antioxidant properties of diet were not related to biochemical markers associated with obesity. Graphical abstract.

Background: Endometriosis is defined as the presence of functioning endometrial tissue in extra uterine structures that causes pain, infertility and reduced quality of life. Diet plays an important role in the modulation of endometriosis. Aim: This study aimed to evaluate the association between the dietary inflammatory index (DII) score and the endometriosis compared to healthy people in a case-control study in Iran. Methods: This study included 78 women with laparoscopically confirmed endometriosis and 78 women with normal pelvis. The DII was calculated from dietary intake assessed using a validated food frequency questionnaire. The association between DII scores (divided in tertiles) and endometriosis risk was investigated using logistic regression analysis and reported as odds ratios (ORs) and 95% confidence intervals (CI) adjusted for age, energy, BMI, education, para, smoking, pelvic pain, menorrhagia, stage of endometriosis, physical activity, and income. Results: In the age-adjusted models, subjects who consumed more pro-inflammatory diets (the upper tertile of DII) had an OR of 2.24 (95% CI = 2.03, 3.91) as compared to subjects in the lowest tertile. Also after multivariable adjustment, women in the highest tertile of DII (versus lowest tertile) were more likely to have endometriosis (OR 2.63; 95% CI 1.88–2.91, p = 0.004). Conclusion: Our results suggest that women with more consumption of pro-inflammatory diet were at increased endometriosis risk.

Background: Polycystic ovary syndrome (PCOS) increases the risk of metabolic syndrome (MetS). Insulin resistance (IR) plays a major role in the pathophysiology of both PCOS and MetS. Objective: This study was designed to compare the prevalence of MetS among different phenotypes of PCOS and its relationship with androgenic components. Materials and Methods: 182 participants eligible for this five-group comparative study were selected by convenience sampling method. They were classified according to the Rotterdam criteria: clinical and/or biochemical hyperandrogenism (H) + PCOS on ultrasound (P) + ovulation disorders (O) (n = 41), clinical and/or biochemical H + PCOS on P (n = 33), PCOS on P + O (n = 40), clinical and/or biochemical H + O (n = 37), and control (without PCOS) (n = 31). MetS was measured based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Androgenic components included free androgen- index (FAI), total-testosterone (TT) level and sex-hormone-binding-globulin (SHBG). Results: A significant difference was observed between the study groups in terms of MetS prevalence (p = 0.01). In phenotype H+P+O, there was a statistically significant positive association between TG and TT, and a significant negative association between SBP and DBP with SHBG. In phenotype O+P, WC was inversely associated with SHBG. In phenotype H+O, FBS and TG were positively associated with FAI but HDL was inversely associated with FAI. Moreover, WC and DBP were positively associated with TT in phenotype H+O. No associations were detected between MetS parameters and androgenic components in other PCOS subjects (phenotype H+P) and in the control group. TT was significantly higher in the PCOS group suffering from MetS (p = 0.04). Conclusion: According to the research results, hyperandrogenic components are potent predictors of metabolic disorders. Thus, we suggest that MetS screening is required for the prevention of MetS and its related complications in PCOS women. Key words: Polycystic ovary syndrome, Metabolic syndrome, Hyperandrogenism.

Following cervical and uterine cancer, ovarian cancer (OC) has the third rank in gynecologic cancers. It often remains non-diagnosed until it spreads throughout the pelvis and abdomen. Identification of the most effective risk factors can help take prevention measures concerning OC. Therefore, the presented review aims to summarize the available studies on OC risk factors. A comprehensive systematic literature search was performed to identify all published systematic reviews and meta-analysis on associated factors with ovarian cancer. Web of Science, Cochrane Library databases, and Google Scholar were searched up to 17th January 2020. This study was performed according to Smith et al. methodology for conducting a systematic review of systematic reviews. Twenty-eight thousand sixty-two papers were initially retrieved from the electronic databases, among which 20,104 studies were screened. Two hundred seventy-seven articles met our inclusion criteria, 226 of which included in the meta-analysis. Most commonly reported genetic factors were MTHFR C677T (OR=1.077; 95 % CI (1.032, 1.124); P-value

Eating disorders (ED) are group of psychological disorders that significantly impair physical health and psychosocial function. ED consists wide range of morbidity such as loss of eating control, binge eating disorder (BED), night eating syndrome, and bulimia nervosa. Eating behavior is a wide range term that includes food choices, eating patterns, eating problems. In this study, we compared eating disorders and eating behaviors in adults with and without type 2 diabetes prior to bariatric surgery.284 participants with class III obesity were included in the single center study. Each case (patients with type 2 diabetes) and control (patients without type 2 diabetes) groups consists 142 patients. Loss of eating control, BED and Bulimia nervosa, Night eating syndrome and eating behaviors and psychosocial factors were screened with standard questionnaires. SPSS version 20 was used for statistical analysis. A P-value of 0.05 was considered significant.There was a significant difference between participants with and without type 2 diabetes in case of BED (76.3% vs. 47.3%, P = 0.001). The logistic regression model has shown that participants without type 2 diabetes had lower odds of exhibiting BED (OR = 0.28, 95% CI 0.142-0.552). Among participants without type 2 diabetes, men had 65% high odds of BED (OR = 1.65, 95% CI 1.13-2.53) in compare with women. Participants with and without type 2 diabetes with high school degree (OR = 5.54, 95% CI 2.46-9.45, P = 0.0001 and OR = 6.52, 95% CI 3.15-10.56, respectively) and moderate depression level (OR = 2.03, 95% CI 0.98-3.95 and OR = 3.12, 95% CI 2.12-4.56, P = 0.0001) had higher odds of BED.These results probably indicate that people with Class III obesity are more cautious about their diet for blood glucose control if they have type 2 diabetes. Future studies are recommended to follow up these patients after surgery to compare weight loss and blood sugar control in patients with and without type 2 diabetes.Present study aimed to comparison of eating disorders and eating behaviors in adults with and without Type 2 diabetes prior to bariatric surgery. 284 patients with class III obesity were enrolled in the study. Half of them had type 2 diabetes. Several questionnaires were completed by patients to assess the eating disorders and eating behaviors. Results of our study showed that patients without diabetes with class III obesity had lower chance for BED and among them; men were 65% more likely than women to have binge eating disorder. Future studies are recommended to follow up these patients after surgery to compare weight loss and blood sugar control in patients with and without type 2 diabetes.

Background: Endometriosis, defined as the attendance of endometrial-like lesions in extra uterine locations, causes pain, infertility, and reduced quality of life. Objective: To evaluate the relationship between food consumption and nutrient intake with risk of endometriosis. Materials and Methods: Of the 156 women approached for the study, 78 women had endometriosis and 78 healthy women were included in the control group. Dietary data were collected using a validated 147-item semi-quantitative Food Frequency Questionnaire (FFQ) with the standard serving size. A logistic regression model was used to determine the association of macronutrients and energy intake with the risk of endometriosis. Results: In women with higher intake of protein, especially animal protein, monounsaturated fatty acids, soluble and insoluble fiber, oleic acid, eicosapentaenoic acid, and docosahexaenoic acid endometriosis is less common (p < 0.05). High consumption of vegetables, fruits, red meat, yellow vegetables, potatoes, legumes, dairy products, liquid oil, and low intake of fried potatoes was associated with a lower risk of endometriosis (p < 0.05). Conclusion: Regarding the association of dietary intake on endometriosis risk, counseling about improving the dietary structure can contribute toward the prevention and control of endometriosis. Key words: Endometriosis, Macronutrient, Diet, Case-control study.

Objective Dietary total antioxidant capacity (DTAC) has been hypothesized as being involved in health promotion and disease prevention. However, data about the association of the DTAC (as estimated by ferric reducing antioxidant power) with diabetes chronic complications are scarce. Therefore, the aim of this study was to determine the associations between the DTAC and chronic kidney disease (CKD) risk in subjects with type 2 diabetic. Methods The present case-control study consisted of 210 (102 cases and 108 controls) patients with type 2 diabetic who were participants of the phase 5 Tehran Lipid and Glucose Study and were classified based on their CKD status. DTAC was estimated based on the ferric reducing antioxidant power of selected foods. Dietary intake, sociodemographic data, medical history, and anthropometric measurements were collected from participants using a validated questionnaire. Results The mean DTAC value, as well as total calorie intake, did not show significant differences between cases and controls. Conclusion No significant association was found between DTAC and CKD in patients with type 2 diabetic. Further studies are needed to confirm the effects of DTAC on the risk of CKD.

Patients with morbid obesity appear to have adequate nutritional intake, but some studies suggest deficiencies in the micronutrient intake in these patients. Present study aimed to determine dietary intakes and their associated biochemical parameters in an Iranian population of patients with morbid obesity prior to bariatric surgery. One hundred seventy patients with morbid obesity who have referred to surgery clinic of Firoozgar Hospital were enrolled in the study. Ideal Body Weight (IBW) and Adjusted Ideal Body Weight (AIBW) were calculated. The dietary data were collected using a Food Frequency Questionnaire (FFQ). Anthropometrics and biochemical parameters were assessed. All the statistical analyses were done using the SPSS with an alpha of 0.05. Mean age of participants was 37.4 ± 10.17 years. The mean and standard deviation (SD) of the BMI and EBW values was 45.75 ± 6.49 kg/m and 47.6 ± 13.74 kg, respectively. All the micro- and macro-nutrient intakes are significantly different from the recommended values, except for vitamin A in the men and calcium in the 51–70-year-old women. 47.1% and 17.1% of the participants were classified as patients with diabetes and pre-diabetes, respectively. Majority of participants had lower serum iron levels than the reference values. Almost all the participants (97%) had normal albumin levels. Despite their excess intakes of energy, patients with obesity usually suffer from micronutrient deficiencies, such as vitamin D, iron, and vitamin B12, which can be accompanied by complicated biochemical disorders like impaired glucose metabolism and dyslipidemia. Therefore, bariatric surgery candidates require close nutritional monitoring before and after their surgical operations.

Aims The aim of this systematic review was to assess the effects of Spirulina supplementation on metabolic syndrome components, its liver manifestation and related inflammatory markers. Methods We searched PubMed and Scopus (up to August 2017) to identify relevant studies. English randomized controlled trials (RCTs) investigating the effects of Spirulina supplementation on factors associated with metabolic syndrome in human models, were included in the review. Results Among 720 articles related to Spirulina in the primary search, 22 of them were eligible human RCTs and finally 18 of them were included in the review. The systematic review revealed that oral dosage range of 1-19gr/day for 0.5–6 months of Spirulina supplementation have positive effects on metabolic syndrome components. Conclusion Spirulina can be possibly administered as a safe and efficient supplementation in the case of metabolic syndrome components, although determining the optimal dosage and period of supplementation still needs further investigations.

Background: Following the outbreak of coronavirus and its impact on the educational process of medical students, attention was paid to e-learning due to importance of education and research. The aim of present study is to evaluation of virtual and actual education models on the learning of internal interns during the pandemic of COVID-19. Results: The mean±SD age of the participants was 24.9±2.3 years, 46% of participants were men and 54% of them live in dormitory. Results of study shows that difference of pre-test and post-test score with actual and virtual education models in the male and female is significantly different (P value=0.020). Virtual education for men and actual education for women have resulted in higher difference scores in pre-test and post-test. Actual and virtual education models were no different in academic achievements of participants. Thus, the scores obtained in 9 areas did not make a significant difference between the two types of educational models.Discussion: Virtual and actual education methods for internal interns were examined and the results showed that there is no significant difference between these two methods in student output. Given the conditions that have created by COVID-19 disease in the world, it seems that the use of virtual education can be a good alternative to educating medical students so that education does not stop.

Background: COVID-19 is a new emerging disease that causes a pandemic situation in the world. Corona virus can enter into the body via several ways and it damages other organs of the body in addition to the respiratory system. This study aimed at verifying extra-pulmonary manifestation of COVID-19.Methods: The present study was done as cross-sectional in the single center from March 1 to May 1 2020 at Firoozgar educational hospital in Tehran, Iran. 107 patients with confirmed Covid-19 pneumonia according to WHO interim guidance were recruited in this study. Extra-pulmonary manifestations of COVID-19 were recorded. SPSS, version 26 was used for all analyses.Results: The mean (SD) and median of age was 59.3 (17.4) and 62.0 respectively and 58 (54.2%) were men. Body temperature of patients who were equal or less than 60 years was significantly higher than other patients (39.02 vs. 38.08, p=0001). The most common extra-pulmonary manifestation was GI symptoms included nausea, vomiting, abdominal pain, diarrhea, Hepatocellular LFT abnormality, Cholestatic LFT abnormality and Amylase lipase incensement (37 patients (34.6%)). Ophthalmological, cardiac, neurological and dermatological manifestations were shown in 6.5%, 6.5%, 14.9% and 14.0% of patients respectively. Conclusion: Investigating the clinical and radiological symptoms of COVID-19 showed that SARS-CoV-2 infection may also be associated with extrapulmonary symptoms. Therefore, clinicians and radiologists should be familiar with such symptoms of this disease.

Background Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. It is one of the risk factors of metabolic syndrome (MetS). These two syndromes have an inflammatory etiologic foundation along with oxidative stress. The present study aimed to compare the dietary intake of antioxidant micronutrients in PCOS women with and without MetS. Materials and methods Overall, 42 participants eligible for this nested case control study were selected by the convenience sampling method. The case group included 14 PCOS patients with MetS and the control group included 28 PCOS patients without MetS. The dietary intake assessment of selenium, chromium, zinc, carotenoids, vitamin D and vitamin E was carried out by a 147-item Food Frequency Questionnaire (FFQ). PCOS and MetS were diagnosed using the Rotterdam criteria and NCEP ATP III, respectively. Statistical analysis was performed using SPSS16 software, T-test and Mann Whitney. Significant P-value was considered 0.05. Results Dietary intake of antioxidant micronutrients (selenium, zinc, chromium, carotenoids and vitamin E) was significantly lower in the PCOS women with MetS than in the control group (P Conclusion Since the PCOS patients without MetS had more intake of the aforementioned micronutrients than those with MetS, it is assumed that the dietary intake of these nutrients could probably have a protective effect on MetS.

Background This study aimed to compare the lifestyle factors and SQ between women with and without endometriosis. Also in this essay, the influence of food intake, socio-demographic and clinical characteristics on sleep quality of women with endometriosis was determined. Methods Of the 156 infertile women approached for the study, 78 women had endometriosis and 78 were included in the control group. At first, each participant completed a checklist including questions about demographics, physical activity, reproductive and menstrual status. SQ was assessed by the Pittsburgh Sleep Quality Index (PSQI). Dietary data were collected using a validated 147-item semi-quantitative FFQ. Results Irregular menstrual status, menorrhagia, dysmenorrhea, pelvic pain, history of abortion, family history of endometriosis were associated with endometriosis risk (P P P p Conclusion In endometriosis women, SQ was lower than healthy individuals. Lifestyle factors can effect on SQ of these patients.

Considering conflicting results on the consequences of all types of obesity surgery, we were to summarize them via a systematic review. Electronic literature search was done via scientific search engines. After the removal of duplicates and selection of articles of interest, 771 studies were included. Insulin resistance indicators were significantly improved after bariatric surgery. Leptin was also significantly decreased while adiponectin was significantly increased. Although the level of metabolic hormones changed after bariatric surgery, they were not statistically significant. Inflammation indicators were significantly decreased. Significant reduction was also detected in PAI-1 and sICAM-1. Bariatric surgery is beneficial in morbidly obese patients. Although treating obesity in a surgical way may cause some complications, the weight loss is generally safe and effective.

Novel alternative treatments such as food supplements may be an effective approach to weight management. The aim of the present study was to investigate the possible effects of Spirulina Platensis (SP) on anthropometric measures, appetite and metabolic parameters in obese or overweight individuals.A total of fifty-two obese and overweight subjects (25 kg/mThirty-eight participants completed the intervention. Body weight, waist circumference, body fat and BMI significantly reduced in the SP group compared to the placebo group (p 0.001, p = 0.049, p = 0.049 and p = 0.02, respectively). In the SP group, the reduction triglycerides (TG) and high sensitivity C-reactive protein levels was considerably significant compared to the placebo group (p = 0.03, p = 0.02, respectively). Appetite score was significantly reduced in the SP group compared to the baseline (p 0.001).This study suggests that spirulina platensis, as a complementary therapy may have beneficial effects on adherence to RCD, management of weight loss and also reduction in TG levels through possible modulatory effects on anti-inflammatory pathways.

Background: Pathogenesis of cardiovascular diseases (CVDs) may be indicated by lipoprotein-associated phospholipase A2 (Lp-PLA2), serving as an inflammatory biomarker. However, the general dietary predictors of Lp-PLA2 have not been investigated so far. The aim of the present study is to investigate the relationship between the serum levels of Lp-PLA2 and dietary patterns in adults with cardiovascular risk factors. Materials and Methods: Dietary patterns extracted using factor analysis and serum levels of Lp-PAL2 in 470 adults aged 40–70 years who participated in the 5th phase of the Tehran Lipid and Glucose Study (2011–2014) were determined. Associations between the dietary patterns and serum levels of Lp-PAL2 considering some confounder factors were evaluated. Results: The results showed that Western and semi-Mediterranean dietary patterns had significant effects on changes in Lp-PLA2 levels in univariate analyses. In multivariate analyses, after adjusting for age, sex, total cholesterol, low-density lipoprotein cholesterol, body mass index and physical activity, energy intake, hormone therapy for women, and taking blood lipid-lowering drugs as potential confounders, the Western dietary pattern remained a significant factor influencing the Lp-PLA2 level (β value: 1.65, 95% confidence interval: 1.12, 1.89; P < 0.05). Moreover, after adjustment for the mentioned confounder factors, the effect of the semi-Mediterranean dietary pattern on Lp-PLA2 disappeared. Conclusion: It can be concluded that the Western dietary pattern is associated with higher Lp-PLA2 levels. We recommend that adults eat less carbonated drinks, fast foods, salty snacks, mayonnaise, and organ meat to counteract increased serum Lp-PLA2 levels, which are directly associated with vascular inflammation and CVDs.

Neurological complications such as peripheral neuropathies are the most common complications among patients with morbid obesity following bariatric surgery. Reduction in nutrient intake especially thiamin may develop polyneuropathy, while neuropathic symptoms improved in patients with diabetes independent of glycemic control after bariatric surgery. The aim of the present review is to investigate the effect of bariatric surgery on peripheral neuropathy. Electronic literature search was done via scientific search engines. After the removal of duplicates and selection of articles of interest, 4 studies were included. A random effects model was applied in this meta-analysis. Considering the pooled analysis, bariatric surgery was significantly associated with Neuropathy Symptoms Score (NSS) (ES = − 3.393, 95% CI (− 4.507, − 2.278), and P value

The primary objective of the present study was to compare the mental health status of Iranian medical vs other health sciences students and to examine how demographic factors relate to their mental health problems. A total of 560 medical and other health sciences students (250 (44.6%) males and 310 (55.4%) females) were recruited from Iran University of Medical Sciences. Data were obtained by self-administered questionnaire, including questions on socio-demographic characteristics. The Beck Depression Inventory, Beck Anxiety Inventory, General Health Questionnaire, and WHO well-being index were used to assess mental health status of students. Ten percent of students had BDI scores consistent with clinically significant depression (6.6% mild, 1.8% moderate, 1.6% severe), and 28.7% had BAI scores consistent with clinically significant anxiety (20.7% mild, 7.1% moderate, 0.9% severe). Kurdish students had an odds ratio (OR) of 2.71 (95% CL, 1.22–6.02) for mild to severe depression symptoms when compared to Persian students. The prevalence of distressed health sciences students and poor psychological well-being was 13.4% and 14.1%, respectively. Maternal education gave an OR of 0.57 (0.35–0.93) for anxiety symptoms, after adjustment for all other factors. The possibility of general psychiatric morbidity was significantly lower in students who studied medicine (OR, 0.40 (0.21–0.71)). Being born in the capital city was associated with better psychological well-being (OR, 0.48 (0.26–0.86)). Ethnicity, birthplace, discipline, and maternal educational level were major determinants of mental health status among health sciences students. Further research should be undertaken to determine the prevalence of psychological disorders using more reliable diagnostic interview.

Background: Dietary patterns and diet quality index (DQI) are widely discussed in relation with different health conditions and have recently been taken into consideration for all cancer types. Since chronic inflammation has been recognized as an important biologic risk factor for cancer occurrence, especially in epithelial tissues, proinflammatory or anti-inflammatory characteristics of diet has become the center of attention. In the present study, we aimed to identify whether a specific dietary pattern, Mediterranean dietary score (MDs), and dietary inflammatory index (DII) were associated with overall cancer risk in Iranian population. Methods: This study was performed in the context of the Golestan cohort study. Participants with extreme daily energy intake or those who did not answer more than 30 question of the Food Frequency questionnaire (FFQ) were excluded. Dietary patterns, MDs, and DII were measured from FFQ. Age, sex, total energy, place of residence, smoking, wealth score, ethnicity, opiate use, BMI, education, marital status, and physical activity score were considered as confounding variables. Using Cox proportional hazards regression models, hazard ratios (HRs) and 95% confidence interval of cancer were estimated. Results: HRs (95% CIs) of all cancers by quartiles of Western dietary pattern, DII, and MDs showed that the forth quartile of the Western dietary pattern is attributed to 23% higher cancer risk (HRs: 1.23, CI: 1.09-1.40, P< 0.001, adjusted for age and sex) compared to the first quartile. It also remained significant after further adjustments (HRs = 1.20, CI: 1.06-1.36, P< 0.001). There was a higher cancer risk in the fourth quartile of DII in comparison with the first quartile (HRs = 1.16, CI: 1.01-1.32, P trend < 0.001, adjusted for age and sex). The lower adherence to the Mediterranean dietary pattern also largely contributes to 27% higher cancer risk (HRs: 1.27, CI: 1.12-1.44), P trend < 0.001, adjusted for age and sex), which also remained remarkable after further adjustments ((HRs =1.19, CI: 1.05-1.35, P trend < 0.001). Conclusion: Cancer is highly correlated to dietary intake and dietary patterns, such as the Western dietary pattern, while the Mediterranean diet score was inversely associated with cancer risk. Further investigations are required to get a broader insight into cancer determinants in population.

Background: Metabolic syndrome is a prevalent condition with dramatic rising trend worldwide. Single dietary factors, such as omega-3 fatty acids consumption protect body against oxidative damage by reinforcement of dietary total antioxidant capacity but the combination of all dietary components may be more effective when studied as integrated dietary patterns. This present study was designed to assess the association between different dietary patterns and oxidative stress in a population of Tehranian adults suffering from metabolic syndrome. Methods: Dietary data were collected using a validated 147-item semi-quantitative FFQ with a standard serving size. Factor analysis method was used to derive dietary patterns. Blood analysis and anthropometric measurements were also obtained. Oxidative stress was assesses using serum levels of Malondialdehyde (MDA) and total antioxidant capacity (TAC). Results: The regression coefficient for TAC and MDA with different quintiles of dietary patterns, adjusted for potential confounder in model 3 reveal a significant positive association between healthy pattern and serum TAC levels (β=0.244, p=0.008) and also between serum MDA levels and the unhealthy pattern (β=0.387, p=0.0001). On the other hand, a significant negative association found between serum TAC levels (β=-0.289, p=0.001) and the unhealthy pattern, a relationship also noted between serum MDA levels and the healthy dietary pattern (β=-0.273, p=0.002). Conclusions: Our findings suggest that following a healthy pattern filled with fruits and vegetables ameliorates oxidative stress status and on the contrary, attachment to an unhealthy pattern, characterized by higher intakes of fast foods and processed foods, aggravated the oxidative stress levels in Tehranian individuals suffering from metabolic syndrome.

The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults.A prospective cohort study, the Tehran Lipid Glucose Study (TLGS).Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD.Obesity phenotypes.Incidence of chronic kidney disease.Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study.CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91-1.43) and 1.43 (95% CI, 1.09-1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93-1.62) and 1.43 (95% CI, 1.08-1.90), respectively.Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.

Background Several studies have shown significant associations between manganese superoxide dismutase (MnSOD) Val16Ala polymorphism and diabetic complications, but this association has not been explored in relation with chronic kidney disease (CKD) in Type 2 diabetes mellitus (T2DM) patients. Total antioxidant capacity (TAC) level changes in diabetic condition and may play important role in onset or progression of the disease and its complications. The present study investigated the association of MnSOD Val16Ala polymorphism and serum TAC with the risk of CKD in T2DM patients. Methods This nested case-control study included 280 type 2 diabetic patients with CKD and 280 age, sex and diabetes duration-matched control subjects selected from the participants of the Tehran Lipid and Glucose Study. MnSOD val16Ala (rs4880) SNP was genotyped by the Tetra-Primer ARMS-polymerase chain reaction analysis. Serum TAC was measured using ferric-reducing antioxidant power assay. Statistical analysis was performed using STATA statistical package v.12.0 or SPSS (Version 22.0). Results The Ala allele of the MnSOD Val16Ala polymorphism was associated with a lower risk of CKD (odds ratio (OR), 0.55; 95% confidence interval (CI), 0.36–0.84; P = 0.006). Median serum TAC in CKD group was 920 μmol/L and was significantly lower (p

Background: The aim of this study was to determine the incidence and prevalence of obesity in Tehranian children. Methods: Data from children participated in Tehran Lipid and Glucose Study (TLGS) were evaluated. Cut off points for definition of obesity was the CDC’s standard thresholds of the 95th percentile and 85th percentile for overweight. Prevalence, annual incidence of obesity, cumulative incidence over 10 year and the incidence density (cases per person-years) totally were calculated. Results: The annual incidence of obesity was 1.9 and 3.4% per year in the first 3 yr and decreased to 0.9 and 2.5% in the last 3 yr of follow-up in girls and boys, respectively. Incidence density rates were in line with cumulative incidence, with a rate of 20.7 per 1000 person-years between the ages of 5.6 and 15.5 yr. The prevalence of obesity was higher among children who had obese parents (P=0.03). Among all ages, across the quartiles of parents’ BMI, the prevalence of obesity increased with rising in paternal (P=0.001) or maternal BMI (P=0.004). Physical activity of mothers affected the prevalence of obesity in children at mean ages of 5.3 and 9.1 yr. Across quartiles of mother’s physical activity, from heavy to light, the prevalence of obesity increased among children, from 4.4% to 5.9% in children, aged 5.3 (P=0.02) and from 11.6% to 13.0% in children, aged 9.1 yr (P=0.03). Conclusion: Prevalence of obesity among children increased with age. Cumulative incidence of obesity in children who were overweight at baseline was much higher than other children.

Critically ill patients usually suffer from catabolic stress that could lead to malnutrition and nutritional support therefore is essential to maintain lean body mass, improve metabolic and immune response and decrease rate of mortality and comorbidity in these patients. This meta-analysis was aimed to evaluate effect of glutamineenriched enteral nutrition in critically ill patients. In order to obtain randomized clinical trial studies (RCTs), international databases including MEDLINE and Google scholar and also electronic resources in Iran, including IRAN MEDEX, IRAN DOC, SID, Magiran were systematically searched without language and publication restriction before December 2014. The final included number of studies for meta-analysis was 10. The methodological quality of eligible studies was assessed by four investigators using the Jadad 5-point scale, a scale containing three items describing randomization, blinding and fate of participants. We analyzed data from the included studies using STATA version 12.0, and calculated a pooled odds ratio for dichotomous data and mean differences for continuous data with 95% confidence intervals (CIs). There was no significant difference in mortality in elevated pooled odds ratios (p-value=0.070). A funnel plot was drawn for evaluation of publication bias, but none was found. The fixed effect model shows significant reduction in gut permeability in who received enteral feeding enriched with glutamine (-0.84, 95% CI=-1.25 to -0.44), moreover the funnel plot did not show publication bias. Based on the available data, our meta-analysis showed that enteral glutamine (Gln) supplementation increased mortality rate, though non-significantly, but decreased gut permeability significantly.重症患者通常患有代谢应激可以导致营养不良，因此营养支持对保持瘦体 重、改善代谢和免疫反应、降低这些病人的死亡率和并发症是必不可少的。 本meta 分析的目的是评估谷氨酰胺强化的肠内营养对重症患者的疗效。为了 获得随机临床试验研究（RCTs），我们检索了MEDLINE 和谷歌学术等国际 数据库，以及MEDEX、IRANDOC、SID 和Magiran 等电子资源中2014 年12 月份以前的文献，不受出版语言限制。最终有10 个研究纳入了meta 分析。 由四个研究者采用包括随机化、盲法和研究对象的合格性三个项目的Jadad5 点量表来评估合格研究的方法学质量。我们用STATA12.0 分析纳入研究的数 据，计算二分类变量的比值比和连续性变量的标准差及它们的95%置信区间 （CIs）。死亡率在升高的合并比值比中无显著差异（p-value=0.070）。在绘 制漏斗图中没有发表偏倚。固定效应模型显示接受谷氨酰胺强化的肠内营养 的患者肠道通透性显著降低（-0.84, 95% CI=-1.25 到-0.44），而且漏斗图显示 没有发表偏倚。根据现有的资料，我们的meta 分析表明，肠内谷氨酰胺补充 增加死亡率，虽然没有显著性，但显著降低了肠道通透性。.

Diabetes Mellitus (DM) is a chronic heterogeneous disorder and oxidative stress is a key participant in the development and progression of it and its complications. Anti-oxidant status can affect vulnerability to oxidative damage, onset and progression of diabetes and diabetes complications. Superoxide dismutase 2 (SOD2) is one of the major antioxidant defense systems against free radicals. SOD2 is encoded by the nuclear SOD2 gene located on the human chromosome 6q25 and the Ala16Val polymorphism has been identified in exon 2 of the human SOD2 gene. Ala16Val (rs4880) is the most commonly studied SOD2 single nucleotide polymorphism (SNP) in SOD2 gene. This SNP changes the amino acid at position 16 from valine (Val) to alanine (Ala), which has been shown to cause a conformational change in the target sequence of manganese superoxide dismutase (MnSOD) and also affects MnSOD activity in mitochondria. Ala16Val SNP and changes in the activity of the SOD2 antioxidant enzyme have been associated with altered progression and risk of different diseases. Association of this SNP with diabetes and some of its complications have been studied in numerous studies. This review evaluated how rs4880, oxidative stress and antioxidant status are associated with diabetes and its complications although some aspects of this line still remain unclear.

The aim of this study was to investigate the role of vitamin A in Foxp3 and TGF-β gene expression in atherosclerotic patients. Patients and healthy controls in the vitamin A group received 25,000 IU retinyl palmitate per day, while patients in the placebo group took one capsule of placebo per day for 4 months. Gene expressions of regulatory T cells were studied by real-time PCR. The levels of Foxp3 expression in phytohemagglutinin-activated cells were much higher in the patients who received vitamin A than in placebo-treated patients and healthy controls, while Foxp3 gene expression in oxidized low-density lipoprotein-activated cells showed no significant differences between all groups (p = 0.357). A significant difference in the expression level of TGF-β gene in fresh cells was observed between patients and healthy controls (p = 0.009). TGF-β gene expression in oxidized low-density lipoprotein-activated cells increased in all groups; however, these changes were not statistically significant (p = 0.65); the changes obtained were 2.8-, 2.2- and 3.9-fold in the vitamin A, placebo, and control groups, respectively. Based on suppressing actions of regulatory T cells on effector T cells and findings that show that vitamin A has the effect of increasing expression of regulatory T cells, it can be concluded that supplementation with vitamin A in atherosclerotic patients may be effective in slowing disease progression.

Background: Elevated blood pressure is still one of the major risk factors for diseases and disabilities and also a public health challenge worldwide. In the present longitudinal study, we aimed to evaluate the association between risk of hypertension and dietary advanced glycation end products (AGEs) as a recently discussed potential risk factor. Materials and Methods: Dietary assessment of 1775 participants in the third phase of Tehran lipid and glucose study to obtain dietary intake of AGEs was performed using a validated semi-quantitative food frequency questionnaire, and they were followed up for a mean duration of approximately 6 years. To determine the incidence of hypertension across quartiles of AGEs intake, logistic regression models with adjustment for potential confounding variables were used. All statistical analyses were conducted using SPSS, and P < 0.05 was considered statistically significant. Results: Higher hypertension occurrence risk was generally attributed to higher AGEs intake quartiles after adjusting for age in men (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.11–1.52, P = 0.038) and additional adjustment for smoking, drugs, and physical activity in women (OR = 1.38%–95% CI = 1.09–1.42, P = 0.042). Moreover, across the increasing trend of dietary AGEs intake, the percentage of fat intake increased and that of carbohydrate significantly decreased (P < 0.0001). Conclusion: In conclusion, it is highly recommended to limit dietary AGEs consumption to prevent and manage hypertension and its complications.

Vitamin A is a potential mediator of T helper cells in atherosclerosis. The purpose of this study was to evaluate the effect of vitamin A supplementation on expression of Th17 cells-related IL-17 and RORc genes in atherosclerotic patients. Thirty one atherosclerotic patients and 15 healthy controls were studied for 4 months. Atherosclerotic patients were randomly divided into vitamin A or placebo groups. Healthy controls and patients in vitamin A group received 25,000 IU retinyl palmitate per day. Peripheral blood mononuclear cells were isolated, cultured and divided into three groups including fresh cells, phytohemagglutinin (PHA)-activated T cells and ox-LDL-activated T cells. Gene expressions of T cells were studied by real-time PCR. In atherosclerotic patients, vitamin A supplementation resulted in significant decrease in IL-17 gene expression by 0.63-fold in fresh cell, 0.82-fold in PHA-activated cells and 0.65-fold in ox-LDL-activated cells (P

Aim: Atherosclerosis is an inflammatory arterial wall disease and T lymphocytes have important role in the pathogenesis and progression of this disease. The aim of this study is determination of vitamin A supplementation effects on gene expression of cytokines secreted by TCD4+ lymphocytes in atherosclerotic patients. Methods-Materials: Thirty one atherosclerotic patients and 12 healthy controls participated in this study. Patients were randomly divided into vitamin A receiving group (n1⁄416) and placebo receiving group (n1⁄415), also healthy controls were receiving vitamin A. vitamin A supplement was given as retinyl palmitate and 25000 IU per day. Fasting blood sample of participants were taken before and after 4 months and plasma was separated and stored at -80 0C for biochemical laboratory tests. Peripheral blood mononuclear cells (PBMC) were separated and cultured in the appropriate number along with PHA and ox-LDL for proliferation assay and determination of gene expression pattern. As well as RNA was extracted and cDNA was synthesized from part of the cells at the same time and was stored for Real-Time PCR analysis. After 72 hour incubation cells supernatant were collected and stored at-800C; cells deposited were collected for PNA extraction and cDNA synthesis. After the intervention period the gene expression pattern of relevant cytokines of CD4+ T cells including Th1, Th2, Th17 and Treg were determined by Real-Time PCR. Results: There was significant difference in fasting blood sugar, total cholesterol and LDL cholesterol between three groups of study, before and after intervention. Vitamin A increased proliferation of cells that stimulated with ox-LDL in all groups. Results of this study show that IFN-y and Tbet gene expression in fresh cells in vitamin Atreated patients was decreased. The IL-4 gene expression was increased 12.7 fold in vitamin A-treated patients. IL-17 gene expression in fresh cells of vitamin A-treated patients was diminished. Foxp3 gene expression in fresh cells was increased after intervention in all groups. Conclusion: vitamin A supplementation had no significant effect on anthropometric factors and effect of this intervention on biochemical factors limited to increase in total cholesterol and HDL cholesterol in both groups of patients and controls but the amounts were in normal value ranges. Vitamin A supplementation could reduce gene expression of IFN-y T-bet in all patients. Increase in gene expression of Th2 cells was seen in all group expect GATA3 gene. According to the results of how the effect of vitamin A on gene expression in atherosclerotic patients, perhaps we thought the positive role of vitamin A supplementation in these patients. Results of this study could pave the way for a more detailed review on effect of vitamin A in patients with immune related diseases.